Health Human Resources Development Center, Ministry of Health, Beijing 100097, China.
Int J Equity Health. 2010 Feb 23;9:7. doi: 10.1186/1475-9276-9-7.
The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes.
A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview.
NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment.
The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.
新型农村合作医疗制度（NRCMS，自愿医疗保险）和医疗救助制度（MFA，财政救济计划）于 2003 年在中国农村建立。本研究的目的是记录它们的覆盖范围，评估它们对住院治疗的可及性以及对因健康支出而导致的灾难性财务和家庭贫困的保护作用，并确定在有和没有这些计划的情况下导致贫困的因素。
2008 年在河北省、陕西省和内蒙古自治区采用多阶段抽样技术进行了一项横断面家庭调查。通过访谈收集个人人口统计学特征、慢性病状况、医疗保健使用、家庭支出和家庭医疗支出信息。
NRCMS 覆盖了研究人群的 90.8%，在指定的贫困人口中，有 7.6%的人通过 MFA 支付保费。在调查前一年需要住院治疗的人中，有 34.3%的人没有住院，其中大部分（80.2%）是由于经济拮据。有 NRCMS 保险的人和没有保险的人在住院需求未得到满足方面没有显著差异。在报销前，灾难性医疗支出（家庭医疗支出超过家庭支付能力的 40%）和医疗贫困（由于医疗费用导致家庭人均收入低于贫困线）的发生率分别为 14.3%和 8.2%。NRCMS 使 9.9%的家庭免于灾难性财务支出，使 7.7%的家庭免于贫困，而 MFA 仅使一户家庭免于贫困，对灾难性财务支出没有影响。家庭人均支出和家庭慢性病比例（家庭中有慢性病成员的比例）是住院需求未得到满足、贫困风险和无法避免贫困的最重要决定因素。
农村人口对 NRCMS 的覆盖率很高，但还不足以改善住院治疗的可及性，并防止因健康支出而导致的灾难性财务和家庭贫困，特别是对贫困和慢性病患者。此外，MFA 几乎没有发挥这种作用；因此，当前的计划需要改进。
