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Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study

Summary Background In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. Methods We used data from the 2003, 2008, and 2011 Na... Full description

Journal Title: The Lancet (British edition) 2012, Vol.379 (9818), p.805-814
Main Author: Meng, Qun, Dr
Other Authors: Xu, Ling, MPhil , Zhang, Yaoguang, MPH , Qian, Juncheng, MPH , Cai, Min, MSc , Xin, Ying, MPH , Gao, Jun, MPH , Xu, Ke, PhD , Boerma, J Ties, MD , Barber, Sarah L, DPH
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study
format: Article
creator:
  • Meng, Qun, Dr
  • Xu, Ling, MPhil
  • Zhang, Yaoguang, MPH
  • Qian, Juncheng, MPH
  • Cai, Min, MSc
  • Xin, Ying, MPH
  • Gao, Jun, MPH
  • Xu, Ke, PhD
  • Boerma, J Ties, MD
  • Barber, Sarah L, DPH
subjects:
  • Abridged Index Medicus
  • Administrative support
  • Adolescent
  • Adult
  • Aged
  • Biological and medical sciences
  • Cesarean Section - economics
  • Child
  • Child, Preschool
  • China
  • Cluster Analysis
  • Consumption data
  • Cross-Sectional Studies
  • Delivery, Obstetric - economics
  • Delivery, Obstetric - statistics & numerical data
  • Delivery, Obstetric - trends
  • Demographic aspects
  • Design
  • Family income
  • Female
  • Finance
  • Forecasts and trends
  • General aspects
  • Health care access
  • Health care policy
  • Health care reform
  • Health facilities
  • Health insurance
  • Health services
  • Health Services Accessibility - economics
  • Health Services Accessibility - statistics & numerical data
  • Health Services Accessibility - trends
  • Hospital Costs - statistics & numerical data
  • Hospitals
  • Households
  • Humans
  • Insurance Coverage - economics
  • Insurance Coverage - statistics & numerical data
  • Insurance Coverage - trends
  • Insurance, Health - economics
  • Insurance, Health - trends
  • Internal Medicine
  • Interviews
  • Male
  • Medical care
  • Medical sciences
  • Middle Aged
  • Miscellaneous
  • Monitoring systems
  • National Health Programs - economics
  • National Health Programs - statistics & numerical data
  • National Health Programs - trends
  • Patient Admission - economics
  • Patient Admission - statistics & numerical data
  • Patient Admission - trends
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Rural areas
  • Rural Population
  • Socioeconomic Factors
  • Trends
  • Urban areas
  • Young Adult
ispartof: The Lancet (British edition), 2012, Vol.379 (9818), p.805-814
description: Summary Background In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. Methods We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions. Findings The number of households interviewed was 57 023 in 2003, 56 456 in 2008, and 18 822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193 689 in 2003, 177 501 in 2008, and 59 835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57 526 of 193 689) to 95·7% (57 262 of 59 835, p
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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titleTrends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study
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creatorMeng, Qun, Dr ; Xu, Ling, MPhil ; Zhang, Yaoguang, MPH ; Qian, Juncheng, MPH ; Cai, Min, MSc ; Xin, Ying, MPH ; Gao, Jun, MPH ; Xu, Ke, PhD ; Boerma, J Ties, MD ; Barber, Sarah L, DPH
creatorcontribMeng, Qun, Dr ; Xu, Ling, MPhil ; Zhang, Yaoguang, MPH ; Qian, Juncheng, MPH ; Cai, Min, MSc ; Xin, Ying, MPH ; Gao, Jun, MPH ; Xu, Ke, PhD ; Boerma, J Ties, MD ; Barber, Sarah L, DPH
descriptionSummary Background In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. Methods We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions. Findings The number of households interviewed was 57 023 in 2003, 56 456 in 2008, and 18 822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193 689 in 2003, 177 501 in 2008, and 59 835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57 526 of 193 689) to 95·7% (57 262 of 59 835, p<0·0001). The average share of inpatient costs reimbursed from insurance increased from 14·4 (13·7–15·1) in 2003 to 46·9 (44·7–49·1) in 2011 (p<0·0001). Hospital delivery rates averaged 95·8% (1219 of 1272) in 2011. Hospital admissions increased 2·5 times to 8·8% (5288 of 59 835, p<0·0001) in 2011 from 3·6% (6981 of 193 689) in 2003. 12·9% of households (2425 of 18 800) had catastrophic health expenses in 2011. Caesarean section rates increased from 19·2% (736 of 3835) to 36·3% (443 of 1221, p<0·0001) between 2003 and 2011. Interpretation Remarkable increases in insurance coverage and inpatient reimbursement were accompanied by increased use and coverage of health care. Important advances have been made in achieving equal access to services and insurance coverage across and within regions. However, these increases have not been accompanied by reductions in catastrophic health expenses. With the achievement of basic health-services coverage, future challenges include stronger risk protection, and greater efficiency and quality of care. Funding None.
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0Meng, Qun, Dr
1Xu, Ling, MPhil
2Zhang, Yaoguang, MPH
3Qian, Juncheng, MPH
4Cai, Min, MSc
5Xin, Ying, MPH
6Gao, Jun, MPH
7Xu, Ke, PhD
8Boerma, J Ties, MD
9Barber, Sarah L, DPH
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0Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study
1The Lancet (British edition)
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descriptionSummary Background In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. Methods We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions. Findings The number of households interviewed was 57 023 in 2003, 56 456 in 2008, and 18 822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193 689 in 2003, 177 501 in 2008, and 59 835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57 526 of 193 689) to 95·7% (57 262 of 59 835, p<0·0001). The average share of inpatient costs reimbursed from insurance increased from 14·4 (13·7–15·1) in 2003 to 46·9 (44·7–49·1) in 2011 (p<0·0001). Hospital delivery rates averaged 95·8% (1219 of 1272) in 2011. Hospital admissions increased 2·5 times to 8·8% (5288 of 59 835, p<0·0001) in 2011 from 3·6% (6981 of 193 689) in 2003. 12·9% of households (2425 of 18 800) had catastrophic health expenses in 2011. Caesarean section rates increased from 19·2% (736 of 3835) to 36·3% (443 of 1221, p<0·0001) between 2003 and 2011. Interpretation Remarkable increases in insurance coverage and inpatient reimbursement were accompanied by increased use and coverage of health care. Important advances have been made in achieving equal access to services and insurance coverage across and within regions. However, these increases have not been accompanied by reductions in catastrophic health expenses. With the achievement of basic health-services coverage, future challenges include stronger risk protection, and greater efficiency and quality of care. Funding None.
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0Abridged Index Medicus
1Administrative support
2Adolescent
3Adult
4Aged
5Biological and medical sciences
6Cesarean Section - economics
7Child
8Child, Preschool
9China
10Cluster Analysis
11Consumption data
12Cross-Sectional Studies
13Delivery, Obstetric - economics
14Delivery, Obstetric - statistics & numerical data
15Delivery, Obstetric - trends
16Demographic aspects
17Design
18Family income
19Female
20Finance
21Forecasts and trends
22General aspects
23Health care access
24Health care policy
25Health care reform
26Health facilities
27Health insurance
28Health services
29Health Services Accessibility - economics
30Health Services Accessibility - statistics & numerical data
31Health Services Accessibility - trends
32Hospital Costs - statistics & numerical data
33Hospitals
34Households
35Humans
36Insurance Coverage - economics
37Insurance Coverage - statistics & numerical data
38Insurance Coverage - trends
39Insurance, Health - economics
40Insurance, Health - trends
41Internal Medicine
42Interviews
43Male
44Medical care
45Medical sciences
46Middle Aged
47Miscellaneous
48Monitoring systems
49National Health Programs - economics
50National Health Programs - statistics & numerical data
51National Health Programs - trends
52Patient Admission - economics
53Patient Admission - statistics & numerical data
54Patient Admission - trends
55Public health. Hygiene
56Public health. Hygiene-occupational medicine
57Rural areas
58Rural Population
59Socioeconomic Factors
60Trends
61Urban areas
62Young Adult
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titleTrends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study
authorMeng, Qun, Dr ; Xu, Ling, MPhil ; Zhang, Yaoguang, MPH ; Qian, Juncheng, MPH ; Cai, Min, MSc ; Xin, Ying, MPH ; Gao, Jun, MPH ; Xu, Ke, PhD ; Boerma, J Ties, MD ; Barber, Sarah L, DPH
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0Abridged Index Medicus
1Administrative support
2Adolescent
3Adult
4Aged
5Biological and medical sciences
6Cesarean Section - economics
7Child
8Child, Preschool
9China
10Cluster Analysis
11Consumption data
12Cross-Sectional Studies
13Delivery, Obstetric - economics
14Delivery, Obstetric - statistics & numerical data
15Delivery, Obstetric - trends
16Demographic aspects
17Design
18Family income
19Female
20Finance
21Forecasts and trends
22General aspects
23Health care access
24Health care policy
25Health care reform
26Health facilities
27Health insurance
28Health services
29Health Services Accessibility - economics
30Health Services Accessibility - statistics & numerical data
31Health Services Accessibility - trends
32Hospital Costs - statistics & numerical data
33Hospitals
34Households
35Humans
36Insurance Coverage - economics
37Insurance Coverage - statistics & numerical data
38Insurance Coverage - trends
39Insurance, Health - economics
40Insurance, Health - trends
41Internal Medicine
42Interviews
43Male
44Medical care
45Medical sciences
46Middle Aged
47Miscellaneous
48Monitoring systems
49National Health Programs - economics
50National Health Programs - statistics & numerical data
51National Health Programs - trends
52Patient Admission - economics
53Patient Admission - statistics & numerical data
54Patient Admission - trends
55Public health. Hygiene
56Public health. Hygiene-occupational medicine
57Rural areas
58Rural Population
59Socioeconomic Factors
60Trends
61Urban areas
62Young Adult
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abstractSummary Background In the past decade, the Government of China initiated health-care reforms to achieve universal access to health care by 2020. We assessed trends in health-care access and financial protection between 2003, and 2011, nationwide. Methods We used data from the 2003, 2008, and 2011 National Health Services Survey (NHSS), which used multistage stratified cluster sampling to select 94 of 2859 counties from China's 31 provinces and municipalities. The 2011 survey was done with a subset of the NHSS sampling frame to monitor key indicators after the national health-care reforms were announced in 2009. Three sets of indicators were chosen to measure trends in access to coverage, health-care activities, and financial protection. Data were disaggregated by urban or rural residence and by three geographical regions: east, central, and west, and by household income. We examined change in equity across and within regions. Findings The number of households interviewed was 57 023 in 2003, 56 456 in 2008, and 18 822 in 2011. Response rates were 98·3%, 95·0%, and 95·5%, respectively. The number of individuals interviewed was 193 689 in 2003, 177 501 in 2008, and 59 835 in 2011. Between 2003 and 2011, insurance coverage increased from 29·7% (57 526 of 193 689) to 95·7% (57 262 of 59 835, p<0·0001). The average share of inpatient costs reimbursed from insurance increased from 14·4 (13·7–15·1) in 2003 to 46·9 (44·7–49·1) in 2011 (p<0·0001). Hospital delivery rates averaged 95·8% (1219 of 1272) in 2011. Hospital admissions increased 2·5 times to 8·8% (5288 of 59 835, p<0·0001) in 2011 from 3·6% (6981 of 193 689) in 2003. 12·9% of households (2425 of 18 800) had catastrophic health expenses in 2011. Caesarean section rates increased from 19·2% (736 of 3835) to 36·3% (443 of 1221, p<0·0001) between 2003 and 2011. Interpretation Remarkable increases in insurance coverage and inpatient reimbursement were accompanied by increased use and coverage of health care. Important advances have been made in achieving equal access to services and insurance coverage across and within regions. However, these increases have not been accompanied by reductions in catastrophic health expenses. With the achievement of basic health-services coverage, future challenges include stronger risk protection, and greater efficiency and quality of care. Funding None.
copKidlington
pubElsevier Ltd
pmid22386034
doi10.1016/S0140-6736(12)60278-5