Factors and key problems influencing insured’s poor perceptions of convenience of basic medical insurance: a mixed methods research of a northern city in China

Abstract

Background This study aimed to explore the factors that affect insured’s perceptions of convenience of the basic medical insurance (PCBMI) in Harbin, China and to diagnose the key problems to further propose corresponding measures. The findings provide evidence-based support for the reform of convenience of the basic medical insurance system (BMIS) and the cultivation of public literacy. Methods We adopted a mixed methods design composing a multivariate regression model using the data from a cross-sectional questionnaire survey (n = 1045) of residents who were enrolled for BMIS in Harbin to identify the factors influencing the PCBMI. A quota sampling method was further adopted. Semi-structured interviews were then conducted with 30 important information providers selected by convenience sampling. Interpretative phenomenological analysis was employed to summarize and analyze the key problems. Results Overall, approximately 51% of respondents reported poor PCBMI. The logistic regression model showed that insured without outpatient experience within two weeks (OR = 2.522, 95% CI = 1.267–5.024), had poorer levels of understanding of basic medical insurance information (OR = 2.336, 95% CI = 1.612–3.386), lived in rural areas (OR = 1.819, 95% CI = 1.036–3.195), had low levels of annual out-of-pocket medical expenses (OR = 1.488, 95% CI = 1.129–1.961), and were more likely to give the PCBMI a worse evaluation than their counterparts. The results of the qualitative analysis showed that the key problem areas of the PCBMI were the design of the BMIS, the cognitive biases of the insured, publicity information about the BMIS, and the health system environment. Conclusions This study found that in addition to the design of BMIS, the cognition of the insured, the BMIS information publicity and the health system environment are also the key problems hindering PCBMI. While optimizing system design and implementation, Chinese policymakers need to focus on the insured with low PCBMI characteristics. Moreover, it is necessary to focus on exploring effective BMIS information publicity methods, supporting public policy literacy and improving the health system environment.

The identity of the benefits of the medical insurance system among the medical insurance- related professionals: A cross-sectional study of a northern city in China

“…We draw on the theory of user experience (UE) to design an analytical framework for the IBMIS [45]. In addition, lots of literatures have shown that factors such as " nancial burden [46], convenience [12,47], equity [48], regulation [49], informatization [12,50], and policy quality [9] [50] " can in uence people's experience of perceived bene ts from MIS. Based on the above theory and literatures, we designed a 2-part questionnaire.…”

“…According to the statistical data annual reports of the NHSA, as of the end of 2022, the number of inter-provincial networked designated medical institutions for hospitalization expenses was 63,000, which is more than a seven-fold increase compared to the end of 2017, but compared to the total number of health care institutions in the country, there is great room for improvement. In addition to the impact of the existing system design, the degree of the insured's perception of the convenience of MIS also affects the e ciency of their utilization of medical insurance services, which in turn causes them to give a negative evaluation of their experience of the convenience of MIS services [12].…”

“…An analysis of the domestic and international literature reveals that among the various studies related to the MIS, the perspectives of the studies are mainly based on the insured [11,12], patients [13,14], the elderly [15][16][17], civil servants [18], and migrant workers [19]. And the scholars analyzed different research topics, such as the attitudes or choices of different groups of people towards various types of MIS [18, [20][21][22], the analysis of the main bene ciaries of the basic MIS [19,23], the impact of medical insurance coverage on healthcare utilization and health outcomes [24][25][26], the impact of the MIS on alleviating the nancial burden of the insured [27], the impact of the MIS on reducing the health poverty [28,29], the impact of the MIS on increasing the rate of utilization of the MIS or the rate of enrollment in medical insurance [30,31], comparative study of existing medical insurance policies [13], evaluation of the effectiveness of the medical insurance policy implementation [32].…”