Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.
Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.
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实现全民健康覆盖所面临的挑战：中国社会医疗保险管理者/行政人员的横断面调查
DOI：
10.1136/bmjopen-2016-014425
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发表时间：
2017-06-02
期刊：
影响因子：
2.9
通讯作者：
Han L
中科院分区：
文献类型：
--
作者：
Shan L;Wu Q;Liu C;Li Y;Cui Y;Liang Z;Hao Y;Liang L;Ning N;Ding D;Pan Q;Han L
目的中国实现了96%以上的医保覆盖率。然而，全民健康覆盖(UHC)涉及人口覆盖率和覆盖的服务范围以及覆盖的医疗服务费用的范围。本研究旨在探讨中国的医疗保险制度在医疗保健工作中所扮演的角色，并找出医疗保险管理人员/行政人员在医疗保险制度发展过程中遇到的挑战。方法于2014-2015年间在北京、宁波、哈尔滨、重庆四地进行横断面问卷调查。采用分层整群随机抽样策略选择研究对象。共有1277名(64.8%)的受访者表示熟悉当前的医疗保险制度和UHC的要求，为分析提供了有效数据。他们对当前医疗保险制度在实现UHC方面的作用进行了评级。开发了一个多元Logistic回归模型，以确定评级与保险安排特征之间的关联。结果无论他们是谁，以及他们在组织中的职责(即政策制定、基金交易管理等)，受访者对当前医疗保险制度在UHC中的角色表现达成了共识。总体而言，约45%的受访者认为实现UHC还有很长的路要走。调查发现，低评级与有限的经济保护(OR=1.656，95% CI 1.279至2.146)、医疗不公平(OR=1.607，95% CI 1.268至2.037)、可携性差(OR=1.347，95% CI 1.065至1.703)和基金监督管理不力(OR=1.339，95% CI 1.061至1.692)有关。结论中国地区医保管理者对现行医保制度的绩效持悲观态度。他们对保险计划总体上缺乏给成员带来的好处感到担忧，包括应享福利水平较低、医疗保健不公平程度较大、财务保护有限以及可携带性差。对现有基金结构设计的单一修改可能不足以为这些已查明的障碍提供令人满意的解决办法。有必要提高筹资能力，制定统一和一致的政策，并提高集资水平。
Objective China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. Methods A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. Results There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Conclusion Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members, including low levels of entitlements, large healthcare inequity, limited financial protection and poor portability. A singular amendment of the structural design of the existing funds may not be enough to offer a satisfactory solution to these identified barriers. There is a need to increase funding capacities, to develop unified and consistent policies and to increase the level of fund pooling.
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