Financial protection from catastrophic health expense by urban residents' basic medical insurance (URBMI) in China

Abstract

Background World Health Organization has committed universal health coverage (UHC) in 2005 in order to protect people from catastrophic health expense. Since 2009, China has invested 850 billion into health care reform and reached the expansion of health insurance coverage, up to 95% of total population in China. However, it is highly unlikely to find systematic reviews of researches on the financial protection by universal health coverage in China. Therefore, this article intends to focus on the financial effect of urban residents’ basic medical insurance, figure out how URBMI in China health care system affect the household health care expenditure and protect some population from catastrophic health payment. Finally, this article would recommend several measurements which might improve the effectiveness of universal health coverage on financial protection in China health system.

Methods The key words, like “financial burden”, “financial risk”, “catastrophic health expense” AND “universal health coverage”, “urban residents’ basic medical insurance” were searched in several databases, including PubMed, China Journal Net, Science Direct and Google Scholar. Both English and Chinese languages were used for searching these studies. The quality evaluation of the studies would be based on the guidelines of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE).

Results Totally 240 articles were identified via the four databases, 198 articles have been excluded because they themselves were literature reviews which concentrated on specific diseases, and were not related to URBMI and financial burden, and not the case studied in China. Through screening and excluding the articles, 6 articles studying on the effect of URBMI in China on financial protection are included in this review. It was found that URBMI has slightly reduced the incidences of catastrophic health expenditure but it has insufficient impact on financial protection.

Conclusion Through the systematic review on financial protection from catastrophic health expenditure by URBMI in China, it could be concluded that URBMI has slight effect on reduction of catastrophic health expenditure rate, but it do not significantly make differences in financial protection. Moving towards universal coverage, financial protection could be improved by the expansion of coverage in population, health services and cost sharing. However, due to the low quality of studies and lack of sufficient quantization researches, more studies on the effect of URBMI are required.