ObjectivesIt is to explore the perceived financial risk protection effect of the Urban–Rural Resident Basic Medical Insurance Scheme (URRBMI) and its influencing factors to provide evidence to further improve the URRBMI.DesignIt is a cross-sectional survey.ParticipantsThis mixed-methods study is conducted in five provinces in rural China. Through stratified cluster random sampling, 1681 rural residents participate in a cross-sectional questionnaire survey (1657 valid questionnaires are retrieved). Thirty rural residents participate in in-depth interviews.Primary and secondary outcome measuresA multivariate logistic regression analysis is adopted to identify factors influencing respondents’ perceptions. Semistructured interviews are used to identify the reasons why some respondents believed the URRBMI to be ineffective.ResultsOverall, 77.5% of respondents believe that the URRBMI is effective. Respondents, who are older, have a higher household income, prefer primary health facilities and provide a higher rating for critical illness compensation and maximum compensatory payouts. They are more likely to give the URRBMI a higher effectiveness rating than their counterparts. Qualitatively, participants who believe the URRBMI to be ineffective list the following reasons: low outpatient service coverage, insufficient or undersupplied drugs and services in the insurance list, problems in the arrangement of deductibles and maximum compensatory payouts, provider-induced behaviour and increased healthcare service price.ConclusionsThis exploration focuses on the reasons why rural residents think the scheme is invalid, which are vital for policy reform. Policies should focus on benefits design and coverage, the assumption of a supervisory role, avoiding financial risk stemming from critical illness and cross-sectoral actions to strengthen the primary healthcare system and comprehensive social security wealth.

Background To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies. Methods Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness. Results From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years. Conclusions Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.

Background Grassroots CDC laboratory efficiency can reflect and influence a country's capacity for disease control and prevention, improving the efficiency of the grassroots CDC laboratory is very important to national CDC system, this article is based on DEA method, on the basis of clearly defining the concept of efficiency, more methods to build grassroots CDC laboratory efficiency evaluation index, taking China as an example, the grassroots CDC laboratory efficiency study, discusses the current problems in the development of grassroots CDC laboratory operation efficiency. Methods Using data from China National Health Development Research Center, combined with some public data from National Bureau of Statistics and China Health Statistics Yearbook data, use data envelopment analysis (DEA) to analyze the operation of China's grassroots CDC disease control laboratories from 2017 to 2019 Efficiency, input-output improvement value and total factor productivity changes. Results From 2017 to 2019, the operational efficiency of grass-roots CDC laboratories in China showed a downward trend, and there was a serious problem of insufficient output, especially the grass-roots CDC laboratories in western China, which had the lowest operational efficiency. By analyzing the change of total factor productivity, it is found that the total factor productivity of grass-roots CDC laboratories in China generally shows a downward trend, and the technical level and management efficiency have declined to a certain extent, and the working ability of CDC laboratories has not been effectively improved. Conclusions The operational efficiency of grass-roots CDC laboratories is declining, and the technical level and management efficiency are declining. The unreasonable utilization of laboratory resources and unbalanced development are still outstanding, and the operational efficiency of laboratories needs to be further developed. Policymakers should pay attention to the imbalance of resource utilization and development of grass-roots CDC laboratories, give certain policy support to inferior CDC laboratories, and urge grass-roots CDC laboratories to strengthen management, improve technical level and management efficiency, increase the actual output of laboratories, and further enhance the working ability of grass-roots CDC laboratories.

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BackgroundRural residents' participation in medical insurance has a significant relationship to the affordability of their medical care. This study aims to investigate the willingness of rural residents to participate in basic medical insurance for urban and rural residents and its determinants so as to enhance their willingness to participate in medical insurance.MethodsData were obtained from 1,077 validated questionnaires from rural residents. Chi-square test and multiple logistic regression analysis were adopted to analyze determinants of rural residents' willingness to participate in basic medical insurance for urban and rural residents.Results94.3% of respondents were willing to participate in basic medical insurance for urban and rural residents and this was associated with the familiarity with the medical insurance policies [OR = 2.136, 95% CI (1.143, 3.989)], the reasonability of medical insurance premiums [OR = 2.326, 95% CI (0.998, 5.418)], the normality of doctors' treatment behavior [OR = 3.245, 95% CI (1.339, 7.867)] and the medical insurance's effectiveness in reducing the economic burden of disease [OR = 5.630, 95% CI (2.861, 11.079)].ConclusionEven though most respondents were willing to participate in basic medical insurance for urban and rural residents, some aspects need to be improved. The focus should be on promoting and regulating the behavior of medical staff. Financing policies and reimbursement of treatment costs need to be more scientifically developed. A comprehensive basic healthcare system needs to be optimized around the core function of “hedging financial risks”.