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Frontiers of Medicine

Front Med    2012, Vol. 6 Issue (1) : 79-84     DOI: 10.1007/s11684-012-0179-5
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Integration of current identity-based district-varied health insurance schemes in China: implications and challenges
Hai-Qiang Wang, Zhi-Heng Liu, Yong-Zhao Zhang, Zhuo-Jing Luo()
Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
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Abstract

With China’s great efforts to improve public health insurance, clear progress has been achieved toward the ambitious full health insurance coverage strategy for all. The current health insurance schemes in China fall into three categories: urban employee basic health insurance scheme, urban resident scheme, and new rural cooperative medical system. Despite their phasic success, these substantially identity-based, district-varied health insurance schemes have separate operation mechanisms, various administrative institutions, and consequently poor connections. On the other hand, the establishment and implementation of various health insurance schemes provide the preconditioning of more sophisticated social health insurance schemes, the increase in the income of urban and rural people, and the great importance attached by the government. Moreover, the reform of the “Hukou” (household register) system provides economical, official, and institutional bases. Therefore, the establishment of an urban-rural integrated, citizen-based, and nationwide-universal health insurance scheme by the government is critically important to attain equality and national connection. Accordingly, the differences between urban and rural areas should be minimized. In addition, the current schemes, administrative institutions, and networks should be integrated and interconnected. Moreover, more expenditure on health insurance might be essential for the integration despite the settings of global financial crisis. Regardless of the possible challenges in implementation, the proposed new scheme is promising and may be applied in the near future for the benefit of the Chinese people and global health.

Keywords health insurance      urban employee basic health insurance scheme      urban-resident scheme      new rural cooperative medical system     
Corresponding Authors: Luo Zhuo-Jing,Email:zjluo@fmmu.edu.cn   
Issue Date: 05 March 2012
 Cite this article:   
Hai-Qiang Wang,Zhi-Heng Liu,Yong-Zhao Zhang, et al. Integration of current identity-based district-varied health insurance schemes in China: implications and challenges[J]. Front Med, 2012, 6(1): 79-84.
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http://journal.hep.com.cn/fmd/EN/10.1007/s11684-012-0179-5
http://journal.hep.com.cn/fmd/EN/Y2012/V6/I1/79
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Fig.1  Derivation, making-up, and usage of pooled fund and individual medical savings accounts (MSAs) of the current health insurance schemes in China.
Fig.2  Flowchart of handling the proceedings of medical insurance for patients in hospitals, including outpatient and inpatient diagnoses and therapies.
Fig.3  Increasing enrollment of the basic health insurance scheme and the balance of the social pooled fund. Note that the balance in 2007 and 2008 includes the pooled fund of both basic health insurance and urban resident schemes. Data were according to Refs. 11 and 32.
1 Wen JB. Report on the work of the government at the Forth Session of the Tenth National People's Congress on March 5, 2007. http://www.gov.cn/ztzl/2006-03/15/content-227782.htm (Access on March 26, 2009)
2 Blumenthal D, Hsiao W. Privatization and its discontents—the evolving Chinese health care system. N Engl J Med 2005; 353(11): 1165–1170
doi: 10.1056/NEJMhpr051133 pmid:16162889
3 Wang H, Xu T, Xu J. Factors contributing to high costs and inequality in China’s health care system. JAMA 2007; 298(16): 1928–1930
doi: 10.1001/jama.298.16.1928 pmid:17954544
4 Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, de Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. Lancet 2008; 372(9652): 1846–1853
doi: 10.1016/S0140-6736(08)61368-9 pmid:18930520
5 Watts J. China’s rural health reforms tackle entrenched inequalities. Lancet 2006; 367(9522): 1564–1565
doi: 10.1016/S0140-6736(06)68675-3 pmid:16703674
6 Hennock M. China’s health insurance system is failing poor people. BMJ 2007; 335(7627): 961
doi: 10.1136/bmj.39391.527338.DB pmid:17991966
7 Yip W, Hsiao WC. The Chinese health system at a crossroads. Health Aff (Millwood) 2008; 27(2): 460–468
doi: 10.1377/hlthaff.27.2.460 pmid:18332503
8 Xu L, Wang Y, Collins CD, Tang S. Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003. BMC Health Serv Res 2007; 7(1): 37
doi: 10.1186/1472-6963-7-37 pmid:17335584
9 Liu Y. Reforming China’s urban health insurance system. Health Policy 2002; 60(2): 133–150
doi: 10.1016/S0168-8510(01)00207-X pmid:11897373
10 Lu M, Zhang J, Ma J, Li B, Quan H. Child health insurance coverage: a survey among temporary and permanent residents in Shanghai. BMC Health Serv Res 2008; 8(1): 238
doi: 10.1186/1472-6963-8-238 pmid:19014693
11 China Statistical Yearbook 2011. Beijing: Chinese Statistics Press, 2011
12 You X, Kobayashi Y. The new cooperative medical scheme in China. Health Policy 2009; 91(1): 1–9
doi: 10.1016/j.healthpol.2008.11.012 pmid:19121873
13 Guidelines of launching pilot cities of urban residents health insurance. The State Council, 2007
14 Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health insurance and access to primary care for children. N Engl J Med 1998; 338(8): 513–519
doi: 10.1056/NEJM199802193380806 pmid:9468469
15 Schroeder SA. Prospects for expanding health insurance coverage. N Engl J Med 2001; 344(11): 847–852
doi: 10.1056/NEJM200103153441113 pmid:11248165
16 Carter TM, Adams MH, Judd AH, Leeper JD, Wang L, Yu J. Children’s health insurance status, access to and utilization of health services, and unmet health needs in a rural Alabama school system. J Rural Health 2003; 19(4): 511–513
doi: 10.1111/j.1748-0361.2003.tb00590.x pmid:14526511
17 Skinner AC, Mayer ML. Effects of insurance status on children’s access to specialty care: a systematic review of the literature. BMC Health Serv Res 2007; 7(1): 194
doi: 10.1186/1472-6963-7-194 pmid:18045482
18 Wilson D. Meeting the health needs of migrant workers affected by the tsunami. PLoS Med 2005; 2(6): e176
doi: 10.1371/journal.pmed.0020176 pmid:15971948
19 Ye YJ, Shi WX, Li L. Health status of migrant workers in cities and policy suggestions. Chin J Hosp Admin (Zhonghua Yi Yuan Guan Li Za Zhi) 2004; 20(9): 562–566 (in Chinese)
20 Ren JP, Xu W. A study on intention of enterprise to medical insurance of migrant workers in Hangzhou City, Zhejing Province of China. Chin Health Econ(Zhongguo Wei Sheng Jing Ji) 2006; 25(3): 66–67 (in Chinese)
21 Jiu W. Urban resident health insurance: accelerate with breakthroughs. Chin Health Insurance (Zhongguo Yi Liao Bao Xian) 2009; 2: 9(in Chinese)
22 Wang DJ. Assessment reports on pilot cities of urban residents health insurance. Chin Health Insurance(Zhongguo Yi Liao Bao Xian) 2008; 31: 7–10 (in Chinese)
23 Reform and development of health of China in 2008. http://www.gov.cn/gzdt/2009-02/17/content_1233236.htm (Access on March 26, 2009)
24 Zheng BW. How does health insurance cope with crisis in finance. Chin Health Insurance (Zhongguo Yi Liao Bao Xian) 2009; 5: 10–14 (in Chinese)
25 Liu GG, Zhao Z, Cai R, Yamada T, Yamada T. Equity in health care access to: assessing the urban health insurance reform in China. Soc Sci Med 2002; 55(10): 1779–1794
doi: 10.1016/S0277-9536(01)00306-9 pmid:12383462
26 Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q. Extending health insurance to the rural population: an impact evaluation of China’s new cooperative medical scheme. J Health Econ 2009; 28(1): 1–19
doi: 10.1016/j.jhealeco.2008.10.007 pmid:19058865
27 Wang H, Yip W, Zhang L, Hsiao W. The impact of rural mutual health care on health status: evaluation of a social experiment in rural China. Health Econ 2009;18: S65–S82
doi: 10.1002/hec.1465 pmid:19267321
28 Zhao YX, Wan Q, Zhang YH, Zhai TM, Ying YZ. Total expenditure on health in 2006 and the strategy of essential health services financing. Chin Health Econ (Zhongguo Wei Sheng Jing Ji) 2008; 27(4): 5–10 (in Chinese)
29 Kang YJ, Zhang HB, Xu CQ. Causes of the current rise in medical expenses and counter measures. Chin J Hosp Admin (Zhonghua Yi Yuan Guan Li Za Zhi) 2005; 21(4): 220–223 (in Chinese)
30 Wang XD. Government's responsibility in solving the problem of high healthcare costs. Chin J Hosp Admin (Zhonghua Yi Yuan Guan Li Za Zhi) 2006; 22(1): 20–22 (in Chinese)
31 China population statistics yearbook 2006. Beijing: China statistics press, 2006
32 Wen JB. Report on the work of the government at the Second Session of the Eleventh National People's Congress on March 5, 2009. http://www.gov.cn/2009lh/cotent-1259471.htm (Access on April 15, 2009)
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