Yang Wei, Wu Xun
Department of Social Policy, LSE Health, The London School of Economics and Political Science, London WC2A 2AE, UK and Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772
Department of Social Policy, LSE Health, The London School of Economics and Political Science, London WC2A 2AE, UK and Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772.
Health Policy Plan. 2015 Mar;30(2):187-96. doi: 10.1093/heapol/czt111. Epub 2014 Jan 28.
China's New Co-operative Medical Scheme (NCMS), a government-subsidized health insurance programme, was launched in 2003 in response to deterioration in access to health services in rural areas. Initially designed to cover inpatient care, it has begun to expand its benefit package to cover outpatient care since 2007. The impacts of this initiative on outpatient care costs have raised growing concern, in particular regarding whether it has in fact reduced out-of-pocket (OOP) payments for services among rural participants. This study investigates the impacts on outpatient costs by analysing data from an individual-level longitudinal survey, the China Health and Nutrition Survey, for 2004 and 2009, years shortly before and after NCMS began coverage of outpatient services in 2007. Various health econometrics strategies were employed in the analysis of these data, including the Two-Part Model, the Heckman Selection Model and Propensity Score Matching with the Differences-in-Differences model, to estimate the effects of the 2007 NCMS initiative on per episode outpatient costs. We find that NCMS outpatient coverage starting in 2007 had little impact on reducing its participants' OOP payments for outpatient services. The new coverage may also have contributed to an observed increase in total per episode outpatient costs billed to the insured patients. This increase was more pronounced among village clinics and township health centres-the backbone of the health system for rural residents-than at county and municipal hospitals.
中国新型农村合作医疗制度（新农合）是一项政府补贴的医疗保险计划，于2003年启动，以应对农村地区医疗服务可及性的恶化。该计划最初旨在覆盖住院治疗，自2007年起开始扩大福利包范围以涵盖门诊治疗。这一举措对门诊费用的影响引发了越来越多的关注，特别是它是否实际上降低了农村参保者的门诊服务自付费用。本研究通过分析来自个人层面纵向调查——中国健康与营养调查——2004年和2009年的数据来调查对门诊费用的影响，这两年分别是新农合在2007年开始覆盖门诊服务之前和之后不久。在分析这些数据时采用了各种健康计量经济学策略，包括两部模型、赫克曼选择模型以及倾向得分匹配与差分模型，以估计2007年新农合举措对每次门诊费用的影响。我们发现，2007年开始的新农合门诊覆盖对降低其参保者的门诊服务自付费用影响甚微。新的覆盖范围可能也导致了向参保患者收取的每次门诊总费用出现了观察到的增加。这种增加在村卫生室和乡镇卫生院（农村居民医疗体系的支柱）中比在县级和市级医院更为明显。
