CATASTROPHIC MEDICAL PAYMENT AND FINANCIAL PROTECTION IN RURAL CHINA: EVIDENCE FROM THE NEW COOPERATIVE MEDICAL SCHEME IN SHANDONG PROVINCE
CATASTROPHIC MEDICAL PAYMENT AND FINANCIAL PROTECTION IN RURAL CHINA: EVIDENCE FROM THE NEW COOPERATIVE MEDICAL SCHEME IN SHANDONG PROVINCE
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DOI：
10.1002/hec.1346
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发表时间：
2009-01-01
期刊：
影响因子：
2.1
通讯作者：
Sleigh, Adrian C.
中科院分区：
文献类型：
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作者：
Sun, Xiaoyun;Jackson, Sukhan;Sleigh, Adrian C.
目的：为研究新型农村合作医疗（NCMS）对山东省临猗县农村居民灾难性医疗费用的影响，采用分层整群抽样方法，对2005年山东省临猗县3101户农村居民进行了调查，通过对NCMS报销单的检索和关键知情人的访谈，确定了375户可能存在灾难性医疗费用风险的农户。我们采访了这375户家庭，并证实231户在2004年期间有灾难性的付款（>= 40%的档案家庭支付能力; CTP）。我们的筛选方法的有效性测试发现，另外8个案例中的近邻，这375个家庭，通过外推，我们得到了调整后的总数为289个灾难性的家庭在3101个样本。本文通过反事实分析，比较了新型农村合作医疗补偿前后的灾难性支出，测量了新型农村合作医疗对贫困缓解的影响。在实施新型农村合作医疗之前，临沂市有8.98%的人有过灾难性的自付经历，实施新型农村合作医疗后，这一比例为8.25%。灾难严重度的家庭仍然在灾难后报销下降了18.7%，平均为6.34倍的家庭的CTP。结论：自付医疗费用仍然是农村家庭的负担。全国医疗保险制度的财务保护（平均报销率为17.8%）并不高，应该进行重组，以针对最需要的人提供更好的福利。版权所有（c）2008约翰威利父子有限公司。
Objective: To measure the impact of China's New Cooperative Medical Scheme (NCMS) on catastrophic medical payments of rural households in Linyi County, Shandong Province.Method: In 2005, from a stratified cluster sample of 3101 rural households, we identified 375 households that might be at risk of catastrophic payments by searching through NCMS claims and interviewing key informants. We interviewed these 375 households and confirmed that 231 had had catastrophic payments (>= 40% of file households' capacity to pay; CTP) during 2004. A validity test of our screening method found another eight cases among immediate neighbours of these 375 households; by extrapolation, we obtained an adjusted total of 289 catastrophic households in the sample of 3101. We measured the impact of the NCMS on hardship alleviation by counterfactual analysis, comparing catastrophic payments before and after NCMS reimbursements.Result: The effect was twofold. Before NCMS intervention 8.98% of Linyi population had had catastrophic out-of-pocket payments compared with 8.25% after reimbursements. Catastrophic severity for households remaining in catastrophe after reimbursement dropped by 18.7% to an average of 6.34 times the household's CTP.Conclusion: Out-of-pocket medical payments remain a burden for rural households. Financial protection from the NCMS, with ail average reimbursement of 17.8%, was modest and should be restructured to provide better benefits that are targeted to those in most need. Copyright (c) 2008 John Wiley & Sons, Ltd.