School of Social Development and Public Policy, Beijing Normal University, Beijing, China.
PLoS One. 2012;7(8):e40850. doi: 10.1371/journal.pone.0040850. Epub 2012 Aug 20.
In 2002, the Chinese government launched a new rural health financing policy to provide health insurance (New Cooperative Medical Scheme, NCMS) for its rural population. NCMS, jointly financed by governments and individual households, aims to protect households from impoverishment due to catastrophic health expenditure. In 2011, NCMS covered more than 96% of the rural population. We have systematically searched and reviewed available evidence to estimate the effects of NCMS on health outcomes and on alleviating catastrophic health expenditure.
PubMed, Web of Science with Conference Proceedings, ProQuest Digital Dissertations, CMCI, CNKI, and VIP were searched. We also obtained literature from colleague communications. Quasi-experimental studies regarding the effect of NCMS on health outcomes and catastrophic health expenditure were included. Two independent reviewers screened the literature, extracted the data, and assessed the study quality.
Fifteen studies out of the 6123 studies in the literature fulfilled criteria and were included in this review. Twelve studies identified the relationship between NCMS and health outcomes, among which six studies measured sickness or injury in the past four weeks, four measured sickness or injury in the past two weeks, and five measured self-reported health status. Four studies focused on the relationship between NCMS and alleviating catastrophic health expenditure. However, the results from these studies were in conflict: individual studies indicated that NCMS had positive, negative, or no effect on health outcomes and/or the incidence of catastrophic health payments, respectively.
We still have no clear evidence that NCMS improves the health outcomes and decreases the alleviating catastrophic health expenditure of the China's rural population. In addition, the heterogeneity among individual studies reminds us that provider payment method reforms, benefit package and information systems around NCMS should be improved in the future.
2002 年，中国政府启动了一项新的农村卫生筹资政策，为农村人口提供健康保险（新型农村合作医疗制度，NCMS）。NCMS 由政府和个人家庭共同出资，旨在保护家庭免受因灾难性卫生支出而致贫。2011 年，NCMS 覆盖了超过 96%的农村人口。我们系统地搜索和审查了现有证据，以估计 NCMS 对健康结果和减轻灾难性卫生支出的影响。
我们检索了 PubMed、Web of Science with Conference Proceedings、ProQuest Digital Dissertations、CMCI、CNKI 和 VIP，并从同事的交流中获取了文献。我们纳入了关于 NCMS 对健康结果和灾难性卫生支出影响的准实验研究。两位独立的审查员筛选文献、提取数据并评估研究质量。
在 6123 篇文献中，有 15 篇符合标准并纳入本综述。其中 12 项研究确定了 NCMS 与健康结果之间的关系，其中 6 项研究测量了过去四周的疾病或伤害，4 项研究测量了过去两周的疾病或伤害，5 项研究测量了自我报告的健康状况。四项研究侧重于 NCMS 与减轻灾难性卫生支出之间的关系。然而，这些研究的结果相互矛盾：个别研究表明 NCMS 对健康结果和/或灾难性卫生支付的发生率分别有积极、消极或没有影响。
我们仍然没有明确的证据表明 NCMS 改善了中国农村人口的健康结果和减轻了灾难性卫生支出。此外，个别研究之间的异质性提醒我们，未来应改进 NCMS 的供方支付方式改革、福利套餐和信息系统。
