Abstract
IntroductionThe Chinese New Cooperative Medical Scheme (NCMS) was launched in 2003 aiming at protecting the poor in rural areas from high health expenditures and improving access to health services. The income related inequality of the reform is a debating and concerning policy issue in China. The purpose of this study is to analyze the degree and changes of income related inequalities in both inpatient and outpatient services among NCMS enrollees from 2007 to 2011.Data and methodsData was extracted from the NCMS information system of Junan County in Shandong province from 2007 to 2011. The study targeted all NCMS enrollees in the county, 726850 registered in 2011. Detailed information included demographic data, inpatient and outpatient data in each year. Descriptive analysis of quintiles and standardized concentration index (CI*) were employed to examine the income related inequalities in both inpatient and outpatient care.ResultsFor inpatient care, the benefit rate CI* was positive (pro-rich) and increased from 2007 to 2011 while for outpatient care was negative (pro-poor) and a decreasing pattern was observed. For outpatient visits and expenses, the CI* changed from a positive sign in 2007 to a negative sign in 2011 with some fluctuations. The pro-rich inequality exacerbated for admissions while alleviated for length of stay and total inpatient expenses during the study period. The pro-rich inequality for inpatient reimbursement aggravated from 2007 to 2010 and alleviated from 2010 to 2011. For outpatient reimbursement, it altered from a positive sign in 2007 to a small negative sign in 2011. Finally, the richer needed to afford more self-payments for inpatient services and the CI* decreased from 2009 to 2011 while the inequality for outpatient self-payments changed from pro-rich in 2007 to pro-poor in 2011.ConclusionsIn the NCMS, the pro-rich inequality dominated for the inpatient care while a pro-poor advantage was shown for outpatient care from 2007 to 2011 in Junan. The extent of pro-rich inequality in length of stay, inpatient expenses and inpatient reimbursement increased from 2007 to 2009, but recently between 2010 and 2011 showed a change favoring the poor.
Highlights
The Chinese New Cooperative Medical Scheme (NCMS) was launched in 2003 aiming at protecting the poor in rural areas from high health expenditures and improving access to health services
At the beginning of this section, the general status of income related inequality for total medical expenses, NCMS reimbursement and Out of pocket expenditures (OOP) for both inpatient and outpatient care was presented to reflect an overall impact in the NCMS from 2007 to 2011
According to the analyzed indicators, the four aspects of income related inequality in the NCMS were illustrated for inpatient and outpatient care respectively, that is, (1) NCMS benefit rate; (2) medical service utilization, including three indicators for inpatient service utilization and two indicators for outpatient service utilization; (3) NCMS reimbursement; and (4) OOP
Summary
The Chinese New Cooperative Medical Scheme (NCMS) was launched in 2003 aiming at protecting the poor in rural areas from high health expenditures and improving access to health services. The central and provincial governments designed the essential or basic rules about implementation of NCMS, such as the minimum level of NCMS premium and policy reimbursement rate, the priority for the reimbursement of essential drugs or Chinese traditional medicine, etc., while the county governments are responsible for specific operations, such as defining benefit packages, designating participating providers, pooling risk across the local rural population and experimenting health policy innovations like payment reform. Under this context, the benefit package was usually the same for the participants in one county or province while it may differentiate across counties or provinces, which was closely related to the varied financing levels of NCMS in different areas
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