Zhang Donglan, Shi Lu, Tian Fang, Zhang Lingling
Department of Health Policy and Management, College of Public Health, University of Georgia, Wright Hall, 100 Foster Road, Athens, GA, 30602, USA.
Department of Public Health Sciences, Clemson University, 525 Edwards Hall, Clemson, SC, 29634-0745, USA.
Int J Behav Med. 2016 Dec;23(6):655-663. doi: 10.1007/s12529-016-9560-0.
China's New Rural Cooperative Medical Scheme (NRCMS), a healthcare financing system for rural residents in China, underwent significant enhancement since 2008. Studies based on pre-2008 NRCMS data showed an increase in inpatient care utilization after NRCMS coverage. However evidence was mixed for the relationship between outpatient care use and NRCMS coverage.
We assessed whether enrollment in the enhanced NRCMS was associated with less delaying or foregoing medical care, as a reduction in foregoing needed care signals about removing liquidity constraint among the enrollees.
Using a national sample of rural residents (N = 12,740) from the 2011-2012 wave of China Health and Retirement Longitudinal Study, we examined the association between NRCMS coverage and the likelihood of delaying or foregoing medical care (outpatient and inpatient) by survey-weighted regression models controlling for demographics, education, geographic regions, household expenditures, pre-existing chronic diseases, and access to local healthcare facilities. Zero-inflated negative binomial model was used to estimate the association between NRCMS coverage and number of medical visits.
NRCMS coverage was significantly associated with lower odds of delaying or foregoing inpatient care (OR: 0.42, 95 % CI: 0.22-0.81). A negative but insignificant association was found between NRCMS coverage and delaying/foregoing outpatient care when ill. Among those who needed health care, the expected number of outpatient visits for NRCMS enrollees was 1.35 (95 % CI: 1.03-1.77) times of those uninsured, and the expected number of inpatient visits for NRCMS enrollees was 1.83 (95 % CI: 1.16-2.88) times of those uninsured.
This study shows that the enhanced NRCMS coverage was associated with less delaying or foregoing inpatient care deemed as necessary by health professionals, which is likely to result from improved financial reimbursement of the NRCMS.
中国新型农村合作医疗制度（新农合）是中国农村居民的医疗融资体系，自2008年以来经历了重大改进。基于2008年前新农合数据的研究表明，新农合覆盖后住院服务利用率有所提高。然而，关于门诊服务使用与新农合覆盖之间的关系，证据并不一致。
我们评估了强化后的新农合参保是否与减少延迟或放弃医疗服务相关，因为减少放弃所需医疗服务表明消除了参保者的流动性约束。
利用2011 - 2012年中国健康与养老追踪调查的全国农村居民样本（N = 12740），我们通过控制人口统计学、教育程度、地理区域、家庭支出、既往慢性病以及当地医疗设施可及性的调查加权回归模型，研究了新农合覆盖与延迟或放弃医疗服务（门诊和住院）可能性之间的关联。采用零膨胀负二项模型来估计新农合覆盖与就诊次数之间的关联。
新农合覆盖与延迟或放弃住院服务的较低几率显著相关（比值比：0.42，95%置信区间：0.22 - 0.81）。新农合覆盖与生病时延迟/放弃门诊服务之间存在负相关但不显著。在那些需要医疗保健的人群中，新农合参保者的预期门诊就诊次数是未参保者的1.35倍（95%置信区间：1.03 - 1.77），新农合参保者的预期住院就诊次数是未参保者的1.83倍（95%置信区间：1.16 - 2.88）。
本研究表明，强化后的新农合覆盖与减少卫生专业人员认为必要的住院服务延迟或放弃相关，这可能是新农合财务报销改善的结果。
