Abstract
BackgroundSeveral years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement. Its policies on chronic diseases vary by county but have certain shared characteristics. Following this modification of medical insurance policy, this study reassesses the provision of insurance against expenditure on chronic diseases in rural areas, and analyzes its effect on impoverishment.MethodsWe conducted an empirical study using multi-stage stratified random sampling. We surveyed 1,661 rural households in three provinces and analyzed the responses from 1,525 households that participated in NCMS, using descriptive and logistic regression analysis.ResultsThe NCMS has reduced the prevalence of poverty and catastrophic health expenditure (CHE), as measured by out-of-pocket (OOP) payments exceeding 40% of total household expenditure, by decreasing medical expenditure. It provides obvious protection to households which include someone with chronic diseases. However, these households continue to face a higher financial risk than those without anyone suffering from chronic diseases. Variables about health service utilization and OOP payment differed significantly between households with or without people suffering from chronic disease. And CHE risk is commonly associated with household income, the number of family members with chronic diseases, OOP payment of outpatient and inpatient service in all three provinces.ConclusionTo reduce CHE risk for these households, it is critical to decrease OOP payments for health services by enhancing the effective reimbursement level of NCMS and strictly regulating the providers’ behaviors. We recommend that a combinatory changes should be made to the rural health insurance scheme in China to improve its effect. These include improving the NCMS benefit package by broadening the catalogue of drugs and treatments covered, decreasing or abolishing deductible and increasing the reimbursement ratio of outpatient services for people with chronic diseases, together with expansion of insurance fund, and modifying health providers’ behaviors by payment reform.
Highlights
Several years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement
To describe the effect of NCMS, we calculated the prevalence of poverty and catastrophic health expenditure (CHE) before and after NCMS reimbursement, and compared the situation for households with and without people suffering from chronic diseases in the three provinces
Households with people suffering from chronic diseases had more elder members, a higher ratio of lower educational levels, more outpatient visits, higher OOP payments for outpatient services in the previous 14 days, and utilized more inpatient services in the last year than those without people suffering from chronic diseases
Summary
Several years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement. Its policies on chronic diseases vary by county but have certain shared characteristics. Following this modification of medical insurance policy, this study reassesses the provision of insurance against expenditure on chronic diseases in rural areas, and analyzes its effect on impoverishment. The fourth National Health Service Survey (NHSS) in 2008 showed the prevalence of chronic disease in sample populations in rural areas was 17.1%, 4.94% higher than that found by the third NHSS in 2003. The financial burden of chronic diseases in China is expected to increase significantly in the foreseeable future, with population aging, anticipated changes in social and economic structures, and progressive pollution in the environment [7]
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