Free Content How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?

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Abstract:

Summary Objectives  China has implemented the New Cooperative Medical Scheme (NCMS) in rural areas since 2003 to provide financial protection to its rural population. This article explores the effect of NCMS on relieving catastrophic health expenditure (CHE) among the poor and non-poor groups. Methods  A questionnaire survey was conducted in three counties, with a random sample of 358 poor and 523 non-poor NCMS enrollees who used inpatient services and obtained NCMS reimbursement in 2005. Results  Majority of NCMS enrollees suffered CHE because of using inpatient services; the occurrence and intensity of CHE was greater among poor inpatients. NCMS reimbursement helped relieve CHE to a certain degree. Poor inpatients benefited more from NCMS than non-poor, but the effects varied among counties. Cost control measures and other medical financial assistance (MFA) helped reduce inpatients’ economic burden. Conclusions  The objective of NCMS is only partly achieved. However, NCMS has promoted equity in health financing as poor inpatients can acquire more protection than the non-poor. Our analysis suggests that efforts should be made to improve NCMS design, strengthen cost containment and extend other MFA to further relieve economic burden of disease.

French
Objectifs: 

La Chine a adopté le Nouveau Schéma de Coopérative Médicale (NSCM) dans les zones rurales depuis 2003 afin de fournir une protection financière à sa population rurale. Cet article explore l’effet du NSCM sur le soulagement des dépenses catastrophiques de santé (DCS) dans les groupes pauvres ou non pauvres. Méthodes: 

Une surveillance par questionnaire a été menée dans trois comtés, avec un échantillon aléatoire de 358 pauvres et 523 non-pauvres inscrits dans le NSCM qui ont utilisé les services d’hospitalisation et obtenu le remboursement du NSCM en 2005. Résultats: 

La majorité des personnes inscrites au NSCM ont subi des DCS dues à l’utilisation des services d’hospitalisation, la fréquence et l’intensité de DCS ont été plus importantes chez les patients hospitalisés pauvres. Le remboursement par le NSCM a aidéà soulager la DCS à un certain degré. Les patients hospitalisés pauvres ont plus bénéficié de NSCM que les non-pauvres, mais les effets variaient selon les comtés. Des mesures de contrôle des coûts et autre assistance financière médicale ont contribuéà réduire la charge économique des patients hospitalisés. Conclusions: 

L’objectif du NSCM n’est que partiellement atteint. Toutefois, le NSCM a favorisé l’équité dans le financement de la santé car les patients hospitalisés pauvres peuvent acquérir une plus grande protection que les non-pauvres. Notre analyse suggère que des efforts devraient être faits pour améliorer la conception du NSCM, renforcer la maîtrise des coûts et étendre d’autres assistances financières médicales pour soulager d’avantage la charge économique des maladies.

Keywords: China; Chine; Gasto sanitario catastrófico; Seguro sanitario; actions; assurance maladie; catastrophic health expenditure; dépenses catastrophiques de santé; equidad; equity; health insurance

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2010.02469.x

Affiliations: 1:  Department of Health Economics, School of Public Health, Fudan University, Shanghai, China 2:  International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK

Publication date: April 1, 2010

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