Pan Bingbing, Towne Samuel D, Chen Yuxing, Yuan ZhaoKang
Department of Health Statistics, School of Public Health, Nanchang University, Nanchang, People' Republic of China.
Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA.
Health Policy Plan. 2017 Jun 1;32(5):634-646. doi: 10.1093/heapol/czw175.
The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China.
A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality.
An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year.
The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended.
2003年实施的新型农村合作医疗制度（新农合）的主要目标是减少弱势群体在获得医疗服务方面的经济障碍。本研究的目的是评估新农合与中国江西省农村居民住院利用方面的收入相关不平等之间的关联。
采用多阶段分层随机整群抽样方法，分别选取1838户、1879户和1890户家庭作为2003/2004年、2008年和2014年的研究对象。计算包括住院和避免住院这两项住院医疗服务指标的艾雷格斯集中指数（EI），以衡量与收入相关的不平等。对EI进行分解，以描述社会经济和需求因素对所测不平等的贡献。
随着时间推移，在调整需求因素后，住院方面观察到以富裕人群为重点（有利于富人）的不平等。住院不平等水平大幅下降，而避免住院情况略有下降，2008年的值较高（EI，-0.0176）。新农合的实施与2008年和2014年不平等的减少有关，但关联有限。每年收入对住院利用不平等的贡献最大。
到2014年，新农合覆盖范围扩大到江西省几乎所有农村居民，且与住院不平等的微小减少相关。为了增加公平获得医疗服务的机会，需要为弱势群体提供额外的经济保护。建议提高乡镇医院相对较低的医疗服务水平以及新农合的低报销率和财政补助。
