• Ru Chen, Limei Jing, Jing Xu, Junwei Wang, Jiquan Lou, and Xiaoming Sun.
• Pudong Institute for Health Development, Shanghai, China.
• Lancet. 2016 Oct 1; 388 Suppl 1: S14.

BackgroundTo help drive the consolidation and integrated management of basic medical insurance in China, we analysed participants' satisfaction, and factors associated with satisfaction, for the Urban Employees' Basic Medical Insurance (UEBMI), Urban Residents' Basic Medical Insurance (URBMI), and New Rural Cooperative Medical Scheme (NRCMS).MethodsPudong New Area in Shanghai was chosen as a typical sample of basic medical insurance coverage and management. 3395 residents (1200 households) were selected in September, 2013, by stratified cluster sampling and participants were interviewed face-to-face by trained investigators. Factors associated with satisfaction were analysed by ordinal logistic regression. Ethics approval was obtained from the ethics committee of Pudong Institute for Health Development.FindingsURBMI participants reported a higher rate of dissatisfaction in outpatient (n=7, 5·10%), inpatient (7, 12·50%), and overall (127, 12·85%) experience. NRCMS had the highest rate of outpatient satisfaction (65, 84·4%), with no participants reporting dissatisfaction. UEBMI had the highest rate of inpatient satisfaction (96, 70·1%). Affordability of out-of-pocket cost, proportion of reimbursement, and time of insurance reimbursement were positively correlated with satisfaction for UEBMI; awareness of premium and compensation policy, affordability of out-of-pocket cost, proportion of reimbursement, and procedure of reimbursement were associated with greater satisfaction with URBMI, whereas participants with lower education were more satisfied. Factors associated with satisfaction with NRCMS were the same as for URBMI, with the exception of education level, and the addition of affordability of premium and time of reimbursement, which were positively correlated.InterpretationThe Chinese government should take effective measures, such as taking advantage of the family doctor system, to regulate and reinstitute sequential medical order (referral from primary medical institutions to high level medical institutions), which could lead to short-term implications of satisfaction but will lead to both satisfaction and rational medical order in the long term. The fairness of financing and reimbursing across different basic medical insurance policies (in terms of reasonable costs to patients) needs to be improved.FundingFunded by the National Nature Science Foundation of China (NSFC 71503170), Shanghai Municipal Commission of Health and Family Planning (201440036, 2016HP009).Copyright © 2016 Elsevier Ltd. All rights reserved.

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