Evaluation on performance of urban employee basic medical insurance in Heilongjiang province

  Objective  To evaluate the fairness in health financing, health service utilization and economic protection capacity of urban employee basic medical insurance (UEBMI) in Heilongjiang province and to provide evidences for improving the performance of the medical insurance system.

  Methods  We collected the data on operation effect of UEBMI in Heilongjiang province from statistics published by National Bureau of Statistics and other governmental agencies and the dataset of three waves of national health service survey conducted in 2003, 2008 and 2013. We adopted burden contribution rate, fairness index, concentration index (CI), and catastrophic health expenditure (CHE) in analyses on the fairness in the operation of the health insurance system.

  Results  In the province, the family health financing contribution index decreased from 0.293 9 to 0.252 6 after the implementation of UEBMI, indicating a decline in the equity of family health financing among the workers; the utilization of outpatient and hospitalization medical service were not balanced generally among workers with various income levels, with the horizontal fairness index of 0.024 0 and 0.088 0 for outpatient and hospitalization service utilization in 2013. The CHE increased from 9.79% in 2003 to 21.63% in 2013 among the urban workers surveyed.

  Conclusion  The fairness in health financing, health service utilization and economic protection capacity need to be improved for the operation of urban employee basic medical insurance in Heilongjiang province.