Social medical insurance integration and health care disparities in China: Evidence from an administrative claim dataset

Health care disparities continue to coexist with universal health coverage in China due to the fragmentation of social medical insurance. In this study, a pilot city located in Southeast China that integrated employee and resident medical insurance programs in 2017 is used to evaluate the impacts of employee–resident medical insurance integration on health care disparities in hospital utilization and expenditure. We use a unique administrative insurance claim dataset from 2015 to 2017 and adopt the propensity score matching and difference-in-differences (PSM-DID) regression approach. The results show that in general, employees utilize more inpatient services and receive more reimbursement than residents. However, after the policy change, the medical insurance benefits for residents greatly improved. Thus, they significantly increased their frequency of inpatient utilization and used more services per admission, which increased total inpatient expenditure and reimbursement by 10.65% and 9.94%, respectively. However, the corresponding figures for employees remained at their historical levels, thus reducing the health care disparities between these two groups. These findings provide empirical evidence to support the integration of the social medical insurance system in China and can serve as a reference for governments in low- and middle-income countries seeking to improve equality in their medical security systems.