title: Disparity in reimbursement for tuberculosis care among different health insurance schemes: evidence from three counties in central China.
abstract: BACKGROUND
  Health inequity is an important issue all around the world. The Chinese basic medical security system comprises three major insurance schemes, namely the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Cooperative Medical Scheme (NCMS). Little research has been conducted to look into the disparity in payments among the health insurance schemes in China. In this study, we aimed to evaluate the disparity in reimbursements for tuberculosis (TB) care among the abovementioned health insurance schemes.
  
  
  METHODS
  This study uses a World Health Organization (WHO) framework to analyze the disparities and equity relating to the three dimensions of health insurance: population coverage, the range of services covered, and the extent to which costs are covered. Each of the health insurance scheme's policies were categorized and analyzed. An analysis of the claims database of all hospitalizations reimbursed from 2010 to 2012 in three counties of Yichang city (YC), which included 1506 discharges, was conducted to identify the differences in reimbursement rates and out-of-pocket (OOP) expenses among the health insurance schemes.
  
  
  RESULTS
  Tuberculosis patients had various inpatient expenses depending on which scheme they were covered by (TB patients covered by the NCMS have less inpatient expenses than those who were covered by the URBMI, who have less inpatient expenses than those covered by the UEBMI). We found a significant horizontal inequity of healthcare utilization among the lower socioeconomic groups. In terms of financial inequity, TB patients who earned less paid more. The NCMS provides modest financial protection, based on income. Overall, TB patients from lower socioeconomic groups were the most vulnerable.
  
  
  CONCLUSIONS
  There are large disparities in reimbursement for TB care among the three health insurance schemes and this, in turn, hampers TB control. Reducing the gap in health outcomes between the three health insurance schemes in China should be a focus of TB care and control. Achieving equity through integrated policies that avoid discrimination is likely to be effective.
authors.affiliation: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China. panyao0301@163.com.|The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. panyao0301@163.com.
authors.forename: Yao
authors.initials: Y
authors.lastname: Pan
authors.affiliation: The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China. shanquan0301@gmail.com.
authors.forename: Shanquan
authors.initials: S
authors.lastname: Chen
authors.affiliation: School of Management, Hubei University of Chinese Medicine, Wuhan, China. lily1680@163.com.
authors.forename: Manli
authors.initials: M
authors.lastname: Chen
authors.affiliation: Yichang Center for Disease Control and Prevention, Yichang, China. 2905517214@qq.com.
authors.forename: Pei
authors.initials: P
authors.lastname: Zhang
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA. qian.long@dku.edu.cn.|Global Health Research Center, Duke Kunshan University, Kunshan, China. qian.long@dku.edu.cn.
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.affiliation: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China. xllyf@126.com.
authors.forename: Li
authors.initials: L
authors.lastname: Xiang
authors.affiliation: Institute of Development Studies, Sussex University, Brighton, UK. h.lucas@ids.ac.uk.
authors.forename: Henry
authors.initials: H
authors.lastname: Lucas
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000458:organization & administration; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D014376:Tuberculosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D014505:Urban Population; D055815:Young Adult
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