Study On Reimbursement Modes And Effect Of Catastrophic Health Insurance In Rural China In The Perspective Of UHC

[Purpose]This study focuses on patients with catastrophic illness in rural China. We evaluate their disease economic risk and its influence factors in the perspective of UHC, then, we estimate the effect of the New Rural Cooperative Medical Scheme(NCMS) and catastrophic health insurance(CHI) on alleviating their disease economic risk. And base on the above, we put forward reasonable advices on perfecting CHI, in order to improve its anti-risk capacity and equity.[Methods]This study based on the general international evaluation system of “structure-process-outcome”, combine the perspective of UHC, reasonable sets of metrics and measurement methods were designed to evaluate the policy,compensation effect, and fairness of the compensation.We introduce domestic and foreign health insurance schemes for catastrophic illness and evaluation of disease economic risk 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 2014 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 472 patients with catastrophic illness are collected by household survey. Descriptive Statistical Method, Parametric Statistics and Nonparametric Statistics are employed to analyze the reimbursement level and influencing factors of patients with catastrophic illness. Related indexes, such as catastrophic health expenditure(CHE) incidence and relative gap and Counterfactual Analysis, which analyzes the financial burden alleviation under NCMS and CHI, and the extent to which this results in CHE, are used to measure the anti-risk capacity of health insurance schemes. Meanwhile, we estimate the equity of their reimbursement effect by Concentration Index.Focus Group Discussions(FGDs) are held with the leaders in NCMS and health administrative departments and patients.[Results](1)After carding the CHI policy of every province, we find all the provinces are Weigh the fund strength To expand coverage and improve the level of security as possible, and combined with their own characteristics at the same time when it makes policy. In the implementation of CHI, In addition to the basic system difference on UE-BMI and UR-BMI, there are still other differences in all respects.(2)According to the NCMS database, inpatients with catastrophic illness were confronted with long length of stay, and the average level was 37 days. A majority of inpatients(90.0%) were hospitalized in tertiary medical institutes. Compared to the remaining others, their OOP remained high. Average OOP for inpatient care were 24000 Yuan. Inpatients got reimbursed with lower effective reimbursement rate(about 50%) and higher non-reimbursable expenses rates(about 27%). According to the household survey, two-week visiting rate of patients with catastrophic illness was 25.2%. And among them, 44.4% sought outpatient care in city or higher level hospitals. Reimbursement rate for outpatient care was only 20.6%. Patients were also confronted with high direct non-medical expenditure and indirect costs. 11.4% of patients did not see a doctor while they were supposed to be due to economic hardship. 7.1% were not hospitalized while they were supposed to be because of financial difficulty. 21% patients gave up their treatment. And still, the CHE rate is 31.3% after the reimbursement of NCMS and CHI. 72% patients get into debt because of catastrophic illness, borrowing amount up to 46339 Yuan per capita. 52.5% considered catastrophic illness an extremely heavy burden.(3)Education levels, medical assistance, amount of basic medical insurance reimbursement and amount of CHI reimbursement were proved to be significant factors influencing OOP. Patients with high level education are likely has lower OOP. Patients without medical assistance pays fee is 1.02 times of medical assistance of patients. Every point rise of basic medical insurance/CHI reimbursement lead to a point drop in OOP.(4)Family income, medical costs, amount of basic medical insurance reimbursement and amount of CHI reimbursement were proved to be significant factors influencing CHE. The low income families are more likely to fall into CHE. The risk of financial catastrophe due to catastrophic illness in low income families is 2.747 times than high income families, and the probability of fall into CHE is 3.235 in middle income families than high income families.(5) NCMS reimbursement decreased the incidence of CHE by 41.3%,and CHI reimbursement decreased the incidence of CHE by 12.2%. But the incidence of CHE is still reach 31.3% after reimbursement by NCMS and CHI. The relative gap of CHE were alleviated by both NCMS and CHI. But the relative gap of CHE is still reach 25% after reimbursement by NCMS and CHI.(6) Concentration indexes after their reimbursement by NCMS and CHI were all below zero and their absolute values were lower than that before reimbursement NCMS, while were higher than that before reimbursement by CHI.[ Conclusions](1) CHI system is relatively complete, but there is still a perfect space.(2) CHI fund-raising channel is relatively single, need to broaden the financing channels, establishing stable financing mechanism. In order to realize the UHC to the greatest extent, and reduce the economic risks of catastrophic illness, we need to dynamically adjust optimization of CHI compensation mode, Science to design compensation parameters. And scientifically prediction the fund expenditure scale of CHI, provide a scientific basis for make suitable financing standards.(3) The implementation of CHI stimulate patients release their demand. It is improving the accessibility for patients with serious illness, effectively promote the UHC. At the same time, we should also pay attention to the moral risk. We need control the unreasonable demand release, and scientific control unreasonable medical expenses growth.(4) NCMS and CHI were found to be protective factors for CHE, but the impact was modest. And the equity of CHE has not been improved. CHI enlarged the gap of disease economic risk between the rich and the poor. The reimbursement schemes should be optimized from three dimensions.(5) Promote the effective connection of basic medical insurance, CHI and MFA. CHI should be formulated according to the basic medical insurance level, and science design parameters, and dynamic adjustment at the same time. Expand the low-income people security level to improve equity. Implementing medical assistant in patients with high OOP. Promote the effective connection of CHI and MFA from all the aspects.