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The Influence of China’s Rural Health Security Schemes on Catastrophic Health Payment

Author: WangGuanQun
Tutor: ShiWuXiang
School: Dali University
Course: Epidemiology and Biostatistics,
Keywords: NRCMS MFA Catastrophic Health Payment Influencing factor
CLC: R197.1
Type: Master's thesis
Year: 2011
Downloads: 31
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Abstract

Objectives:(1) to find the change of catastrophic health payment before and after reimbursement of the New Rural Cooperative Medical Scheme (NRCMS), the Medical Financial Aid(MFA), NRCMS plus MFA. (2) to discuss the association between household chronic disease proportion and Catastrophic health payment. (3) to discuss the association between NRCMS and catastrophic health payment.Methods:(1) A cross-sectional, community, household survey was conducted in Hebei and Shanxi provinces, and the Inner Mongolia Autonomous Region, which represent Western and Central China. The respondents are residents of their own free will who lived for more than one year (2) Discuss the association between household chronic disease proportion, After reimbursement of NRCMS, After reimbursement of MFA, after reimbursement of NRCMS and MFA and Catastrophic health payment with multi-variate logistic regression.Results:(1) A total of 3,340 households in six counties were selected covering 11,252 individuals, representing a response rate of 99.8%. Of the 11,252 individuals,90.8% participated in NRCMS (91.2% of all households) and 8.0% had no insurance (7.8% of all households). Among the designated poor (1,337 individuals), only 7.6% had their premium paid by MFA. In addition, the prevalence of chronic illness among the expenditure groups, in ascending quintile order, was 34.5%,27.9%,22.3%,20.6%, and 19.4%, respectively. (2) Non-admission expenditure incurred a larger financial catastrophe (the incidence and intensity were 8.9% and 1.6%, respectively) than admission spending (the incidence and intensity were 2.7% and 0.5%, respectively). For all of the health services combined, the incidence and intensity of catastrophic health payment were 14.3% and 2.8%, respectively. NRCMS reduced those parameters by 9.9% and 16.9%, respectively. However, NRCMS was more effective in decreasing both the incidence and intensity of catastrophic expense for hospital admission (41.6% of the incidence and 49.0% of the intensity) than those for non-hospital care (1.0% of the incidence and 2.5% of the intensity). The differences between the effects of NRCMS alone and the combinations of NRSMS plus the various other insurances were minimal. (3) All variables except NRCMS were significantly associated with the outcome variables, the household per capita income had a very strong independent inverse association with both financial catastrophe health payment. Households with a larger proportion of members having serious chronic illness were more likely than others to incur catastrophic health expenditure, as were households with larger proportions of elderly members and households with hospitalized members. Larger households were more likely to escape financial catastrophe than smaller households. Households with an unemployed household head were more likely to incur financial catastrophe.Conclusion:(1) Households with a larger proportion of members having serious chronic illness, households with larger proportions of elderly members and households, households with hospitalized members, Households size, household per capita income and occupation of household head are influencing factors of catastrophic health payment. (2) Household chronic disease proportion and incidence of catastrophic health expenditure were positively correlated. Households with a larger proportion of members having serious chronic illness were more likely than others to incur catastrophic health expenditure. (3) NRCMS protected household from catastrophic health payment was limited. NRCMS was more effective in decreasing both the incidence and intensity of catastrophic expense for hospital admission than those for non-hospital care. The differences between the effects of NRCMS alone and the combinations of NRSMS plus the various other insurances were minimal. (4) The current medical care insurance schemes hardly protected against catastrophic health payment. Keywords:NRCMS, MFA, Catastrophic Health Payment, Influencing factor

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