Peking University China Center for Health Development Studies, Beijing 100191, China.
Int J Equity Health. 2014 May 16;13:38. doi: 10.1186/1475-9276-13-38.
The Chinese New Cooperative Medical Scheme (NCMS) was launched in 2003 aiming at protecting the poor in rural areas from high health expenditures and improving access to health services. The income related inequality of the reform is a debating and concerning policy issue in China. The purpose of this study is to analyze the degree and changes of income related inequalities in both inpatient and outpatient services among NCMS enrollees from 2007 to 2011.
Data was extracted from the NCMS information system of Junan County in Shandong province from 2007 to 2011. The study targeted all NCMS enrollees in the county, 726850 registered in 2011. Detailed information included demographic data, inpatient and outpatient data in each year. Descriptive analysis of quintiles and standardized concentration index (CI*) were employed to examine the income related inequalities in both inpatient and outpatient care.
For inpatient care, the benefit rate CI* was positive (pro-rich) and increased from 2007 to 2011 while for outpatient care was negative (pro-poor) and a decreasing pattern was observed. For outpatient visits and expenses, the CI* changed from a positive sign in 2007 to a negative sign in 2011 with some fluctuations. The pro-rich inequality exacerbated for admissions while alleviated for length of stay and total inpatient expenses during the study period. The pro-rich inequality for inpatient reimbursement aggravated from 2007 to 2010 and alleviated from 2010 to 2011. For outpatient reimbursement, it altered from a positive sign in 2007 to a small negative sign in 2011. Finally, the richer needed to afford more self-payments for inpatient services and the CI* decreased from 2009 to 2011 while the inequality for outpatient self-payments changed from pro-rich in 2007 to pro-poor in 2011.
In the NCMS, the pro-rich inequality dominated for the inpatient care while a pro-poor advantage was shown for outpatient care from 2007 to 2011 in Junan. The extent of pro-rich inequality in length of stay, inpatient expenses and inpatient reimbursement increased from 2007 to 2009, but recently between 2010 and 2011 showed a change favoring the poor.
中国新型农村合作医疗制度（NCMS）于 2003 年启动，旨在保护农村地区的贫困人口免受高额医疗支出的影响，并改善其获得医疗服务的机会。改革带来的收入相关不平等是中国一个备受争议和关注的政策问题。本研究旨在分析 2007 年至 2011 年期间，NCMS 参保人员在住院和门诊服务方面的收入相关不平等程度及其变化。
数据来自山东省莒南县的 NCMS 信息系统，时间跨度为 2007 年至 2011 年。研究对象为该县所有的 NCMS 参保人员，2011 年登记人数为 726850 人。详细信息包括人口统计学数据、每年的住院和门诊数据。采用五分位数法和标准化集中指数（CI*）描述分析，以检验住院和门诊服务中与收入相关的不平等程度。
对于住院治疗，受益率 CI为正（有利于富人），并从 2007 年至 2011 年呈上升趋势，而对于门诊治疗，CI为负（有利于穷人），呈下降趋势。对于门诊就诊次数和费用，CI在 2007 年为正，在 2011 年为负，期间存在波动。在研究期间，住院人数的富贫差距加剧，而住院天数和总住院费用的富贫差距有所缓解。住院补偿的富贫差距从 2007 年至 2010 年加剧，从 2010 年至 2011 年缓解。对于门诊补偿，它从 2007 年的正指数转变为 2011 年的小负指数。最后，富人需要承担更多的住院自费部分，CI从 2009 年至 2011 年下降，而门诊自费部分的富贫差距从 2007 年的有利于富人转变为 2011 年的有利于穷人。
在莒南县，2007 年至 2011 年期间，NCMS 参保人员的住院服务中存在有利于富人的不平等，而门诊服务中则存在有利于穷人的不平等。从 2007 年至 2009 年，住院天数、住院费用和住院补偿的富贫差距呈扩大趋势，但在 2010 年至 2011 年期间，情况有所改变，有利于穷人。
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