ORCID Profile
0000-0002-1315-3474
Current Organisation
Shandong University
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Publisher: Springer Science and Business Media LLC
Date: 12-07-2021
DOI: 10.1186/S12889-021-11456-7
Abstract: Multimorbidity is a significant contributor to inequalities in healthcare and has become a major unaddressed challenge for the health system in China. The aim of this study is to assess the socio-demographic distribution of multimorbidity and the relationships between multimorbidity, primary healthcare, hospitalization and healthcare spending. We conducted this nationwide population-based panel data study in China. Study participants included 12,306 residents aged ≥45 years from the China Health and Retirement Longitudinal Study in 2011, 2013 and 2015. Random-effects logistic regression models were applied to estimate the association between multimorbidity and primary healthcare as well as admission to the hospital. We used log-linear regression models to investigate the association between multimorbidity and health spending. Overall, 46.2% of total interviewees reported multimorbidity. Random-effects logistic regression analyses showed that multimorbidity was associated with a higher likelihood of medication use (Adjusted odds ratio (AOR) =19.19, 95% CI = 17.60, 20.93), health check (AOR = 1.51, 95% CI = 1.43, 1.59), outpatient care (AOR = 2.39, 95% CI = 2.23, 2.56) and admission to hospital (AOR = 2.94, 95% CI = 2.68, 3.21). Log-linear regression models showed that multimorbidity was also positively associated with spending for outpatient care (coefficient = 0.64, 95% CI = 0.59, 0.68) and hospitalization (coefficient = 0.65, 95% CI = 0.60, 0.71). Multimorbidity is associated with higher levels of primary care, hospitalization and greater financial burden to in iduals in China. Health systems need to shift from single-disease models to new financing and service delivery models to more effectively manage multimorbidity.
Publisher: Informa UK Limited
Date: 08-2022
DOI: 10.2147/PPA.S367985
Publisher: Springer Science and Business Media LLC
Date: 29-10-2019
DOI: 10.1186/S12939-019-1068-1
Abstract: The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. The integration had no significant effects on probability of outpatient visits (β = 0.01, P 0.05), inpatient visits (β = 0.01, P 0.05), and unmet hospitalization needs (β =0.01, P 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P 0.05) and inpatient visits (β = 0.39, P 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P 0.05) and inpatient visits (β = 0.49, P 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.
No related grants have been discovered for Haipeng Wang.