Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?
Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?
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DOI：
10.1186/s12913-016-1883-7
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发表时间：
2016-11-14
影响因子：
2.8
通讯作者：
Shi L
中科院分区：
文献类型：
--
作者：
Guo N;Iversen T;Lu M;Wang J;Shi L
2003年，中国推出了新型合作医疗制度，为全国广大农村人口重新建立了医疗保险。此外，自2009年启动新的卫生保健改革以来，新农合的覆盖范围一直在扩大。本研究旨在考察新农合及其最近的扩展是否达到了降低中国农村居民灾难性医疗支出风险和不平等的目标。我们于2009年和2012年在山东省的三个县进行了面对面的入户调查。使用这一独特的面板数据，我们检查了在新农合报销前后灾难性卫生支出（CHEs）的发生率和强度的变化。我们采用浓度指数（CI）和分解方法研究了CHEs不平等的变化。我们发现，新农合报销对降低chs的发生率和强度都有作用，并且在新医改启动后这种影响更强。医保报销后，2009年和2012年的医保报销集中度指数分别为0.073和0.021，说明2012年医保报销后富人发生医保报销的倾向性更大，医保报销后医保报销发生率不平等程度较2009年有所降低。分解分析结果表明，2009年至2012年CHE不平等的变化归因于经济地位和家庭规模的变化，而不是报销水平的变化。我们的研究结果表明，从2009年到2012年，不平等现象正在缩小，这可能是2012年与2009年相比，拥有ch的富人数量减少的结果。新农合在减轻农村居民经济负担方面的作用仍然有限，特别是在贫困人口中。在中国，旨在减少慢性医疗保健的医疗改革政策必须继续把重点放在改善报销、成本控制和减少收入不平等上。
In 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country’s vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the goal of reducing the risk and inequality of catastrophic health spending for rural residents in China. We conducted a face-to-face household survey in three counties of the Shandong province in 2009 and 2012. Using this unique panel data, we examined the changes in the incidence and intensity of catastrophic health expenditures (CHEs) before and after NCMS reimbursement. We used concentration index (CI) and decomposition method to study the changes in inequality in CHEs. We found that NCMS reimbursement played a role of reducing both the incidence and intensity of CHEs, and that this impact was stronger after the new health care reform was launched. After reimbursement, the concentration indices for CHEs were 0.073 and 0.021 in 2009 and 2012, indicating that the rich had a greater tendency to incur CHEs and there existed less inequality in the incidence of CHEs after reimbursement in 2012 compared with 2009. The decomposition analysis results suggested that changes in CHE inequality between 2009 and 2012 were attributed to changes in economic status and household size rather than reimbursement levels. Our results indicated that inequality was shrinking from 2009 to 2012, which could be a result of fewer rich people having CHEs in 2012 compared with 2009. The impact of NCMS in alleviating the financial burden of rural residents was still limited, especially among the poor. Health care reform policies in China that aim to reduce CHEs must continue to place an emphasis on improving reimbursement, cost containment, and reducing income inequalities.
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影响因子：
4
作者：
Shi W;Chongsuvivatwong V;Geater A;Zhang J;Zhang H;Brombal D
通讯作者：
Brombal D
影响因子：
2.1
作者：
Lei, Xiaoyan;Lin, Wanchuan
通讯作者：
Lin, Wanchuan
影响因子：
5.4
作者：
Somkotra, Tewarit;Lagrada, Leizel P.
通讯作者：
Lagrada, Leizel P.
影响因子：
2.1
作者：
Wagstaff, A;van Doorslaer, E
通讯作者：
van Doorslaer, E
影响因子：
2.1
作者：
Van Doorslaer, Eddy;O'Donnell, Owen;Zhao, Yuxin
通讯作者：
Zhao, Yuxin