Guo Na, Iversen Tor, Lu Mingshan, Wang Jian, Shi Luwen
School of Pharmaceutical Sciences, Peking University, Beijing, China.
International Research Center for Medicinal Administration, Peking University, Beijing, China.
BMC Health Serv Res. 2016 Nov 14;16(1):653. doi: 10.1186/s12913-016-1883-7.
In 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country's vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the goal of reducing the risk and inequality of catastrophic health spending for rural residents in China.
We conducted a face-to-face household survey in three counties of the Shandong province in 2009 and 2012. Using this unique panel data, we examined the changes in the incidence and intensity of catastrophic health expenditures (CHEs) before and after NCMS reimbursement. We used concentration index (CI) and decomposition method to study the changes in inequality in CHEs.
We found that NCMS reimbursement played a role of reducing both the incidence and intensity of CHEs, and that this impact was stronger after the new health care reform was launched. After reimbursement, the concentration indices for CHEs were 0.073 and 0.021 in 2009 and 2012, indicating that the rich had a greater tendency to incur CHEs and there existed less inequality in the incidence of CHEs after reimbursement in 2012 compared with 2009. The decomposition analysis results suggested that changes in CHE inequality between 2009 and 2012 were attributed to changes in economic status and household size rather than reimbursement levels.
Our results indicated that inequality was shrinking from 2009 to 2012, which could be a result of fewer rich people having CHEs in 2012 compared with 2009. The impact of NCMS in alleviating the financial burden of rural residents was still limited, especially among the poor. Health care reform policies in China that aim to reduce CHEs must continue to place an emphasis on improving reimbursement, cost containment, and reducing income inequalities.
2003年，中国推出新型农村合作医疗制度（新农合），为广大农村人口重新建立医疗保险。此外，2009年新医改启动后，新农合的覆盖范围不断扩大。本研究旨在探讨新农合及其近期的扩面是否实现了降低中国农村居民灾难性医疗支出风险和不平等的目标。
2009年和2012年，我们在山东省的三个县进行了面对面的家庭调查。利用这一独特的面板数据，我们研究了新农合报销前后灾难性医疗支出（CHEs）的发生率和强度变化。我们使用集中指数（CI）和分解方法来研究CHEs不平等的变化。
我们发现，新农合报销起到了降低CHEs发生率和强度的作用，且在新医改启动后这种影响更强。报销后，2009年和2012年CHEs的集中指数分别为0.073和0.021，表明富人发生CHEs的倾向更大，与2009年相比，2012年报销后CHEs发生率的不平等程度有所降低。分解分析结果表明，2009年至2012年CHEs不平等的变化归因于经济状况和家庭规模的变化，而非报销水平。
我们的结果表明，2009年至2012年不平等程度在缩小，这可能是因为与2009年相比，2012年发生CHEs的富人减少。新农合在减轻农村居民经济负担方面的影响仍然有限，尤其是对贫困人口。中国旨在减少CHEs的医疗改革政策必须继续强调提高报销水平、控制成本和减少收入不平等。
