IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v17y2020i11p4131-d369455.html
   My bibliography  Save this article

Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES

Author

Listed:
  • Jiaoling Huang

    (School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)

  • Li Yuan

    (School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
    International Department, All China Youth Federation, Beijing 100051, China)

  • Hong Liang

    (School of Social Development and Public Policy, Fudan University, Shanghai 200433, China)

Abstract

Background: China has achieved universal coverage, with a higher rate of 95% medical insurance. However, huge inequalities are concealed under universal coverage. This article aims to explore the medical insurance utilization disparities over different insurance schemes, regions, and socioeconomic statuses (SES). Methods: This study was based on an open-access dataset in 2010, 2012, 2014, and 2016. A longitudinal analysis and separate logistic models were performed. Results: Urban Employee Basic Medical Insurance (UEBMI) members had an outstanding advantage in specialist visiting over those on the Urban Resident Basic Medical Insurance Scheme (URBMI) (OR = 0.607, p < 0.001) and New Cooperative Medical System (NCMS) (OR = 0.262, p < 0.001). However, in terms of a doctor visiting if a person is sick, the odds of patients in the NCMS receiving a visit were 55.1% ((OR = 1.551; p < 0.05) higher than those on the UEBMI. Compared with west China, the odds of those in the north-east and east were 2.1% ( p > 0.05) and 97.2% (OR = 1.972; p < 0.001) higher for seeking medical treatment if sick, and 10.8% (OR = 0.892; p < 0.01) and 42.7% lower (OR = 0.573; p < 0.001) for a specialist visiting. In terms of SES, for each unit of increase in the Standard International Occupational Prestige Scale (SIOPS), the odds of seeking medical treatment decreased by 4.3% (OR = 0.958; p < 0.05), and the odds of a specialist visiting increased by 17.1% (OR = 1.171; p < 0.001) for each unit of the annual income logarithm. Conclusions: NCMS members and residents in west China were in a disadvantage status in terms of access to specialists, though had a higher probability of medical care if sick. SES variables were positively correlated with a specialist visiting consistently. We suggest a further focus on healthcare quality in the west and rural areas.

Suggested Citation

  • Jiaoling Huang & Li Yuan & Hong Liang, 2020. "Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES," IJERPH, MDPI, vol. 17(11), pages 1-17, June.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:11:p:4131-:d:369455
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/17/11/4131/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/17/11/4131/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    2. Chen, Yuyu & Jin, Ginger Zhe, 2012. "Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 1-14.
    3. Xin Xie & Qunhong Wu & Yanhua Hao & Hui Yin & Wenqi Fu & Ning Ning & Ling Xu & Chaojie Liu & Ye Li & Zheng Kang & Changzhi He & Guoxiang Liu, 2014. "Identifying Determinants of Socioeconomic Inequality in Health Service Utilization among Patients with Chronic Non-Communicable Diseases in China," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.
    4. Yip, Winnie & Hsiao, William, 2009. "China's health care reform: A tentative assessment," China Economic Review, Elsevier, vol. 20(4), pages 613-619, December.
    5. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    6. Chaofan Li & Lei Dou & Haipeng Wang & Shanshan Jing & Aitian Yin, 2017. "Horizontal Inequity in Health Care Utilization among the Middle-Aged and Elderly in China," IJERPH, MDPI, vol. 14(8), pages 1-13, July.
    7. Gang Chen & Gordon Liu & Fei Xu, 2014. "The Impact of the Urban Resident Basic Medical Insurance on Health Services Utilisation in China," PharmacoEconomics, Springer, vol. 32(3), pages 277-292, March.
    8. Win Lin Chou & Zijun Wang, 2009. "Regional inequality in China's health care expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 137-146, July.
    9. Xiaoyan Lei & Wanchuan Lin, 2009. "The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 25-46, July.
    10. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    11. E Xie, 2011. "Income-Related Inequalities of Health and Health Care Utilization," Frontiers of Economics in China-Selected Publications from Chinese Universities, Higher Education Press, vol. 6(1), pages 131-156, March.
    12. Liu, Xingzhu & Hsiao, William C. L., 1995. "The cost escalation of social health insurance plans in China: Its implication for public policy," Social Science & Medicine, Elsevier, vol. 41(8), pages 1095-1101, October.
    13. E. Xie, 2011. "Income-related inequalities of health and health care utilization," Frontiers of Economics in China, Springer;Higher Education Press, vol. 6(1), pages 131-156, March.
    14. You, Xuedan & Kobayashi, Yasuki, 2009. "The new cooperative medical scheme in China," Health Policy, Elsevier, vol. 91(1), pages 1-9, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Lin Pan & Cong Wang & Xiaolin Cao & Huanhuan Zhu & Li Luo, 2022. "Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai," IJERPH, MDPI, vol. 19(9), pages 1-18, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jing You, 2016. "Lending to Parents and Insuring Children: Is There a Role for Microcredit in Complementing Health Insurance in Rural China?," Health Economics, John Wiley & Sons, Ltd., vol. 25(5), pages 543-558, May.
    2. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    3. Feng, Jin & Song, Hong & Wang, Zhen, 2020. "The elderly's response to a patient cost-sharing policy in health insurance: Evidence from China," Journal of Economic Behavior & Organization, Elsevier, vol. 169(C), pages 189-207.
    4. Ling Li & Hongqiao Fu, 2017. "China's health care system reform: Progress and prospects," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(3), pages 240-253, July.
    5. Lingguo Cheng & Hong Liu & Ye Zhang & Ke Shen & Yi Zeng, 2015. "The Impact of Health Insurance on Health Outcomes and Spending of the Elderly: Evidence from China's New Cooperative Medical Scheme," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 672-691, June.
    6. Bairoliya, Neha & Miller, Ray, 2021. "Social insurance, demographics, and rural-urban migration in China," Regional Science and Urban Economics, Elsevier, vol. 91(C).
    7. Feiyan Yang & Li Wei, 2023. "The impact of tax-subsidized health insurance on health and out-of-pocket burden in China," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 48(1), pages 194-246, January.
    8. Qin Zhou & Gordon G. Liu & Sam Krumholz, 2017. "Is Chinese National Health Insurance Effective in the Face of Severe Illness? A Perspective from Health Service Utilization and Economic Burden," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 132(3), pages 1307-1329, July.
    9. Li, Cheng & Yu, Xuan & Butler, James R.G. & Yiengprugsawan, Vasoontara & Yu, Min, 2011. "Moving towards universal health insurance in China: Performance, issues and lessons from Thailand," Social Science & Medicine, Elsevier, vol. 73(3), pages 359-366, August.
    10. Chan, Marc K. & Zeng, Guohua, 2018. "Unintended consequences of supply-side cost control? Evidence from China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 61(C), pages 27-46.
    11. Xiaoyun Liang & Hong Guo & Chenggang Jin & Xiaoxia Peng & Xiulan Zhang, 2012. "The Effect of New Cooperative Medical Scheme on Health Outcomes and Alleviating Catastrophic Health Expenditure in China: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-11, August.
    12. Bairoliya, Neha & Canning, David & Miller, Ray & Saxena, Akshar, 2018. "The macroeconomic and welfare implications of rural health insurance and pension reforms in China," The Journal of the Economics of Ageing, Elsevier, vol. 11(C), pages 71-92.
    13. Huang, Xian & Wu, Bingxiao, 2020. "Impact of urban-rural health insurance integration on health care: Evidence from rural China," China Economic Review, Elsevier, vol. 64(C).
    14. Hai Zhong, 2011. "Effect of patient reimbursement method on health‐care utilization: evidence from China," Health Economics, John Wiley & Sons, Ltd., vol. 20(11), pages 1312-1329, November.
    15. Kuangnan Fang & BenChang Shia & Shuangge Ma, 2012. "Health Insurance Coverage and Impact: A Survey in Three Cities in China," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-8, June.
    16. Zhiyuan Hou & Ellen Van de Poel & Eddy Van Doorslaer & Baorong Yu & Qingyue Meng, 2014. "Effects Of Ncms On Access To Care And Financial Protection In China," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 917-934, August.
    17. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    18. Jay Pan & Xiaoyan Lei & Gordon G. Liu, 2016. "Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention," Health Economics, John Wiley & Sons, Ltd., vol. 25(11), pages 1389-1402, November.
    19. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    20. Chu, Xueling & Chen, Qihui & Fang, Xiangming, 2013. "Can National Health Insurance Programs Improve Health Outcomes?—Re-Examining the Case of the New Cooperative Medical Scheme in Rural China," 2013 Annual Meeting, August 4-6, 2013, Washington, D.C. 150488, Agricultural and Applied Economics Association.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:17:y:2020:i:11:p:4131-:d:369455. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.