Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

The impact of the New Rural Cooperative Medical Scheme on the“health poverty alleviation”of rural households in China

This study investigates the impact of the New Rural Cooperative Medical Scheme(NRCMS)on rural households to escape poverty.We employ the instrumental variable method,the IVProbit model,to analyze the national data from the rural-resident field survey by the China Family Panel Studies(CFPS)in 2016.Based on the large-scale data,we found that,first,the hospitalization of family members is the key factor in increasing the risk of the family falling into poverty.The NRCMS has significantly reduced the likely risk of falling into poverty.Second,the impact of the NRCMS on poverty alleviation varies among groups with different levels of income.There is no impact on the upper-middle and high-income groups;in contrast,the NRCMS has substantially improved the capacity of low-income rural families to prevent poverty due to illness,especially for the lower-middle-income group.Third,there exist significant regional differences in the impact of NRCMS on the health poverty alleviation of rural households in China.The NRCMS has successfully reduced the risk of rural households in the western region falling into poverty,simultaneously,no significant impact on those in the eastern and central regions.In order to diminish and eliminate poverty eventually and boost rural residents'capacity for income acquisition,we propose the following:raise the actual compensation ratio of the NRCMS,control the rising expense of NRCMS by promoting the payment method reform,construct the comprehensive healthcare system in the western region,strengthen the medical security for the poor in remote area,and enhance the living environment for rural residents.

Optimized Reimbursement Scheme of China's New Cooperative Medical System Using Monte Carlo Simulation

China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,

The impact of the New Cooperative Medical Scheme in Sangzhi County,Hunan Province

In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed to further resolve illness-led poverty and the poor state of health care in the local area.The program had a positive impact and spread to other regions in Hunan Province.This paper will discuss the progress made as a result of the policies and several issues that challenge the scheme in practice.A total sample of 1212 individuals and 303 households were included in the analysis,and98 interviews were conducted with people related to the scheme.Our major findings indicate that the 201!NCMS has significantly reduced the out-of-pocket medical payment of rural residents,and also increased the township hospitals'patient flow.However,the medical scheme still faces many challenging issues during the implementation.With the increasing interest among the Chinese policy makers in strengthening and promoting the Sangzhi Model,the impacts of the scheme deserve greater attention in practice so as to further improve NCMS in rural China.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Summary:Throughout the duration of the New Cooperative Medical Scheme(NCMS),it was found that an increasing number of rural patients were seeking out-of^county medical treatment,which posed a great burden on the NCMS fund.Our study was conducted to examine the prevalence of out-of^county hospitalizations and its related factors,and to provide a scientific basis for follow?up health insurance policies.A total of 215 counties in central and western China from 2008 to 2016 were selected.The total out-of-county hospitalization rate in nine years was 16.95%,which increased from 12.37%in 2008 to 19.21%in 2016 with an average annual growth rate of 5.66%.Its related expenses and compensations were shown to increase each year,with those in the central region being higher than those in the western region.Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region(XI),rural population(X2),per capita per year net income(X3),per capita gross domestic product(GDP)(X4),per capita funding amount of NCMS(X5),compensation ratio of out-of^county hospitalization cost(X6),per time average in-county(X7)and out-of-county hospitalization cost(X8).According to Bayesian network(BN),the marginal probability of high out-of^county hospitalization rate was as high as 81.7%.Out-of^county hospitalizations were directly related to X8,X3,X4 and X6.The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors,economy factors,regional characteristics and NCMS policy factors was 95.7%,91.1%,93.0% and 88.8%,respectively.And how these factors affect out-of-county hospitalization and their interrelationships were found out.Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations,and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

The New Rural Cooperative Medical Scheme and Its Implications on Rural Labor Migration in China：Evidence from Longitudinal Surveys

In 2003, China initiated the New Rural Cooperative Medical Scheme （NRCMS） in order to provide basic health care coverage for the rural population. However, the NRCMS has had a marked impact on rural-urban labor migration as its current regulations present a barrier for cross-region participation in the NRCMS, and its reimbursement system is biased when the enrollees seek medical services outside their location of hukou, a household registration system in China. This paper performs a variety of empirical tests on a panel data set from the China Health and Nutrition Survey （CHNS） to study how the NRCMS affects rural residents＇ work location choices. We observed a ＂locking effect＂ on potential rural migrant workers and a ＂pulling effect＂ on existing ones. According to the results, the NRCMS has discouraged rural residents from working outside their location of hukou, lowering the probability of relocation by 3.52 percent. Meanwhile, the NRCMS system actually encourages existing migrant workers to return home. This paper concludes that the NRCMS has to some extent restrained the free flow of the labor force and exacerbated the migrant worker shortage.

Effects of New Rural Cooperative Medical Scheme on Medical Service Utilization and Medical Expense Control of Inpatients： A 3-year Empirical Study of Hainan Province in China

Background： The New Rural Cooperative Medical Scheme （NCMS） has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years. Methods： The research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS. Results： In the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund ofNCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively. Conclusions： With the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers＇ medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.

The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients

Background:Tuberculosis(TB)is still a major public health problem in China.To scale up TB control,an innovative programme entitled the'China-Gates Foundation Collaboration on TB Control in China was initiated in 2009.During the second phase of the project,a policy of increased reimbursement rates under the New Cooperative Medical Scheme(NCMS)was implemented.In this paper,we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data.Methods:In two cross-sectional surveys,quantitative data were collected before(January 2010 to December 2012)and after(April 2014 to June 2015)the intervention in the existing NCMS routine data system.Information on all 313 TB inpatients,among which 117 inpatients in the project was collected.Qualitative data collection included 11 focus group discussions.Three main indicators,non-reimbursable expenses rate(NER),effective reimbursement rate(ERR),and out-of-pocket payment(OOP)as a percentage of per capita household income,were used to measure the impact of intervention by comprising post-intervention data with baseline data.The quantitative data were analysed by descriptive analysis and non-parametric tests(Mann-Whitney U test)using SPSS 22.0,and qualitative data were subjected to thematic framework analysis using NvivolO.Results:The nominal reimbursement rates for inpatient care were no less than 80%for services within the package.Total inpatient expenses greatly increased,with an average growth rate of 11.3%.For all TB inpatients,the ERR for inpatient care increased from 52 to 66%.Compared with inpatients outside the project,for inpatients covered by the new policy,the ERR was higher(78%),and OOP showed a sharper decline.In addition,their financial burden decreased significantly.Conclusions:Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy,inpatient OOP expenditure was still a major financial problem for patients.Limited diagnosis and treatment options in county general hospitals and inadequate implementation of the new policy resulted in higher inpatient expenditures and limited reimbursement.Comprehensive control models are needed to effeaively decrease the financial burden on all TB patients.

中美公共医疗保险制度的比较研究——以美国Medicaid计划和我国新农合制度为实证研究对象

Medicaid计划系美国主流公共医疗保险项目,用以针对性补偿中低收入人群的医疗费用。自1965年推行以来,Medicaid计划的覆盖率和筹资额度保持较快增速,有效缓解了中低收入人群的就医压力。经过多年发展,Medicaid计划形成了较为成熟的筹资和补偿机制,值得我国新农合制度借鉴。

新型农村合作医疗:农民认知与受益调查

利用对5个省25个县(市)2 024个农户的抽样调查数据,研究2007年农村居民参加新型农村合作医疗的受益水平,以及这些农户对新型农村合作医疗补偿政策的认知状况。研究结果表明,相对于新型农村合作医疗制度实施初期而言,参合患者从新型农村合作医疗得到的补偿金额占其当年医疗总支出的比例显著上升,但是,与理论补偿水平相比还存在很大的差距,尤其是对大病医疗支出的实际补偿水平不到其理论补偿水平的1/3。从农民对新型农村合作医疗补偿政策的认知来看,曾报销过住院费的农户的认知水平要高于其他农户,但总体而言,认知水平依旧非常低,且大多数农户对补偿政策的认知都低于实际执行的补偿政策。

新型农村合作医疗满意度及影响因素分析

目的了解山东省威海市农民对新型农村合作医疗制度满意度及影响因素,为进一步推行新型农村合作医疗制度提供科学依据。方法按照分层随机整群抽样的方法抽取威海市4303名农村居民,用多元Logistic回归分析满意度影响因素。结果对新型农村合作医疗的满意率为73.2%。满意度主要受是否参加过体检(P=0.024)和是否住院(P=0.002)因素影响。结论威海市农村居民对新型农村合作医疗制度的满意率较高,扩大体检覆盖率有利于提高新型农村合作医疗制度的满意率。

农民参与新型农村合作医疗及满意度分析--基于3省245户农户的调查

调查数据表明,农民的新型农村合作医疗参合率高达93.33%。logistic模型实证发现,与周围的人大多不参与新农合的受访者相比,周围的人大多参与新农合的受访者的新农合参与率要高出314倍。通过其他方式宣传而参与的农户要低68%。高收入者参与新型农村合作医疗的可能性要高3.45倍。有90.3%的参合者对新型农村合作医疗制度总体表示满意,农民对各级医疗机构服务的满意程度均超过80%,但仍存在着新农合制度保障水平偏低以及基层卫生医疗服务在技术、态度、收费等方面不能满足农民需求等问题。

完善新型农村合作医疗制度的对策措施

新型农村合作医疗制度是现阶段我国农村居民的基本医疗保障制度。文章通过对南通市2003～2011年新农合制度运行情况及农村居民的问卷调查,分析当前新农合制度运行过程中存在的主要问题,从加强新农合立法工作、健全筹资机制、缩小城乡医保差距和控制医疗费用不合理增长等方面提出对策建议,为进一步完善新农合制度提供科学依据。

我国新农合重大疾病保障制度的政策分析

目的:回顾我国新农合大病保障制度的发展过程,分析政策执行现状和运行效果,为完善政策提供参考。方法:利用政策分析方法,分析新农合大病医疗保障政策的形成背景、执行与效果,其中定量资料用描述性统计方法进行分析。结果:自2010年政策启动,新农合大病保障的病种及试点范围稳步扩大,2012年全国大病保障有99.6万名患者受益,受益率为12.45人次/10万参合人口,东部地区受益率高于中部和西部地区;全国20种大病实际补偿比达65.39%,儿童两病等4类大病的实际补偿比超过70%,中部地区补偿水平略高于东部和西部地区。结论:新农合重大疾病保障政策推进良好,基本实现政策目标,但区域间保障待遇存在差异,保障受益面有待进一步提高,可持续发展也面临挑战。建议:多种方式提高新农合大病保障水平,处理好新农合大病与一般疾病保障的关系,促进保障工作的可持续发展,加强对政策实施的监督与评价。

陕西省新农合单病种定额付费改革的效果分析——基于镇安和旬邑两县的抽样调查

目的:实证分析陕西省单病种定额付费改革的实施效果。方法:选择陕西省镇安和旬邑两县作为研究对象。资料主要包括两县2008—2011年的新农合报表;同时对两县164名县级医院医务人员进行调查,了解他们对单病种定额付费的认知。定性资料主要采用焦点组访谈和个人深入访谈的方法,共访谈32人。利用SPSS13.0和EXCEL2007等软件进行数据分析。结果:单病种定额付费改革后医疗机构次均住院费用增速减缓,对医疗服务质量的影响尚不确定,对医务人员的满意度产生一定影响,提高了参合农民住院医疗服务的可及性,有助于引导患者合理就医,促进卫生资源有效利用;实施单病种定额付费患者的疾病负担缓解程度更加明显,也有助于降低新农合基金的风险。建议:科学制定支付标准,为顺利实施单病种定额付费改革奠定基础;建立健全针对供方的有效激励约束机制;加强单病种定额付费对医疗服务质量影响的研究和对定点医疗机构的监管。

农户参加新型农村合作医疗项目的影响因素分析

本文以农户参与新型农村合作医疗项目的决策行为为例,探讨农户大病风险处理行为及参加新农合的影响因素。本文分析认为,农户比较购买医疗保险和自我保险的预期效用来决定是否参加"新农合";农户比较正规和非正规医疗保障成本高低实现净收益最大化。农户参与"新农合"的决策受到资源禀赋、疾病风险特征和"新农合"制度环境因素的影响。本文最后提出了相关政策建议。

中国西部农村地区某县孕产期保健利用现状及对策研究

目的了解西部农村地区某县妇女孕产期保健利用现状及影响因素。方法对544名妇女进行问卷调查,对44名卫生服务管理者/供者以及42名妇女进行访谈。结果 70.6%的孕产妇参加了新型农村合作医疗(新农合),32.9%获得报销,未获报销的66.0%是因为超生。新农合缓解了具有产科危重症或并发症的孕产妇的经济负担。流动人口的报销手续复杂。卫生人力资源主要分布在县医院和妇幼保健院,在乡镇卫生院,中专以下学历占1/4。2005年至2008年的保健总收入中,政府拨款仅占妇幼保健总收入的5.0%。近1/5妇女的孕产期保健总费用超过家庭年收入的20%。选择县级医院、乡镇卫生院分娩的分别占39.8%和58.6%,服务质量和交通方便是选择的主要原因。偏远山区交通不便影响地理可及性。"坐月子"、重男轻女、为挑时辰而择时剖宫产、"方音岛"现象阻碍了孕产妇保健利用。结论新农合政策在一定程度上提高了该地区的孕产期保健的服务利用度,偏远乡镇的地理可及性亟须提高。目前尚有多种社会文化因素制约孕产妇保健利用。

2003—2012年吉林省新农合住院患者就诊及费用流向调查分析

目的:分析近10年来吉林省农村住院患者就诊与医疗费用的流向,探讨存在的主要问题并提出相应的对策。方法:通过2003—2012年吉林省新型农村合作医疗(新农合)信息系统中的统计报表收集资料,同时采用整群抽样方法,对2003—2012年参加新农合(简称参合)的住院患者进行调查,分析各级医院的住院人次、住院费用、住院补偿金额和次均住院补偿比等。结果:2003—2012年分流到县级以上和县级医疗机构的住院人次、住院费用和住院补偿费用逐年增加。2009年参合农民住院人次分流到县级以上、县级、乡级医疗机构的构成比分别为26.7%、46.3%和27.0%,2012年分别为30.4%、54.2%和15.4%。2009年住院费用分流到县级以上、县级、乡级医疗机构的构成比分别为57.0%、34.0%和9.0%,2012年分别为56.3%、37.9%和5.8%。2009年住院补偿费用分流到县级以上、县级、乡级医疗机构的构成比分别为49.2%、38.1%和12.7%,2012年分别为46.3%、45.6%和8.1%。2009年县级以上、县级、乡级医疗机构的次均住院补偿比例分别为32.2%、41.5%和52.6%,2012年分别为43.2%、63.1%和73.4%。结论:近10年来,吉林省参合农民的住院人次、住院费用和住院补偿费用分流到县级以上和县级医疗机构的比例均明显增多,分流到乡级医疗机构则逐年减少。次均住院补偿比在省内各级医院均逐年升高,乡级医疗机构的次均住院补偿比最高。

新型农村合作医疗病种大病费用及其结构变动度的分析

目的:大病住院费用给农户带来了巨大的经济负担,将武汉市下辖9个区,2014~2015年所有大病住院病例分为22类疾病,分析人数、费用的分布和构成比,及其结构变动情况,为疾病的防控和费用的控制提供依据。方法:采用描述性统计分析和结构变动度的分析方法,分析各区各类疾病的人数、费用、构成比和结构变动。结果:若干类疾病的例均费用较高、人数比重较高、总费用占比重较高;各区的各类疾病的人数构成比和费用构成比均有明显差异;各区变动贡献率大的疾病各有不同,总体而言三类疾病贡献率较大,22类疾病中7类负向变动,15类正向变动。结论:对于例均费用高、发病人数多或费用占比高的疾病应予以重视;各区中构成比显著偏高的疾病要进行控制;对于结构变动度较大的疾病,尤其是正向变动的疾病,控制其造成的经济负担。

新型农村合作医疗供方支付方式的利益相关者分析

运用利益相关者理论,分析主要供方支付方式在新农合制度中,对经办机构、供方和需方三方主要利益相关者的各种利益影响,认为单一支付方式无法满足三方多层面的利益诉求,唯有采用混合支付方式的形式,融合各支付方式的优点,才能平衡三方利益,维持新农合的制度均衡,促进新农合制度的可持续发展。通过理论分析,提出将按项目付费、按病种定额付费和总额预付制相融合的混合支付方式,是目前适合新型农村合作医疗的利益均衡支付方式。然而,这种支付方式与实际应用之间还有一定距离,还需要理论和操作上若干研究支持。