Does the New Cooperative Medical Scheme Reduce Inequality in Catastrophic Health Expenditure in Rural China?

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2017 Jan 6

PMID 28052775

Citations 21

Authors

Na Guo

Tor Iversen

Mingshan Lu

Jian Wang

Luwen Shi

Affiliations

Soon will be listed here.

Abstract

Background: In 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country's vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the goal of reducing the risk and inequality of catastrophic health spending for rural residents in China.

Methods: We conducted a face-to-face household survey in three counties of the Shandong province in 2009 and 2012. Using this unique panel data, we examined the changes in the incidence and intensity of catastrophic health expenditures (CHEs) before and after NCMS reimbursement. We used concentration index (CI) and decomposition method to study the changes in inequality in CHEs.

Results: We found that NCMS reimbursement played a role of reducing both the incidence and intensity of CHEs, and that this impact was stronger after the new health care reform was launched. After reimbursement, the concentration indices for CHEs were 0.073 and 0.021 in 2009 and 2012, indicating that the rich had a greater tendency to incur CHEs and there existed less inequality in the incidence of CHEs after reimbursement in 2012 compared with 2009. The decomposition analysis results suggested that changes in CHE inequality between 2009 and 2012 were attributed to changes in economic status and household size rather than reimbursement levels.

Conclusions: Our results indicated that inequality was shrinking from 2009 to 2012, which could be a result of fewer rich people having CHEs in 2012 compared with 2009. The impact of NCMS in alleviating the financial burden of rural residents was still limited, especially among the poor. Health care reform policies in China that aim to reduce CHEs must continue to place an emphasis on improving reimbursement, cost containment, and reducing income inequalities.

Citing Articles

The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities.

Tao X, Zeng Y, Jiao W BMC Health Serv Res. 2024; 24(1):892.

PMID: 39103801 PMC: 11299280. DOI: 10.1186/s12913-024-11323-2.

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families' Wellbeing: An Investigation From Catastrophic Health Expenditure in China.

Xu X, Yang H Int J Public Health. 2022; 67:1605030.

PMID: 36090833 PMC: 9452624. DOI: 10.3389/ijph.2022.1605030.

Patterns of Outpatient Service Satisfaction among Low-Income Adults in Rural China: A Latent Class Analysis.

Lu P, Yang C, Yao J, Xian M, Shelley M Healthcare (Basel). 2022; 10(8).

PMID: 35893202 PMC: 9330119. DOI: 10.3390/healthcare10081380.

Socio-economic inequalities in health service utilization among Chinese rural migrant workers with New Cooperative Medical Scheme: a multilevel regression approach.

Li D, Zhang J, Yang J, Xu Y, Lyu R, Zhong L BMC Public Health. 2022; 22(1):1110.

PMID: 35659640 PMC: 9164856. DOI: 10.1186/s12889-022-13486-1.

The comparison of catastrophic health expenditure and its inequality between urban and rural households in China.

Fu X Health Econ Rev. 2022; 12(1):19.

PMID: 35266107 PMC: 8908628. DOI: 10.1186/s13561-022-00365-z.

References

Hosseinpoor A, van Doorslaer E, Speybroeck N, Naghavi M, Mohammad K, Majdzadeh R . Decomposing socioeconomic inequality in infant mortality in Iran. Int J Epidemiol. 2006; 35(5):1211-9. DOI: 10.1093/ije/dyl164. View

Devadasan N, Criel B, Van Damme W, Ranson K, Van der Stuyft P . Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Serv Res. 2007; 7:43. PMC: 1852553. DOI: 10.1186/1472-6963-7-43. View

Daneshkohan A, Karami M, Najafi F, Karami Matin B . Household catastrophic health expenditure. Iran J Public Health. 2012; 40(1):94-9. PMC: 3481728. View

van Doorslaer E, ODonnell O, Rannan-Eliya R, Somanathan A, Adhikari S, Garg C . Catastrophic payments for health care in Asia. Health Econ. 2007; 16(11):1159-84. DOI: 10.1002/hec.1209. View

Doorslaer E, Wagstaff A, Bleichrodt H, Calonge S, Gerdtham U, Gerfin M . Income-related inequalities in health: some international comparisons. J Health Econ. 1997; 16(1):93-112. DOI: 10.1016/s0167-6296(96)00532-2. View

Shi W, Chongsuvivatwong V, Geater A, Zhang J, Zhang H, Brombal D . The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China. Int J Equity Health. 2010; 9:7. PMC: 2838900. DOI: 10.1186/1475-9276-9-7. View

Nguyen H, Ivers R, Jan S, Martiniuk A, Pham C . Catastrophic household costs due to injury in Vietnam. Injury. 2012; 44(5):684-90. DOI: 10.1016/j.injury.2012.05.006. View

Sun X, Sleigh A, Carmichael G, Jackson S . Health payment-induced poverty under China's New Cooperative Medical Scheme in rural Shandong. Health Policy Plan. 2010; 25(5):419-26. DOI: 10.1093/heapol/czq010. View

Pal R . Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India. Int J Health Care Finance Econ. 2012; 12(1):63-85. DOI: 10.1007/s10754-012-9103-4. View

10.

Wagstaff A, Lindelow M . Can insurance increase financial risk? The curious case of health insurance in China. J Health Econ. 2008; 27(4):990-1005. DOI: 10.1016/j.jhealeco.2008.02.002. View

11.

Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q . Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme. J Health Econ. 2008; 28(1):1-19. DOI: 10.1016/j.jhealeco.2008.10.007. View

12.

Wagstaff A, van Doorslaer E . Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health Econ. 2003; 12(11):921-34. DOI: 10.1002/hec.776. View

13.

Sun X, Jackson S, Carmichael G, Sleigh A . Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ. 2008; 18(1):103-19. DOI: 10.1002/hec.1346. View

14.

van Doorslaer E, Masseria C, Koolman X . Inequalities in access to medical care by income in developed countries. CMAJ. 2006; 174(2):177-83. PMC: 1329455. DOI: 10.1503/cmaj.050584. View

15.

Liang X, Guo H, Jin C, Peng X, Zhang X . The effect of new cooperative medical scheme on health outcomes and alleviating catastrophic health expenditure in China: a systematic review. PLoS One. 2012; 7(8):e40850. PMC: 3423411. DOI: 10.1371/journal.pone.0040850. View

16.

Jing S, Yin A, Shi L, Liu J . Whether New Cooperative Mmedical Schemes reduce the economic burden of chronic disease in rural China. PLoS One. 2013; 8(1):e53062. PMC: 3541405. DOI: 10.1371/journal.pone.0053062. View

17.

Yardim M, Cilingiroglu N, Yardim N . Catastrophic health expenditure and impoverishment in Turkey. Health Policy. 2009; 94(1):26-33. DOI: 10.1016/j.healthpol.2009.08.006. View

18.

Zhang L, Cheng X, Tolhurst R, Tang S, Liu X . How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?. Trop Med Int Health. 2010; 15(4):468-75. DOI: 10.1111/j.1365-3156.2010.02469.x. View

19.

Somkotra T, Lagrada L . Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to Universal Coverage in Thailand. Soc Sci Med. 2008; 67(12):2027-35. DOI: 10.1016/j.socscimed.2008.09.047. View

20.

Kavosi Z, Rashidian A, Pourreza A, Majdzadeh R, Pourmalek F, Hosseinpour A . Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan. 2012; 27(7):613-23. DOI: 10.1093/heapol/czs001. View