Effective reimbursement rates of the rural health insurance among uncomplicated tuberculosis patients in China.

OBJECTIVE

China has established universal health coverage for 830 million rural residents through the rapid expansion of the New Cooperative Medical Scheme (NCMS). This study accesses the effective reimbursement rates of NCMS among patients with tuberculosis (TB) who lived in counties where their schemes covered costs within TB dispensaries and those who did not.

METHODS

We randomly selected 50 patients with uncomplicated TB from each of the eight counties in two provinces. We reviewed all patient clinical charts and conducted face-to-face surveys. Effective reimbursement was measured as the proportion of patients who received reimbursement from NCMS and the average reimbursement rate of total medical costs.

RESULTS

A total of 393 patients with TB were included with 186 from Zhejiang and 206 from Sichuan. In the covered group, only 41% of patients with TB received reimbursements for medical costs in TB dispensary in Zhejiang as compared to 84% in Sichuan, because patients in Zhejiang needed to keep their bills and claim later, while Sichuan had patient medical costs automatically deducted at the point of care. Patients in the covered group had a significantly higher average reimbursement rate compared with those in the uncovered group (13% vs. 8% in Zhejiang and 17% vs. 12% in Sichuan). For all patients, the biggest cost was due to hospitalisation, and their overall reimbursement rates were low.

CONCLUSION

New Cooperative Medical Scheme has not relieved the financial burden of TB-related medical costs. NCMS should cover costs in TB dispensaries. Measures are also needed to minimise unnecessary hospitalisation, and lower the barriers to claims.