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Equity in health care access to: assessing the urban health insurance reform in China

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  • Liu, Gordon G.
  • Zhao, Zhongyun
  • Cai, Renhua
  • Yamada, Tetsuji
  • Yamada, Tadashi

Abstract

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.

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Bibliographic Info

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 55 (2002)
Issue (Month): 10 (November)
Pages: 1779-1794

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Handle: RePEc:eee:socmed:v:55:y:2002:i:10:p:1779-1794

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Keywords: Equity Reform Urban health care Insurance China Access;

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Cited by:
  1. Martine Audibert & Xiao Xian Huang & Jacky Mathonnat & Aurore Pelissier & Ningshan Chen & Anning Ma, 2012. "Curative Activities of Township Hospitals in Weifang Prefecture, China: An Analysis of Environmental and Supply-Side Determinants," Working Papers halshs-00640742, HAL.
  2. Chen, Zhuo & Eastwood, David B. & Yen, Steven T., 2005. "Childhood Malnutrition In China: Change Of Inequality In A Decade," 2005 Annual meeting, July 24-27, Providence, RI 19205, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
  3. JunQiang Liu & Tao Chen, 2013. "Sleeping money: investigating the huge surpluses of social health insurance in China," International Journal of Health Care Finance and Economics, Springer, vol. 13(3), pages 319-331, December.
  4. Karen Eggleston & Keqin Rao & Jian Wang, 2005. "From Plan to Market in the Health Sector? China's Experience," Discussion Papers Series, Department of Economics, Tufts University 0501, Department of Economics, Tufts University.
  5. Sujin Kim & Soonman Kwon, 2014. "The effect of extension of benefit coverage for cancer patients on health care utilization across different income groups in South Korea," International Journal of Health Care Finance and Economics, Springer, vol. 14(2), pages 161-177, June.
  6. Yusuf, Shahid & Nabeshima, Kaoru & Wei Ha, 2007. "What makes cities healthy ?," Policy Research Working Paper Series 4107, The World Bank.
  7. Xilong Pan & Hassan H. Dib & Minmin Zhu & Ying Zhang & Yang Fan, 2009. "Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1146-1162.
  8. Luo, Juhua & Zhang, Xiulan & Jin, Chenggang & Wang, Dongmin, 2009. "Inequality of access to health care among the urban elderly in northwestern China," Health Policy, Elsevier, vol. 93(2-3), pages 111-117, December.

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