Abstract

BackgroundThe alarming progression of an increasingly aging population in China has attracted much attention within the country and abroad. In 2003, the Chinese central government launched the New Cooperative Medical Scheme (NCMS) to resolve problems of healthcare inequity in regions with inadequate infrastructure and relative poverty. The purpose of this study was to investigate the effect of NCMS on health expenditures by the Chinese rural elderly population.MethodsThe data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which was conducted in 2005, 2008, 2011 and 2014. Elderly people living in rural areas and 60 years old or above were screened for the investigation. The sample size was 7472 in 2005, 11,705 in 2008, 9239 in 2011, and 6059 in 2014. The OOP% and reimbursement ratio were the medical expenses paid by individuals accounting for their per capita annual income and the medical expenses paid by medical insurance accounting for their total medical expenses, respectively. By controlling for individuals’ sociodemographic characteristics, pensions, demands and utilization of health services, we estimated the effect of the NCMS on the OOP% and reimbursement ratio for the rural elderly using seemingly unrelated regression (SUR).ResultsThe NCMS coverage ranged from 11.63% in 2005 to 80.34% in 2014. The medical expenses of the elderly also increased from an average of $204.77 in 2005 to $696.23 in 2014, which was more than three times as much as in 2005. From 2005 to 2014, the reimbursement ratio for medical expenses of rural elderly people with NCMS increased significantly from 30.6% in 2005 to 56.1% in 2014. The proportion of reimbursement ratio for rural seniors with NCMS increased by 6.4% across each survey cycle (every 3 years). However, the NCMS resulted in an insignificant decrease in OOP% by 1.4% across each survey cycle (every 3 years). Among other medical insurances, public insurance and private elder insurance had significant positive impacts on reimbursement ratio but did not influence OOP%.ConclusionsNCMS remarkably increased the rural elderly’s reimbursement ratio but insignificantly decreased the rural elderly’s OOP%. In addition, the proportion of reimbursement ratio for NCMS participants increased by 6.4% every 3 years. Lower outpatient reimbursement, migration, limited reimbursement scope, an increasing demand for medical services and the rapid growth of medical expenses may be reasons for the gaps between the nominal reimbursement ratio and the actual reimbursement ratio and OOP%. Policymakers should further modify NCMS policies in rural China.

Highlights

  • The alarming progression of an increasingly aging population in China has attracted much attention within the country and abroad

  • The National Bureau of Statistics in China showed that the annual growth rate of medical expenses for elderly people aged 65 years and above was 2.7% between 1990 and 2010 and was projected to be 2.2% between 2010 to 2030, which exceeds that of the US and other OECD member countries (0.3–0.5%)

  • Farmers were actively encouraged to enroll in the scheme as over 70% of the New Cooperative Medical Scheme (NCMS) fund was contributed by the government and individual contributions were relatively small

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Summary

Introduction

The alarming progression of an increasingly aging population in China has attracted much attention within the country and abroad. The National Bureau of Statistics in China showed that the annual growth rate of medical expenses for elderly people aged 65 years and above was 2.7% between 1990 and 2010 and was projected to be 2.2% between 2010 to 2030, which exceeds that of the US and other OECD member countries (0.3–0.5%). In 2003, the Chinese central government launched a policy in rural areas called the ‘New Cooperative Medical System’ (NCMS). This scheme aims to safeguard farmers’ access to basic health services and alleviate the financial burden caused by sickness and poverty with a focus on inpatient services and catastrophic outpatient services [6]. The participants are entitled to reimbursements in designated hospitals and regulated by lower reimbursement rates in higher-level hospitals

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