Abstract
BackgroundThe goal of the New Rural Cooperative Medical System (NCMS) is to decrease the financial burden and improve the health of rural areas. The purpose of the present study is to determine how government subsidies vary between poorer and wealthier groups, especially in low-income regions in rural China.MethodsThe distribution, amount, and equity of government subsidies delivered via NCMS to rural residents at different economic levels were assessed using benefit-incidence analysis, concentration index, Kakwani index, Gini index, Lorenz curve, and concentration curve. Household and health institution surveys were conducted in 2010, covering 9701 residents. Household socio-economic status, healthcare costs, out-of-pocket payments, and utilization information were collected in household interviews, and reimbursement policy was provided by institutional survey.ResultsThe government subsidy concentration index was −0.055 for outpatients and 0.505 for inpatients; and the outpatient and inpatient subsidy Kakwani indexes were −0.376 and 0.184, respectively. The poorest 20 % of populations received 3.4 % of the total subsidy output; while the wealthiest 20 % received 54.3 %. The results showed that the distribution of outpatient subsidies was equitable, but the hospital subsidies disproportionally benefited wealthier people.ConclusionsWealthier people benefited more than poorer people from the NCMS in terms of inpatient and total subsidies. For outpatients, the subsidies were unrelated to ability to pay. This contradicts the common belief that the NCMS does not exacerbate benefit inequity. Long-term policy is required to tackle this problem, specifically of redesign the NCMS reimbursement system.
Highlights
The goal of the New Rural Cooperative Medical System (NCMS) is to decrease the financial burden and improve the health of rural areas
The government has taken on the responsibility of financing many aspects of health insurance, especially for rural residents, who made up of 61.2 % (802 million) of China’s population as of 2013 [1]
Subject protection Ethical approval was obtained from Anhui Medical University Research Ethics Committee prior to data collection
Summary
The goal of the New Rural Cooperative Medical System (NCMS) is to decrease the financial burden and improve the health of rural areas. The New Rural Cooperative Medical System (NCMS) was introduced in 2003 and extended to most rural residents by 2010 with the principal goal of reduce rural people’s financial burden due to illness and to lessen the gap between rich and poor [3]. It is currently the most important type of health insurance in China with respect to protecting rural residents from poverty due to health care expenditure.
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