Abstract
BackgroundIn 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County.MethodsThe study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7353) whose annual serious illness expenses were between CNY 10,000 (1414 USD) and CNY 30,000 (4242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720).ResultsThe results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P < 0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = − 0.016, P < 0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high.ConclusionThe medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.
Highlights
In 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents
The annual average values for medical expenses for serious illness patients amounted to CNY 96, 100 (13,589 USD); for NRCMS payment, CNY 48,000 (6787 USD); for annual average Serious Illness Medical Insurance System (SIMIS) payment, CNY 7600 (1075 USD); for inside medical insurance self
As a supplemental policy arrangement to alleviate the economic burden of patients with high medical expenses, the SIMIS has increased the reimbursement amount for some patients with high medical expenses
Summary
In 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. Its reimbursement for high medical costs was insufficient. China gradually established the Serious Illness Insurance System (SIMIS) based on NRCM S. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. The establishment of the NRCMS had alleviated the burden of medical expenses of rural residents in China, but the reimbursement for high medical expenses was insufficient [5]. To improve the reimbursement level of rural residents, China subsequently established a Serious Illness Medical Insurance System (SIMIS) based on NRCMS. People who use the SIMIS were collectively referred to as patients with serious illnesses
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