An evaluation of China's new rural cooperative medical system: achievements and inadequacies from policy goals.
An evaluation of China's new rural cooperative medical system: achievements and inadequacies from policy goals.
复制标题
中国新型农村合作医疗制度评价：从政策目标看成绩与不足
DOI：
10.1186/s12889-015-2410-1
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发表时间：
2015-10-23
影响因子：
4.5
通讯作者：
Hao M
中科院分区：
文献类型：
--
作者：
Li C;Hou Y;Sun M;Lu J;Wang Y;Li X;Chang F;Hao M
中国新型农村合作医疗制度实施以来，虽然公众关注和学术关注都集中在制度实施的评价上，但很少有研究系统地评价政策目标的实现情况。这项研究的目的是检查新农合的政策目标在多大程度上已经实现。采用多阶段抽样方法，于2000年和2008年对中国东部地区的9,787户和7,921户农户进行了两轮横断面入户调查。采用实施前后比较的方法，从重大健康危害致贫、医疗费用家庭财务风险和农村收入不平等三个方面对政策目标的实现情况进行评估。还进行了意向调查，以找出实施新农合制度的潜在障碍。健康危害致贫率由事前的2.69%降至事后的2.12%，下降21.13%。贫困严重度从之前的4.66%下降到3.02%，下降了35.18%。就医人群相对于总人口的经济风险从事前的2.62降至事后的2.03，下降了22.52%。作为改善收入公平效果的指标，坚尼系数从0.4629降至0.4541。NRCMS的效果明显优于RCMS。尽管取得了初步成果，但我们对主要受访者的意向调查发现，精算筹资方面的技术困难和更可持续的偿还时间表已成为实现新农合目标的最具挑战性的障碍，而提高新农合的保险费不再是那么大的障碍。中国通过新农合建立了医疗保障体系，以减轻农村居民的医疗保健经济负担。新农合取得了一些积极但有限的效果，但实施中的技术困难已成为实现预定政策目标的障碍。应努力改进为新农合实施者设计补偿计划的能力建设，例如确定医疗贫困，计算风险分担的精算资金水平。
Although much public scrutiny and academic attention has focused on the evaluations of system implementation since the beginning of New Rural Cooperative Medical System (NRCMS) in China, few studies have systematically evaluated the achievements of the stated policy goals. The purpose of this study is to examine to what extent the policy goals of NRCMS have been achieved. Using multistage sampling processes, two rounds of cross-sectional household surveys including 9787 and 7921 rural households were conducted in Eastern China in year 2000 and year 2008, respectively. A pre- and post-implementation comparison was used to evaluate the achievement of policy goals in three measures: impoverishment from major health hazards, household financial risk from medical expenses, and rural income inequity. Intention surveys were also applied to find out potential obstacles in the implementation of NRCMS. The rate of re-impoverishment from health hazard was reduced from 2.69 % ex ante to 2.12 % ex post, a decrease of 21.13 %. The severity of impoverishment fell from a previous 4.66 % to 3.02 %, a decline of 35.18 %. Economic risk of medical treatment population relative to the whole population fell from 2.62 ex ante to 2.03 ex post, a 22.52 % reduction. As indication of effect on improving income equity, the Gini coefficient fell from 0.4629 to 0.4541. The effects of NRCMS were significantly better than those of RCMS. Despite the preliminary achievements, our intention survey of key respondents identified that technical difficulties in actuarial funding and more sustainable reimbursement schedules has become the most challenging barriers in achieving the goals of NRCMS, while raising the insurance premium on NRCMS was no longer as big a barrier. With NRCMS, China has established a medical security system to reduce the financial burden of healthcare on rural residents. NRCMS has achieved some positive though limited effects; but technical difficulties in the implementation of NRCMS have become barriers to achieve the pre-set policy goals. Efforts should be made to improve the capacity building in the design of the reimbursement schemes for the implementers of NRCMS, such as identifying medical impoverishment, calculating actuarial funding levels for the risk pooling.