Impact of Urban-Rural Resident Basic Medical Insurance integration on individual social fairness perceptions: evidence from rural China.

Background: Achieving universal health insurance coverage has become a fundamental policy for improving the accessibility and equity of healthcare services. China's Urban-Rural Resident Basic Medical Insurance (URRBMI) is a crucial component of the social security system, aimed at promoting social equity and enhancing public welfare. However, the effectiveness of this policy in improving rural residents' social fairness perceptions (SFP) remains to be tested. Objective: To examine the impact of the urban-rural resident basic medical insurance (URRBMI) on rural residents' social fairness perception (SFP) in China. Methods and samples: The study utilizes city-level and national micro-survey (CGSS) datasets, applying a time-varying difference-in-difference (DID) approach to analyze the equity effects of URRBMI. Excluding urban samples, the final dataset consists of 20,800 rural respondents from 2010, 2011, 2013, and 2015, covering 89 cities. Results: Key findings reveal that URRBMI has a significant negative effect on SFP. The impact varies depending on the integration model and intensifies over time. Additionally, the negative effect shows heterogeneity based on income, age, health, and region. Conclusion: This study highlights the complexities and impacts of integrating China's urban and rural healthcare systems. It provides a detailed understanding of the role of URRBMI in rural China, emphasizing the need for targeted approaches to improve rural residents' perceptions of social fairness. The research offers specific policy recommendations, such as establishing differentiated contribution standards, implementing welfare policies favoring rural residents, and adopting varied reimbursement rates for different diseases.

How should regulatory schemes be optimized to enhance deterrence against medical insurance fraud by enrollees? Evidence from a discrete choice experiment in China.

Medical insurance fraud (MIF) poses a substantial global financial challenge, necessitating effective regulatory strategies, especially in China, where such measures are in a critical developmental phase. This study investigates the effectiveness of various regulatory components in deterring MIF among enrollees and explores preference heterogeneity among individuals with different characteristics, utilizing a discrete choice experiment survey. Grounded in deterrence theory, our conceptual framework incorporates five attributes: intensity of economic penalties, restrictions on medical insurance benefits, deterioration of social reputation, and certainty and celerity of penalties. Employing a D-efficiency design, 24 choice sets were generated and blocked into three versions. A multistage stratified sampling method was adopted to collect data from the basic medical insurance enrollees in Shanghai. The survey was conducted from September to October 2022. The sample representativeness was further improved via the entropy balancing approach. Data from the final sample of 1034 respondents were analyzed using mixed logit models (MIXLs), incorporating interactions with individual characteristics to assess preference heterogeneity. Results reveal that escalating economic penalties, suspending insurance benefits, listing individuals as unfaithful parties, ensuring penalty certainty, and expediting enforcement significantly enhance the deterrent effect. We observed preference heterogeneity across different demographics, including age, gender, education, health status, and employment status. The study underscores the pivotal role of economic penalties in deterring MIF, while also acknowledging the significance of non-economic measures such as enforcement efficiency and social sanctions. These findings offer valuable insights for policymakers to tailor and strengthen regulatory schemes against MIF, contributing to the advancement of more effective and precise healthcare policies.

Development of an assessment tool for designated medical institutions in China--Based on the application of an online assessment system.

Background: Due to the expanding coverage of medical insurance and the growth of medical expenses, the ability to assess the performance of designated medical institutions (DMIs) in supporting the delivery of high-quality patient care and the standardized use of funds represents a priority in China. Despite such interest, there has yet to be an operable standard and labor-saving method for assessing DMIs in China. Objective: The main objectives include two aspects: (1) establishing an evaluation index system for DMIs based on contracts; (2) designing and developing an online evaluation platform. Methods: A group of 20 experts with theoretical and practical expertise in medical insurance regulation and performance evaluation were invited to select available indicators. A combination weighting method based on analytic hierarchy process and entropy method was used to determine the weight coefficient. Shanghai was taken as the sample area, and 760 DMIs were included in the empirical research. The test-retest reliability method and criterion-related validity method was used to test the reliability and the validity of the evaluation result. Results: An assessment index system that included 6 domains and 56 indicators was established in this study. Furthermore, we developed an online platform to assist in the implementation of the assessment. The results showed that the average score of assessment was 94.39, the median was 96.92. The test-retest reliability value was 0.96 (P ≤ 0.01), which indicated high stability of the assessment. In addition, there was a significant negative relationship between assessment score and the penalty amount of DMIs (R = -0.133, P < 0.001). After adjusting for the basic characteristics of medical institutions, the number of visits and revenue, the negative relationship was still significant (B = -0.080, P < 0.05). These results are consistent with expectations, indicating that the assessment had good criterion-related validity. Conclusions: This study established an operable assessment measure and developed an online platform to assess the performance of DMIs. The results showed good feasibility and reliability in empirical research. Our research findings provided an operable Chinese solution for DMI assessment that saves manpower and time, which would have good enlightening significance in other regions of China and in low-income and middle-income countries internationally.

Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis.

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.

Enhancing pooling levels strengthens the risk resilience of healthcare insurance: a case study of basic medical insurance fund operations data in Gansu, China.

BACKGROUND: In China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China's basic health insurance. METHODS: The research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province. RESULTS: From 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance. CONCLUSION: From 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.

The effect of urban-rural resident basic medical insurance on physical health of the rural older adult in China.

Introduction: Urban-Rural Resident Basic Medical Insurance (URRBMI) is an important system for effectively transferring disease risks to the rural older adult. As China experiences rapid aging, maintaining the physical health of the rural older adult is key to achieving the goal of healthy aging. Methods: The study explores the impact of URRBMI on physical health of the rural older adult in China using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018. Ordinary least square models were used to analyze the relationship between URRBMI and physical health of the rural older adult, and we used instrumental variable method to address the potential endogenous problem. Results: We find that URRBMI greatly improves physical health of the rural older adult. The heterogeneity analysis indicates that URRBMI contributes more significantly to the rural older adult in eastern areas and the advanced rural older adult. The results also suggested that URRBMI improves physical health of the rural older adult through increasing life satisfaction and enhancing the timeliness of medical services. Recommendations: This study implies that we need to further improve the participation rate, increase the actual reimbursement ratio and increase financial subsidies for URRBMI in central and western areas, and further integrate the distribution of medical resources to promote physical health of the rural older adult.

Analysis on Basic Medical Insurance Fund Balance Status and Risk Warning in China from 2009 to 2022 / 中国卫生经济

Objective:To analyze the basic medical insurance fund balance status in China and the risk warning since the new medical reform,in order to provide decision-making references for the sustainable development of basic medical insurance fund in China.Methods:Collecting the data on the basic medical insurance fund in China from 2009 to 2022 for descriptive statistical analysis,and conduct fund balance risk warning analysis based on the risk warning interval.Results:During 2009-2021,the percentage of retirees enrolled in UEBMI has continued to increase,and there will still be a certain accumulated balance in the integrated fund.The number of participants in the URBMI has been decreased since 2020,the growth rate of fund expenditures became higher than the growth rate of fund revenues,the fund balance showed a decreasing trend.Conclusion:There are certain risks to the long-term balance of the basic medical insurance fund,which may caused by factors such as aging population,funding mechanisms,and treatment levels.

Study on the Problems and Countermeasures in Reforming the Outpatient Co-payment Protection Mechanism of Basic Medical Insurance for Urban Workers Policy / 中国卫生经济

The process of establishing and improving the Employee Health Insurance Outpatient Co-payment Protection Mecha-nism is one of the major livelihood projects to deepen the reform of China's medical insurance system.The implementation of the mu-tual-aid mechanism for covering outpatient bills in each coordinating region is accompanied by the risks of squeezing outpatient medi-cal resources,the prevalence of fraud and deception,the increase of the government s economic burden and the lack of public ac-ceptance.In this regard,suggestions are made to improve the policy:open source and cut costs to make up for the shortage of funds,linkage of three medical institutions to build a medical security pattem,coordinated supervision to maintain the stability of medical insurance funds,and optimized policies to promote the reform of medical insurance payment methods.

Research on the Operation Efficiency of Basic Medical Insurance for Urban Workers and Its Influencing Factors in China from 2020 to 2021 / 中国卫生经济

Objective:Efficiency is a key factor in the sustainable operation of the medical insurance system.By measuring the current efficiency of the urban employee basic medical insurance system in 31 provinces in China from 2020 to 2021,it discovers possible problems,and provides reference suggestions for improving the efficiency of the system.Methods:Using the super efficiency SBM model based on unexpected output and the Malmquist index to measure the static and dynamic efficiency of employee medical in-surance in 31 provinces in China,and using Tobit regression analysis to analyze its influencing factors.Results:The overall compre-hensive efficiency of the national employee medical insurance operation is 0.826 in 2020 and 0.827 in 2021 respectively.The efficien-cy of employee medical insurance operation in the eastern region is significantly higher than that in the central and westem regions.Over 60％of provinces have inefficient operation of employee medical insurance.The overall total factor productivity of employee medical insurance operation is showing a downward trend,and the decline in technological progress is the main limiting factor.The level of economic development has a significant promotion effect on the efficiency of employee medical insurance operation,and the degree of population aging has a significant inhibitory effect on it.Conclusion:The efficiency of employee medical insurance opera-tion in China still needs to be improved,and there is a significant efficiency gap among different regions.Therefore,investment and attention should be increased in the central and western regions to bridge regional gaps and promote the equity development of medi-cal insurance.Therefore,the reform efforts should be continuously intensified to achieve technological progress.In addition,attention should also be paid to the driving role of economic development in the efficiency of employee medical insurance operation and the for-mulation of positive policies on population aging.

Research on the operation efficiency of the basic medical insurance system for urban and rural residents in China and its influencing factors / 中国卫生政策研究

Objective:Operational efficiency and influencing factors of China's basic medical insurance system from 2020 to 2021 is conducted to provide reference for improving the operational efficiency and optimizing the input-output relationship.Methods:The super-efficiency SBM model based on unexpected output and the Malmquist index are used to measure the static and dynamic efficiency of resident medical insurance in 31 provinces in China,and Tobit regression analysis is employed to analyze the influencing factors.Results:The overall operational efficiency of resident medical insurance still needs improvement.The operational efficiency of resident medical insurance in the central and western regions is lower than that in the eastern region,and the gap is significant.Different levels and regions have differentiated main constraints on the operational efficiency of resident medical insurance.In terms of dynamic efficiency,the total factor productivity of resident medical insurance operation shows an increasing trend,mainly due to technological progress.In terms of influencing factors,the degree of aging,the level of medical expenses and the level of medical insurance supervision have a significant impact on the operational efficiency.Suggestions:Efforts should be made to bridge regional disparities,promote the equitable development of medical insurance,reasonably control the level of medical expenses,strengthen the supervision of medical insurance funds,and implement active aging policies.

Construction of a Theoretical Framework for the Performance Assessment of Basic Medical Insurance Designated Medical Institutions Based on the Objectives of Medical Insurance Policy / 中国医院管理

It collected relative policy documents systematically and analyzed the development process and policy objective evolution of Chinese basic medical insurance system.Based on this,it determined the performance assessment objectives of the designated medical institutions of basic medical insurance and constructed the assessment framework guided by the goal realization.Then,from the perspective of contract management and performance management,it determined the assessment elements of contract enforcement assessment system of designated medical institutions and the logical relationship between the elements,and to construct a conceptual model,which provides a reference for guiding the research of the contract enforcement assessment of the designated medical institutions of basic medical insurance.

Research on the Operational Efficiency of Basic Medical Insurance for Urban Employees in China-Based on Three-Stage DEA Model.

Purpose: To conduct a three-stage data envelopment analysis (DEA) of the operational efficiency of urban employee basic medical insurance (UEBMI) across 31 provinces in China from 2012 to 2021. Methods: Utilized a three-stage DEA model, this study measured and evaluated the operational efficiency of urban employee basic medical insurance within China's 31 provinces. Results: The operational efficiency of urban employee basic medical insurance in China was notably low, displaying significant disparities across different regions and periods. Substantial room for improvement exists. Environmental factors, including urbanization level and unemployment rate, wielded a pronounced influence on the operational efficiency of China's employee medical insurance. Conversely, the fiscal revenue and expenditure ratio hindered the enhancement of employee medical insurance efficiency. Conclusion: This study held valuable insights for enhancing the operational efficiency of China's urban employee basic medical insurance. To effectively improve insurance efficiency, the following recommendations are put forth: firstly, relevant departments should escalate resource investments and optimize resource utilization based on rational allocation; secondly, enhance legislation and regulations, fortify fund oversight, and ensure equitable and judicious utilization of the medical insurance fund; finally, leveraging modern high-tech advancements can comprehensively elevate the operational efficiency of the employee medical insurance fund. Ultimately, with the advent of cutting-edge technology, the operational efficiency of employee medical insurance fund can be comprehensively elevated.

Effects of basic medical insurance integration on subjective wellbeing of residents in China: empirical evidence from a quasi-experiment.

Introduction: Enhancing the wellbeing of residents through universal health coverage (UHC) is a long-term policy goal for China. In 2016, China integrated the New Rural Cooperative Medical Scheme (NRCMS) and the Urban Resident Basic Medical Insurance (URBMI) into the Urban and Rural Resident Basic Medical Insurance (URRBMI) to address the problem of fragmentation. Objective: The objective of this study was to investigate whether the integration of basic medical insurance had an impact on the subjective wellbeing of Chinese residents. Methods: Using the China Household Finance Survey data of 2015 and 2019, we empirically estimated the influence of the integration of basic medical insurance on Chinese residents through the difference-in-difference method based on propensity score matching (PSM-DID). Results: Our findings indicate that the integration of basic medical insurance improved the subjective wellbeing of the insured population. Additionally, through heterogeneity testing, we validated that the integration increased the subjective wellbeing of residents from less developed regions in West China and rural areas, as well as those with older adult dependents. However, the subjective wellbeing of low-income groups, who were expected to benefit more from the URRBMI, did not improve significantly, at least in the short term. Conclusion: According to our research, the integration of basic medical insurance in China supports the country's objective of achieving equality and providing universal benefits for its residents. The introduction of the URRBMI has had a positive impact on the subjective wellbeing of insured individuals. This is particularly beneficial for disadvantaged groups in less developed regions, as well as for residents with older adult dependents. However, the subjective wellbeing of the middle-income group has improved significantly, whereas that of the low-income group, despite being the intended beneficiaries of the integration, did not show significant improvement. Recommendations: From a funding perspective, we recommend establishing a dynamic adjustment funding system that links residents' medical insurance funding standards with their disposable income. Regarding the utilization of the URRBMI, the benefit packages should be expanded, particularly by covering more outpatient services through risk pooling. We call for further research with additional data and continued efforts on improving wellbeing of residents, particularly for disadvantaged populations.

The association between Urban and Rural Resident Basic Medical Insurance and instrumental activity of daily living disability among middle-aged and older adults in China.

BACKGROUND: Previous studies have not investigated the association between medical insurance and instrumental activity of daily living (IADL) disability. To fulfill this research gap, this study aims to explore the association between Urban and Rural Resident Basic Medical Insurance (URRBMI) and IADL disability among middle-aged and older adults in China. METHODS: The data of this study were sourced from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). Logit regression models were used to analyze the association between URRBMI and odds of suffering from IADL disability. Furthermore, we used IV-Probit regression model to address the potential endogeneity problem. Moreover, propensity score matching and generalized random forest model were employed to conduct robustness checks. RESULTS: The logit regression results reveal that URRBMI participation was significantly related to reduced odds of suffering from IADL disability by 39.86% after adjusting for the control variables (p < 0.01). The results of IV-Probit estimation show that URRBMI was an exogenous variable. Further robustness checks reported similar estimation results. The results of heterogeneity analysis reveal that URRBMI produced a statistically stronger effect on IADL disability for the older adults (OR = 0.5815, p < 0.01) when compared with the middle-aged adults (OR = 0.5690, p < 0.05). The results of impact channel analysis indicate that physical exercise was a channel involving the effect of URRBMI on IADL disability. CONCLUSION: This study finds that the middle-aged and older adults who were covered by URRBMI had a reduced possibility of suffering from IADL disability when compared with those without URRBMI. Furthermore, it is found that URRBMI produced a statistically stronger effect on IADL disability for the older adults when compared with the middle-aged adults. Moreover, we obtain evidence indicating that physical exercise was a channel involving the effect of URRBMI on IADL disability.

Is sub-national healthcare social protection sufficient for protecting rare disease patients? the case of China.

Background: Failing to provide social support to cover healthcare costs for rare diseases would lead to great financial distress for the patients and their families. People from countries without a well-developed health safety-net are particularly vulnerable. Existing literature on rare diseases in China focuses on the unmet needs for care of the patients and the difficulties of caregivers and physicians. Very few studies examine the state of social safety-net, the unresolved issues and whether the current localized arrangements are sufficient. This study aimed to gain in-depth knowledge of the current policy system and make sense of the local varieties, which would be essential for developing strategies for future policy changes. Methods: This systematic policy review focuses on the provincial level policies on subsidizing the healthcare costs for people with rare diseases in China. The cut-off point for the policies was March 19, 2022. The researchers coded the healthcare cost reimbursement policies and identified the different provincial level models based on the usage of reimbursement components in each provinces reimbursement arrangements. Results: 257 documents were collected. Five provincial level models (Process I, II, III, IV and V) have been identified with the five components across the country: Basic Medical Insurance for Outpatient Special Diseases (OSD), Catastrophic Medical Insurance for Rare Diseases (CMIRD), Medical Assistance for Rare Diseases (MARD), Special Fund for Rare Diseases (SFRD) and Mutual Medical Fund (MMF). The local health safety-net in each region is a combination of one or more of the five processes. Regions vary greatly in their rare diseases coverage and reimbursement policies. Conclusion: In China, the provincial health authorities have developed some level of social protection for rare disease patients. However, there are still gaps regarding coverage and regional inequality; and there is room for a more integrated healthcare safety-net for people suffering from rare diseases at the national level.

Ex-ante moral hazard and health insurance: Evidence from China's urban residence basic medical insurance scheme.

This study examines whether implementing Urban Residents Medical Insurance Scheme decreased an individual's risky lifestyle behavior before illness, termed ex-ante moral hazard. Ex-ante moral hazard is predicted by the classical economic theory suggesting that health insurance coverage reduces an individual's incentive to take preventive efforts to remain healthy. Studies have provided mixed evidence for this prediction. China's 2006 nationwide social experiment of implementing the Urban Residents Basic Medical Insurance Scheme offers an excellent opportunity for examining the effect of the transition from uninsured to insured on an individual's health behaviors. We exploit the longitudinal dimension of a representative survey data for 2007-2010 and employ the instrumental variable technique, thereby addressing the issue of self-selection into voluntary health insurance schemes. The results do not provide evidence for and contrast the prediction of the ex-ante moral hazard. Significant differences exist between insured and uninsured groups with respect to smoking, drinking habits, and being overweight. People with insurance care more about their health than people without insurance do. The main results still hold if we use alternative estimation methods and other robustness tests.

Factors and key problems influencing insured's poor perceptions of convenience of basic medical insurance: a mixed methods research of a northern city in China.

BACKGROUND: This study aimed to explore the factors that affect insured's perceptions of convenience of the basic medical insurance (PCBMI) in Harbin, China and to diagnose the key problems to further propose corresponding measures. The findings provide evidence-based support for the reform of convenience of the basic medical insurance system (BMIS) and the cultivation of public literacy. METHODS: We adopted a mixed methods design composing a multivariate regression model using the data from a cross-sectional questionnaire survey (n = 1045) of residents who were enrolled for BMIS in Harbin to identify the factors influencing the PCBMI. A quota sampling method was further adopted. Semi-structured interviews were then conducted with 30 important information providers selected by convenience sampling. Interpretative phenomenological analysis was employed to summarize and analyze the key problems. RESULTS: Overall, approximately 51% of respondents reported poor PCBMI. The logistic regression model showed that insured without outpatient experience within two weeks (OR = 2.522, 95% CI = 1.267-5.024), had poorer levels of understanding of basic medical insurance information (OR = 2.336, 95% CI = 1.612-3.386), lived in rural areas (OR = 1.819, 95% CI = 1.036-3.195), had low levels of annual out-of-pocket medical expenses (OR = 1.488, 95% CI = 1.129-1.961), and were more likely to give the PCBMI a worse evaluation than their counterparts. The results of the qualitative analysis showed that the key problem areas of the PCBMI were the design of the BMIS, the cognitive biases of the insured, publicity information about the BMIS, and the health system environment. CONCLUSIONS: This study found that in addition to the design of BMIS, the cognition of the insured, the BMIS information publicity and the health system environment are also the key problems hindering PCBMI. While optimizing system design and implementation, Chinese policymakers need to focus on the insured with low PCBMI characteristics. Moreover, it is necessary to focus on exploring effective BMIS information publicity methods, supporting public policy literacy and improving the health system environment.

Achievements and Challenges of the Healthcare System in China.

China's healthcare system has made great achievements in the management of medical services and public health challenges for the Chinese people. However, the issue of an aging population in Chinese society is becoming more and more salient. The gap between demand and supply of healthcare is expanding. China's healthcare system is facing unprecedented challenges. These problems include an insufficient medical insurance fund, nonuniform insurance reimbursement policies, a poor integrity system, and a lack of supervision in the management of the medical insurance fund. To address these challenges, some practical solutions are worth considering. A national medical insurance supervision platform should be strengthened. Besides, blacklists for illegal medical institutions and individuals engaged in malicious medical disturbances should be created. The country should also introduce policies to narrow the differences in regional medical insurance policies and balance the reimbursement levels of residents in different regions. Big data and artificial intelligence can be used to monitor the entire process of medical insurance fund utilization. The government needs to establish relevant laws and regulations to optimize the medical insurance system and ensure the safe and effective operation of the medical insurance fund.

Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China.

Background: The perceptions of the benefits of the basic medical insurance system among the insured not only reflect the system's performance but also the public's basic medical insurance policy literacy, valuable information for countries that have entered the stage of deepening reform. This study aims to examine the factors that affect the perceptions of the benefits of the basic medical insurance system in China, diagnose the key problems, and propose corresponding measures for improvement. Methods: A mixed method design was used. Data for the quantitative study were obtained from a cross-sectional questionnaire survey (n = 1,045) of residents of Harbin who had enrolled for basic medical insurance system. A quota sampling method was further adopted. A multivariate logistic regression model was then employed to identify the factors influencing the perceptions of the benefits of the basic medical insurance system, followed by semi-structured interviews with 30 conveniently selected key informants. Interpretative phenomenological analysis was used to analyze the interview data. Results: Approximately 44% of insured persons reported low perceptions of benefits. The logistic regression model showed that low perceptions of the benefits of the basic medical insurance system was positively correlated with the experience of daily drug purchases (OR = 1.967), perceptions of recognition with basic medical insurance system (OR = 1.948), perceptions of the financial burden of participation costs (OR = 1.887), perceptions of the convenience of using basic medical insurance for medical treatment (OR = 1.770), perceptions of the financial burden of daily drug purchases costs (OR = 1.721), perceptions of the financial burden of hospitalization costs (OR = 1.570), and type of basic medical insurance system (OR = 1.456). The results of the qualitative analysis showed that the key problem areas of perceptions of the benefits of the basic medical insurance system were: (I) system design of basic medical insurance; (II) intuitive cognition of the insured; (III) rational cognition of the insured; and (IV) the system environment. Conclusions: Improving the perceptions of the benefits of the basic medical insurance system of the insured requires joint efforts in improving system design and implementation, exploring effective publicity methods of basic medical insurance system information, supporting public policy literacy, and promoting the health system environment.

Research on the influence of patient cost-sharing on medical expenses and health outcomes: Taking patients with heart failure as an example.

Objective: The objective of this study is to assess the impact of the changes in patient cost-sharing on the medical expenses and health outcomes of patients with heart failure in China. Methods: The claim data of patients diagnosed with heart failure enrolled in the Urban Employees' Basic Medical Insurance (UEBMI) in the Zhejiang province, China, was used, covering the period from 1 January 2013 to 31 December 2017. The impact of the policy change was estimated through the use of the difference-in-differences method and the event study method. Results: A total of 6,766 patients and their electronic health insurance claim data were included in the baseline year of 2013. Following the change in the UEBMI reimbursement policies (policy change), a notable decrease was observed in the patient cost-sharing ratios, particularly in the copayment ratio within the policy. However, it did not result in a reduction of the out-of-pocket ratio, which remains a primary concern among patients. An increase was observed in annual outpatient medical expenses, while annual inpatient medical expenses decreased, leading to higher annual medical expenses in the treatment group in comparison to the control group. The effect of the UEBMI reimbursement policy change on health outcomes showed a reduction in the rehospitalization rate within 90 days; however, no significant impact was seen on the rehospitalization rate within 30 days. Conclusion: The impact of the policy change on medical expenses and health outcomes was found to be modest. To effectively address the financial burden on patients, it is crucial for policymakers to adopt a comprehensive approach that considers all aspects of medical insurance policies, including reimbursement policies.