Study On Benefit Distribution Of New Cooperative Medical Schemes

To develop social security system for protecting the vulnerables from catastrophic diseases in developing countries has been increasingly implemented. China has experienced rapid economic development and dramatic social changes over the past two decades. All these changes have had profound implications for every aspect of people's livings. Health care financing reform in China has led health facilities to largely rely on user charges, which has resulted in greater financial difficulties in accessing health care, especially for the rural poor. Due to lack of health protection, health related poverty is being one of serious social issues in rural China.Equity is one of the ultimate aims of national health policies. It is significant to study health equity in China with its increasing disparity in income. It is still an unsolved policy question to provide the most efficient health protection system for the poor against diseases caused economic burden. World Health Report 2000 says that a great deal of poor population lacked health protection against catastrophic diseases. In China, health protection is the groundwork for stabilizing socialist market. So, how to set up both equitable and sustainable health insurance is a must-solve policy question in rural area.With the data from European Union Project-Bringing health care to the vulnerable -developing equitable and sustainable rural health insurance in China and Vietnam, the benefit distribution of New Cooperative Medical Schemes (NCMS) is examined. The main objective of this study is to explore the equity of health services and to describe and examine the benefit difference between the poor and others and to discover the influencing factors.In this study, stratified sampling is used to select samples in Shandong Province and Ningxia Hui Municipality. According to the development levels of society and economic and the geographical distribution, Zhangqiu City (high economic level), Changle County (middle economic level), and DongE County (low economic level) in Shandong provice; and Qingtongxia (high economic level), Yongning County (middle economic level), and Zhongning County (low economic level) in Ningxia Hui Municipality are selected. The corresponding townships and villages are also selected by the same method. Quantity and Quality data are collected. One-way and multivariate statistical methods are used in the analysis of the healthcare service utilization and the benefit distribution and its influencing factors.The major results include: enrolment rates in both low-income and high-income groups are lower than the other middle-income groups. The enrolment rate in less-developed area and far geographic area is low. It is better for Shandong province than Ningxia Hui Municipality. To the poor, the policy that the Department of Civil Affair should pay the premium for Dibao family is not well carried out. There are still many poor people who are not enrolled. NCMS makes the release of the health demand, especially for the poor. The enrolment rate is relative low under the age of 35. Qualitative study has shown out there exists the adverse selection and some old people who lack of income resource are not excluded by the schemes, either. Both four-week visiting doctor rate and hospitalization rate are much higher than the national general level. Although the equity of health service utilization is relative good, over 60 percent of serious illness persons did not seek health services. Nearly half (48.14%) hospitalized NCMS members in the past year who suffered the catastrophic medical expenditures led them into poverty. Over 60 percentages of NCMS member families had ever benefited from the schemes. For outpatient services, the poor NCMS members in Zhangqiu benefits a little bit more, but Changle is very inequitable; for inpatient services, Zhangqiu, Yongning, and Changle are relatively equitable, Qingtongxia is also good, however, the equity in Zhongning and DongE are the worst. The factors influencing the outpatient benefit are including age, education, the geographic distance of the nearest health institute, and area variables; and the factors influencing the inpatient benefit are including income, hospital level, and area variables. Generally, the satisfaction of NCMS member families is good.Conclusion includes: can the NCMS member benefit from the scheme and benefit level is up to many internal and external factors. At present, the economic burden for hospitalization is still very high and NCMS protection capability is very limited for it can only delay the health related poverty. The poverty caused by catastrophic medical expenditure is still serious. The benefit distribution are relatively equitable in the well economic developed and good geographic area to both inpatient and outpatient services. Without deductibles or low deductibles are helpful to reduce the health service utilization and benefit barrier, but it must not better the benefit equity. Fix reimbursement rate in same level health institutes are also helpful to improve the equity.Policy recommendations are as follows: 1) to promote economic development and create convenient traffic conditions and to reinforce the foundation of township hospitals and promote the capability; 2) to encourage the department of Civil Affair to carry out the central government policy to pay the premium for the poor; 3) to cancel or reduce the deductibles to the poor and reimburse for outpatient service with a fixed reimbursement rate and set up a ceiling. A fixed reimbursement rate should also be used in same level hospitals for inpatient services, or to increase the reimbursement rate within the low medical expenditure scales and measure the optimal reimbursement rate; 4) to reform the payment method, it should be considered that hospitals should pay some part of medical expenditure for the poor so that they can utilize the health services and benefit from NCMS; 5) to carry out the medical assistance plan, we should help the catastrophic diseases families give more reimbursement, especially for those extremely poor families.