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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,10.1002/he

Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province   (Citations: 13)
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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 the 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 an average reimbursement of 17.8%, was modest and should be restructured to provide better benefits that are targeted to those in most need. Copyright © 2008 John Wiley & Sons, Ltd.
Journal: Health Economics , vol. 18, no. 1, pp. 103-119, 2009
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    • ...Although coverage and the utilization of medical services has increased, and the costs of care have been reduced, out-of-pocket expenses for medical treatment is still a significant financial burden for many rural households (Sun, Jackson, Carmichael, & Sleigh, 2009)...

    Yapeng Zhu. Social Protection in Rural China: Recent Developments and Prospects

    • ...The schemes aim to prevent impoverishment by pooling funds raised from government and participants and reimbursing a proportion of health care costs [2,3]...

    Qicheng Jianget al. Evaluation of a pilot cooperative medical scheme in rural China: impac...

    • ...China, where there is a culture of a high rate of saving money (53% of total income) [19], non-essential expenditure is likely to be distorted by this propensity to save, hence household consumption expenditure is considered as not a good proxy of household economic status [20,21]...
    • ...The annual household income was defined as the aggregate of household income from production (10 categories), wage incomes of household members, transfer income (gifts, pensions, remittances, welfare) and property income (interest, rent) [20]...
    • ...Our study and other studies [13,20] demonstrate clearly that this facility is not reaching the population in need and its implementation, in relation to both the content and level of benefit, and the current mechanism for reaching the target population, needs to be carefully assessed...

    Wuxiang Shiet al. Effect of household and village characteristics on financial catastrop...

    • ...While the expansion of NCMS coverage since 2003 is impressive, there is, however, concern over whether these coverage rates are matched by improvements in the utilisation of health services, and how the impact differs between different income groups [11-13]...
    • ...Studies published internationally have also analysed the NCMS [11,12], but these studies have mainly focused on the impact of NCMS on financial protection...
    • ...For many common health problems (especially some chronic diseases), outpatient services are more commonly used for effective and efficient interventions; therefore considerable expenses will occur in outpatient services [11,12]...

    Baorong Yuet al. How does the New Cooperative Medical Scheme influence health service u...

    • ...Some studies[20-24] on NCMS for rural population have been carried out, but most of them focused on the capacity of NCMS in reducing financial risk and few studies could be found on the relationship between NCMS and health services utilization, and even fewer [25] on maternal healthcare utilization...

    Shengbin Xiaoet al. Utilization of delivery care among rural women in china: does the heal...

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