Differences exist across insurance schemes in China post-consolidation

Area of Science:

• Health Economics
• Public Health Policy
• Healthcare Systems Research

Background:

• China's basic health insurance comprises Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS).
• Significant disparities in coverage and benefits have been observed across these schemes.
• Central government initiatives since 2009 aim to consolidate these disparate insurance programs.

Purpose of the Study:

• To evaluate the persistence of differences in medical costs and insurance reimbursement rates among China's basic health insurance schemes post-consolidation.
• To assess the impact of insurance scheme consolidation on out-of-pocket expenditures and overall healthcare costs.

Main Methods:

• A survey was conducted in Suzhou, China, involving 583 subjects aged 45 and above with recent inpatient or outpatient treatment.
• Comparative analysis of subject characteristics across different insurance schemes was performed.
• A resampling-based method was utilized to calculate predicted gross medical costs, out-of-pocket (OOP) costs, and insurance reimbursement rates.

Main Results:

• Subjects under different insurance schemes exhibited significant variations in costs and reimbursement.
• For inpatient care, URBMI participants incurred the highest gross and OOP costs, while UEBMI participants had the lowest.
• For outpatient care, UEBMI and URBMI participants had similar costs, whereas NCMS participants had substantially lower costs and reimbursement rates.

Conclusions:

• Consolidation of China's basic health insurance schemes has not eliminated existing disparities in medical costs and reimbursement rates.
• Further investigation is required to understand the underlying causes of these persistent differences.
• Targeted interventions are necessary to promote equity and reduce financial burdens across all insurance schemes.