Effects of NCMS on Access to Care and Financial Protection in China

Hou, Zhiyuan; Poel, Ellen Van de; Doorslaer, Eddy van; Yu, Bo; Meng, Qingyue

doi:10.1002/hec.2965

Cited by 52 publications

(55 citation statements)

References 40 publications

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“…Although the newly established New Cooperative Medical Scheme (NCMS) has yet to show its effect on child mortality, 36 NCMS could improve the use of inpatient services in the poor and in turn improve the health of the population in remote rural areas in the coming years. With increases in insurance financing and the expansion in the scope of reimbursement for childhood diseases since the introduction of the health-care reform in 2009, 37 further and timely assessment of the effect of NCMS on under-5 mortality rates is necessary.…”

Section: Discussionmentioning

confidence: 99%

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

et al. 2016

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Summary Background In the past two decades, the under-5 mortality rate in China has fallen substantially, but progress with regards to the Millennium Development Goal (MDG) 4 at the subnational level has not been quantified. We aimed to estimate under-5 mortality rates in mainland China for the years 1970 to 2012. Methods We estimated the under-5 mortality rate for 31 provinces in mainland China between 1970 and 2013 with data from censuses, surveys, surveillance sites, and disease surveillance points. We estimated under-5 mortality rates for 2851 counties in China from 1996 to 2012 with the reported child mortality numbers from the Annual Report System on Maternal and Child Health. We used a small area mortality estimation model, spatiotemporal smoothing, and Gaussian process regression to synthesise data and generate consistent provincial and county-level estimates. We compared progress at the county level with what was expected on the basis of income and educational attainment using an econometric model. We computed Gini coefficients to study the inequality of under-5 mortality rates across counties. Findings In 2012, the lowest provincial level under-5 mortality rate in China was about five per 1000 livebirths, lower than in Canada, New Zealand, and the USA. The highest provincial level under-5 mortality rate in China was higher than that of Bangladesh. 29 provinces achieved a decrease in under-5 mortality rates twice as fast as the MDG 4 target rate; only two provinces will not achieve MDG 4 by 2015. Although some counties in China have under-5 mortality rates similar to those in the most developed nations in 2012, some have similar rates to those recorded in Burkina Faso and Cameroon. Despite wide differences, the inter-county Gini coefficient has been decreasing. Improvement in maternal education and the economic boom have contributed to the fall in child mortality; more than 60% of the counties in China had rates of decline in under-5 mortality rates significantly faster than expected. Fast reduction in under-5 mortality rates have been recorded not only in the Han population, the dominant ethnic majority in China, but also in the minority populations. All top ten minority groups in terms of population sizes have experienced annual reductions in under-5 mortality rates faster than the MDG 4 target at 4·4%. Interpretation The reduction of under-5 mortality rates in China at the country, provincial, and county level is an extraordinary success story. Reductions of under-5 mortality rates faster than 8·8% (twice MDG 4 pace) are possible. Extremely rapid declines seem to be related to public policy in addition to socioeconomic progress. Lessons from successful counties should prove valuable for China to intensify efforts for those with unacceptably high under-5 mortality rates. Funding National “Twelfth Five-Year” Plan for Science and Technology Support, National Health and Family Planning Commission of The People’s Republic of China, Program for Changjiang Scholars and Innovative Research Team in U...

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Section: Discussionmentioning

confidence: 99%

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

et al. 2016

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“…Outpatient visits increased by 3.6 percentage points for Rural Resident Insurance enrollees (57) and by 7-13 percentage points for Urban Resident Insurance enrollees (38), and the probability of outpatient treatment increased by 12.6% for Urban Employee Insurance enrollees (34). Additionally, more generous insurance plans, including immediate cost-sharing at higher levels, increased outpatient visits (24,68,95). There are significantly fewer studies on inpatient treatment, but insurance coverage has generally increased inpatient visits (89), with significant geographic variation because the magnitude of the impact of insurance is dependent on province (34).…”

Section: Access and Utilizationmentioning

confidence: 99%

China's Health Reform Update

Liu

Vortherms

Hong

2017

Annu. Rev. Public Health

214

215

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China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

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“…Some studies focusing on specific health insurance programs find little or no effect of reducing financial risks (Hou et al, 2014;Lei and Lin, 2009;Li and Zhang, 2013;Meng et al, 2012;Wagstaff et al, 2009a;Yip and Hsiao, 2009), 1 while others arrive at the opposite conclusion (Jung and Streeter, 2015;Meng et al, 2004), due to differences in data sources and methodologies used.…”

Section: Introductionmentioning

confidence: 99%

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

Zhang

Nikoloski

Mossialos

2017

Social Science & Medicine

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China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-ofpocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low-and mediumincome individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system.

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Effects of NCMS on Access to Care and Financial Protection in China

Cited by 52 publications

References 40 publications

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

Under-5 mortality in 2851 Chinese counties, 1996–2012: a subnational assessment of achieving MDG 4 goals in China

China's Health Reform Update

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

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