Urban-rural differences in healthcare utilization among beneficiaries in China\u2019s new cooperative medical scheme

Dian Luo,Jing Deng,Edmund R. Becker

doi:10.1186/s12889-021-11573-3

Abstract

BackgroundThe New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries.MethodsData for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group.ResultsOur regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables – 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures – all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits.ConclusionsFor both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.

Highlights

The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind
By the end of 2009, calculations show that 95.3% of all counties and 91.5% (815 million) of all rural population were covered by the NCMS [2]
NCMS urban residents with a rural hukou designation, as we reported earlier, have migrated from a rural to urban area and we hypothesized this would lead to increased levels of health care resource utilization

Summary

Introduction

The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. The New Cooperative Medical Scheme (NCMS) in China, established in 2002 to provide financial protection for rural residents, was a voluntary program designed to facilitate cost sharing between government and rural residents. The NCMS is designed to reduce the financial burden of illness on the rural population focusing mostly on inpatient services and some outpatient services [1]. By the end of 2009, calculations show that 95.3% of all counties and 91.5% (815 million) of all rural population were covered by the NCMS [2]

Methods

Results

Discussion

Conclusion