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Health Insurance Coverage and Impact: A Survey in Three Cities in China

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  • Kuangnan Fang
  • BenChang Shia
  • Shuangge Ma

Abstract

Background: China has one of the world's largest health insurance systems, composed of government-run basic health insurance and commercial health insurance. The basic health insurance has undergone system-wide reform in recent years. Meanwhile, there is also significant development in the commercial health insurance sector. A phone call survey was conducted in three major cities in China in July and August, 2011. The goal was to provide an updated description of the effect of health insurance on the population covered. Of special interest were insurance coverage, gross and out-of-pocket medical cost and coping strategies. Results: Records on 5,097 households were collected. Analysis showed that smaller households, higher income, lower expense, presence of at least one inpatient treatment and living in rural areas were significantly associated with a lower overall coverage rate. In the separate analysis of basic and commercial health insurance, similar factors were found to have significant associations. Higher income, presence of chronic disease, presence of inpatient treatment, higher coverage rates and living in urban areas were significantly associated with higher gross medical cost. A similar set of factors were significantly associated with higher out-of-pocket cost. Households with lower income, inpatient treatment, higher commercial insurance coverage, and living in rural areas were significantly more likely to pursue coping strategies other than salary. Conclusions: The surveyed cities and surrounding rural areas had socioeconomic status far above China's average. However, there was still a need to further improve coverage. Even for households with coverage, there was considerable out-of-pocket medical cost, particularly for households with inpatient treatments and/or chronic diseases. A small percentage of households were unable to self-finance out-of-pocket medical cost. Such observations suggest possible targets for further improving the health insurance system.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0039157
    DOI: 10.1371/journal.pone.0039157
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    References listed on IDEAS

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    5. Runguo Wu & Niying Li & Angelo Ercia, 2020. "The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review," IJERPH, MDPI, vol. 17(6), pages 1-21, March.
    6. Chaochao Hong & Qiong Yan & Hongmei Qi & Yaoyao Zhang & Ling Yu & Lijie Dong & Jing Wang, 2024. "Acceptability, Preferred Medium, and Components of Nurse-Led Cardiac Telerehabilitation: A Cross-Sectional Study," Clinical Nursing Research, , vol. 33(2-3), pages 146-156, March.
    7. Fang, Kuangnan & Wang, Xiaoyan & Shia, Ben-Chang & Ma, Shuangge, 2016. "Identification of proportionality structure with two-part models using penalization," Computational Statistics & Data Analysis, Elsevier, vol. 99(C), pages 12-24.
    8. Thanh Duc Nguyen & Andrew Wilson, 2017. "Coverage of health insurance among the near-poor in rural Vietnam and associated factors," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(1), pages 63-73, February.
    9. Chaw-Yin Myint & Milena Pavlova & Khin-Ni-Ni Thein & Wim Groot, 2019. "A systematic review of the health-financing mechanisms in the Association of Southeast Asian Nations countries and the People’s Republic of China: Lessons for the move towards universal health coverag," PLOS ONE, Public Library of Science, vol. 14(6), pages 1-18, June.
    10. Yang Li & Yinjun Zhao & Danhui Yi & Xiaojun Wang & Yan Jiang & Yu Wang & Xinchun Liu & Shuangge Ma, 2017. "Differences exist across insurance schemes in China post-consolidation," PLOS ONE, Public Library of Science, vol. 12(11), pages 1-13, November.
    11. Yan Jiang & Yu Wang & Le Zhang & Yang Li & Xiaojun Wang & Shuangge Ma, 2013. "Access to Healthcare and Medical Expenditure for the Middle-Aged and Elderly: Observations from China," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-10, May.

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