The integration of urban and rural medical insurance to reduce the rural medical burden in China: a case study of a county in Baoji City

Background: In 2003, the Chinese government launched the New Rural Cooperative medical System(NRCMS) for its rural population. In 2007, the Urban Resident Basic Medical Insurance Scheme(URBMS) was inaugurated, which aimed to cover all urban residents who are out of the labor market. However, the accessibility and fairness of the healthcare service have hindered the progress of universal healthcare. At the beginning of 2010, the Integration of Urban and Rural Medical Insurance Scheme(IURMIS) was implemented to bridge the gap in medical care between urban and rural areas. The main objective of this study is to determine the extent to which the IURMIS has been successful. Methods: The statistical software packages SPSS 19.0 and STATA 12.0 were used for all analyses, and P < 0.05 was set as the required level of significance. Data were collected from outpatients from 2009 (July to December, n = 20,459) through 2011 (n = 65,258 in 2010, n = 59,036 in 2011) and from inpatients in 2011 (n = 3662). Due to the enormous amount of data and the short time span, most of our analysis was descriptive. However, regression discontinuity (RD) and the chi squared (chi(2)) test were used to compare the ratios of medical expenses before and after the IURMIS. Results: In the RD analysis, there was a downward trend in the mean medical expense (Coef. = - 0.66, P < 0.001), and rural outpatients flowed to township hospitals and village clinics after the implementation of the IURMIS (Coef. = - 0.45, P < 0.001). However, compensation expenses showed an upward trend (Coef. = 11.59, P < 0.001). In the analysis of inpatient expenses, the average expenses (CNY 2067) and hospitalization days (10.0) for all the hospitals were less than those in the Chinese Fourth National Health Services Survey (CNY 3412 and 10.3, respectively). Conclusions: Rural residents' healthcare options and quality were improved and medical expenses were significantly reduced after implementation of the scheme. These results provide an evidence-based reference for improving the integration of the urban and rural medical security systems throughout China.