The association between basic medical insurance and the management of chronic obstructive pulmonary disease in China: a cross-sectional study based on the national “Happy Breathing” Programme

作者：Yiwen Yu, Zixuan Feng, Qiushi Chen, Zhuang Hao, Zhong Cao, Ke Huang, Ping He, Xingyao Tang, Cunbo Jia, Yong Li, Fang Fang, Jun Pan, Till Bärnighausen, Simiao Chen, Ting Yang, Chen Wang · 发表于：BMC Medicine · 年份：2025 · DOI：10.1186/s12916-025-04422-2 · 被引用次数：2 · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Healthcare Systems and Reforms、Primary Care and Health Outcomes

BACKGROUND: China has established universal basic medical insurance to reduce financial barriers to improve healthcare access. However, the role of medical insurance in addressing broader population health challenges remains understudied. As China faces a significant challenge in managing the substantial burden of chronic obstructive pulmonary disease (COPD), it is imperatively important to understand how medical insurance is associated with each step of the care for patients with COPD. METHODS: We used individual-level patient data from the national Chinese "Happy Breathing" Programme from 2018 to 2023. We applied region fixed effects models with modified Poisson regression to assess the association between being insured and reaching each care cascade step: (i) had ever undergone a pulmonary function test, (ii) had been diagnosed with COPD in the past, (iii) were currently on treatment for COPD, and (iv) had achieved COPD control. Stratified analyses were performed by local reimbursement policy, age group, sex, occupation, and residential location. RESULTS: A total of 8841 COPD patients were included in the analysis, with 98.7% covered by basic medical insurance, including 83.1% under the Urban and Rural Resident Basic Medical Insurance (URRBMI) and 15.6% under the Urban Employee Basic Medical Insurance (UEBMI). Patients with URRBMI and UEBMI were more likely to receive a diagnosis compared with the uninsured, with modest risk ratios of 2.20 (95% CI: 1.01-4.78, p = 0.047) an...