Study On The Effect Of New Cooperative Medical Schemes On The Economic Burden Of Disease

The role of health insurance became more and more important with the rising health expenditure and the aging of population. 70% of the population in China are living in rural area. In 1980s, the Cooperative Medical Schemes which used to be very important in rural areas collapsed during the economic restructuring. The economic burden of disease was very heavy for rural people.In order to decrease the burden of the rural residents, in October of 2002 , on the meeting about rural health works . The government decided to build the New Cooperative Medical Schemes. Now, the NCMS has become the main health insurance in rural area.After developing for six years and the increasing of premium and reimbursement rate, we must study on whether the NCMS could reduce the economic burden, how much burden could it reduce.Purpose: To study the economic burden of the rural in 2006 and 2008 before and after the reimbursement of NCMS. Find out the effect of NCMS on the expenditure of outpatient and inpatient service. Supply evidence to the policy maker of NCMS management.Methodology: In this study, stratified sampling is used to select samples in Shandong Province and Ningxia Hui Municipality in 2006 and 2008. 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, descriptive statistical methods are used in the analysis. Descriptive statistical method is used for the factors of economic burden of disease as the spending of outpatient and outpatient service and factors of the effect of NCMS on financial burden as the reimbursement rate and evidence of catastrophic health expenditure, etc.The major results include: 1) Economic burden: The health expenditure per capita is about 200 yuan, health expenditure per family is nearly 800-1000 yuan in 2006 and 2008. The borrowing rate because of disease declined in 2008; 2) Benefit rate: The benefit rate of outpatient is higher in 2008 than in 2006. The benefit rate of inpatient improved in both provinces in 2008, nearly 70%-80% in township hospital and county hospital. 3) The reimbursement rate: The reimbursement rate for outpatient in each level of Medical institutions improved in both provinces. The rate was above 20% in village clinic in Shandong and Ningxia in 2008. The rate of township hospital improved most.In Ningxia it was 50% and in Shandong it was above 30% in 2008. The improvement of reimbursement rate for inpatient is the same as the outpatient. The reimbursement rate in township hospital in Shandong is 32.1%, increasing by 11.5% than 2006, in Ningxia is 38.1%, 15.8% higher than 2006. The rate in county hospital increased in Ningxia by 21% and 9% in Shandong in 2006. The reimbursement rate in tertiary hospital is almost the same for both provinces, about 15%. 4) Catastrophic health expenditure because of inpatient fees: The incidence of catastrophic health expenditure was declined by 20% after the reimbursement in 2008. The rate is much higher than 2006. The effect of NCMS on the mean gap of catastrophic health expenditure was higher in 2008 than 2006.The decreasing was above 30% in 2008.Conclusion includes: 1) Nowadays the economic burden of disease is very heavy for rural people. The expense rises with the rising of medical institution level. Village clinic is the first choice for the rural when common diseases happen because of its convenience and low price. The inpatient fees of much more different in every level of medical institution. The high inpatient fees is the main reason of catastrophe for a family. 2) The benefit rate of NCMS was improved. The policies of NCMS influence the outpatient benefit rate a lot. The reimbursement rate is still low for outpatient. For the inpatient, the real reimbursement rate is much lower than it is set in policy. 3) The effect of NCMS on reducing the catastrophic health expenditure is significantly higher in 2008. As the inpatient fees rising, it is difficult for NCMS to reduce the risk of catastrophe happens.Policy recommendations are as follows: 1) Increase the subsidy on NCMS for both government and rural people. 2) Increase the reimbursement rate of outpatient. Change the family account into risk pooling for outpatient service. 3) Cancel the deductible of inpatient reimbursement. It is important to reform the drug list of NCMS and supervise the behavior of doctors. 4) It is necessary to reform the supply side of health service. 5) Supporting policies: Village clinics and township hospitals are the main institution that rural resident often choose. Making policy improve the condition of the medical environment, the ability of the staff and improve the level of diagnosis .Encourage the rural to use the basic level when they visit a doctor for the first time. It's important to combine between Medicaid and NCMS. Second reimbursement should be given for very high expenditure. The government should make some policy on it.