Abstract
ObjectiveTo determine whether the New Cooperative Medical Insurance Scheme (NCMS) is associated with decreased levels of catastrophic health expenditure and reduced impoverishment due to medical expenses in rural households of China.MethodsAn analysis of a national representative sample of 38,945 rural households (129,635 people) from the 2008 National Health Service Survey was performed. Logistic regression models used binary indicator of catastrophic health expenditure as dependent variable, with household consumption, demographic characteristics, health insurance schemes, and chronic illness as independent variables.ResultsHigher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. While the higher socio-economic status households had similar levels of catastrophic health expenditure as compared with the lowest. Households covered by the NCMS had similar levels of catastrophic health expenditure and medical impoverishment as those without health insurance.ConclusionDespite over 95% of coverage, the NCMS has failed to prevent catastrophic health expenditure and medical impoverishment. An upgrade of benefit packages is needed, and effective cost control mechanisms on the provider side needs to be considered.
Highlights
In 2012 China’s population numbered 1.37 billion
Our study revealed that only 36.9% of hospital expenses for inpatient services were recompensed by the New Cooperative Medical Insurance Scheme (NCMS)
Our study revealed that households with one or more members admitted to hospitals were 4.8 times more likely to experience catastrophic health expenditure (CHE) than those without hospitalized members
Summary
In 2012 China’s population numbered 1.37 billion. Despite rapid urbanization over the past decade, half of the total population resides in non-urban areas. A large disparity in wealth and health status exists between urban and rural populations, resulting from a dualistic economic structure compounded by uneven social development and distance to amenities [1]. Compared to their urban counterparts, rural residents have lower levels of remuneration, relatively lower social security welfare entitlements and less access to services. This is a paradox: the government is determined to achieve social equality in a developing society where progress has unintended consequences. International evidence has shown that people of lower economic status are more likely to suffer from serious illness and may become impoverished due to the medical costs [2]
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