NDLI: Income-related benefit mobility before and after Urban and Rural Resident Basic Medical Insurance integration: a longitudinal analysis of China

Content Provider	Springer Nature : BioMed Central
Author	Xu, Yongjian Liu, Yazhuo Li, Hui Guo, Ruirui Sun, Jiaxin Zhou, Zhongliang Ma, Jie
Abstract	Background To improve equity in medical insurance benefits, the Chinese government integrated the New Rural Cooperative Medical Scheme for rural residents and the Urban Resident Basic Medical Insurance for nonworking urban residents into a unified Urban and Rural Resident Basic Medical Insurance system (URRBMI). This study aims to assess income-related mobility in medical insurance benefits before and after the integration of the two schemes, and to explore its contribution to improving medical insurance equity. Methods The panel data were obtained from the 2011 and 2018 China Health and Retirement Longitudinal Study, with 9,662 participants. To assess the benefits residents received from medical insurance, four indicators were analyzed for outpatient and inpatient care respectively: benefit rate, benefit probability, compensation fee, and reimbursement probability. The concentration index (CI) was used to measure the income-related inequality of medical insurance benefits. Changes in inequality across the two waves were decomposed into income-related benefit mobility and benefit-related income mobility, which reflect variations in relative benefit changes among individuals with different initial income levels, capturing the effect of integration on benefit inequality. Results Results indicated a significant increase in all medical insurance benefit measures following integration, except for outpatient care benefit probability and inpatient care reimbursement probability. The CIs shifted from positive in 2011 to negative in 2018 (0.129 vs. −0.052 for the benefit rate, 0.147 vs. −0.044 for the benefit probability, and 0.148 vs. −0.097 for the reimbursement probability, p < 0.001). The income-related mobility for inpatient care (benefit rate, benefit probability, and compensation amount) were positive when the average benefit level increased across the two waves. In contrast, no statistically significant difference was observed in outpatient benefit mobility. Conclusions The findings indicated that income-related inequalities in medical insurance benefits were narrowed due to pro-poor changes in inpatient care equity for inpatient care after integration. This integration has contributed to building a more equitable healthcare system. However, further efforts are needed to expand outpatient benefit coverage in the integrated URRBMI scheme.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-025-12574-3.pdf
Ending Page	12
Page Count	12
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-025-12574-3
Journal	BMC Health Services Research
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-03-27
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Income-related benefit mobility Health equity Medical insurance integration China
Content Type	Text
Resource Type	Article
Subject	Health Policy

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