Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China

Abstract

ObjectivesThis study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China.DesignWe conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association.SettingChinese urban social insurance system.ParticipantsA total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients.Primary and secondary outcome measuresThe primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure.ResultsThe annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001).ConclusionsSignificant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China’s health insurance schemes.

Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities

“…Since the two insurance schemes were separately managed at 333 different prefecture (municipal)-level cities in 2012, there were approximately 333 different UEBMI and 333 different URBMI schemes in China [ 15 ]. First, the general UEBMI and URBMI schemes varied by the sources of funding, benefit packages, service coverage and financial protection [ 15 – 18 ]. The UEBMI scheme usually had a larger service coverage, better benefit packages and superior financial protection than URMBI, with UEBMI having different rules on reimbursement rates specified in the benefit schedule.…”

A Comparative Analysis of Impact of Universal Two-Child Policy on Maternity Insurance Fund in Jiangsu Province and Guangxi Zhuang AR

“…Currently, 97% of the maternity insurance fund income in most of the provinces in China comes from the contributions paid by employers for their female employees [ 24 ]. Per the law, only the employer contributes to the maternity insurance fund without proportional contribution from the employee as it pertains to the other social insurance funds.…”

“…Unfortunately, the affected employees are afraid to insist on the right contribution largely because they are afraid to lose their job. In the work of [ 24 ], they explain that salaries and minimum wages themselves are also influenced by several external factors such as economic growth, seasonal changes, unemployment rate, age differences, geographical differences, elasticity of demand, wage equality and many other quantitative and qualitative factors.…”

Psychotropic medication use in cancer patients- a Chinese perspective

“…URBMI covers rural residents, the self-employed and the urban non-employed (including for example children and the elderly) while UEBMI provides mandatory cover for employees in urban areas. These observations are likely influenced by lower socioeconomic levels, lower education attainment, greater out of pocket costs and reduced access to tertiary care among URBMI members [5] . However, data on factors such as socioeconomic status and education was not available, a notable limitation.…”

“…However, data on factors such as socioeconomic status and education was not available, a notable limitation. Substantial variations in healthcare utilization have been reported within China, including for patients with psychiatric disorders [ 5 , 6 ]. In recent years, as part of the Healthy China 2030 vision, China has strived to expand healthcare coverage, and narrow gaps in health insurance, launching the medical security scheme for URBMI in 2016, narrowing urban-rural inequities in financial subsidies, contribution levels and treatment [7] .…”