title: Equity in health care access to: assessing the urban health insurance reform in China.
abstract: This study evaluates changes in access to health care in response to the pilot experiment of urban health insurance reform in China. The pilot reform began in Zhenjiang and Jiujiang cities in 1994, followed by an expansion to 57 other cities in 1996, and finally to a nationwide campaign in the end of 1998. Specifically, this study examines the pre- and post-reform changes in the likelihood of obtaining various health care services across sub-population groups with different socioeconomic status and health conditions, in an attempt to shed light on the impact of reform on both vertical and horizontal equity measures in health care utilization. Empirical estimates were obtained in an econometric model using data from the annual surveys conducted in Zhenjiang City from 1994 through 1996. The main findings are as follows. Before the insurance reform, the likelihood of obtaining basic care at outpatient setting was much higher for those with higher income, education, and job status at work, indicating a significant measure of horizontal inequity against the lower socioeconomic groups. On the other hand, there was no evidence suggesting vertical inequity against people of chronic disease conditions in access to care at various settings. After the reform, the new insurance plan led to a significant increase in outpatient care utilization by the lower socioeconomic groups, making a great contribution to achieving horizontal equity in access to basic care. The new plan also has maintained the measure of vertical equity in the use of all types of care. Despite reform, people with poor socioeconomic status continue to be disadvantaged in accessing expensive and advanced diagnostic technologies. In conclusion, the reform model has demonstrated promising advantages over pre-reform insurance programs in many aspects, especially in the improvement of equity in access to basic care provided at outpatient settings. It also appears to be more efficient overall in allocating health care resources by substituting outpatient care for more expensive care at emergency or inpatient settings.
authors.affiliation: University of North Carolina at Chapel Hill, CB# 7360, Beard Hall, Chapel Hill, NC 27599-7360, USA. ggliu@unc.edu
authors.forename: Gordon G
authors.initials: GG
authors.lastname: Liu
authors.forename: Zhongyun
authors.initials: Z
authors.lastname: Zhao
authors.forename: Renhua
authors.initials: R
authors.lastname: Cai
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Yamada
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D005260:Female; D006264:Health Benefit Plans, Employee / Q000458:organization & administration; D018166:Health Care Reform; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends*; D006302:Health Services Research; D006801:Humans; D008297:Male; D020402:Medical Savings Accounts / Q000458:organization & administration; D008875:Middle Aged; D017059:Models, Econometric; D009313:National Health Programs / Q000458:organization & administration*; D010865:Pilot Projects; D012935:Social Justice; D012959:Socioeconomic Factors; D019472:Universal Health Insurance; D019037:Urban Health Services / Q000191:economics*