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Ethical Reflections on the Equity of the Current Basic Health Insurance System Reform in China: A Case Study in Hunan Province

Published online by Cambridge University Press:  30 May 2018

JUNXIANG LIU ,
JINGZI XU ,
TIANYU ZHANG  and
YONGHUI MA
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Abstract:

China’s current basic health insurance reform aims at promoting equity in the economic accessibility of health services for all citizens, to better ensure healthcare justice. Therefore, it is important to assess equity not only from a socioeconomic perspective but also from an ethical angle. This article investigates the basic health insurance system of Hunan Province in China by focusing on insurance types as well as their classification standards, mechanisms, and utilization according to local policy documents and data. This study demonstrates the reforming achievements and the inequity of institutional design according to two interrelated dimensions: equal opportunity of access to healthcare insurance and reducing inequality in insurance benefits. The article concludes that to achieve opportunity equity and outcome fairness, the reform should focus on designing the system to promote equity with respect to procedures and rules and to be more attentive to the interests of vulnerable groups and especially to rural residents.

Keywords

basic health insuranceequityuniversalityequal opportunityprocedural justiceoutcome fairness
Type
Special Section: Bioethics Beyond Borders
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Issue 3 , July 2018 , pp. 447 - 458
Copyright
Copyright © Cambridge University Press 2018 

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References

Notes

1. Liu, Y. Development of the rural health insurance system in China. Health Policy Plan 2004;19(3):159–65.CrossRefGoogle ScholarPubMed

2. Haislmaier, EF. The complexities of providing health insurance. National Catholic Bioethics Quarterly 2013;13(3):419–26.CrossRefGoogle Scholar

3. Yip, WC, Hsiao, WC, Chen, W, Hu, S, Ma, J, Maynard, A. Early appraisal of China’s huge and complex health-care reforms. Lancet 2012;379(9818):833–42.CrossRefGoogle ScholarPubMed

4. Daniels, N. Equity of access to health care: some conceptual and ethical issues. Milbank Mem Fund Q Health Soc 1982;60(1):51–81.CrossRefGoogle ScholarPubMed

5. Chen, M, Chen, W, Zhao, Y. New evidence on financing equity in China’s health care reform––a case study on Gansu province, China. BMC Health Services Research 2012;12:466.CrossRefGoogle ScholarPubMed

6. Wang, H, Gusmano, MK, Cao, Q. An evaluation of the policy on community health organizations in China: will the priority of new healthcare reform in China be a success? Health Policy 2011;99(1):37–43.CrossRefGoogle Scholar

7. Dong, W. Healthcare-financing reforms in transitional society: a Shanghai experience. J Health Popul Nutr 2003;21(3):223–34.Google ScholarPubMed

8. Wang, H, Yip, W, Zhang, L, Wang, L, Hsiao, W. Community-based health insurance in poor rural China: the distribution of net benefits. Health Policy Plan 2005;20(6):366–74.CrossRefGoogle ScholarPubMed

9. Xin, H. Experiences and lessons from urban health insurance reform in china. Popul Health Manag 2016;19(4):291–7.CrossRefGoogle ScholarPubMed

10. Gu, X, Bloom, G, Tang, S, Zhu, Y, Zhou, S, Chen, X. Financing health care in rural China: preliminary report of a nationwide study. Soc Sci Med 1993;36(4):385–91.Google ScholarPubMed

11. Feng, X, Tang, S, Bloom, G, Segall, M, Gu, Y. Cooperative medical schemes in contemporary rural China. Soc Sci Med 1995;41(8):1111–8.Google ScholarPubMed

12. Statistical Information Center, National Health and Family Planning Commission, People’s Republic of China, Research on National Health Services: an analysis report of the Second National Health Services Survey in 1998(II). Beijing; 1999; available at: http://www.moh.gov.cn/mohwsbwstjxxzx/s8211/201009/49160.shtml (accessed on 1 Jan 2018).

13. Liu, Y, Hsiao, WC, Eggleston, K. Equity in health and health care: the Chinese experience. Social Science & Medicine 1999;49(10):1349–56.CrossRefGoogle ScholarPubMed

14. Yip W, Hsiao WC. The Chinese health system at a crossroads. Health Affairs (Millwood) 2008;27(2):460–8.

15. Bank, W. Financing Health Care: Issues and Options for China. Washington, DC: World Bank; 1997.Google Scholar

16. Yip WC, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet 2010;375(9720):1120–30.

17. 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):1846–53.

18. Hu S. Universal coverage and health financing from China’s perspective. Bulletin of the World Health Organization 2008;86(11):819.

19. Zhang Y, Tang W, Zhang X, Zhang Y, Zhang L. National health insurance development in China from 2004 to 2011: coverage versus benefits. PLoS One 2015;10(5):e0124995.

20. State Council, People’s Republic of China, Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform. 2009, Beijing; available at: http://finance.people.com.cn/GB/9083061.html (accessed 1 Jan 2018).

21. Kasule OHK. Health insurance and the ethical issue of equity. Journal of Taibah University Medical Sciences 2012;7(2):61–8.

22. Bayer R, Callahan D, Caplan AL, Jennings B. Toward justice in health care. American Journal of Public Health 1988;78(5):583–8.

23. Frenk J, Gomez-Dantes O. Ethical and human rights foundations of health policy: lessons from comprehensive reform in Mexico. Health Hum Rights 2015;17(2):31–7.

24. Illingworth P, Parmet WE. The right to health: why it should apply to immigrants. Public Health Ethics 2015;8(2):148–61.

25. Daniels N. Fair equality of opportunity and decent minimums: a reply to Buchanan. Philosophy & Public Affairs 1985;14(1):106–10.

26. Faden RR, Powers M. Health inequities and social justice. The moral foundations of public health. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008;51(2):151–7.

27. Schroder-Back P, Clemens T, Michelsen K, Schulte in den Baumen T, Sorensen K, Borrett G, et al. Public health ethical perspectives on the values of the European Commission’s White Paper “Together for Health”. Central European Journal of Public Health 2012;20(2):95–100.

28. Reid L. Answering the empirical challenge to arguments for universal health coverage based in health equity. Public Health Ethics 2016;9(3):231–43.

29. Moatti J. Ethical issues in the economic assessment of health care technologies. Health Care Analysis 1999;7(2):153–65.

30. Kass NE. An ethics framework for public health. American Journal of Public Health 2001;91(11):1776–82.

31. Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1999:52–72.

32. Aday LA. Equity, accessibility, and ethical issues: is the U.S. health care reform debate asking the right questions? American Behavioral Scientist 1993;36(6):724–40.

33. Brock DW. Ethical and value issues in insurance coverage for cancer treatment. Oncologist 2010;15(Suppl 1):36–42.

34. Marmot M, Bell R. Fair society, healthy lives. Public Health 2012;126 Suppl 1:S4–10.

35. Human SI. The National Economic and Social Development Statistics Bulletin of L. District. Yongzhou City Hunan Province, China. 2014; available at: http://yz.rednet.cn/c/2015/05/06/3671496.htm (accessed 20 Jan 2018).

36. Voorhoeve A, Ottersen T, Norheim OF. Making fair choices on the path to universal health coverage: a precis. Health Economics, Policy and Law 2016;92(1):1–7.

37. Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y, et al. Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet 2012;379(9818):805–14.

38. Qiu P, Yang Y, Zhang J, Ma X. Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China. BMC Public Health 2011;11:520.

39. Flato H, Zhang H. Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province. International Journal for Equity in Health 2016;15:96.

40. Eggleston K, Ling L, Qingyue M, Lindelow M, Wagstaff A. Health service delivery in China: a literature review. Health Economics 2008;17(2):149–65.

41. Rodney AM, Hill PS. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. International Journal for Equity in Health 2014;13:72.

42. Gong P, Liang S, Carlton EJ, Jiang Q, Wu J, Wang L, et al. Urbanisation and health in China. Lancet 2012;379(9818):843–52.

43. Mou J, Cheng J, Zhang D, Jiang H, Lin L, Griffiths SM. Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference? BMC Health Services Research 2009;9(1):1–9.

44. Li X, Song J, Lin T, Dixon J, Zhang G, Ye H. Urbanization and health in China, thinking at the national, local and individual levels. Environmental Health 2016;15( Suppl 1):32.

45. Wang HQ, Liu ZH, Zhang YZ, Luo ZJ. Integration of current identity-based district-varied health insurance schemes in China: implications and challenges. Frontiers of Medicine 2012;6(1):79–84.

46. Meng Q, Fang H, Liu X, Yuan B, Xu J. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet 2015;386(10,002):1484–92.

47. State Council, People’s Republic of China. Opinions on the Integration of Urban and Rural Residents Basic Medical Insurance System. 2016, Beijing; available at: http://www.gov.cn/zhengce/content/2016-01/12/content_10582.htm (accessed 1 Jan 2018).

48. Wang X, Zheng A, He X, Jiang H. Integration of rural and urban healthcare insurance schemes in China: an empirical research. BMC Health Services Research 2014;14:142.

49. Callahan D, Jennings B. Ethics and public health: forging a strong relationship. American Journal of Public Health 2002;92(2):169–76.

50. Daniels N. Just Health: Meeting Health Needs Fairly. Cambridge: Cambridge University Press; 2008, at 79–102.

51. Eyal N, Hurst S, Norheim OF, Wikler D. Inequalities In Health: Concepts, Measures, And Ethics. Oxford: Oxford University Press; 2013, at 1–6.

52. Statistical Information Center, National Health and Family Planning Commission, People’s Republic of China, Brief Report on the Development of Health Service in China During 1997–2001. Beijing, 2003; available at: http://www.nhfpc.gov.cn/mohwsbwstjxxzx/s7967/200805/34846.shtml (accessed 1 Jan 2018).

53. Depart of Planning and Information, National Health and Family Planning Commission, People’s Republic of China,. 2015 Statistical Bulletin on the Development of Health Services in China. Beijing, 2016; available at: http://www.nhfpc.gov.cn/guihuaxxs/s10748/201607/da7575d64fa04670b5f375c87b6229b0.shtml (accessed 1 Jan 2018).

54. China Economic Net, The Change of Income Ratio between Urban and Rural Residents from 2001 to 2014. 2016; available at: http://www.ce.cn/xwzx/gnsz/gdxw/201601/19/t20160119_8372974.shtml (accessed 1 Jan 2018).

55. Cummins PF, Lagerloef GSE, Mitchum G. Communique on China health care development statistics in 2011 (excerpt). China Population Today 2012;32(6):28–37.

56. Johansson KA, Norheim OF. Problems with prioritization: exploring ethical solutions to inequalities in HIV care. American Journal of Bioethics 2011;11(12):32–40.

57. Hendrick J. Justice and Access to Health Care. Wiley Access to Health Care. Wiley-Blackwell; 2010:107–28.

58. Dan WB. Priority to the Worse Off in Health Care Resource Prioritization. Medicine and Social Justice; 2012:155–64.

59. Faden R, Shebaya S. Public Health Ethics. In: Standford Encyclopedia of Philosophy, Stanford: Stanford University, 2015; available at https://plato.stanford.edu/entries/publichealth-ethics/ (accessed 20 Jan 2018)