Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
Int J Equity Health. 2009 Dec 9;8:42. doi: 10.1186/1475-9276-8-42.
A growing number of developing countries are developing health insurance schemes that aim to protect households, particularly the poor, from financial catastrophe and impoverishment caused by unaffordable medical care. This paper investigates the extent to which patients suffering from chronic disease in rural China face catastrophic expenditure on healthcare, and how far the New Co-operative Medical Insurance Scheme (NCMS) offers them financial protection against this.
A household survey was conducted in six counties in Ningxia Autonomous Region and Shandong Province, with a total of 6,147 rural households, including 3944 individual chronic disease patients. Structured questionnaires were used with chronic disease patients to investigate: their basic social and economic characteristics, including income and expenditure levels and NCMS membership; and their health care utilization, associated healthcare costs and levels of reimbursement by NCMS. 'Catastrophic' expenditure was defined as healthcare expenditure of more than 40% of household non-food expenditure.
Expenditure for chronic diseases accounted for an average of 27% of annual non-food per capita expenditure amongst NCMS members in Shandong and 35% in Ningxia. 14-15% of families in both provinces spent more than 40% of their non-food expenditure on chronic healthcare costs. Between 8 and 11% of non NCMS members and 13% of NCMS members did not seek any medical care for chronic illness. A greater proportion of NCMS members in the poorest quintile faced catastrophic expenditure as compared to those in the richest quintile in both study sites. A slightly higher proportion of non-NCMS members than NCMS member households faced catastrophic expenditure, but the difference was not statistically significant.
A significant proportion of patients with chronic diseases face catastrophic healthcare costs and these are especially heavy for the poor. The NCMS offers only a limited degree of financial protection. The heavy financial burden of healthcare for chronic disease poses an urgent challenge to the NCMS. There is an urgent need for a clear policy on how to offer financial protection to those with chronic disease.
越来越多的发展中国家正在制定医疗保险计划，旨在保护家庭，特别是贫困家庭，使其免受因无法负担的医疗费用而导致的经济灾难和贫困。本文研究了中国农村地区慢性病患者在医疗保健方面面临灾难性支出的程度，以及新型农村合作医疗制度（NCMS）在多大程度上为他们提供了抵御这种风险的经济保护。
在宁夏回族自治区和山东省的六个县进行了一项家庭调查，共有 6147 户农村家庭，包括 3944 名个体慢性病患者。使用慢性病患者的结构化问卷，调查了他们的基本社会经济特征，包括收入和支出水平以及 NCMS 成员资格；以及他们的医疗保健利用情况、相关医疗费用和 NCMS 的报销水平。“灾难性”支出被定义为医疗支出超过家庭非食品支出的 40%。
在山东，NCMS 成员的慢性病支出平均占人均年非食品支出的 27%；在宁夏，这一比例为 35%。两省各有 14-15%的家庭在慢性病医疗费用上的支出超过了非食品支出的 40%。在两个研究地点，8-11%的非 NCMS 成员和 13%的 NCMS 成员没有为慢性病寻求任何医疗服务。在最贫困的五分位组中，NCMS 成员面临灾难性支出的比例高于最富裕的五分位组。非 NCMS 成员家庭面临灾难性支出的比例略高于 NCMS 成员家庭，但差异无统计学意义。
相当一部分慢性病患者面临灾难性的医疗保健费用，而贫困人口的负担尤其沉重。NCMS 仅提供有限程度的经济保护。慢性病医疗保健的沉重经济负担对 NCMS 构成了紧迫挑战。迫切需要制定一项明确的政策，为慢性病患者提供经济保护。
