Abstract
BackgroundEquity is an important goal for countries in formulating relevant health policies, and research on the equity of health services is more important for China, where the gap between the rich and poor is widening. The aims of this study are to explore to what extent the benefit equity of New Rural Cooperative Medical System enrollees has been achieved and to determine the geographical disparities in Shaanxi province and thus provide suggestions for future policy formulations.MethodsData were obtained from the fifth Health Service Survey of Shaanxi province in 2013. A two-step mode was used to analyse the influencing factors of the inpatient benefit rate and inpatient compensation fee. Concentration indexes and concentration curves were applied to measure the inequity of the inpatient benefit rate and inpatient compensation fee. The decomposition method was employed to explore the source of inequity and horizontal inequity.ResultsBased on a sample of 38,032 enrollees, our results showed that there were pro-rich inequities in the inpatient benefit rate and compensation fee. The concentration index of the inpatient benefit rate and compensation fee in 2013 were 0.064 and 0.174, respectively. The economic level (224.62%), self-evaluated health status (− 25.89%) and occupation status (− 12.32%) were the primary three contributors to the inequity of the inpatient benefit rate, and the economic level (106.16%) and age (− 2.88%) were the first two contributors to the inequity of the compensation fee. There were regional differences in the sources of inequities. Moreover, pro-rich horizontal inequity remained after standardizing health care needs.ConclusionsOur results indicated that there were pro-rich inequities in the inpatient benefit rate and compensation fee in the New Rural Cooperative Medical System. The economic levels of enrollees accounted for most of the existing inequity, followed by self-evaluated health scores and age. Efforts should be made to strengthen policies and programmes in the New Rural Cooperative Medical System to achieve basic health services equity, such as implementing hierarchical medical treatments and reducing extra inpatient benefits for the rich.
Highlights
Equity is an important goal for countries in formulating relevant health policies, and research on the equity of health services is more important for China, where the gap between the rich and poor is widening
We investigated to what extent the benefit equity of New Rural Cooperative Medical System (NCMS) enrollees has been achieved and the existing geographical disparities in Shaanxi province, which was determined in other provinces with similar situations in China
The results showed that NCMS enrollees living in Guanzhong received fewer inpatient compensation fees than those dwelling in Shannan
Summary
Equity is an important goal for countries in formulating relevant health policies, and research on the equity of health services is more important for China, where the gap between the rich and poor is widening. According to the 2003 Guideline, NCMS is a medical insurance model with government subsidies and has two important policy characteristics: the voluntary participation of the rural residents and the emphasis on preventing catastrophic diseases. The institutional designs of NCMS are to provide medical subsidies to the participants, to alleviate the economic burden of disease on rural population, to solve the problem of peasants suffering from poverty due to serious illnesses, to improve access and equity of health care services in rural areas. By the end of 2013, 98.7% (8.02 billion) of the rural population was covered by the NCMS across the country, which is the health insurance program with the world’s largest coverage [5]
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