An evaluation of China's new rural cooperative medical system: achievements and inadequacies from policy goals.

Chengyue Li,Jun Lu,Mo Hao,Xiaohong Li,Ying Wang,Fengshui Chang,Mei Sun,Yilin Hou

doi:10.1186/s12889-015-2410-1

Abstract

BackgroundAlthough much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. The purpose of this study is to examine to what extent the policy goals of NRCMS have been achieved.MethodsUsing multistage sampling processes, two rounds of cross-sectional household surveys including 9787 and 7921 rural households were conducted in Eastern China in year 2000 and year 2008, respectively. A pre- and post-implementation comparison was used to evaluate the achievement of policy goals in three measures: impoverishment from major health hazards, household financial risk from medical expenses, and rural income inequity. Intention surveys were also applied to find out potential obstacles in the implementation of NRCMS.ResultsThe rate of re-impoverishment from health hazard was reduced from 2.69 % ex ante to 2.12 % ex post, a decrease of 21.13 %. The severity of impoverishment fell from a previous 4.66 % to 3.02 %, a decline of 35.18 %. Economic risk of medical treatment population relative to the whole population fell from 2.62 ex ante to 2.03 ex post, a 22.52 % reduction. As indication of effect on improving income equity, the Gini coefficient fell from 0.4629 to 0.4541. The effects of NRCMS were significantly better than those of RCMS. Despite the preliminary achievements, our intention survey of key respondents identified that technical difficulties in actuarial funding and more sustainable reimbursement schedules has become the most challenging barriers in achieving the goals of NRCMS, while raising the insurance premium on NRCMS was no longer as big a barrier.ConclusionsWith NRCMS, China has established a medical security system to reduce the financial burden of healthcare on rural residents. NRCMS has achieved some positive though limited effects; but technical difficulties in the implementation of NRCMS have become barriers to achieve the pre-set policy goals. Efforts should be made to improve the capacity building in the design of the reimbursement schemes for the implementers of NRCMS, such as identifying medical impoverishment, calculating actuarial funding levels for the risk pooling.

Highlights

Much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals
The word “cooperative” holds the key: rural residents were placed into units of collective economy, by which everyone household contributed to a revenue pool and was provided a basic level of healthcare protection that was funded by the pool
92.7 % of households participated in NRCMS, whereas only 73.6 % participated in Rural Cooperative Medical System” (RCMS) in year 2000 (As we said in the Background section, the sampled areas had strong local collective economy so that the old RCMS was never completed disrupted)

Summary

Introduction

Much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. These rural residents are the largest low-income group They do not have the privilege of health insurance coverage as most urban dwellers, which exacerbates the long-existing, already drastic rural–urban income disparity and implants underlying threats to long-run social stability. With the disappearance of the collective economy during China’s market-oriented economic reform that started in the 1980s, the RCMS collapsed by the 1990s [7], except in the more urban economically developing provinces in Eastern China This left nearly 80 % of the rural population did not have any health coverage [8]. Unaffordable health services and poverty due to medical expenses became daily troubles to low-income rural residents, the couplet of which created a serious threat to the overall social stability and economic progress of the nation

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