Can rural health insurance improve equity in health care utilization? A comparison between China and Vietnam.
Can rural health insurance improve equity in health care utilization? A comparison between China and Vietnam.
复制标题
DOI：
10.1186/1475-9276-11-10
复制
发表时间：
2012-02-29
影响因子：
4.8
通讯作者：
Tolhurst R
中科院分区：
文献类型：
--
作者：
Liu X;Tang S;Yu B;Phuong NK;Yan F;Thien DD;Tolhurst R
中国和越南的医疗融资改革给获得医疗保健带来了更大的经济困难，特别是对农村贫困人口而言。两国几十年来一直在发展农村医疗保险。本研究旨在评估和比较两国农村医疗保险体系中医疗保健获取的公平性。在中国6个县和越南4个区进行了入户调查和定性研究。对健康保险政策及其对门诊和住院服务利用的影响进行了分析和比较，以衡量获得医疗保健的公平性。在中国，健康保险会员资格对门诊服务利用率没有显着影响，但与较高的住院服务利用率相关，尤其是对于高收入群体。越南健康保险会员的门诊和住院服务利用率均高于非会员，且低收入群体的使用率高于高收入群体。定性结果显示，官僚障碍、报销率低、服务质量差是会员使用健康保险的主要障碍。中国在短时间内实现了高人口覆盖率，从有限的福利计划开始。然而，贫困人口从新农合中获得的医疗服务利用率较低。与中国相比，越南医疗保险体系在医疗保险会员内部医疗服务利用公平性方面做得更好。但由于人口覆盖率低，很大一部分人口无法享受医疗保险待遇。相互学习将有助于中国和越南应对这些挑战，并改进政策设计，以促进公平和可持续的医疗保险。
Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.
登录
查看更多内容
影响因子：
3.2
作者：
Sepehri, A;Chernomas, R;Akram-Lodhi, H
通讯作者：
Akram-Lodhi, H
影响因子：
3.2
作者：
Bogg, L;Dong, HJ;Diwan, V
通讯作者：
Diwan, V
DOI：
10.1016/s0140-6736(08)61364-1
发表时间：
2008-10-25
期刊：
Lancet (London, England)
影响因子：
--
作者：
Tang S;Meng Q;Chen L;Bekedam H;Evans T;Whitehead M
通讯作者：
Whitehead M
影响因子：
3.2
作者：
Gao, J;Qian, JC;Blas, E
通讯作者：
Blas, E
影响因子：
3.5
作者：
Wagstaff, Adam;Lindelow, Magnus;Qian Juncheng
通讯作者：
Qian Juncheng