Center for Health Management and Policy, Shandong University, Ji'nan, Shandong Province, China.
PLoS One. 2013;8(1):e53062. doi: 10.1371/journal.pone.0053062. Epub 2013 Jan 9.
The New Cooperative Medical Scheme (NCMS) provides health insurance coverage for rural populations in China. This study aimed to evaluate changes in household catastrophic health expenditure (CHE) due to chronic disease before and after the reimbursement policies for services of chronic disease were implemented to provide additional financial support.
The study used data from the household surveys conducted in Shandong Province and Ningxia Hui Autonomous Region in 2006 and 2008. The study sample in village-level units was divided into two groups: 36 villages which implemented the NCMS reimbursement policies for chronic diseases as the intervention group, and 72 villages which did not as the control group. Health care expenditure of more than 40% of household's non-food expenditure was defined as a household with CHE (i.e., impoverishment). The conceptual framework was established based on the Andersen socio-behavioral model of health care utilization to explore how the NCMS reimbursement policies impacted health expenditures. A difference-in-difference model was employed to compare the change in the proportion of households incurring CHE due to chronic disease between the two groups over time.
The households that participated in the NCMS were less likely to become impoverished (P<0.05). In addition, the households with both male household head and higher income level were protective factors to prevent CHE (P<0.05). Young households with preschool children suffered less from CHE (P<0.05). The effect of the NCMS reimbursement policies for chronic disease on the CHE was negative, yet not statistically significant (p = 0.814).
The NCMS coverage showed financial protection for households with chronic disease. However, the NCMS reimbursement policies should be strengthened in the future.
新型农村合作医疗制度（NCMS）为中国农村人口提供了医疗保险。本研究旨在评估慢性病服务报销政策实施前后，由于慢性病导致的灾难性家庭卫生支出（CHE）的变化，以提供额外的财政支持。
本研究使用了 2006 年和 2008 年在山东省和宁夏回族自治区进行的家庭调查数据。村一级的研究样本分为两组：36 个实施慢性病 NCMS 报销政策的村作为干预组，72 个未实施的村作为对照组。将家庭非食品支出的 40%以上用于医疗支出定义为家庭有 CHE（即贫困）。根据安德森社会行为模型建立了概念框架，以探讨 NCMS 报销政策如何影响医疗支出。采用双重差分模型比较两组在慢性病导致的 CHE 比例随时间的变化。
参加 NCMS 的家庭不太可能陷入贫困（P<0.05）。此外，男性户主和较高收入水平的家庭是预防 CHE 的保护因素（P<0.05）。有学龄前儿童的年轻家庭较少受到 CHE 的影响（P<0.05）。慢性病 NCMS 报销政策对 CHE 的影响为负，但无统计学意义（p=0.814）。
NCMS 的覆盖范围为慢性病患者的家庭提供了财务保护。然而，未来 NCMS 报销政策应得到加强。
