Equity In Medical Service Utilizations Of Employees From Nantong City Health Insurance Scheme

Background The Government Insurance Program (GIP) and Labor Insurance Program (LIP)had paid for medical expenditures for government and enterprise employees since1950, which had many disadvantages such as low coverage, low socialization,inequity, unsteady funding, and weakness of cost control mechanisms. The urbanhealth insurance reform in China was initiated in the 1990's. There was a certaindegree of variation in model design across communities undergoing the healthinsurance reform. However, they all share some common key characteristics: widecoverage, the integration of individual medical savings account (MSA) and socialpooling account (SPA), joint premium contributions by employers and employees, andsome cost sharing mechanisms. Some studies showed that the new scheme improvedthe equity in funding and utilization. Up to now, there has been a few study oncomparing different insurance models effect on equity of medical service utilizationof insurees.Objectives To analyze the level and dynamic trends of medical service utilization of employees with different socioeconomic characteristics under different insurance policies in order to access the equity in medical service utilization and insurance policy's effects. As well as to explore the impact of policy on the behavior of medical providers and the effects of provider's behavior on equity.Methods Combining quantitative and qualitative methods, interviews and participatory observation were used to collect routine registrated data of employee's medical insurance in Nantong City from 1997 to 2002 and special investigated materials. Using SPSS11.0, SAS6.12, Excel 2000 and Word 2000, data and materials were analyzed. The differences of medical service utilization and expenditure among insurees with different socioeconomic characteristics were compared using rate, 3复旦大学博士研究生毕业论文 摘 要 mean value, index of dissimilarity, concentration index and multiple regression to measure equity. Vertical equity by changes among different age groups and horizontal equity through the improvement degrees among different socioeconomic features such as income, occupations, and kinds of employment were estimated. Changes between different times undergoing different insurance policies to measuring the effects of policies on equity were also compared.Main Results and Findings ⑴ Insurance coverage was more extended . ⑵ The ratio of MSA and SPAredistribution was basically rational and there were some accumulation of MSA. ⑶The"Channel model" and other policies, such as the payment by ration for serviceunit could promote medical utilizations and lead to illegal medical behavior, evenmoral hazard,so that the insurance pooling fund was seriously overspent. Thesepolicies ensured vertical equity through increased utilization for elderly population,but the horizontal inequity was increased through the different use of differentsocioeconomic groups. ⑷ The "block model" and changes of payment and costsharing effectively decreased the overuse and waste and consequently ensured thepooling fund balance. Then the real needs could be compensated. Because ofincreasing patients economic burden for outpatient services, which restrained theoutpatient services utilization of high-need,such as the elderly, and low-incomepeople, these policies depressed vertical equity but improved horizontal equity. Thesepolicies were propitious to get both vertical and horizontal equity in inpatient services.⑸The favorable policy for retired employees considered the elderly, the high-needsand the low-incomes,thus promoted their utilization by high ratio compensated. ⑹Inequity existing to a certain degree in medical service utilization such as the differentuse among different jobs, and among the patients falling ill at different...