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. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Social Work / Master / Master of Social Work

To enable high-risk individuals to have access to private health insurance, the Hong Kong government has announced the establishment of a high-risk pool reinsurance mechanism. Under the voluntary and government-regulated insurance program, “Health Protection Scheme”, the high-risk pool will accept individuals with pre-existing medical conditions or higher health risks. Critics have long expressed their concerns regarding the financial sustainability of Hong Kong’s healthcare system due to its heavy reliance on government subsidies and publicly funded services. Patients with pre-existing conditions are denied coverage by the private insurance sector, and have to rely heavily on the overburdened public healthcare system. Following the United States, the Hong Kong government suggests that a high-risk pool proposal will offer a relatively simpler approach compared to other alternatives. However, little is known about its applicability in Hong Kong or potential problems. Therefore, the objective of this study is to evaluate the effectiveness of high-risk pool in promoting healthcare efficiency, equity, and to make recommendations for the operations in Hong Kong. A systematic literature review was conducted on the MEDLINE database to study the overseas experience of high-risk insurance pools. Of the 52 articles included in the systematic review, the majority of the studies cover the operations in the United States. Results are analysed from the following eight perspectives. For efficiency, the studied areas include (1) fiscal sustainability, (2) adverse selection, (3) risk sharing and (4) cost containment. For equity, (5) insurance premium, (6) out-of-pocket expense, (7) enrolment barrier and (8) program awareness of the high-risk pools are analysed. Results of the systematic review show the inadequacies of the high-risk pool mechanisms in all of the above studied areas. In the United States, while industry assessment and government subsidization intend to facilitate risk sharing for high-risk population, insufficient funding and the industry’s deteriorated risk sharing capabilities undermine system efficiency. In addition, adverse selection and cost containment add to the already lengthy list of problems that high-risk pools have yet to address. Limited subsidies, high out-of-pocket payments, strict eligibility rules, and insufficient program awareness remain the four major barriers to health equity for the uninsurable. While studies on the overseas healthcare system have revealed several inadequacies regarding the high-risk pool mechanism, these uncertainties have to be resolved before Hong Kong can move forward to improve its healthcare efficiency and equity. More thoughts should be given on how the risk sharing capability can be enhanced within the insurance industry. Without a clear definition or a standardized underwriting rule that clearly defines “high-risk”, the high-risk pool could become a platform to practice adverse selection and further deteriorate the already limited risk sharing among the population. For addressing the issue of cost containment, the DRG charging system and chronic disease management programs are pivotal components to be incorporated. The government should perform a concrete assessment to justify how the spending on high-risk pool can essentially promote a more equitable system in Hong Kong. By considering the impact on both private insurance market and the public healthcare system, the government should further consider how to implement a high-risk pool that can effectively improve the healthcare efficiency and equity in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

by Lo Ming Ngai, Wong Tai Wai. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1990. / Bibliography: leaves 76-78. / ABSTRACT --- p.ii / TABLE OF CONTENTS --- p.iii / ACKNOWLEDGMENT --- p.iv / Chapter I. --- HEALTH CARE SYSTEM AND HEALTH INSURANCE / Introduction --- p.1 / Function of Health Insurance --- p.4 / History of Contract Medicine & Health Insurance in HK --- p.6 / The Present Health Insurance Market in HK --- p.7 / Medical Services in HK --- p.10 / Scott's Report --- p.12 / Provisional Hospital Authority Report --- p.15 / Chapter II. --- POSSIBLE SCENARIOS FOR HEALTH CARE FINANCING --- p.19 / Chapter III. --- RESEARCH METHODOLOGY --- p.31 / The Delphi Methodology --- p.33 / Questionnaire Design --- p.39 / Selection of Panel --- p.42 / Collection of Data --- p.43 / Chapter IV. --- RESULTS AND DISCUSSION --- p.44 / Chapter V. --- IMPLICATIONS AND CONCLUSIONS --- p.60 / APPENDICES --- p.75 / "Questionnaires for Round 1,2,3" / "Results for Round 1,2,3" / Comments from panelists / Medical Expenditure in recent 10 years / Medical Expenditure Forecast / Medical Benefits for Employees in HK / "Analysis of General Insurance Business,1986,1987" / BIBLIOGRAPHY --- p.76

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Business Administration / Master / Master of Business Administration

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

University of Macau / Faculty of Social Sciences. / Department of Government and Public Administration

University of Macau / Institute of Chinese Medical Sciences