Study On Equity Of Medical Assistance Schemes For Catastrophic Illness Of Rural Residents

[Purpose] This study focuses on Equity of Medical Assistance Schemes for Catastrophic Illness of Rural Residents. We estimate epuity of two catastrophic medical assistance schemes. And simulate ?catastrophic health insurance(CHI) + catastrophic medical assistance based-on expenses(CMAE)? and ?catastrophic health insurance(CHI) + catastrophic medical assistance based-on disease(CMAD)?, then analyses and estimate anti-risk capacity and equity of the two different schemes, in order to provide theoretical and practical basis for improving catastrophic medical assistance schemes, after the implementation of catastrophic health insurance(CHI).[Methods]This study uses the framework put forward by WHO to exhibit reimbursement effect and then examines equity among the three dimensions of health insurance schemes: population coverage; the range of services covered; the extent to which health service costs are covered.We introduce domestic and foreign medical assistance schemes for catastrophic illness and estimation of equity by literature review, then we study and arrange these literature documents by Documentary Research Method.A claim database analysis of all hospitalizations reimbursed from 2010 to 2012 in the sampling area is conducted to identify the difference in reimbursement rates and OOP among patients with catastrophic illness and the remaining others. Health seeking behavior and medical expenses of 842 patients with catastrophic illness are collected by household survey. Descriptive Statistical Method, Parametric Statistics and Nonparametric Statistics are employed to analyze the reimbursement level of patients with catastrophic illness. Related indexes, such as catastrophic health expenditure(CHE) incidence and average gap and Counterfactual Analysis are used to measure the anti-risk capacity and epuity of catastrophic medical assistance schemes.[Results](1)City A: The coverage rate is 28.4%; actual reimbursement rate is 9.9%; the reimburseent money is 3719 yuan per capita; The incidence rate, average gap and relative gap of CHE are decreased by 0.9%, 1.7% and 1.3%. The effect of reducing the intensity and frequency of disease economic risk is extremely limited. The epuity of coverage of patients is limited.(2)City B: The coverage rate is 31.0%; actual reimbursement rate is 19.0%; the reimburseent money is 6731 yuan per capita; The incidence rate, average gap and relative gap of CHE are decreased by 5.8%, 10.0% and 6.9%. The effect of reducing the intensity and frequency of disease economic risk of CMAE is positive, and the epuity of coverage of patients is better than CMAD. But the deductible is too high and the reimbursement rate is too low. The ability of anti disease economic risk still needs to strengthen.(3) ?CHI + CMAE? schemes: The incidence rate, of CHE are decreased by 9.2% and 30.0%, which are still up to 86.2% and 65.4%. The average gap of CHE are decreased by 20.1% and 14.0%, which are still up to 34.5% and 20.5%. The relative gap of CHE are decreased by 17.2% and 8.6%, which are still up to 40.1% and 31.5%. The implemention of CHI has exacerbated the gap of CHE impact severity among different income family, but The implemention of CHI has narrowed the gap of CHE impact severity among different income family. The coordination effect of CHI and CMAE is positive, which is beneficial to improving health equity.(4) Ideal CMAE(the deductible is 10000 yuan and the reimbursement rate is 50% for another types of patients): The coverage rate is 79.2%; actual reimbursement rate is 35.8%; the reimburseent money is 6345 yuan per capita; The incidence rate, average gap and relative gap of CHE are decreased by 15.3%, 8.6% and 4.3%. The effect of reducing the intensity and frequency of disease economic risk is positive, and the epuity of coverage of patients is significantly improved[ Conclusions](1)For CMAD, the effect of reducing he economic burden of patients is extremely limited and the covereage of object patients is also limited, which will easily cause unepuity inside and outside of the schemes. CMAD has extended the covereage of object patients, which improving the epuity. And the of reducing the intensity and frequency of disease economic risk is positive, which is still insufficient, either. So we advise to gradually exploring and spreading the CMAD schemes in order to increase coverage rate of catastrophic medical assistance, which is order to improve the epuity.(2)The actual rebuisement rate of CMA is low because of high deductible, low policy rebuisement rate, narrow coverage of patients and imperfect mechanism of outpatient medical assistance. We advise to extend the coverage of expenditure assistance, which includes outpatient expenses, and set deductible and rebuisement rate scientifically in order to improve health epuity.(3)The coordination effect of CHI and CMAE is positive. CHE can reduce encomic burden of patients effectively, but it aggravate the unepuity of CHE. CMAE can also reduce encomic burden of patients effectively, and narrow the gap of CHE impact severity among different income family. We suggest strengthen the cohesion among catastrophic medical assistance, catastrophic health insurance, commercial insurance, and so on, in order to make more patient be covered by catastrophic medical assistance and alleviate e economic burden of catastrophic patients, effectively.(4) The amount of catastrophic medical assistance fund is insufficient and sources of financing is single. So it is inevitable to establish a reasonable-sharing funding mechanism of catastrophic medical assistance with multi sources. Increasing the proportion of financial budget for catastrophic medical assistance, defining the responsibilities of the central and local and rasing funds through social sources are recommended to used, so that the ?backstop? effect of catastrophic medical assistance can be strengthened.