title: Outcome-based health equity across different social health insurance schemes for the elderly in China.
abstract: BACKGROUND
  Against the achievement of nearly universal coverage for social health insurance for the elderly in China, a problem of inequity among different insurance schemes on health outcomes is still a big challenge for the health care system. Whether various health insurance schemes have divergent effects on health outcome is still a puzzle. Empirical evidence will be investigated in this study.
  
  
  METHODS
  This study employs a nationally representative survey database, the National Survey of the Aged Population in Urban/Rural China, to compare the changes of health outcomes among the elderly before and after the reform. A one-way ANOVA is utilized to detect disparities in health care expenditures and health status among different health insurance schemes. Multiple Linear Regression is applied later to examine the further effects of different insurance plans on health outcomes while controlling for other social determinants.
  
  
  RESULTS
  The one-way ANOVA result illustrates that although the gaps in insurance reimbursements between the Urban Employee Basic Medical Insurance (UEBMI) and the other schemes, the New Rural Cooperative Medical Scheme (NCMS) and Urban Residents Basic Medical Insurance (URBMI) decreased, out-of-pocket spending accounts for a larger proportion of total health care expenditures, and the disparities among different insurances enlarged. Results of the Multiple Linear Regression suggest that UEBMI participants have better self-reported health status, physical functions and psychological wellbeing than URBMI and NCMS participants, and those uninsured. URBMI participants report better self-reported health than NCMS ones and uninsured people, while having worse psychological wellbeing compared with their NCMS counterparts.
  
  
  CONCLUSIONS
  This research contributes to a transformation in health insurance studies from an emphasis on the opportunity-oriented health equity measured by coverage and healthcare accessibility to concern with outcome-based equity composed of health expenditure and health status. The results indicate that fragmented health insurance schemes generate inequitable health care utilization and health outcomes for the elderly. This study re-emphasizes the importance of reforming health insurance systems based on their health outcome rather than entitlement, which will particularly benefit the most vulnerable older groups.
authors.affiliation: Department of Social Security & Risk Management, School of Public Affairs, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, China. xtliu@zju.edu.cn.
authors.forename: Xiaoting
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, SAR, China.
authors.forename: Hung
authors.initials: H
authors.lastname: Wong
authors.affiliation: Department of Social Security, School of Labor and Human Resources, Renmin University of China, 59 Zhongguancun Street, Beijing, 100872, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D004651:Employment; D005260:Female; D019538:Health Care Surveys; D000069576:Health Equity / Q000191:economics / Q000458:organization & administration; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration*; D006304:Health Status; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D057566:Self Report; D019472:Universal Health Insurance / Q000458:organization & administration