The Opinions marks that the URRBMI has entered the “full implementation” stage. As shown in Figure 1, only 400 million people participated in the URRBMI before 2016. However, the URRBMI progressed slowly in this stage. Before the Opinions, local governments made spontaneous and initial exploration according to local conditions, which we call the “spontaneous integration” stage. The medical insurance is called the Urban and Rural Residents Basic Medical Insurance (URRBMI) after the “integrating” reform, and we use the URRBMI to represent the reform in this article.Ĭhina’s central government issued the “Opinions on Integrating the Basic Medical Insurance Systems for Urban and Rural Residents” (“Opinions” below), including six aspects: integrating the coverage, integrating the fundraising policies, integrating the benefits and reimbursement rates, integrating the drug list, integrating the healthcare providers, and integrating the fund management. The URBMI and NCMS are integrated at the first stage because they share more similarities.
To deal with the fragmentation, China’s central government and some local governments began to explore “integrating” the UEBMI, NCMS, and URBMI and carry out the medical insurance reform step by step. The fragmentation gives rise to divisions of eligibility and benefits between urban and rural areas, between different regions, and among social groups. However, just like some other developing countries, such as Vietnam and Colombia, China has to face the inequality coexisting with universal healthcare coverage due to the fragmentation of the Basic Medical Insurance System. China’s central government established the Urban Employees Basic Medical Insurance (UEBMI), the New Cooperative Medical Insurance (NCMS), and the Urban Residents Basic Medical Insurance (URBMI) in 1998, 2003, and 2007, respectively, as the basic medical insurance system. Social health insurance effectively provides universal health and healthcare coverage, especially in developing countries.
Increasing investment in medical resources and constructing the hierarchical medical system and medical treatment combination may make a difference. These findings help clarify what deserves more attention to enlarge benefits and reduce inequality in this medical reform and provide policy implications for policymakers.
Besides, the URRBMI significantly promotes healthcare utilization, reduces the medical burden, and narrows the gap among different income groups, though this effect is generally downward. We find that the URRBMI improves health but expands health inequality among different income groups, with its contribution growing over time. To make clear what role the Urban and Rural Residents Basic Medical Insurance (URRBMI) plays in the inequality in health and healthcare, this article combines the time-varying DID method with the concentration index to conduct an empirical study.
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