Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiang'an Nan Road, Xiang'an District, Xiamen, 361102, Fujian, China.
Center for Health Economics Experiment and Public Policy, School of Public Health, Shandong University, Jinan, China.
Int J Equity Health. 2019 Feb 6;18(1):27. doi: 10.1186/s12939-019-0933-2.
The alarming progression of an increasingly aging population in China has attracted much attention within the country and abroad. In 2003, the Chinese central government launched the New Cooperative Medical Scheme (NCMS) to resolve problems of healthcare inequity in regions with inadequate infrastructure and relative poverty. The purpose of this study was to investigate the effect of NCMS on health expenditures by the Chinese rural elderly population.
The data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which was conducted in 2005, 2008, 2011 and 2014. Elderly people living in rural areas and 60 years old or above were screened for the investigation. The sample size was 7472 in 2005, 11,705 in 2008, 9239 in 2011, and 6059 in 2014. The OOP% and reimbursement ratio were the medical expenses paid by individuals accounting for their per capita annual income and the medical expenses paid by medical insurance accounting for their total medical expenses, respectively. By controlling for individuals' sociodemographic characteristics, pensions, demands and utilization of health services, we estimated the effect of the NCMS on the OOP% and reimbursement ratio for the rural elderly using seemingly unrelated regression (SUR).
The NCMS coverage ranged from 11.63% in 2005 to 80.34% in 2014. The medical expenses of the elderly also increased from an average of $204.77 in 2005 to $696.23 in 2014, which was more than three times as much as in 2005. From 2005 to 2014, the reimbursement ratio for medical expenses of rural elderly people with NCMS increased significantly from 30.6% in 2005 to 56.1% in 2014. The proportion of reimbursement ratio for rural seniors with NCMS increased by 6.4% across each survey cycle (every 3 years). However, the NCMS resulted in an insignificant decrease in OOP% by 1.4% across each survey cycle (every 3 years). Among other medical insurances, public insurance and private elder insurance had significant positive impacts on reimbursement ratio but did not influence OOP%.
NCMS remarkably increased the rural elderly's reimbursement ratio but insignificantly decreased the rural elderly's OOP%. In addition, the proportion of reimbursement ratio for NCMS participants increased by 6.4% every 3 years. Lower outpatient reimbursement, migration, limited reimbursement scope, an increasing demand for medical services and the rapid growth of medical expenses may be reasons for the gaps between the nominal reimbursement ratio and the actual reimbursement ratio and OOP%. Policymakers should further modify NCMS policies in rural China.
中国日益老龄化人口的惊人增长引起了国内外的广泛关注。2003 年，中国中央政府启动了新型农村合作医疗制度（NCMS），以解决基础设施不足和相对贫困地区医疗保健不平等的问题。本研究旨在调查 NCMS 对中国农村老年人口卫生支出的影响。
数据来自 2005 年、2008 年、2011 年和 2014 年进行的中国长寿纵向研究（CLHLS）。筛选出居住在农村地区且年龄在 60 岁及以上的老年人进行调查。2005 年的样本量为 7472 人，2008 年为 11705 人，2011 年为 9239 人，2014 年为 6059 人。自付比例%和报销比例分别为个人人均年收入中支付的医疗费用占比和医疗保险支付的医疗费用占总医疗费用的比例。通过控制个人的社会人口特征、养老金、卫生服务需求和利用情况，我们使用似不相关回归（SUR）估计了 NCMS 对农村老年人自付比例%和报销比例的影响。
NCMS 的覆盖范围从 2005 年的 11.63%到 2014 年的 80.34%。老年人的医疗费用也从 2005 年的平均 204.77 美元增加到 2014 年的 696.23 美元，是 2005 年的三倍多。2005 年至 2014 年，NCMS 农村老年人的医疗费用报销比例从 2005 年的 30.6%显著增加到 2014 年的 56.1%。每个调查周期（每 3 年），NCMS 农村老年人的报销比例增加了 6.4%。然而，NCMS 导致自付比例%每个调查周期（每 3 年）的变化不显著，减少了 1.4%。在其他医疗保险中，公共保险和私人老年人保险对报销比例有显著的正向影响，但对自付比例%没有影响。
NCMS 显著提高了农村老年人的报销比例，但对农村老年人的自付比例%影响不大。此外，NCMS 参与者的报销比例每 3 年增加 6.4%。较低的门诊报销、迁移、有限的报销范围、医疗服务需求的增加和医疗费用的快速增长，可能是名义报销比例和实际报销比例与自付比例%之间存在差距的原因。政策制定者应进一步修改中国农村的 NCMS 政策。
