Study Of Sustainable Financing Models Of Urban Resident Basic Health Insurance In China

BackgroundsIn 2007 Urban Resident Basic Health Insurance (URBHI) was established to cover residents who were uninsured by Urban Employee Basic Health Insurance (UEBHI) and New Cooperative Medical Scheme in urban areas, following the guidelines outlined in State Council Policy Document 2007 No.20. It mainly covers children, senior citizens without pension and so on, who don't have stable income.URBHI is financed by government and residents, which is the main difference from UEBHI. For URBHI, how to balance the financing of government and residents is a question in order to meet the financing requirement of enlarging the benefit package of URBHI.This study estimated the willingness-to-pay (WTP) for different skemes of the enlarged benefit package of URBHI (URBHI+) at different government financings, aiming to understand the demand of URBHI+, the WTP at different government financings and the determinants of WTP. AimThis study was to explore the financing stratigy for enlarging URBHI, to advancing the implementing of URBHI and promote the sustainable devopment of URBHI.Contents1. To summarize and evaluate experiences of URBHI in China.2. To analyse the need and utilization of health service.3. To explore the relationship between the financing of government and residents of URBHI.4. To bring forward suggestions of URBHI for its sustainable development.Data Sources1. Household Survey.Two provinces were chosen in eastern and western China respectively. In each province,800-1000 households were interviewed. The contents of interviews were to gather information of demography, family, the need and utilization of health service, the demand and WTP for URBHI+ and so on.2. Secondary Data.Policies of URBHI in 86 pilot cities in China were collected with the help of website, phones and search engines.3. Qualitative InterviewsMethods1. Contingent Valuation MethodsIt is to explore the relationship of the financing of government and residents using contingent valuation methods. Also, demand model for URBHI+ was extablished using regression analysis.2. Literature review.It is to study the status, features and development of policies of URBHI in 86 cities in China using literature review.Research Findings1. In recent years, the development of URBHI is mainly relied on government financing. From 2007 to 2009, the government financing plays a decisive role in its financing, and this effect is becoming more and more important.2. It is a relatively heavy burden of out-of-pocket for the insured of URBHI. The out-of-pocket for the outpatient and inpatient service of the insured of URBHI is much higher than that of Urban Employee Basic Medical Insurance.3. The respondents are willing to pay much money for URBHI+. There are above 42% of respondents who want to participate in URBHI+ for children, of which the median WTP is all above 92 RMB. There are above 31% of respondents who want to participate in URBHI+ for senior residents, and the median WTP of which is above 140 RMB.4. Within a certain range, government financing is a positive determinant for URBHI+. When government financing locates in the middle level, the possibility of purchasing URBHI+ was higher than that in the lowest level and in the higher level. So was the WTP.5. The demand of the lowest quartile group for URBHI+ is reletively low.Suggestions1. In the initial stage of URBHI, its development is largely relied on the government financing. It is also an effective means to achieve the universal coverage in China.2. When URBHI develops to a certain mature level, the financing model leaded by government financing will transit to another one leaded by residents financing. This transition could be realized by the establishment of URBHI with multi-level benefit package.3. It is to improve the benefit package of URBHI that is the ultimate goal of the sustainable development of URBHI.4. The lowest quartile group should be paid emphasis in the development of URBHI. Increasing government financing so as to decrease residents financing is an effective way to guarantee the coverage ratio of this group.