China’s New Cooperative Medical Scheme Improved Finances Of Township Health Centers But Not The Number Of Patients Served

Abstract

China's New Cooperative Medical Scheme, launched in 2003, was designed to protect rural households from the financial risk posed by health care costs and to increase the use of health care services. This article reports on findings from a longitudinal study of how the program affected the use of health care services, out-of-pocket spending on medical care, and the operations and financial viability of China's township health centers, which constitute a middle tier of care in between village clinics and county hospitals. We found that between 2005 and 2008 the program provided some risk protection and increased the intensity of inpatient care at township health centers. Importantly, the program appears to have improved the centers' financial status. At the same time, the program did not increase the overall number of patients served or the likelihood that a sick person would seek care at a township center. These findings serve as a benchmark of the program's early impact. The results also suggest that the composition of health care use in China has changed, with people increasingly seeking outpatient care at village clinics and inpatient care at township health centers.

China's Health Reform Update

“…Less studied are the urban insurance plans, though early and isolated evidence suggests slight decreases in both total expenditures (35) and drug expenditures (96). Although some studies show no impact of health insurance coverage on OOP expenses in either Urban or Rural Resident health insurance (38,42), some evidence indicates reduced overall OOP expenses in both Rural Resident insurance enrollees (2,13,25) and Urban Employee insurance enrollees (34). This mixed evidence is likely due to differences in study samples with different insurance types and inpatient/outpatient variation.…”

“…Studies on OOP spending for inpatient treatment show that insurance encourages individuals to go to higher-level care, with an approximate 3% rise in higher-level visitsmeaning people go to a county-level health care center rather than a township-level health care center, which is more centralized in the government hierarchy-and stay longer, with a marginal increase of 1.37 days for Rural Resident Insurance enrollees (2), raising the overall cost of care for insured persons (55). These contrasting forces, the increased insurance coverage but more expensive care at higher-level health care centers and greater utilization such as longer stays, drive much of the variation in research study results, depending on if the study measures burden sharing or total OOP expenses (26,40,71), and highlight the need for both cost control mechanisms and careful economic evaluations of the impact of reforms.…”

How does the pharmaceutical industry influence prescription? A qualitative study of provider payment incentives and drug remunerations in hospitals in Shanghai

“…A number of quantitative studies explored the causal relationship between provider incentives and over-prescribing practice; however, due to the nature of quantitative research, these studies were not able to provide an in-depth analyses of the issue of over-prescription or to enunciate the root causes of it (Yip and Eggleston, 2004: 267-277;Wagstaff et al 2005;Lindelow, 2008: 990-1005;Yip and Hsiao, 2009: 613-619;Wagstaff et al, 2009: S7-S23;Babiarz et al, 2010;Babiarz et al, 2012Babiarz et al, : 1065Babiarz et al, -1074Yang and Wu, 2014). Several qualitative studies discussed the relationship between payment incentives and provider behaviours, but results by far are still anecdotal (Yip and Hsiao, 2008: 460-468;Blomqvist and Qian, 2008: 5-26;Yip and Hsiao, 2009: 613-619).…”

The health implications of social pensions: Evidence from China's new rural pension scheme

“…As mortality in older populations is less sensitive to income, our implied income-mortality elasticity is much lower, though the marginal effects of the income shock are similar. that the NCMS enrollment has led to an improvement in physical and cognitive function of the elderly; however, most studies find little or only modest evidence that the NCMS or the basic public health insurance program in urban China have reduced out-of-pocket health expenditure (Wagstaff et al, 2009;Lei and Lin, 2009;Sun et al, 2009;Babiarz et al, 2012;Liu and Zhao, 2014;Cheng et al, 2015). The rising health care costs become an urgent challenge to the government.…”