Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China.
Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China.
复制标题
在不同的健康保险方案中报销结核病护理的差异：来自中国中部三个县的证据。
DOI：
10.1186/s40249-016-0102-4
复制
发表时间：
2016-01-27
影响因子：
8.1
通讯作者：
Lucas H
中科院分区：
文献类型：
--
作者：
Pan Y;Chen S;Chen M;Zhang P;Long Q;Xiang L;Lucas H
卫生不平等是世界各地的一个重要问题。中国的基本医疗保障制度包括三大保险制度，即城镇职工基本医疗保险、城镇居民基本医疗保险和新型合作医疗。很少有研究对中国医疗保险计划之间的支付差距进行调查。在本研究中，我们旨在评估上述医疗保险计划中结核病（TB）治疗报销的差异。本研究使用世界卫生组织（世卫组织）的框架来分析与健康保险三个方面有关的差距和公平性：人口覆盖率、覆盖的服务范围和覆盖费用的程度。对每个健康保险计划的政策进行了分类和分析。通过对宜昌市三县2010 - 2012年所有住院报销的索赔数据库（包括1506例出院患者）进行分析，确定不同医保方案之间报销率和自费费用的差异。结核病患者有不同的住院费用，这取决于他们所覆盖的计划（国家综合管理制度覆盖的结核病患者的住院费用低于城市综合管理制度覆盖的结核病患者，而城市综合管理制度覆盖的结核病患者的住院费用低于城市综合管理制度覆盖的结核病患者）。我们发现在社会经济地位较低的群体中，医疗保健利用存在显著的横向不平等。在经济不平等方面，收入较低的结核病患者支付的费用较高。新农保制度根据收入提供适度的财政保护。总体而言，来自较低社会经济群体的结核病患者最脆弱。三种医疗保险计划在结核病治疗报销方面存在巨大差异，这反过来又阻碍了结核病的控制。缩小中国三种医疗保险计划之间的健康结果差距应成为结核病治疗和控制的重点。通过避免歧视的综合政策实现公平可能是有效的。本文的在线版本（doi:10.1186/s40249-016-0102-4）包含补充材料，可供授权用户使用。
Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, we aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes. This study uses a World Health Organization (WHO) framework to analyze the disparities and equity relating to the three dimensions of health insurance: population coverage, the range of services covered, and the extent to which costs are covered. Each of the health insurance scheme’s policies were categorized and analyzed. An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city (YC), which included 1506 discharges, was conducted to identify the differences in reimbursement rates and out-of-pocket (OOP) expenses among the health insurance schemes. Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by (TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI, who have less inpatient expenses than those covered by the UEBMI). We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups. In terms of financial inequity, TB patients who earned less paid more. The NCMS provides modest financial protection, based on income. Overall, TB patients from lower socioeconomic groups were the most vulnerable. There are large disparities in reimbursement for TB care among the three health insurance schemes and this, in turn, hampers TB control. Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control. Achieving equity through integrated policies that avoid discrimination is likely to be effective. The online version of this article (doi:10.1186/s40249-016-0102-4) contains supplementary material, which is available to authorized users.