Abstract
BackgroundA growing number of developing countries are developing health insurance schemes that aim to protect households, particularly the poor, from financial catastrophe and impoverishment caused by unaffordable medical care. This paper investigates the extent to which patients suffering from chronic disease in rural China face catastrophic expenditure on healthcare, and how far the New Co-operative Medical Insurance Scheme (NCMS) offers them financial protection against this.MethodsA household survey was conducted in six counties in Ningxia Autonomous Region and Shandong Province, with a total of 6,147 rural households, including 3944 individual chronic disease patients. Structured questionnaires were used with chronic disease patients to investigate: their basic social and economic characteristics, including income and expenditure levels and NCMS membership; and their health care utilization, associated healthcare costs and levels of reimbursement by NCMS. 'Catastrophic' expenditure was defined as healthcare expenditure of more than 40% of household non-food expenditure.ResultsExpenditure for chronic diseases accounted for an average of 27% of annual non-food per capita expenditure amongst NCMS members in Shandong and 35% in Ningxia. 14-15% of families in both provinces spent more than 40% of their non-food expenditure on chronic healthcare costs. Between 8 and 11% of non NCMS members and 13% of NCMS members did not seek any medical care for chronic illness. A greater proportion of NCMS members in the poorest quintile faced catastrophic expenditure as compared to those in the richest quintile in both study sites. A slightly higher proportion of non-NCMS members than NCMS member households faced catastrophic expenditure, but the difference was not statistically significant.ConclusionA significant proportion of patients with chronic diseases face catastrophic healthcare costs and these are especially heavy for the poor. The NCMS offers only a limited degree of financial protection. The heavy financial burden of healthcare for chronic disease poses an urgent challenge to the NCMS. There is an urgent need for a clear policy on how to offer financial protection to those with chronic disease.
Highlights
A growing number of developing countries are developing health insurance schemes that aim to protect households, the poor, from financial catastrophe and impoverishment caused by unaffordable medical care
The first research question we aimed to investigate in this study was: what is the financial burden of chronic disease in the study areas, especially for the poor? Our findings show that healthcare expenditure for chronic diseases does place a heavy financial burden on many of those suffering from them, accounting for an average of 27% of annual non-food per capita expenditure amongst New Co-operative Medical Insurance Scheme (NCMS) members in Shandong and 35% in Ningxia
The second research question was: how far does NCMS offer financial protection against chronic disease burdens, especially for the poor? We found that only a relatively small number of NCMS members suffering from chronic diseases were able to get any of their healthcare costs reimbursed
Summary
A growing number of developing countries are developing health insurance schemes that aim to protect households, the poor, from financial catastrophe and impoverishment caused by unaffordable medical care. This paper investigates the extent to which patients suffering from chronic disease in rural China face catastrophic expenditure on healthcare, and how far the New Co-operative Medical Insurance Scheme (NCMS) offers them financial protection against this. China's rural health insurance in the international context A growing number of developing countries are developing health insurance schemes that aim to protect households, the poor, from financial catastrophe and impoverishment caused by unaffordable medical care. The central stated goal of developing the rural health insurance scheme in China is to provide financial protection to individuals and households from catastrophic expenditures due to major illness [5]
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