Equity in health care access to: assessing the urban health insurance reform in China
Equity in health care access to: assessing the urban health insurance reform in China
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DOI：
10.1016/s0277-9536(01)00306-9
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发表时间：
2002-11-01
影响因子：
5.4
通讯作者：
Yamada, T
中科院分区：
文献类型：
--
作者：
Liu, GG;Zhao, ZY;Yamada, T
本研究评估了中国城镇医疗保险改革试点中医疗服务可及性的变化。改革试点于1994年在镇江和九江开始，随后于1996年扩大到其他57个城市，并于1998年底在全国范围内推广。具体而言，本研究考察了不同社会经济地位和健康状况的亚人群在改革前后获得各种医疗服务的可能性的变化，试图揭示改革对医疗保健利用纵向和横向公平措施的影响。利用镇江市1994 ~ 1996年的年度调查数据，采用计量经济模型进行实证估计。主要研究结果如下：在保险改革之前，那些收入、教育程度和工作地位较高的人在门诊获得基本护理的可能性要高得多，这表明对社会经济地位较低的群体存在显著的横向不平等。另一方面，没有证据表明慢性病患者在各种环境中获得护理方面存在纵向不平等。改革后，新的保险计划使社会经济地位较低群体的门诊使用率显著增加，为实现基本医疗服务的横向公平做出了巨大贡献。新计划还在使用所有类型的护理方面保持了纵向公平的衡量标准。尽管进行了改革，社会经济地位较差的人在获得昂贵和先进的诊断技术方面仍然处于不利地位。总之，改革模式在许多方面都比改革前的保险计划显示出有希望的优势，特别是在改善门诊提供的基本医疗服务的公平性方面。它似乎也更有效地分配总体卫生保健资源，用门诊治疗代替更昂贵的急诊或住院治疗。(C) 2002 Elsevier Science Ltd.版权所有。
This study evaluates changes in access to health care in response to the pilot experiment of urban health insurance reform in China. The pilot reform began in Zhenjiang and Jiujiang cities in 1994, followed by an expansion to 57 other cities in 1996, and finally to a nationwide campaign in the end of 1998. Specifically, this study examines the pre- and post-reform changes in the likelihood of obtaining various health care services across sub-population groups with different socioeconomic status and health conditions, in an attempt to shed light on the impact of reform on both vertical and horizontal equity measures in health care utilization.Empirical estimates were obtained in an econometric model using data from the annual surveys conducted in Zhenjiang City from 1994 through 1996. The main findings are as follows. Before the insurance reform, the likelihood of obtaining basic care at outpatient setting was much higher for those with higher income, education, and job status at work, indicating a significant measure of horizontal inequity against the lower socioeconomic groups. On the other hand, there was no evidence suggesting vertical inequity against people of chronic disease conditions in access to care at various settings. After the reform the new insurance plan led to a significant increase in outpatient care utilization by the lower socioeconomic groups, making a great contribution to achieving horizontal equity in access to basic care. The new plan also has maintained the measure of vertical equity in the use of all types of care. Despite reform, people with poor socioeconomic status continue to be disadvantaged in accessing expensive and advanced diagnostic technologies. In conclusion, the reform model has demonstrated promising advantages over pre-reform insurance programs in many aspects, especially in the improvement of equity in access to basic care provided at outpatient settings. It also appears to be more efficient overall in allocating health care resources by substituting outpatient care for more expensive care at emergency or inpatient settings. (C) 2002 Elsevier Science Ltd. All rights reserved.