Study On The Equity Of Health Service Under Two Medical Insurance Patterns

BackgroundThe concept of “Healthy China” has gradually become the direction of development for Chinese healthy policy.Health service plays an important role in the process of national health as an important factor affecting health.On one hand,the equity in health service is highly concerned as one of the people’s livelihood issues.On the other hand,it’s a symbol of social equity.In recent years,Chinese social economy has be developed rapidly,resulting in urban-rural resident’s income gap widened and regional difference increased,the equity in health service is seriously challenged.From the new health reform launched in 2009 to nowadays,the government has invested a lot of health funds,achieving all people can participate in the basic medical insurance.With the development of economy and changing of disease,various provinces adjust measures to local conditions and formulate the medical insurance policy which suitable for the location’s development.Currently,there are three patterns of medical insurance.“Unitary System” is all people pay the same type of medical insurance,the same management platform and the same management mode.“Binary System”are Urban-Rural Residents’ Essential Medical Insurance and Urban Employee Essential Medical Insurance.“Ternary System” are New Rural Cooperation Medical Insurance、Urban Residents’ Essential Medical Insurance and Urban Employee Essential Medical Insurance.ObjectivesBased on the development satus of Chinese essential medical insurance system and the theory of equity for health service.Emplore the people’s health service(health situation、health service utilization 、 health financing)who participate in the medical insurance in“Binary System” and“Ternary System” patterns,and analysis the equity of health service;The next step is to analyze the difference between the“Binary System” and“Ternary System”patterns,analyze the reasons and summarize,put forward reasonable suggestions for reseaech results.MethodsData collection: Qualitative data is collected through literature and interview to the relevant person in charge of the health sector,quantitative data is collected by using self-designed questionnaire for household surveys.Data analysis: Qualitative data is analyzed by NVivo software;In the quantitative data,The auther analyzed general demographic characteristics of the sample data by using descriptive statistics;Then analyzed the health equity(the two-week prevalence rate,the chronic diseases prevalence rate,the two-week off work(study)rate)and the equity of health service utilization(the two-week consultation rate,no consultation rate,hospitalization rate within a year,no hospitalization rate)by using the Concentration Index.At last,analyzed the health finaning equity(the family catastrophic health expenditure)by using Kakwani Index.Results1.Equity of health:(1)the whole crowd: the health condition for people of the “Binary system” pattem is better than that of "Ternary system" pattern,the two-week prevalence rate and the chronic diseases prevalence rate are both lowly,and have lower severity of disease;The health indicators of whole population under two patterns are negative,unfairness tend to low-income people,but the absolute value of CI is close to zero,so the health fairness is better;The unfairness of the two-week prevalence rate and the two-week off work(study)rate in the "Binary system" pattern is higher than " Ternary system" pattern;The unfairness of the chronic diseases prevalence rate in " Ternary system" pattern is more high.(2)the residents:the two-week prevalence rate: New Rural Cooperation Medical Insurance > Urban-Rural Residents’ Essential Medical Insurance > Urban Residents’ Essential Medical Insurance;The chronic diseases prevalence rate: New Rural Cooperation Medical Insurance > Urban Residents’ Essential Medical Insurance > Urban-Rural Residents’ Essential Medical Insurance;The two-week off work(study)rate:Urban-Rural Residents’ Essential Medical Insurance >New Rural Cooperation Medical Insurance > Urban Residents’ Essential MedicalInsurance;The CI of health equity are both negative between the people participate in Urban-Rural Residents’ Essential Medical insurance under the " Binary system" pattern and the people participate in New Rural Cooperation Medical Insurance under the "Ternary system",unfairness tend to low-income people;The CI of the chronic diseases prevalence rate for people who participate in Urban Residents’ Essential Medical Insurance under the "Ternary system";The absolute value of the two-week off work(study)rate under two patterns are maximum,unfair degree is the largest.(3)the worker: the two-week prevalence rate and the chronic diseases prevalence rate in the "Binary system" pattern is lower than that of the "Ternary system";The comparison of the two-week off work(study)rate without statistical significance.The worker’s health indicators of two patterns are negative,unfairness tend to low-income people;All of the absolute value of the CI for health indicators in "Binary system" pattern are less than that of the "Ternary system" pattern,so the worker’s health equity in the "Ternary system" pattern is more unfair.2.Equity of health service utilization:(1)the whole crowd: The two-week prevalence rate of the whole people under the " Binary system" pattern is higher than that of the "Ternary system" pattern;The no consultation rate of the whole people under the "Ternary system" pattern is high,so there is a high potential outpatient service demand;The hospitalization rate of whole population under two patterns are not significant,there is a high no hospitalization rate for the "Binary system" pattern,so it has a high potential demand to the hospital.In the utilization of outpatient service,CI value of the two-week prevalence rate for the whole people is negative,the unfairness tend to low-income people and the " Binary system" pattern has a higher unfair degree;The equity hospital utilization of the whole people under the "Binary system" pattern is lower than that of the "Ternary system" pattern.(2)the residents: the residents of the "Binary system" pattern have better outpatient utilization;The two-week prevalence rate of the residents who participate in Urban Residents’ Essential Medical Insurance under the " Ternary system" pattern is the lowest,and the no consultation rate is highest;The residents hospitalization rate under two patterns are not significant;The no hospitalization rate of the residents who participate in Urban Residents’ Essential MedicalInsurance under the " Binary system" pattern is high,so there has a high potential demand to the hospital.CI value of the hospitalization rate for the residents who participate in Urban-Rural Residents’ Essential Medical Insurance under the "Binary system" pattern and New Rural Cooperation Medical Insurance under the "Ternary system" pattern are negative,tend to the low-income people;Howere,in equity of hospital utilization,the residents who participate in New Rural Cooperation Medical Insurance do it more better,CI value is close to zrero,not same as to the residents under the " Binary system" pattern,it has a great potential demand in the hospital.(3)the worker: there is no significant between no consultation rate and no hospitalization rate,others have statistical significance;the two-week consultation rate of workers under the "Binary system" pattern is higher than that of the "Ternary system" pattern,different from hospitalization rate.CI value of the two-week consultation rate and hospitalization rate within a year are negative,the unfairness tend to low-income people.3.Equity of health financing: The family CHE rate under two patterns are 12.66% and15.67%,suggest that "Binary system" pattern has low incidence rate in CHE;Kakwani index are-0.037 and-0.042,so we can know that the health financing of sample areas under two patterns of are regressive.Compared to the "Binary system" pattern,the financing level has stronger regressive than that of the "Ternary system" pattern.Average gap are 2.46% and4.35%,respectively,for the overall population,samples of two patterns occurred family catastrophic health situation has certain differences;Relative gap are 19.42% and 27.74%,respectively,which indicates that the situation of family which in CHE become poor or return poor because of illness under the pattern of "Ternary system" is more seriously than that of the "Binary system".ConclusionsSamples for two patterns in the general demographic characteristics,family economic level and medical insurance type are different,so the results of health service demand and utilization are different.On the whole,the health level and the situation of the health service utilization for "Binary System" pattern are better than "Ternary System" pattern,but there are certain unfairness within it,tend to low-income people,and the unfair degree for "Binarysystem" pattern is slightly higher than that of "Ternary System" pattern,this also is the common problems in normalization of medical insurance,and it has not yet been transited from formally fair to the substantial justice;The level of health financing under two patterns is regressive,the financing regressive of "Ternary System" pattern is more obviously.The comparison for Residents,the residents’ health service demand and utilization level under two patterns are different,so does the equity is the comparison in terms of worker,the worker’s health level is more seriously under the "Ternary System" pattern,especially in chronic diseases;The worker’s health level and health services utilization under the "Binary System" pattern are better than "Ternary System" pattern.Recommendations1.Improve the ability of public health,strengthen the prevention and control of chronic diseases.2.Adjust measures to local conditions,improve outpatient and hospitalization’s compensation.3.Improve the level of financing,perfect the system of medical rescue.4.Promote the urban and rural medical insurance plan as a whole,enhance the anti-risk ability of the medical insurance fundation.