China’s new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey

Wei Yang

doi:10.1186/1475-9276-12-20

Abstract

IntroductionChina's New Cooperative Medical Scheme (NCMS) was brought to life in 2003 in response to the deterioration in access to health services in rural areas. Despite its fast expansion, the scheme’s impacts on access to health care have raised growing concerns, in particular regarding whether and to what extent the scheme has reduced inequity in access to health care in rural China.MethodsThis study examines income-related inequity in access to health care from 2004 (before the national rollout of NCMS) to 2009 (after the expansion of NCMS across the rural China) by estimating Concentration Indices over both formal health care (outpatient care, prevention care) and informal health care use (folk doctor care). Data were drawn from a longitudinal household survey dataset - China Health and Nutrition Survey (CHNS).ResultsThe study suggested that the level of inequity remained the same for outpatient care, and an increased favouring-poor gap in terms of folk doctor care was observed. In terms of preventive care, a favouring-rich inequity was observed both in 2004 and 2009, but the effects of inequity were narrowed. The NCMS had some effects in reducing income-related health inequity in folk doctor care and preventive care, but the contribution was rather small. The study also found that the rural better-off had started to seek for commercial insurance to cover possible financial risks from the burden of diseases.ConclusionThe study concludes that the impacts of the NCMS on improving access to formal care for the poor are limited. Without a more comprehensive insurance package that effectively targets the rural poor, the intended equity goals expected from the scheme will be difficult to realize.

Highlights

China's New Cooperative Medical Scheme (NCMS) was brought to life in 2003 in response to the deterioration in access to health services in rural areas
Health insurance has the potential to lower financial barriers of access to health care, since the financial risk of health care is shared among insurance participants and health cost will be reduced at the point of health care use [1]
Since “equitable access” has been officially declared by the State Council to be the principal aim of the rural health insurance reform [2], the main objective of the NCMS is to provide universal coverage and to improve equity and access to health care to the rural population regardless of individual characteristics such as job status, education, pre-existing condition, and level of wealth

Summary

Introduction

China's New Cooperative Medical Scheme (NCMS) was brought to life in 2003 in response to the deterioration in access to health services in rural areas. The scheme’s impacts on access to health care have raised growing concerns, in particular regarding whether and to what extent the scheme has reduced inequity in access to health care in rural China. The government targets its public funds for health insurance by focusing on the rural population through the New Rural Cooperative Health Scheme (NCMS). For the past few decades, the state and enterprise funded health insurance only covered well-off urban employees, leaving the majority of the rural residents unprotected from health risks [3], the launch of the NCMS in 2003 is considered as a crucial step in closing the insurance gap and reducing inequity in access to health care for the rural population

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Results

Conclusion