Does health insurance matters to the use of health service for elderly in urban China? A nationwide cross-sectional study

Abstract Background China’s rapidly aging population is raising many challenges for the delivery and financing of health care. The Urban Residents Basic Medical Insurance (URBMI) has provided financial protection for the urban elderly population not covered by other health insurance schemes since 2007. We conducted a national level assessment to measure on the perceived health needs of this population as well as their use of health services. Methods Data on individuals over the age of 60 were extracted from two National Health Service Surveys conducted in 2008 and 2013. Multivariate regression models were used to estimate associations of socioeconomic factors and perceived health needs with the use of health services while controlling for demographic characteristics and year of survey. Findings Perceived health needs increased significantly between 2008 and 2013, regardless of insurance enrollment, age group or income level. In 2013, over 75% of individuals reported having at least one Non-communicable disease (NCD). Outpatient services decreased for those without insurance but increased for those with insurance. Middle- and high-income groups with insurance experienced a faster growth in outpatient visits and hospital admissions than the low-income group. Proportion of forgone hospital admissions, and proportion of forgone hospital admissions due to financial difficulties decreased. Yet there were still over 20% elderly forgone necessary hospital admissions, among which more than 40% were caused by financial barriers in 2013. Multivariate regression models found an increase of outpatient visits and hospital admissions from 2008 to 2013 when controlling for socioeconomic and health need factors. Conclusion Perceived health needs among the elderly increased at an alarming rate, and results showed a high prevalence of NCDs. Use of overall services increased and forgone necessary admissions decreased after the implementation of URBMI, indicating the improvement of access to health services. However, high-income groups had the highest increase in service use calling for further attention to issues related to equity. The service benefit packages offered by health insurance schemes should provide more support to the care of NCD patients.