New evidence on the impact of China's New Rural Cooperative Medical Scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis.
New evidence on the impact of China's New Rural Cooperative Medical Scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis.
复制标题
DOI：
10.1136/bmj.c5617
复制
发表时间：
2010-10-21
期刊：
影响因子：
--
通讯作者：
Rozelle S
中科院分区：
文献类型：
--
作者：
Babiarz KS;Miller G;Yi H;Zhang L;Rozelle S
目的探讨旨在为8亿农村居民提供医疗保障和纠正农村初级卫生保健扭曲的新型农村合作医疗制度（NCMS）及其政策属性是否对村卫生室的运作和使用产生影响。设计我们进行了差异中的差异分析，使用多元线性回归，控制临床和个人属性以及村庄和年份的影响。在2004年和2007年，在中国五个省的25个县的100个村庄。 参与者160个村初级保健诊所和8339个人。 主要结果测量临床结果是对数平均每周病人流量，对数平均每月总收入，对数总的年净收入，每月总收入的比例从药品销售。个人结果是寻求医疗保健的概率，日志年度“自付”医疗支出，和两个措施暴露于金融风险（发生自付医疗支出的概率高于90百分位数的支出之间的未投保和融资的概率通过借贷或出售资产的医疗保健）。结果在村卫生室，实施新型农村合作医疗后，村卫生室每周就诊人次增加了26%，月总收入增加了29%，但年净收入和药品收入占月总收入的比例没有变化。对于个人而言，参加新型农村合作医疗与村诊所使用增加5%相关，但总体医疗服务使用没有变化。此外，自付医疗支出下降了19%，两项衡量金融风险的指标下降了24- 63%。这些变化发生在各种各样的州方案中，甚至在那些福利最少的州方案中。结论新型农村合作医疗为中国农村个人提供了一定的财务风险保护，并部分纠正了中国农村医疗的扭曲（减少专业服务和处方药的过度供应）。然而，该计划也可能将新的责任无偿转移给了村卫生室。鉴于中国政策制定者对加强初级保健的兴趣重新燃起，新型农村合作医疗的效果值得更多关注。
Objectives To determine whether China’s New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics. Design We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects. Setting 100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007. Participants 160 village primary care clinics and 8339 individuals. Main outcome measures Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual “out of pocket” health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets). Results For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages. Conclusions NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.
登录
查看更多内容
影响因子：
2.1
作者：
Brown, Philip H.;Theoharides, Caroline
通讯作者：
Theoharides, Caroline
影响因子：
3.5
作者：
Wagstaff, Adam;Lindelow, Magnus;Qian Juncheng
通讯作者：
Qian Juncheng
影响因子：
4.3
作者：
Rozelle, S
通讯作者：
Rozelle, S
影响因子：
5.4
作者：
Yip, W;Eggleston, K
通讯作者：
Eggleston, K
影响因子：
9.7
作者：
Yip, WC;Hsiao, WC
通讯作者：
Hsiao, WC