Background
Methods
Study sample
Indicators | Foshan | Changshu | Shenyang | Changchun |
---|---|---|---|---|
Total population (N × 104) | 726.2 | 150.7 | 822.8 | 758.9 |
Per capita GDP (RMB) | 86073 | 123882 | 80532 | 52649 |
UEBMI enrollment (N) | 242.4 | 38.9 | 351.2 | 151.0 |
URBMI enrollment (N) | 205.8 | 12.2 | 110.8 | 239.2 |
NRCMS enrollment (N) | 205.0 | 43.2 | 228.3 | 377.0 |
Changshu | Foshan | Shenyang | Changchun | ||
---|---|---|---|---|---|
NRCMS | The minimum deduction line and the correspongding deduction rate | First-level and second-level designated hospitals: 100RMB; for ≦10000: 65% for (<10000)≦20000: 70% for (<20000)≦30000: 75% for >30000: 85% third-level designated hospitals: 300RMB, 60% for ≦10000: 55% for (<10000)≦20000: 60% for (<20000)≦30000: 70% for >30000: 80% outside-city designated hospitals: 500RMB, 45% | First-level designated hospitals: 300 RMB second-level designated hospitals: 500 RMB third-level designated hospitals: 700 RMB for male ≥60 years old or female ≥55 years old, the reimbursment rate is 95%; for the rest, the reimbursement rate is 90% | First-level designated hospitals: 50 RMB, 80% second-level designated hospitals: 200 RMB, 65% third-level designated hospitals: 600RMB, 40% | First-level designated hospitals: 300 RMB, 70% second-level designated hospitals: 400 RMB, 60% third-level designated hospitals: 500 RMB, 45% |
The maximum deduction line | 100000 RMB | 30000 RMB | 30000RMB | 30000RMB | |
URBMI | The minimum deduction line and the correspongding deduction rate | As Changshu has integrated NRCMS with URCMS, they share the same standards | First-level designated hospitals: 400 RMB, 85% second-level designated hospitals: 600 RMB, 75% third-level designated hospitals: 1200 RMB, 50% | First-level designated hospitals: for adults and aged residents:200RMB, 90% for students and juveniles: 100 RMB, 90% second-level designated hospitals: for adults and aged residents:400 RMB, 80% for students and juveniles: 200 RMB, 85% third-level designated hospitals: for adults and aged residents:600 RMB, 75% for students and juveniles: 300 RMB, 78% | First-level designated hospitals: 500 RMB second-level designated hospitals: 800 RMB third-level designated hospitals: 1200 RMB for adults and aged residents: ≦2000: 55% (>2000)≦5000: 60% (>5000)≦10000: 65% (>10000)≦30000: 70% for students and juveniles: ≦5000: 65% (>5000)≦10000: 70% (>10000)≦30000: 75% (>30000)≦50000: 80% |
The maximum deduction line | 160000 RMB | For adults and aged residents:80000 RMB; for students and juveniles: 125000 RMB | For adults and aged residents:30000 RMB; for students and juveniles: 50000RMB | ||
UEBMI | The minimum deduction line and the correspongding self-payment ratio | For in-service employees: first-level designated hospitals: 400 RMB second-level designated hospitals: 600 RMB third-level designated hospitals: 1000 RMB for retired employees: the minimum deduction line is half of the corresponding in-service employees minimum deduction line ≦10000: 12.8% (>10000)≦30000: 9.6% (<30000)≦50000: 6.4% | For in-service employees: first-level designated hospitals: 400RMB; 2% second-level designated hospitals: 600RMB; 10% third-level designated hospitals: 1200RMB; 15% for retired employees: irst-level designated hospitals: 300RMB; 0% second-level designated hospitals: 500RMB; 7% third-level designated hospitals: 1000RMB; 15% | For in-service employees: first-level designated hospitals: 300 RMB; 6% second-level designated hospitals: 500 RMB; 7% third-level designated hospitals: 800RMB; 12% for retired employees: irst-level designated hospitals: 300 RMB; 3% second-level designated hospitals: 500 RMB; 4% third-level designated hospitals: 800 RMB; 9% | The minimum deduction line is based on the average salary of Changchun last year first-level designated hospitals:9% second-level designated hospitals: 500RMB; 12% third-level designated hospitals: 800RMB; 15% |
The maximum deduction line | 50000 RMB | 200000 RMB (including supplemented insurance) | 100000 RMB | 4 times of the average salary of Changchun last year |
Measures
Demographic characteristics
Payment intention
Reimbursement expectation
Preferred healthcare insurance package
Data analysis
URBMI | NRCMS | UEBMI | ||
---|---|---|---|---|
Amount (N) | 392 | 391 | 395 | |
Gender (%) | Male | 54.8 | 47.5 | 56.7 |
Female | 46.2 | 52.5 | 43.3 | |
χ2 = 7.345, df = 2, P = 0.025 | ||||
Age (%) | 20 or younger | 11.0 | 3.1 | 0 |
21–40 | 40.4 | 36.8 | 51.8 | |
41 or older | 48.4 | 60.1 | 48.2 | |
χ2 = 72.150, df = 4, P < 0.001 | ||||
Education level (%) | Elementary or lower | 33.3 | 62.5 | 13.6 |
Secondary to high school | 35.9 | 24.7 | 26.2 | |
College or higher | 30.8 | 12.8 | 60.2 | |
χ2 = 272.922, df = 4, P < 0.001 | ||||
Health status (%) | Healthy | 80.1 | 79.5 | 84.0 |
Ill | 19.9 | 20.5 | 16.0 | |
χ2 = 3.015, df = 2, P = 0.221 |
Results
Characteristics of study sample
Payment intention
URBMI (%) | NRCMS (%) | UEBMI (%) | ||
---|---|---|---|---|
Payment intention | 20 yuan or below | 4.8 | 10.2 | 4.8 |
21–50 yuan | 14.3 | 25.1 | 8.4 | |
51–100 yuan | 24.8 | 19.4 | 9.9 | |
101–200 yuan | 28.6 | 14.1 | 15.9 | |
201–300 yuan | 10.7 | 9.5 | 7.4 | |
301–500 yuan | 9.4 | 5.1 | 14.9 | |
501–800 yuan | 3.6 | 4.3 | 15.2 | |
801–1000 yuan | 1.8 | 7.4 | 9.1 | |
above 1000 yuan | 2.0 | 4.9 | 14.4 | |
Total | 100.0 | 100.0 | 100.0 | |
Reimbursement expectation | 30% or below | 0.0 | 3.6 | 0.0 |
31%–40% | 3.6 | 4.6 | 0.0 | |
41%–50% | 4.1 | 5.6 | 1.5 | |
51%–60% | 5.1 | 10.7 | 1.8 | |
61%–70% | 6.1 | 5.1 | 2.3 | |
71%–80% | 31.4 | 27.4 | 18.7 | |
81%–90% | 30.1 | 25.6 | 38.2 | |
above 90% | 19.6 | 17.4 | 37.5 | |
Total | 100.0 | 100.0 | 100.0 | |
Preferred healthcare insurance package | Package 1 | 11.7 | 19.2 | 5.6 |
Package 2 | 57.9 | 47.1 | 36.7 | |
Package 3 | 30.4 | 33.7 | 57.7 | |
Total | 100.0 | 100.0 | 100.0 | |
Integration willingness | Support | 69.6 | 80.5 | 57.7 |
Oppose | 18.9 | 8.2 | 30.6 | |
Not sure | 11.5 | 11.3 | 11.7 | |
Total | 100.0 | 100.0 | 100.0 | |
Reasons of supporting healthcare insurance integration | It would achieve equal access to healthcare services. | 45.0 | 65.7 | 64.0 |
There would be more options of hospital for participants. | 48.7 | 40.6 | 27.1 | |
It would reduce the healthcare gap between urban and rural areas. | 31.5 | 38.4 | 38.5 | |
Participants would enjoy better healthcare services. | 35.8 | 27.3 | 47.9 | |
It would improve the overall risk resistance ability of insuran scheme. | 12.4 | 10.1 | 25.8 | |
It would facilitate the labour flow between urban and rural areas. | 6.2 | 8.8 | 17.1 | |
It would reduce the administration costs. | 7.6 | 3.4 | 14.4 | |
Others. | 1.8 | 2.2 | 1.7 | |
Reasons of opposing healthcare insurance integration | The payment and treatment standards of the systems are different. | 36.4 | 46.8 | 31.4 |
Administration of insurance may fall behind after integration. | 39.1 | 28.1 | 32.2 | |
Urban and rural participants have different healthcare needs. | 31.0 | 46.8 | 21.4 | |
Some pilot areas should be implemented before implementation on a large scale. | 28.3 | 21.8 | 25.6 | |
Some people may take advantage of the integrated insurance scheme | 33.7 | 34.3 | 17.3 | |
The conditions for integration are not yet ripe. | 29.7 | 25.0 | 13.0 | |
Others. | 25.6 | 40.6 | 18.1 |
Reimbursement expectation
Preferred healthcare insurance package
Integration willingness and the corresponding reasons
Factors associated with integration willingness
Support | Oppose | |||||
---|---|---|---|---|---|---|
B | Odds ratio (95% CI) | P | B | Odds ratio (95% CI) | P | |
Male | 0.039 | 1.040 (0.722–1.497) | 0.834 | 0.266 | 1.305 (0.851–2.003) | 0.223 |
Age <20 | –0.391 | 0.676 (0.283–1.618) | 0.380 | 0.333 | 1.394 (0.553–3.515) | 0.481 |
Age >40 | 0.007 | 1.007 (0.691–1.467) | 0.972 | –0.348 | 0.706 (0.454–1.100) | 0.124 |
URBMI | 0.202 | 1.224 (0.783–1.914) | 0.376 | –0.470 | 0.625 (0.378–1.033) | 0.067 |
NRCMS | 0.368 | 1.444 (0.924–2.259) | 0.107 | –1.286 | 0.276 (0.157–0.488) | P < 0.001 |
Elementary school or lower | 0.083 | 1.087 (0.697–1.695) | 0.713 | –0.835 | 0.434 (0.230–0.817) | 0.010 |
College or higher | –0.286 | 0.752 (0.472–1.197) | 0.229 | 1.091 | 2.979 (1.738–5.104) | P < 0.001 |
Household annual income per capita <10000 RMB | 0.355 | 1.426 (0.912–2.230) | 0.119 | –0.956 | 0.384 (0.195–0.759) | 0.006 |
Household annual income per capita ≧20000 RMB | –0.257 | 0.774 (0.497–1.205) | 0.256 | 1.017 | 2.764 (1.694–4.509) | P < 0.001 |
Foshan | –0.314 | 0.730 (0.491–1.244) | 0.248 | –0.041 | 0.960 (0.515–1.789) | 0.960 |
Shenyang | –0.097 | 0.907 (0.526–1.564) | 0.726 | –0.185 | 0.831 (0.434–1.590) | 0.831 |
Changchun | –0.573 | 0.564 (0.335–0.948) | 0.031 | –0.031 | 0.970 (0.531–1.770) | 0.970 |