The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China.
The impact of the new cooperative medical scheme on financial burden of tuberculosis patients: evidence from six counties in China.
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DOI：
10.1186/s40249-015-0094-5
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发表时间：
2016-01-28
影响因子：
8.1
通讯作者：
Tang S
中科院分区：
文献类型：
--
作者：
Xiang L;Pan Y;Hou S;Zhang H;Sato KD;Li Q;Wang J;Tang S
中国的结核病患者在整个治疗过程中面临沉重的经济负担，目前尚不清楚中国的医疗保险制度如何在综合方法下影响减轻这一负担。本研究旨在测量中国农村新型农村合作医疗（NCMS）结核病服务的补偿情况，并评估补偿政策对灾难性卫生支出（CHE）的影响。补偿数据来自宜昌和汉中两市的常规数据系统。纳入2010 - 2012年全国新型农村合作医疗报销的结核病住院患者1884例。进行了住户调查。本研究共收集了494例新型农村合作医疗结核病患者。举行了12次焦点小组讨论。采用反事实分析法对新型农村合作医疗的影响进行了测度，分析了新型农村合作医疗对农民负担的缓解作用。公平性按集中指数评估，并按项目地点分列。结核病住院病人得到有效补偿，有效补偿率为57.3%。YC和HZ的门诊和住院诊断后平均自付费用分别为1413元和430元，3572元和3013元。由于门诊配额有限，诊断后结核病门诊治疗的报销水平非常低。HZ地区肺结核患者的有效补偿率较高，但CHE的发生率仍较高。两组间比较差异无统计学意义（P > 0.05）。CHE的严重程度略有减轻。报销后的CI均小于零，其绝对值高于报销前。对结核病患者的低补偿可能导致沉重的经济负担。贫困结核病患者CHE发生率高。结果表明，新型农村合作医疗对居民医疗保健具有保护作用，但其保护作用不大，居民医疗保健的公平性并未得到改善。未来应完善新型农村合作医疗报销政策，以包括更全面的护理覆盖范围。可能需要补充方案来扩大结核病护理的覆盖面。本文的在线版本（doi：10.1186/s40249-015-0094-5）包含补充材料，可供授权用户使用。
Tuberculosis (TB) patients in China encounter heavy financial burdens throughout the course of their treatment and it is unclear how China’s health insurance systems affect the alleviation of this burden under the integrated approach. This study aimed to measure reimbursement for TB services under the New Cooperative Medical Scheme (NCMS) in rural China and to evaluate changes in catastrophic health expenditure (CHE) caused by the reimbursement policies. Reimbursement data were obtained from routine data systems for the NCMS in Yichang (YC) and Hanzhong (HZ). 1884 TB inpatients reimbursed by NCMS from 2010 to 2012 were included. Household surveys were conducted. A total of 494 TB patients under the NCMS were selected in this paper. 12 Focus Group Discussions (FGDs) were held. We measured the impact of the NCMS by counterfactual analysis, which analyzed the financial burden alleviation. Equity was assessed by Concentration Index (CI), and disaggregated by project sites. TB inpatients were reimbursed with an effective reimbursement rate of 57.3 %. Average out-of-pocket (OOP) payments for outpatient and inpatient services after diagnosis were 1413 yuan and 430 yuan, and 3572 yuan and 3013 yuan in YC and HZ, respectively. The reimbursement level for TB outpatient care after diagnosis was very low due to a limited outpatient quota. TB patients in HZ incurred higher effective reimbursement rates, but the incidence of CHE remained higher. The reduction of CHE incidence after the NCMS showed no difference statistically (P > 0.05). The severity of CHE was alleviated slightly. CIs after reimbursement were all below zero and their absolute values were higher than those before reimbursement. Low reimbursement for TB patients could lead to heavy financial burden. Poor TB patients incurred high rates of CHE. The NCMS was found to be a protective factor for CHE, but the impact was modest and the equity of CHE did not improve. The NCMS reimbursement policies should be improved in the future to include a more comprehensive coverage of care. Supplemental programs may be necessary to expand coverage for TB care. The online version of this article (doi:10.1186/s40249-015-0094-5) contains supplementary material, which is available to authorized users.