Abstract：
OBJECTIVE: This study investigates whether differences in individual-level and provincial-level health funding could explain or mitigate health inequalities among older people in terms of non-communicable diseases within a population served by fragmented health insurance schemes.
METHODS: A national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over.
METHODS: Respondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases.
RESULTS: Compared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes.
CONCLUSIONS: Given the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.
METHODS: A national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over.
METHODS: Respondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases.
RESULTS: Compared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes.
CONCLUSIONS: Given the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.
摘要：
目的：本研究调查了个体水平和省级卫生资金的差异是否可以解释或减轻由分散的健康保险计划服务的人群中老年人在非传染性疾病方面的健康不平等。
方法：对2008年、2011年、2014年和2018年中国纵向健康长寿调查进行全国重复横断面分析。这些服务共提供了44,623名60岁及以上的人。
方法：询问受访者是否被医生诊断出患有任何类型的非传染性疾病。构建了一个二分法结果变量，以指示老年人是否患有任何诊断的非传染性疾病。
结果：与未投保的老年人相比，参加公务员干部社会医疗保险计划的人，城市雇员和城市居民更有可能报告较高的非传染性疾病发病率。未参加保险的老年人与新型农村合作医疗的老年人之间的非传染性疾病患病率没有显着差异。尽管在研究期间，老年人的非传染性疾病发病率有所增加，卫生支出增加与非传染性疾病风险降低显著相关.个人社会健康保险计划与公共卫生支出之间的相互作用结果表明，随着公共卫生支出的增加，不同健康保险计划之间的非传染性疾病发病率差异正在缩小。与其他健康保险计划相比，拥有公共免费医疗服务的老年人在公共卫生支出较高的省份中受益最大。
结论：鉴于全民健康覆盖对老年人非传染性疾病的有益影响的证据，这些结果应鼓励决策者增加公共卫生资金，并提高社会健康保险计划的总体福利方案。
方法：对2008年、2011年、2014年和2018年中国纵向健康长寿调查进行全国重复横断面分析。这些服务共提供了44,623名60岁及以上的人。
方法：询问受访者是否被医生诊断出患有任何类型的非传染性疾病。构建了一个二分法结果变量，以指示老年人是否患有任何诊断的非传染性疾病。
结果：与未投保的老年人相比，参加公务员干部社会医疗保险计划的人，城市雇员和城市居民更有可能报告较高的非传染性疾病发病率。未参加保险的老年人与新型农村合作医疗的老年人之间的非传染性疾病患病率没有显着差异。尽管在研究期间，老年人的非传染性疾病发病率有所增加，卫生支出增加与非传染性疾病风险降低显著相关.个人社会健康保险计划与公共卫生支出之间的相互作用结果表明，随着公共卫生支出的增加，不同健康保险计划之间的非传染性疾病发病率差异正在缩小。与其他健康保险计划相比，拥有公共免费医疗服务的老年人在公共卫生支出较高的省份中受益最大。
结论：鉴于全民健康覆盖对老年人非传染性疾病的有益影响的证据，这些结果应鼓励决策者增加公共卫生资金，并提高社会健康保险计划的总体福利方案。
