BackgroundMany countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China.MethodsUsing multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey.ResultsNCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location.Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital.High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization.ConclusionsOutpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low income group. While providing financial protection against catastrophic medical expenditure is the principal focus of NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development. NCMS policy should also be more equity oriented to achieve its policy goal.

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BackgroundRoad traffic injuries (RTIs) are a substantial cause of mortality and disability globally. There is little published information regarding healthcare resource utilization following RTIs, especially in low and middle-income countries (LMICs). The aim of this study was to assess total hospital charges and length of stay (LOS) associated with RTIs in Iran and to explore the association with patients’ socio-demographic characteristics, insurance status and injury-related factors (e.g. type of road users and safety equipment).MethodThe study was based on the Iranian National Trauma Registry Database (INTRD), which includes data from 14 general hospitals in eight major cities in Iran, for the years 2000 to 2004. 8,356 patients with RTI admitted to the hospitals were included in the current study. The variables extracted for the analysis included total hospital charges and length of stay, age, gender, socio-economic and insurance status, injury characteristics, medical outcome and use of safety equipment among the patients. Univariable analysis using non-parametric methods and multivariable regression analysis were performed to identify the factors associated with total hospital charges and LOS.ResultsThe mean hospital charges for the patients were 1,115,819 IRR (SD=1,831,647 IRR, US$128 ± US$210). The mean LOS for the patients was 6.8 (SD =8 days). Older age, being a bicycle rider, higher injury severity and longer LOS were associated with higher hospital charges. Longer LOS was associated with being male, having lower education level, having a medical insurance, being pedestrian or motorcyclist, being a blue-collar worker and having more severe injuries. The reported use of safety equipment was very low and did not have significant effect on the hospital charges and LOS.ConclusionThe study demonstrated that the hospital charges and LOS associated with RTI varied by age, gender, socio-economic status, insurance status, injury characteristics and health outcomes of the patients. The results of the study provide information that can be of importance in the planning and design of road traffic injury control strategies.