The Equity Of Benefit For New Cooperative Medical System In Rural Area

Object: Take the equity of benefit from New Cooperative Medical System (NCMS) among the income groups as the core, analyzing the degree and the distribution of the benefit. The theory and method of the equity was used to find out the influence factors of inequity, and provide the policy basis for improving the equity of benefit from NCMS and promoting to realize the goal of NCMS, as well as provide the reference for the development of NCMS in the province, more effectively.Methods: The statistical descriptive methods, the concentration index, the poverty index and the incidence of catastrophic health expenditures to analyze the medical expenditure and compensation from NCMS of the different income groups used, and the equity of benefit from NCMS and the alleviation of the household out-of-pocket expenditure analyzed.Results: (1)Although the NCMS covered about 87.9% of the rural population, the level of the premium per person is 1.16% of the income per person year.(2)The benefit rate from NCMS is 1.56%, and the rate of compensation is 13.49% which is lower than the level from an evaluating survey nationally undertaking in 2006.(3)The rate of the household out-of-pocket medical expenditure in income quintile is 16.26% to 65.49%, and the lowest income quintile is the highest.(4)It is different from compensation rate in respective income quintile. The highest group gets 1197 yuan as the compensation, which is 6.5 times of the lowest ones. The concentration index of the compensation expense of in-patients is 0.158, which illustrate inequity in different income quintile. (5)The average out-of-pocket expense accounts for the family yearly average income theproportion is 33.03%. After the compensation from NCMS, the proportion reduces approximately 4.5 percentage points. (6)FGT index of the baseline is 0.1346. Before the compensation from NCMS, the index is 3.7555, which illustrate the disparity rapid increase among the poverty. After the compensation from NCMS, the index is 0.1378. Although the disparity has reduced, it is higher than the baseline. That is to say, inequity exists among the poverty benefit from NCMS.Discussion: The benefit from NCMS exist inequity vertically, the highest income quintile get most compensation from NCMS. After the compensation from NCMS, the burden is still heavy in the lowest income quintile. It is limited to reduce the disparity for NCMS.Policy Suggestion: (1) Improve the design of NCMS, and reduce the rate of co-payment in the low income crowd suitably. Adjust compensation mode of NCMS appropriately, reduce the rate of co-payment of the low income crowd, enhance the low income crowd the level of the compensation, and reduce the inequity of the benefit from NCMS. (2) Establish the multi-level medical security system, and strengthen the function of financial protection for the lower income crowd. Take NCMS as the main body, the supplement system of medical insurance and the medical assistant should establish. (3) Pay more attention to the poverty, and promote the equity of the benefit from NCMS among the poverty. Government might subsidy for the poverty by the insurance premium form directly. In the mean time, we should engage NCMS with Medical Assistance effectively, and enable it achieve double safeguard for the poverty. (4) Enhance the level of the income in the lower income quintile, and improve the equity of the benefit from NCMS. The government enlarges technology support for the low income people, and increases their incomes, so as to reduce substantially the disparity among the income quintile, and enhance their payment ability of out-of-pocket expense in health care.Conclusion: Using the concentration index and poverty index to study the equity of the benefit from NCMS, it exist inequity either among the income quintile or among the poverty, and the highest income quintile is the most beneficiary from NCMS.