Outcome-based health equity across different social health insurance schemes for the elderly in China.
Outcome-based health equity across different social health insurance schemes for the elderly in China.
复制标题
中国老年人不同社会医疗保险计划中基于结果的健康公平
DOI：
10.1186/s12913-016-1261-5
复制
发表时间：
2016-01-14
影响因子：
2.8
通讯作者：
Liu K
中科院分区：
文献类型：
--
作者：
Liu X;Wong H;Liu K
背景在中国实现老年人社会医疗保险近乎全民覆盖的同时，不同保险计划之间的健康结果不公平问题仍然是医疗保健系统面临的一大挑战。不同的医疗保险计划对健康结果是否有不同的影响仍然是一个谜。方法采用具有全国代表性的调查数据库《中国城乡老年人口调查》，比较改革前后老年人健康状况的变化。使用单向方差分析来检测不同健康保险计划之间的医疗费用和健康状况的差异。结果单因素方差分析结果显示，虽然城镇职工基本医疗保险(UEBMI)与其他保险方案的报销差距较大，但新型农村合作医疗(NCMS)和城镇居民基本医疗保险(URBMI)的报销比例有所下降，自付费用占总医疗费用的比例较大，不同保险之间的差异有所扩大。多元线性回归结果表明，UEBMI参与者的自我报告健康状况、身体功能和心理健康状况好于URBMI和新农合参与者以及未参保的参与者。与新农合参与者和未参保者相比，新农合参与者自我报告的健康状况较好，而心理健康状况较差。结论本研究促进了医疗保险研究从强调以覆盖面和医疗保健可及性衡量的机会导向型健康公平向关注由健康支出和健康状况组成的基于结果的公平的转变。结果表明，支离破碎的医疗保险计划给老年人带来了不公平的医疗保健利用和健康结果。这项研究再次强调了根据他们的健康结果而不是权利来改革医疗保险制度的重要性，这将特别有利于最脆弱的老年群体。
BackgroundAgainst the achievement of nearly universal coverage for social health insurance for the elderly in China, a problem of inequity among different insurance schemes on health outcomes is still a big challenge for the health care system. Whether various health insurance schemes have divergent effects on health outcome is still a puzzle. Empirical evidence will be investigated in this study.MethodsThis study employs a nationally representative survey database, the National Survey of the Aged Population in Urban/Rural China, to compare the changes of health outcomes among the elderly before and after the reform. A one-way ANOVA is utilized to detect disparities in health care expenditures and health status among different health insurance schemes. Multiple Linear Regression is applied later to examine the further effects of different insurance plans on health outcomes while controlling for other social determinants.ResultsThe one-way ANOVA result illustrates that although the gaps in insurance reimbursements between the Urban Employee Basic Medical Insurance (UEBMI) and the other schemes, the New Rural Cooperative Medical Scheme (NCMS) and Urban Residents Basic Medical Insurance (URBMI) decreased, out-of-pocket spending accounts for a larger proportion of total health care expenditures, and the disparities among different insurances enlarged. Results of the Multiple Linear Regression suggest that UEBMI participants have better self-reported health status, physical functions and psychological wellbeing than URBMI and NCMS participants, and those uninsured. URBMI participants report better self-reported health than NCMS ones and uninsured people, while having worse psychological wellbeing compared with their NCMS counterparts.ConclusionsThis research contributes to a transformation in health insurance studies from an emphasis on the opportunity-oriented health equity measured by coverage and healthcare accessibility to concern with outcome-based equity composed of health expenditure and health status. The results indicate that fragmented health insurance schemes generate inequitable health care utilization and health outcomes for the elderly. This study re-emphasizes the importance of reforming health insurance systems based on their health outcome rather than entitlement, which will particularly benefit the most vulnerable older groups.