Impact of Payment Standard Differentials on Healthcare Equity Under Payment Method Reform: A Continuous Triple-Difference Study on Tuberculosis in China
1
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Popul. Med. 2026;8(Supplement Supplement 1):A640
ABSTRACT
BACKGROUND:
China’s payment method reforms (DRG/DIP) often set different payment standards for Urban Employee (UEBMI) and Resident (URRBMI) Basic Medical Insurance, potentially exacerbating healthcare inequity. This study investigates whether a widening payment standard gap affects the equity of healthcare access, outcomes, and financial burden for tuberculosis (TB) patients.
METHODS:
We conducted a retrospective study using TB inpatient data (N=37,332) from City A (large payment gap) and B (small payment gap) between 2018 and 2024. A continuous Triple-Difference (DDD) model was employed. The core independent variable was the specific monetary gap between UEBMI and URRBMI payment standards. Outcome measures included innovation drug use, cure rate, and annual out-of-pocket (OOP) spending ratio.
RESULTS:
The widening payment gap was associated with a significant reduction in the disparity of innovation drug use between employees and residents (Interaction coefficient = -0.001, p<0.001), suggesting residents caught up in access despite the gap. No significant association was found between the payment gap and the disparity in cure rates or OOP spending trends. However, a substantial baseline structural inequity remains: UEBMI patients enjoyed a 20.5% lower OOP spending ratio (p<0.05) unrelated to the payment limit gap.
CONCLUSIONS:
Contrary to concerns, widening payment standard gaps under reform did not worsen clinical or financial equity trends for TB patients, and coincided with improved equity in innovation drug access. Healthcare inequity in China is primarily driven by the structural dichotomy of insurance schemes rather than specific payment limit parameters.
China’s payment method reforms (DRG/DIP) often set different payment standards for Urban Employee (UEBMI) and Resident (URRBMI) Basic Medical Insurance, potentially exacerbating healthcare inequity. This study investigates whether a widening payment standard gap affects the equity of healthcare access, outcomes, and financial burden for tuberculosis (TB) patients.
METHODS:
We conducted a retrospective study using TB inpatient data (N=37,332) from City A (large payment gap) and B (small payment gap) between 2018 and 2024. A continuous Triple-Difference (DDD) model was employed. The core independent variable was the specific monetary gap between UEBMI and URRBMI payment standards. Outcome measures included innovation drug use, cure rate, and annual out-of-pocket (OOP) spending ratio.
RESULTS:
The widening payment gap was associated with a significant reduction in the disparity of innovation drug use between employees and residents (Interaction coefficient = -0.001, p<0.001), suggesting residents caught up in access despite the gap. No significant association was found between the payment gap and the disparity in cure rates or OOP spending trends. However, a substantial baseline structural inequity remains: UEBMI patients enjoyed a 20.5% lower OOP spending ratio (p<0.05) unrelated to the payment limit gap.
CONCLUSIONS:
Contrary to concerns, widening payment standard gaps under reform did not worsen clinical or financial equity trends for TB patients, and coincided with improved equity in innovation drug access. Healthcare inequity in China is primarily driven by the structural dichotomy of insurance schemes rather than specific payment limit parameters.
| eISSN: | 2654-1459 |
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