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New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China

BACKGROUND: Subsidizing healthcare costs through insurance schemes is crucial to overcome financial barriers to health care and to avoid high medical expenditures for patients in China. The health insurance could decrease financial risk by less out-of-pocket (OOP) payment, but not promise the protec...

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Autores principales: Ma, Jingdong, Xu, Juan, Zhang, Zhiguo, Wang, Jing
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855492/
https://www.ncbi.nlm.nih.gov/pubmed/27142618
http://dx.doi.org/10.1186/s12939-016-0361-5
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author Ma, Jingdong
Xu, Juan
Zhang, Zhiguo
Wang, Jing
author_facet Ma, Jingdong
Xu, Juan
Zhang, Zhiguo
Wang, Jing
author_sort Ma, Jingdong
collection PubMed
description BACKGROUND: Subsidizing healthcare costs through insurance schemes is crucial to overcome financial barriers to health care and to avoid high medical expenditures for patients in China. The health insurance could decrease financial risk by less out-of-pocket (OOP) payment, but not promise the protection equity. With the growth of New Cooperative Medical Scheme (NCMS) financing and coverage since 2008, the protection effectiveness and equity of the modified NCMS policies on financial burden should be further evaluated. METHODS: A cross-sectional household survey was conducted in Zhejiang, Hubei, and Chongqing provinces by multi-stage stratified random sampling in 2011. A total of 1,525 households covered by the NCMS were analyzed. The protection effectiveness and protection equity of NCMS was analyzed by comparing the changes in health care utilization and medical expenditures, and the changes in the prevalence of catastrophic health expenditure (CHE) and its concentration indices (CIs) between pre- and post-NCMS reimbursement, respectively. RESULTS: The medical financial burden was still remarkably high for the low income rural residents in China due to high OOP payment, even after NCMS reimbursement. In Hubei province, the OOP payment of the poorest quintile was almost same as their households’ annual expenditures. Even it was higher than their annual expenditures in Chongqing municipality. Effective reimbursement ratio of both outpatient and inpatient services were far lower than nominal reimbursement ratio originally designed by NCMS plans. After NCMS reimbursement, the prevalence of CHE was considerably high in all three provinces, and the absolute values of CIs were even higher than those before reimbursement, indicating the inequity exaggerated. CONCLUSION: Policymakers should further modify NCMS policy in rural China. The high OOP payment could be decreased by expanding the drug list and check directory for benefit package of NCMS to minimize the gap between nominal reimbursement ratio and effective reimbursement ratio. And the increase in medical expenditures should be controlled by monitoring excess demand from both medical service providers and patients, and changing fee-for-service payment for providers to a prospective payment system. Service accessibility and affordability for vulnerable rural residents should be protected by modifying regressive financing in NCMS, and by providing extra financial aid and reimbursement from government.
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spelling pubmed-48554922016-05-05 New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China Ma, Jingdong Xu, Juan Zhang, Zhiguo Wang, Jing Int J Equity Health Research BACKGROUND: Subsidizing healthcare costs through insurance schemes is crucial to overcome financial barriers to health care and to avoid high medical expenditures for patients in China. The health insurance could decrease financial risk by less out-of-pocket (OOP) payment, but not promise the protection equity. With the growth of New Cooperative Medical Scheme (NCMS) financing and coverage since 2008, the protection effectiveness and equity of the modified NCMS policies on financial burden should be further evaluated. METHODS: A cross-sectional household survey was conducted in Zhejiang, Hubei, and Chongqing provinces by multi-stage stratified random sampling in 2011. A total of 1,525 households covered by the NCMS were analyzed. The protection effectiveness and protection equity of NCMS was analyzed by comparing the changes in health care utilization and medical expenditures, and the changes in the prevalence of catastrophic health expenditure (CHE) and its concentration indices (CIs) between pre- and post-NCMS reimbursement, respectively. RESULTS: The medical financial burden was still remarkably high for the low income rural residents in China due to high OOP payment, even after NCMS reimbursement. In Hubei province, the OOP payment of the poorest quintile was almost same as their households’ annual expenditures. Even it was higher than their annual expenditures in Chongqing municipality. Effective reimbursement ratio of both outpatient and inpatient services were far lower than nominal reimbursement ratio originally designed by NCMS plans. After NCMS reimbursement, the prevalence of CHE was considerably high in all three provinces, and the absolute values of CIs were even higher than those before reimbursement, indicating the inequity exaggerated. CONCLUSION: Policymakers should further modify NCMS policy in rural China. The high OOP payment could be decreased by expanding the drug list and check directory for benefit package of NCMS to minimize the gap between nominal reimbursement ratio and effective reimbursement ratio. And the increase in medical expenditures should be controlled by monitoring excess demand from both medical service providers and patients, and changing fee-for-service payment for providers to a prospective payment system. Service accessibility and affordability for vulnerable rural residents should be protected by modifying regressive financing in NCMS, and by providing extra financial aid and reimbursement from government. BioMed Central 2016-05-04 /pmc/articles/PMC4855492/ /pubmed/27142618 http://dx.doi.org/10.1186/s12939-016-0361-5 Text en © Ma et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Ma, Jingdong
Xu, Juan
Zhang, Zhiguo
Wang, Jing
New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China
title New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China
title_full New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China
title_fullStr New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China
title_full_unstemmed New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China
title_short New cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural China
title_sort new cooperative medical scheme decreased financial burden but expanded the gap of income-related inequity: evidence from three provinces in rural china
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855492/
https://www.ncbi.nlm.nih.gov/pubmed/27142618
http://dx.doi.org/10.1186/s12939-016-0361-5
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