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Ten-year impacts of China’s rural health scheme: lessons for universal health coverage

China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly ov...

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Autores principales: Zhang, Yaoguang, Dong, Di, Xu, Ling, Miao, Zhiwen, Mao, Wenhui, Sloan, Frank, Tang, Shenglan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070863/
https://www.ncbi.nlm.nih.gov/pubmed/33888485
http://dx.doi.org/10.1136/bmjgh-2020-003714
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author Zhang, Yaoguang
Dong, Di
Xu, Ling
Miao, Zhiwen
Mao, Wenhui
Sloan, Frank
Tang, Shenglan
author_facet Zhang, Yaoguang
Dong, Di
Xu, Ling
Miao, Zhiwen
Mao, Wenhui
Sloan, Frank
Tang, Shenglan
author_sort Zhang, Yaoguang
collection PubMed
description China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly over time. This study aims to assess the impact of changing NCMS policies on NCMS enrollees’ service utilisation, medical financial burden and equity between 2003 and 2013. Data are from China National Health Services Survey (NHSS) which is conducted every 5 years. We used the subsample of NHSS that were enrolled in NCMS in 2003, 2008 and 2013. From 2003 to 2013, we found increased service utilisation and an elimination of inequity in service utilisation with respect to income. Contradicting prior findings of increasing financial burden after the NCMS implementation, we identified significant protective effect of NCMS against financial risks, and a reduction in percentage of households with high medical expenditure in the middle-income and high-income quintiles. The rural residents from the low-income groups have high financial risk, therefore, should be the priority target for future reforms. In pursuit of UHC globally, many countries struggle to provide good coverage to the disadvantaged rural population and balance between the competing priorities of various UHC dimensions. Our trend analysis revealed China’s two-stage approach with NCMS reform that first focused on expanding population coverage, then on service coverage and financial risk protection. This path could potentially be replicated in other middle-income and low-income countries to pave the way for UHC.
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spelling pubmed-80708632021-05-11 Ten-year impacts of China’s rural health scheme: lessons for universal health coverage Zhang, Yaoguang Dong, Di Xu, Ling Miao, Zhiwen Mao, Wenhui Sloan, Frank Tang, Shenglan BMJ Glob Health Original Research China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly over time. This study aims to assess the impact of changing NCMS policies on NCMS enrollees’ service utilisation, medical financial burden and equity between 2003 and 2013. Data are from China National Health Services Survey (NHSS) which is conducted every 5 years. We used the subsample of NHSS that were enrolled in NCMS in 2003, 2008 and 2013. From 2003 to 2013, we found increased service utilisation and an elimination of inequity in service utilisation with respect to income. Contradicting prior findings of increasing financial burden after the NCMS implementation, we identified significant protective effect of NCMS against financial risks, and a reduction in percentage of households with high medical expenditure in the middle-income and high-income quintiles. The rural residents from the low-income groups have high financial risk, therefore, should be the priority target for future reforms. In pursuit of UHC globally, many countries struggle to provide good coverage to the disadvantaged rural population and balance between the competing priorities of various UHC dimensions. Our trend analysis revealed China’s two-stage approach with NCMS reform that first focused on expanding population coverage, then on service coverage and financial risk protection. This path could potentially be replicated in other middle-income and low-income countries to pave the way for UHC. BMJ Publishing Group 2021-04-22 /pmc/articles/PMC8070863/ /pubmed/33888485 http://dx.doi.org/10.1136/bmjgh-2020-003714 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Zhang, Yaoguang
Dong, Di
Xu, Ling
Miao, Zhiwen
Mao, Wenhui
Sloan, Frank
Tang, Shenglan
Ten-year impacts of China’s rural health scheme: lessons for universal health coverage
title Ten-year impacts of China’s rural health scheme: lessons for universal health coverage
title_full Ten-year impacts of China’s rural health scheme: lessons for universal health coverage
title_fullStr Ten-year impacts of China’s rural health scheme: lessons for universal health coverage
title_full_unstemmed Ten-year impacts of China’s rural health scheme: lessons for universal health coverage
title_short Ten-year impacts of China’s rural health scheme: lessons for universal health coverage
title_sort ten-year impacts of china’s rural health scheme: lessons for universal health coverage
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070863/
https://www.ncbi.nlm.nih.gov/pubmed/33888485
http://dx.doi.org/10.1136/bmjgh-2020-003714
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