Whether New Cooperative Medical Schemes Reduce the Economic Burden of Chronic Disease in Rural China

Shanshan Jing,Aitian Yin,Lizheng Shi,Jinan Liu,Hamid Reza Baradaran

doi:10.1371/journal.pone.0053062

Shanshan Jing, Aitian Yin + Show 3 more

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https://doi.org/10.1371/journal.pone.0053062

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Abstract

BackgroundThe New Cooperative Medical Scheme (NCMS) provides health insurance coverage for rural populations in China. This study aimed to evaluate changes in household catastrophic health expenditure (CHE) due to chronic disease before and after the reimbursement policies for services of chronic disease were implemented to provide additional financial support.MethodsThe study used data from the household surveys conducted in Shandong Province and Ningxia Hui Autonomous Region in 2006 and 2008. The study sample in village-level units was divided into two groups: 36 villages which implemented the NCMS reimbursement policies for chronic diseases as the intervention group, and 72 villages which did not as the control group. Health care expenditure of more than 40% of household’s non-food expenditure was defined as a household with CHE (i.e., impoverishment). The conceptual framework was established based on the Andersen socio-behavioral model of health care utilization to explore how the NCMS reimbursement policies impacted health expenditures. A difference-in-difference model was employed to compare the change in the proportion of households incurring CHE due to chronic disease between the two groups over time.ResultsThe households that participated in the NCMS were less likely to become impoverished (P<0.05). In addition, the households with both male household head and higher income level were protective factors to prevent CHE (P<0.05). Young households with preschool children suffered less from CHE (P<0.05). The effect of the NCMS reimbursement policies for chronic disease on the CHE was negative, yet not statistically significant (p = 0.814).ConclusionsThe NCMS coverage showed financial protection for households with chronic disease. However, the NCMS reimbursement policies should be strengthened in the future.

Highlights

Chronic disease accounts for an estimated 80% of total deaths and 70% of total loss of disability-adjusted-life-years (DALYs) in China [1], and the estimated losses in national income from heart disease, stroke and diabetes are US$18 billion in China in 2005 [2]
The objective of this paper is to examine the impact of the New Cooperative Medical Scheme (NCMS) reimbursement policies for chronic disease on the household catastrophic health expenditure (CHE)
Data and Sampling The data are derived from the household surveys conducted in Shandong Province and Ningxia Hui Autonomous Region in May 2006 and August/September 2008 [17,18,19]. It is part of a European Union-funded project aiming to improve the design of rural health insurance in rural China and Vietnam entitled ‘Bringing health care to the vulnerable developing equitable and sustainable rural health insurance in China and Vietnam (RHINCAV)’ [20,21].Using the structured questionnaires in the face-to-face interviews, individuals with one or more chronic conditions reported basic social and economic characteristics; health care utilization, costs, and levels of NCMS reimbursement where applicable

Summary

Introduction

Chronic disease accounts for an estimated 80% of total deaths and 70% of total loss of disability-adjusted-life-years (DALYs) in China [1], and the estimated losses in national income from heart disease, stroke and diabetes are US$18 billion in China in 2005 [2]. The Fourth Chinese National Health Services Survey in 2008 showed that 270 million Chinese people were diagnosed with at least one chronic disease, and about 82% of deaths and 70% of DALYs lost were caused by chronic diseases. Average inpatient expenditure on common types of chronic disease, such as hypertension and diabetes, can cost 1.5 times the annual per capita income of rural residents [4]. It is estimated that 54% of total household medical expenditure on chronic disease is spent on outpatient services. One study in Shandong and Gansu provinces estimated the annual per capita outpatient expenditure on chronic disease at half of total annual medical expenditure [6]. This study aimed to evaluate changes in household catastrophic health expenditure (CHE) due to chronic disease before and after the reimbursement policies for services of chronic disease were implemented to provide additional financial support

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