Table_1_The impact of integrated urban and rural resident basic medical insurance on health service equity: Evidence from China.DOCX

BackgroundMany countries and regions worldwide are improving their healthcare systems through the integration and unification of health insurance programs covering different groups of people. In China, the past 10 years has been the time when Chinese government promote the Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating the Urban Residents' Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS).
ObjectivesTo evaluate the impact of the URRBMI on equity in relation to health services.
MethodsThe quantitative data used in this study were obtained from the CFPS 2014–2020 database, and all respondents with health insurance type UEBMI, URBMI, and NRCMS were included. UEBMI respondents were set as the control group and URBMI or NRCMS as the intervention group, and a DID method model was used to analyze the impact of integrating health insurance on health service utilization, costs and health status. Heterogeneity analysis was also conducted after stratifying the sample according to income level and chronic disease status. This was done to investigate whether there were differences in the effects of the integrated health insurance program across different social groups.
ResultsThe implementation of URRBMI is found to be associated with a significant increase in inpatient service utilization (OR = 1.51, P < 0.01) among rural Chinese residents. Regression results by income stratum show that the utilization of inpatient services increased in rural areas for high-, middle- and low-income groups, with the fastest increase (OR = 1.78, P < 0.05) emerging for low-income groups. Analysis by chronic disease status shows that rural residents with chronic disease are associated with a higher increase in hospitalization rates (OR = 1.64, P < 0.01).
ConclusionThe implementation of URRBMI is found to have improved health insurance's ability to withstand risks and effectively improve access to health services for rural residents. In this regard, it can be considered as playing a positive role in bridging the gap in health service utilization between rural and urban areas and in improving regional equity.

研究背景 全球诸多国家与地区正通过整合覆盖不同人群的健康保险计划，优化完善本国医疗保障体系。十余年来，中国政府通过整合城镇居民基本医疗保险（Urban Residents' Basic Medical Insurance, URBMI）与新型农村合作医疗（New Rural Cooperative Medical Scheme, NRCMS），大力推进城乡居民基本医疗保险（Urban and Rural Residents Basic Medical Insurance, URRBMI）制度建设。
研究目标 评估城乡居民基本医疗保险（URRBMI）对医疗服务公平性的影响。
研究方法 本研究采用的定量数据来源于2014-2020年中国家庭追踪调查（China Family Panel Studies, CFPS）数据库，研究样本涵盖参加城镇职工基本医疗保险（Urban Employee Basic Medical Insurance, UEBMI）、城镇居民基本医疗保险（URBMI）及新型农村合作医疗（NRCMS）的所有受访者。以城镇职工基本医疗保险参保人群作为对照组，以城镇居民基本医疗保险或新型农村合作医疗参保人群作为干预组，采用双重差分（Difference-in-Differences, DID）模型分析医保整合对医疗服务利用、医疗费用及健康状况的影响。此外，本研究根据收入水平与慢性病患病情况对样本进行分层，开展异质性分析，以探究医保整合政策的实施效果在不同社会群体间是否存在差异。
研究结果 研究发现，城乡居民基本医疗保险（URRBMI）的实施与中国农村居民住院服务利用的显著提升相关（优势比OR=1.51，P<0.01）。按收入分层的回归结果显示，农村地区高、中、低收入群体的住院服务利用均有所提升，其中低收入群体的提升幅度最大（OR=1.78，P<0.05）。按慢性病患病情况开展的分析表明，患有慢性病的农村居民住院率提升幅度更为显著（OR=1.64，P<0.01）。
研究结论 本研究表明，城乡居民基本医疗保险（URRBMI）的实施提升了医保的风险抵御能力，有效改善了农村居民的医疗服务可及性。综上，该政策在缩小城乡医疗服务利用差距、提升区域医疗服务公平性方面发挥了积极作用。