How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China.
How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China.
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DOI：
10.1186/1472-6963-10-116
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发表时间：
2010-05-10
影响因子：
2.8
通讯作者：
Liu X
中科院分区：
文献类型：
--
作者：
Yu B;Meng Q;Collins C;Tolhurst R;Tang S;Yan F;Bogg L;Liu X
许多国家正在发展卫生筹资机制，以实现全民覆盖的目标。在中国，自2003年以来，一项名为“新型合作医疗”的农村医疗保险制度正在发展。尽管人们关注新农合是否会影响中国农村卫生服务利用不公平的严重状况，但现有证据有限。本文旨在评估中国农村不同收入群体和省份在新农合下门诊和住院服务的利用情况。采用多阶段抽样方法，对山东省和宁夏6个县的6147户农户和22636人进行了横断面调查。采用卡方检验、泊松回归和对数线性回归分析NCMS与门诊、住院服务利用和住院时间的关系。采用个别访谈和焦点小组讨论等定性方法对住户调查结果进行解释和补充。2006年，山东和宁夏的新农合覆盖率分别为95.9%和88.0%。不论收入水平和地区，新农合会籍与门诊服务利用率无显著关联。在新农合下，高收入群体的住院服务利用率有所提高，但中低收入群体的变化不显著。与非会员相比，来自宁夏的新农合会员使用住院服务的频率更高，而来自山东的新农合会员住院时间更长。医疗费用高、报销率低以及地区间新农合政策设计差异是造成卫生服务利用差异的主要原因。在新农合制度下，门诊服务利用率没有显著变化。虽然在新农合制度下，住院服务的利用总体上有所增加，但高收入人群往往比低收入群体受益更多。虽然提供针对灾难性医疗支出的财务保护是新农合的主要重点，但本研究建议门诊服务应纳入未来的新农合政策制定。新农合政策也应更加注重公平，以实现其政策目标。
Many countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China. Using multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey. NCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location. Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital. High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization. Outpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low income group. While providing financial protection against catastrophic medical expenditure is the principal focus of NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development. NCMS policy should also be more equity oriented to achieve its policy goal.
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