Health insurance and its impact on access to health care in China

Abstract

Background The transition to a market-oriented economy in China has created huge economic growth in the recent two decades. However, the health care system was transformed to the one that residents cannot afford health care services and some households are driven to poverty. This is mainly because of the rapid medical expense inflation and imbalanced health resources. The health insurance schemes, on the other hand, contribute to the accessible health care and financial part of individuals’ out-of-pocket spending. The promotion of health insurance coverage, with strong association on access to health care, is crucial to utilization of health services under the current health care system. Methods This systematic review was conducted by electronic database searching PubMed, Google Scholar and CNKI published in recent 15 years. The keywords of “health insurance” OR “insurance scheme” AND “access to health care” OR “health care utilization” AND “urban China” OR “rural China” were used. 12 observational studies were identified and included in the systematic review. The STROBE Guideline was adopted for the quality assessment among these studies. Results Of the12 observational studies included in the systematic review, these studies were mainly focusing on New Cooperative Medical Scheme (NCMS) and Urban Resident Basic Medical Insurance (URBMI) Scheme and the relation with access to health care in recent decade in China. Household survey-based designs were the most commonly used method. Based on the results conducted in the studies, a preliminary outcome showed that health insurance enrollees had a positive effect on health care utilization. Both the NCMS and URBMI schemes have increased the utilization in health care, with different percentage, and the accessibility because of financial assistant and subsidization. Conclusion The health insurance schemes, both for NCMS and URBMI, have increased inpatient and outpatient utilization. Additionally, the schemes have reduced the cost of delivery, but it does not reduce the out-of-pocket payments on seeking health care in some regions. Lastly, policy implications and recommendations were made on the demand and supply sides in health care, as well as the financial protection regarding to the schemes. Overall, the health insurance schemes have made a remarkable achievement, but a lot more remains to be improved in the health care reform.