Xie Biao, Huo Minghe, Wang Zhiqiang, Chen Yongjie, Fu Rong, Liu Meina, Meng Qun
Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, China.
Department of Health Management, Public Health College, Harbin Medical University, Harbin, China.
BMJ Open. 2018 Feb 8;8(2):e019442. doi: 10.1136/bmjopen-2017-019442.
To evaluate the trend of catastrophic health expenses (CHE) for inpatient care in relation to the commencement of the New Cooperative Medical Scheme (NCMS) in rural China from 2003 to 2013, and the roles of NCMS in protecting affected households from CHE.
We assessed the 10-year trend of the incidence and severity of CHE in rural households with hospitalised members using data from the Chinese National Health Services Survey. Generalised estimating equations were used to estimate the OR and 95% CI of the association between incidence rates of CHE ([Formula: see text]) and NCMS reimbursement.
The incidence and severity of CHE after NCMS reimbursement both decreased and their changes increased rapidly from 2003 to 2013. After adjustment of the covariates, [Formula: see text] before reimbursement was significantly higher than that after reimbursement, and the OR (95% CI) was 1.50 (1.24 to 1.81), 1.79 (1.69 to 1.90) and 2.94 (2.77 to 3.11) in 2003, 2008 and 2013, respectively.
The incidence and severity of CHE both reduced after NCMS reimbursements in each year. Excluding some confounding factors, [Formula: see text] was significantly associated with NCMS reimbursement. NCMS partly protected the rural households with hospitalised members from CHE. However, the inequalities between different income groups still existed. [Formula: see text] in rural households with hospitalised members was still rather high in 2003, 2008 and 2013 even though they were covered by NCMS. This study will provide suggestions for further reforms in China and guidance for other low-income/middle-income countries.
评估2003年至2013年中国农村新型农村合作医疗制度（新农合）启动后住院治疗灾难性医疗支出（CHE）的趋势，以及新农合在保护受影响家庭免受CHE影响方面的作用。
我们利用中国国家卫生服务调查的数据，评估了有住院成员的农村家庭中CHE的发生率和严重程度的10年趋势。采用广义估计方程来估计CHE发生率（[公式：见原文]）与新农合报销之间关联的比值比（OR）和95%置信区间（CI）。
新农合报销后CHE的发生率和严重程度均有所下降，且从2003年至2013年其变化迅速增加。在调整协变量后，报销前的[公式：见原文]显著高于报销后，2003年、2008年和2013年的OR（95%CI）分别为1.50（1.24至1.81）、1.79（1.69至1.90）和2.94（2.77至3.11）。
每年新农合报销后CHE的发生率和严重程度均有所降低。排除一些混杂因素后，[公式：见原文]与新农合报销显著相关。新农合在一定程度上保护了有住院成员的农村家庭免受CHE影响。然而，不同收入群体之间的不平等仍然存在。2003年、2008年和2013年，即使有住院成员的农村家庭参加了新农合，其[公式：见原文]仍然相当高。本研究将为中国的进一步改革提供建议，并为其他低收入/中等收入国家提供指导。
