Measuring the Benefit Equity in China's Basic Health Insurance Schemes

Background: Although the health insurance has nearly achieved universal coverage in China, the co-payment ratio is still very high. Therefore, it is doubtful that the insured could get equitable benefit from the health insurance schemes. The purpose of this study is to evaluate the benefit equity which the insured residents with different economic levels get from the Urban Employee basic Health Insurance (UEHI), the Urban Resident basic Health Insurance (URHI) and the New rural Cooperative Medical Scheme (NCMS), respectively. Methods: The data were from the household survey in Mei County, Shannxi Province, in which the number of the urban employees, the urban residents and the rural residents used in this study were 1258, 733 and 2870 respectively. The benefit equity was measured by the equity of benefit rate and the equity of benefit degree in health insurance scheme. By subtracting the concentration index of health care need from the concentration index of benefit rate/degree, the horizontal index of inequity of benefit rate/degree were generated. Results: There were pro-rich horizontal inequities of benefit rate in UEHI, RUHI and NCMS, and the horizontal indexes of inequity of benefit rate were 0.061, 0.122 and 0.161, respectively. In terms of the benefit degree, the horizontal indexes of inequity of benefit degree for the residents covered by UEHI, URHI and NCMS were 0.027, -0.187 and 0.178 respectively, which means both the inequity of benefit degree in UEHI and NCMS were pro-rich and the inequity of benefit degree in URHI was pro-poor. Conclusion: When the insured with different economic levels have the same health care need, the number of the rich who can get benefit from UEHI, URHI and NCMS is more than the poor; meanwhile the rich can get more compensation from the UEHI and NCMS than the poor.