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The march to universal health coverage (UHC) in China is unparalleled. Since the establishment of the State Council Medical Reform team in 2006, the basic objective of China’s health reforms has been to provide the whole nation with basic medical and health care, while ensuring equal access to, and affordability of, health services. The Chinese gov...
Contexts in source publication
Context 1
... illustrate how China's complex institutional arrangement has affected the HCP fund management, this section looks into financial flows of the NRCM. As figure 3 shows, the MoH unifies the pooling agent, payer, and purchaser of the NRCMS in one institute called the NRCMS Management Office under the jurisdiction of the county BoH. There are approximately 2,800 offices nationwide, so the number of risk pools is large. ...
Context 2
... cost savings derived from a marginal increase in the use of primary care could be offset by the increase in intensity of hospital care. During 2007-11, the inflation-adjusted average inpatient fees grew by 18 percent (from Y8,087 to Y9,551) in tertiary hospitals, by 21 percent in large county and city hospitals, and by 17 percent in small county and city hospitals (and large township/community health centers) (see figure 3). Moreover, it was found that hospitalization fees were higher for the insured and the uninsured due to longer hospital stays and higher drug expenses ( Pan et al. 2009). ...
Citations
... (6) Access to water and sanitation was considered, which indicates the household's ability to satisfy children/adolescents' functional living requirements (Briones 2017) and includes access to tap water and in-door flush toilets in the household. (7) Access to medical insurance captures the effect of expanding social health insurance coverage for children/adolescents (Liang and Langenbrunner 2013). (8) Wave dummies capturing time-varying macroeconomic factors that might affect child/adolescent health outcomes were also included (Nie et al. 2021). ...
Inequality of opportunity (IOp) in stunting arises when disparities are linked to observable circumstances beyond a child/adolescent’s control, such as socioeconomic background or environmental characteristics. We use data from the 1991–2015 China Nutrition and Health Survey (CNHS) to investigate the overall level and temporal changes in inequality of opportunity (IOp) in stunting among Chinese children and adolescents aged 0–18 years while also investigating the underlying factors contributing to this inequality. Additionally, we identify the differences in IOp between children and adolescents in rural and urban areas, how these differences change over time, and how circumstances affect IOp differently in rural and urban areas. For the entire sample, the relative share of IOp in stunting in China is 3.34%, with similar levels in urban (3.47%) and rural areas (3.44%), possibly due to the presence of similarly disadvantaged subgroups in both settings, albeit driven by differing underlying factors of disadvantage. The IOp in stunting mostly stems from region and household socioeconomic status. Over time, the incidence of IOp in stunting has decreased, with differences between urban and rural children and adolescents shrinking. The contribution of parental health has become more significant over time. Heterogeneity analysis further revealed that boys, older children and adolescents, and those from the western region experienced greater IOp in stunting. Continued efforts are thus needed to improve access to affordable nutritious foods, healthcare and nutrition education, especially in rural and Western China.
... Significant disparities existed among the three schemes in terms of pooling levels, financing standards, and security benefits, especially between the URBMI and NRCMS [11,12]. The NRCMS funds were pooled at the county level, while the URBMI and UEBMI funds were pooled at the municipal (prefecture) level. ...
Background
To improve equity in medical insurance benefits, the Chinese government integrated the New Rural Cooperative Medical Scheme for rural residents and the Urban Resident Basic Medical Insurance for nonworking urban residents into a unified Urban and Rural Resident Basic Medical Insurance system (URRBMI). This study aims to assess income-related mobility in medical insurance benefits before and after the integration of the two schemes, and to explore its contribution to improving medical insurance equity.
Methods
The panel data were obtained from the 2011 and 2018 China Health and Retirement Longitudinal Study, with 9,662 participants. To assess the benefits residents received from medical insurance, four indicators were analyzed for outpatient and inpatient care respectively: benefit rate, benefit probability, compensation fee, and reimbursement probability. The concentration index (CI) was used to measure the income-related inequality of medical insurance benefits. Changes in inequality across the two waves were decomposed into income-related benefit mobility and benefit-related income mobility, which reflect variations in relative benefit changes among individuals with different initial income levels, capturing the effect of integration on benefit inequality.
Results
Results indicated a significant increase in all medical insurance benefit measures following integration, except for outpatient care benefit probability and inpatient care reimbursement probability. The CIs shifted from positive in 2011 to negative in 2018 (0.129 vs. −0.052 for the benefit rate, 0.147 vs. −0.044 for the benefit probability, and 0.148 vs. −0.097 for the reimbursement probability, p < 0.001). The income-related mobility for inpatient care (benefit rate, benefit probability, and compensation amount) were positive when the average benefit level increased across the two waves. In contrast, no statistically significant difference was observed in outpatient benefit mobility.
Conclusions
The findings indicated that income-related inequalities in medical insurance benefits were narrowed due to pro-poor changes in inpatient care equity for inpatient care after integration. This integration has contributed to building a more equitable healthcare system. However, further efforts are needed to expand outpatient benefit coverage in the integrated URRBMI scheme.
... Limited awareness and lack of understanding about social insurance are one of important barriers to the participation in voluntary social insurance of informal sector workers. The practice has shown that disinformation and social marketing have indeed played an important role in expanding coverage of contribution-based social security schemes(Liang and Langenbrunner, 2013). Communication plays an important role in conveying the messages of the social insurance policy to the affected people. ...
Expanding voluntary social insurance coverage is one of the important goals of the social insurance system in Vietnam and many developing countries around the world. This study uses a combination of document research methods, traditional statistical analysis methods; synthesize, compare, contrast, and clarify the theoretical basis for the expansion of voluntary social insurance coverage, the legal provisions on voluntary social insurance policies and the current status of voluntary social insurance coverage in Vietnam. Based on the research results, the authors propose some recommendations to improve the policy and organize the implementation of social insurance, aiming to expand the coverage of voluntary social insurance. Recommendations include: financial incentives through participation and support from the Government, adding short-term benefits to the voluntary social insurance program, reforming administrative procedures and boosting investment application of information technology in the management of the social insurance system, and strengthening communication on voluntary social insurance.
... Limited awareness and lack of understanding about health insurance is one of the important barriers for informal sector worke rs to participate in health insurance. Practice shows that disseminating information and social marketing has actually played an important role in expanding health insurance coverage in some countries (Liang and Langenbrunner, 2013;Bredenkamp et al., 2015). To ensure that all people can receive information about health insurance and health care services covered by health insurance (especially the poor, near-poor, and those living in remote areas), it is necessary to implement groups of solutions on: (i) strengthening the organization, improving the capacity and qualifications of communication staff; effectively use facilities and investment resources for communication work; (ii) raising awareness and responsibility of collectives and individuals across the social insurance industry for the communication of health insurance policies; (iii) strengthening direct communication coordination among target groups; (iv) Improve the quality and effectiveness of communication of health insurance policies on the mass media, promote the role of press agencies and the electronic information system of the social insurance industry; (v ) promote participation and effective organization of social media activities. ...
In recent years, health insurance coverage in Vietnam has been increasingly expanded. Up to now, the health insurance coverage rate has reached about 90% of the population; There is still a gap with about 10% of the population not covered by health insurance, most of which are informal sector workers. This is a significant challenge in the roadmap to implement the policy of universal health insurance in Vietnam. Based on the literature review method, this study synthesized and analyzed the main factors affecting the non-participation in health insurance of informal sector workers. On that basis, the authors propose some policy suggestions to attract this group of people to participate in health insurance, expand health insurance coverage, and realize the goal of developing universal health insurance for efficient and sustainable people.
... Health insurance is currently the most effective policy tool for controlling ICHE. China has made remarkable achievements in approaching the goal of near-universal health insurance coverage, although its depth is in need of enhancement [39]. For depth, we focused on two main questions: "how much protection to provide" and "who to protect. ...
Background
The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population characteristics, ignoring the differences in regional characteristics. Thus, our study aimed to explore the impact of various influencing factors on the ICHE from a spatiotemporal perspective.
Methods
We used data from the China Health and Retirement Longitudinal Study (waves 1 to 4), to conduct a retrospective cohort study across 28 provinces, from 2011 to 2018. We measured regional incidences of catastrophic health expenditure using methods recommended by the World Health Organization. Ordinary least squares (OLS) and geographical and temporal weighted regression (GTWR) were used as the global and local estimation models, respectively. The Fortheringham method was used to test the spatiotemporal non-stationarity.
Results
National ICHE showed a gradual increase from 2011 to 2015, but suddenly decreased from 2015 to 2018, also showing the spatial heterogeneity. And the southwest area and Hebei showed persistently high ICHE (Qinghai even reached the highest value of 27.5% in 2015). Out-of-pocket payment, gross domestic product, PM2.5, ageing, incidence of non-communicable diseases and disabilities, number of nurses, and health insurance coverage in the global estimation passed the significance test, and the GTWR model showed a better model fit (0.769) than the OLS model (0.388). Furthermore, except for health insurance coverage, all seven variables had spatiotemporal non-stationarity among their impacts on ICHE.
Conclusion
In this longitudinal study, we found spatiotemporal non-stationarity among the variable relationships, supporting regional governments’ adoption of regional-target policies. First, after the completion of universal health insurance coverage, the spatiotemporal non-stationarity of the prevalence of non-communicable diseases and disability and ageing should be the focus of the next phase of health insurance design, where improvements to compensation coverage and benefit packages are possible policy instruments. Second, the governance and causes of catastrophic health expenditure need to be laid out from a macro perspective rather than only from the individual/household perspective, especially for the potential impact of economic development, air pollution and nursing resources.
... The benefit packages and financial protection are not identical within and across the schemes, hindering universal health insurance coverage in China. The annual per capita fund for UEBMI is approximately 6 and 7 times higher than that for the NCMS and URBMI, respectively 7 . Furthermore, NCMS is not transferable between provinces. ...
In 2016, China initiated the merge of the urban resident basic medical insurance scheme and new rural cooperative medical scheme into one unified health insurance scheme: the urban and rural resident basic medical insurance. This study investigates the impact of integrated insurance on the direct hospitalization cost of inpatients with catastrophic illnesses. An interrupted time series analysis was conducted based on a sample of 6174 inpatients with catastrophic illness from January 2014 to December 2018. The factors surveyed included per capita total inpatient expense, out-of-pocket expense, and reimbursement ratio. Univariate analysis indicated that after the implementation of the unified urban and rural medical insurance, the reimbursed expense increased from 9398 to 13,842 Yuan ( P < 0.001), average reimbursement ratio increased from 0.57 to 0.59 ( P < 0.05). Expenses on both western and traditional medicines increased, although the proportion of medicine expense decreased after the integration. Interrupted time series analysis showed that per capita total inpatient expense and per capita out-of-pocket expense increased but showed a gradually decreasing trend after the integration. After the integration of urban and rural medical insurance, the average reimbursement ratio increased slightly, which had limited effect on the alleviation of patients’ financial burden. Furthermore, the integration effect on inpatient expense is offset by increased out-of-pocket medical expense due to suspected supplier-induced demand.
... Important health indicators in China beyond the average level of high-income countries and objective indicators such as maternal mortality, infant survival rate and average life expectancy have shown that China's health service capacity and health of the public have been improved [5]. Evidence from existing research suggests that China's new healthcare reform offers valuable lessons for the world, especially reflected in the coverage and service quality of primary health care [6][7][8]. Although the Chinese government has continuously increased its investment in medical and health-care and various objective indicators have reflected the results of this comprehensive measure, what is the actual benefit to the public? ...
... On the one hand, although China's health-care reform has made remarkable achievements in all aspects, the phenomenon of 'difficult and expensive medical treatment' still exists, especially in general hospitals [4,55,56]. On the other hand, the coverage, content and quality of primary health services and public health services in China have been significantly improved with the support of health-care reform policies in recent years [1,2,4,5,8]. Thus, people benefit more from primary health institutions and thus have stronger SGHR. ...
Background
The sense of gain has gradually become the main evaluation index for the effectiveness of China’s deepening reform and is affected by many factors. However, there is no relevant research on the sense of gain of health-care reform (SGHR) and its influencing factors. The purpose of this study was to explore the influence of subjective socioeconomic status (SSS) on SGHR and the mediating role of self-rated health (SRH) between them.
Methods
Data (25,149 samples total) from China Family Panel Studies (CFPS) in 2018 were included in the analysis. A nonparametric test was used to explore the differences in demographic characteristics of SGHR, and a correlation analysis and mediating effect model were used to explore the influence of SSS on SGHR and the mediating effect of SRH.
Results
Demographic characteristics such as age, urban and rural areas, educational background, marriage and choice of medical treatment had significant differences in the distribution of perceived acquisition of medical reform. SSS, SRH and SGHR are statistically positively correlated with each other. SSS has a positive statistical correlation with SGHR, and may have an indirect effect through SRH.
Conclusions
SSS is an important predictor of SGHR, and SRH may play a partially mediating role in SGHR.
... The WHO has also proposed 4 essential attributes needed to achieve UHC, which include an efficient and well-run health system, an affordable and equitable system for financing, access to essential medicines and technologies, and a sufficiently trained and motivated health workforce [10]. The common challenges faced by countries when moving toward UHC are coming into sharper focus, and early research [11,12] has begun to identify the most and least effective approaches for addressing these challenges. The solutions to these challenges will likely be highly context-dependent, inherently path-dependent, and shaped by the political leadership and administrative capabilities [13]. ...
Objectives:
No systematic review has explored the challenges related to worldwide universal health coverage (UHC). This study reviewed challenges on the road to UHC.
Methods:
A systematic electronic search of all studies that identified the challenges of worldwide UHC was conducted, without any restrictions related to the publication date or language. A hand search and a bibliographic search were also conducted to identify which texts to include in this study. These sources and citations yielded a total of 2500 articles, only 26 of which met the inclusion criteria. Relevant data from these papers were extracted, summarized, grouped, and reported in tables.
Results:
Of the 26 included studies, 7 (27%) were reviews, 6 (23%) were reports, and 13 (50%) had another type of study design. The publication dates of the included studies ranged from 2011 to 2020. Nine studies (35%) were published in 2019. Using the World Health Organization conceptual model, data on all of the challenges related to UHC in terms of the 4 functions of health systems (stewardship, creating resource, financing, and delivering services) were extracted from the included studies and reported.
Conclusions:
This study provides a straightforward summary of previous studies that explored the challenges related to UHC and conducted an in-depth analysis of viable solutions.
... Having successfully extended the breadth of health coverage (in terms of the numbers of people covered), the major challenges now are to increase its scope (in terms of the comprehensiveness and quality of services) and its depth (the degree of financial protection), which remain insufficient (Liang and Langenbrunner, 2013). This new phase of reforms happens in a context of slower economic growth which, coupled with demographic and epidemiological pressures, means that serious consideration needs to be given to economic sustainability (China Joint Study Partnership, 2016). ...
... China has made big improvements in protecting the population from the risk of very high out-of-pocket healthcare costs. The share of out-of-pocket payments has decreased compared to total health expenditure, from a high point of 60% in 2001 to 32% in 2014, which is just under the average for other uppermiddle income countries (33%), although still above WHO's recommended level of 20% for reducing the risk of impoverishment as a result of disease (Liang and Langenbrunner, 2013 and China Joint Study Partnership, 2016). ...
Több mint negyedszázada már, hogy a Magyar Máltai Szeretetszolgálat Egyesülettel, illetve a fenntartásában működő siófoki Gondviselés Háza intézményével kapcsolatba kerültem. Kezdetben gondozóként, majd szakmai vezetőként (támogató szolgáltatás és fogyatékos személyek nappali ellátása), 2008. augusztus 1-jétől pedig a Gondviselés Háza integrált intézmény vezetőjeként tevékenykedem. Segítői hivatásom több évtizedes gyakorlása során szembesültem a folyamatosan változó körülményekkel, melyek a társadalom, a szociális ellátórendszer, az intézményünk, a családok és egyének számára egyaránt nehézségeket, megoldásra váró élethelyzeteket generálnak. Írásom a demenciára fókuszál, a Gondviselés Házában tapasztaltakat alapul véve. A rövid bemutatkozás után a probléma komplex bemutatására, elemzésére törekszem. Bemutatom az intézményünk által alkalmazott terápiákat, beavatkozási módokat, értékelésüket, valamint a megoldási alternatívákat.
... Moreover, the evaluation of the World Health Organization (WHO) suggests that the new health-care reform of China regarding the basic health coverage problem of the processing path provides a valuable reference for the world [8]. Although the Chinese government has continuously increased its investment in medical and health-care and various objective indicators have reflected the results of this comprehensive measure, what is the actual benefit to the public? ...
... On the one hand, although China's health-care reform has made remarkable achievements in all aspects, the phenomenon of 'difficult and expensive medical treatment' still exists, especially in general hospitals [4,55,56]. On the other hand, the coverage, content and quality of primary health services and public health services in China have been significantly improved with the support of health-care reform policies in recent years [1,2,4,5,8]. Thus, people benefit more from primary health institutions and thus have stronger SGHR. ...
Background: The sense of gain has gradually become the main evaluation index for the effectiveness of China’s deepening reform and is affected by many factors. However, there is no relevant research on the sense of gain of health-care reform (SGHR) and its influencing factors. The purpose of this study was to explore the influence of subjective socioeconomic status (SSS) on SGHR and the mediating role of self-rated health (SRH) between them.
Methods: Data (27,437 samples total) from China Family Panel Studies (CFPS) in 2018 were included in the analysis. A nonparametric test was used to explore the differences in demographic characteristics of SGHR, and a correlation analysis and mediating effect model were used to explore the influence of SSS on SGHR and the mediating effect of SRH.
Results: Demographic characteristics such as age, urban and rural areas, educational background, marriage and choice of medical treatment had significant differences in the distribution of perceived acquisition of medical reform. SSS, SHR and SGHR are positively correlated with each other. SSS not only directly affects SGHR positively but also indirectly affects SGHR through SRH.
Conclusions: SSS is an important predictor of SGHR, and SHR plays a partially mediating role in SGHR.
