背景:医疗保险制度的分散是实现健康公平的主要挑战。针对这个问题,中国政府正在通过整合新型农村合作医疗计划和城镇居民基本医疗保险来推动建立统一的城乡居民基本医疗保险(URRBMI)制度。到2020年底,URRBMI几乎完全在中国实施。
目的:本研究旨在研究URRBMI整合对居民健康水平的影响,以及整合是否有助于减少健康差距和促进健康公平。
方法:我们使用了基于2014年至2018年中国家庭小组研究调查的交错差异方法。我们的研究有来自98个城市的27,408个人的全国代表性样本。我们选择自评健康状况作为健康状况的衡量标准。为了更准确地辨别样本是否被URRBMI覆盖,我们根据地方政府发布的官方文件获得了URRBMI的确切积分时间。最后,我们按城市和农村地区对样本进行分组,regions,和家庭收入,以检查一体化对健康公平的影响。
结果:我们发现,URRBMI积分提高了我国居民的健康水平(B=0.066,95%CI0.014~0.123;P=.01)。在卫生公平方面,结果表明,首先,整合提高了农村居民的健康水平(B=0.070,95%CI0.012-0.128;P=.02),中国西部居民(B=0.159,95%CI0.064-0.255;P<.001),和中低收入群体(B=0.113,95%CI0.004-0.222,P=.04),因此,一体化在缩小城乡卫生差距方面发挥了一定作用,不同地区,不同的收入水平。通过进一步的机理分析,我们发现,在中国,URRBMI整合通过促进获得较高评级的医院和提高医疗费用的报销率,减少了健康不平等.然而,一体化并没有改善中部地区和低收入群体的健康状况,低收入群体无法获得医疗保健的情况没有得到有效缓解。
结论:URRBMI整合在促进城乡居民健康公平方面的作用是显着的(P=0.02),但是在不同的地区和收入群体中,它是有限的。注重医疗资源在地区间的合理配置,加大对低收入群体的政策倾斜,有利于提高医保整合的公平性。
BACKGROUND: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents?
OBJECTIVE: This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity.
METHODS: We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity.
RESULTS: We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration
did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced.
CONCLUSIONS: The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration.