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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2013

Open Access 01-12-2013 | Research

China’s new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey

Author: Wei Yang

Published in: International Journal for Equity in Health | Issue 1/2013

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Abstract

Introduction

China's New Cooperative Medical Scheme (NCMS) was brought to life in 2003 in response to the deterioration in access to health services in rural areas. Despite its fast expansion, the scheme’s impacts on access to health care have raised growing concerns, in particular regarding whether and to what extent the scheme has reduced inequity in access to health care in rural China.

Methods

This study examines income-related inequity in access to health care from 2004 (before the national rollout of NCMS) to 2009 (after the expansion of NCMS across the rural China) by estimating Concentration Indices over both formal health care (outpatient care, prevention care) and informal health care use (folk doctor care). Data were drawn from a longitudinal household survey dataset - China Health and Nutrition Survey (CHNS).

Results

The study suggested that the level of inequity remained the same for outpatient care, and an increased favouring-poor gap in terms of folk doctor care was observed. In terms of preventive care, a favouring-rich inequity was observed both in 2004 and 2009, but the effects of inequity were narrowed. The NCMS had some effects in reducing income-related health inequity in folk doctor care and preventive care, but the contribution was rather small. The study also found that the rural better-off had started to seek for commercial insurance to cover possible financial risks from the burden of diseases.

Conclusion

The study concludes that the impacts of the NCMS on improving access to formal care for the poor are limited. Without a more comprehensive insurance package that effectively targets the rural poor, the intended equity goals expected from the scheme will be difficult to realize.
Appendix
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Literature
1.
Yip W, Berman P: Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insurance. Health Econ. 2001, 10 (3): 207-220. 10.1002/hec.589.CrossRefPubMed
2.
You X, Kobayashi Y: The new cooperative medical scheme in China. Health Policy. 2009, 91 (1): 1-9. 10.1016/j.healthpol.2008.11.012.CrossRefPubMed
3.
Yip W, Hsiao WC:The Chinese Health System At A Crossroads. Health Aff. 2008, 27 (2): 460-468. 10.1377/hlthaff.27.2.460.CrossRef
4.
Watanabe R, Hashimoto H: Horizontal inequity in healthcare access under the universal coverage in Japan; 1986–2007. Soc Sci Med. 2012, 75 (8): 1372-1378. 10.1016/j.socscimed.2012.06.006.CrossRefPubMed
5.
Jehu-Appiah C: Equity aspects of the national health insurance scheme in Ghana: Who is enrolling, who is not and why?. Soc Sci Med. 2011, 72 (2): 157-165. 10.1016/j.socscimed.2010.10.025.CrossRefPubMed
6.
Van Doorslaer E: Horizontal inequities in Australia's mixed public/private health care system. Health Policy. 2008, 86 (1): 97-108. 10.1016/j.healthpol.2007.09.018.CrossRefPubMed
7.
van Doorslaer E, Masseria C: Income-Related Inequality in the Use of Medical Care in 21 OECD Countries. 2004, Paris: OECD Health Equity Research GroupCrossRef
8.
Kavosi Z: Inequality in household catastrophic health care expenditure in a low-income society of Iran. Health Policy Plan. 2012, 27 (7): 613-623. 10.1093/heapol/czs001.CrossRefPubMed
9.
Shahrawat R, Rao KD: Insured yet vulnerable: out-of-pocket payments and India's poor. Health Policy Plan. 2012, 27 (3): 213-221. 10.1093/heapol/czr029.CrossRefPubMed
10.
Barber SL, Yao L: Development and status of health insurance systems in China. Int J Health Plann Manage. 2011, 26 (4): 339-356. 10.1002/hpm.1109.CrossRefPubMed
11.
Babiarz KS: China's New cooperative medical scheme improved finances Of township health centers But Not The number Of patients served. Health Aff. 2012, 31 (5): 1065-1074. 10.1377/hlthaff.2010.1311.CrossRef
12.
Babiarz KS:New evidence on the impact of China's New rural cooperative medical scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis. Br Med J. 2010, 341: c5617-10.1136/bmj.c5617.CrossRef
13.
Liu J:Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009. Int J Equity Health. 2012, 11 (42): 42-PubMedCentralCrossRefPubMed
14.
Wang J: Financial protection under the New rural cooperative medical schemes in China. Med Care. 2012, 50 (8): 700-704. 10.1097/MLR.0b013e318249d8bf.CrossRefPubMed
15.
Wang Y:Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China. BMC Health Serv Res. 2012, 12 (1): 302-10.1186/1472-6963-12-302.PubMedCentralCrossRefPubMed
16.
17.
Wang H: Health insurance benefit design and healthcare utilization in northern rural china. PLoS One. 2012, 7 (11): e50395-10.1371/journal.pone.0050395.PubMedCentralCrossRefPubMed
18.
Yu B:How does the New cooperative medical scheme influence health service utilization? A study in two provinces in rural China. BMC Health Serv Res. 2010, 10 (1): 116-10.1186/1472-6963-10-116.PubMedCentralCrossRefPubMed
19.
Mou J:Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?. BMC Health Serv Res. 2009, 9 (1): 214-10.1186/1472-6963-9-214.PubMedCentralCrossRefPubMed
20.
O'Donnell O, Van Doorslaer E, Wagstaff A: Decomposition of inequalities in health and health care. The Elgar companion to health economics. Edited by: Andrew M, Jones A, Jones M. 2006, Cheltenham: Edward Elgar, 565-xvii
21.
O'Donnell O: Analyzing health equity using household survey data: a guide to techniques and their implementation. 2008, Washington, D.C: World Bank, 220-xi
22.
Kakwani N, Wagstaff A, van Doorslaer E: Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econometrics. 1997, 77 (1): 87-103. 10.1016/S0304-4076(96)01807-6.CrossRef
23.
Dong KY: Medical insurance system evolution in China. China Econ Rev. 2009, 20 (4): 591-597. 10.1016/j.chieco.2009.05.011.CrossRef
24.
Chen L: Addressing vulnerability in an emerging economy: China's New cooperative medical scheme (NCMS). Can J Dev Stud-Rev Can D Etudes Du Dev. 2011, 32 (4): 399-413.CrossRef
25.
WHO: W.H.O., Implementing the New Cooperative Medical Schemes in rapidly changing China. 2004, Beijing, China: O.o.t.W.H.O.R.i. China
26.
Xinhua: Report on the Work of the Chinese Government in Xinhua News2012. 2012, Beijing: Xinhua News
27.
China Daily: China calls for universal healthcare, in China Daily2012. 2012, Geneva: China Daily
28.
Hernandez Quevedo C, Jimenez Rubio D: Socioeconomic differences in health between the Spanish and immigrant population: evidence from the National Health Survey. Gac Sanit. 2009, 23 (Suppl 1): 47-52.CrossRefPubMed
29.
Allin S, Hurley J: Inequity in publicly funded physician care: what is the role of private prescription drug insurance?. Health Econ. 2009, 18 (10): 1218-1232. 10.1002/hec.1428.CrossRefPubMed
30.
Erreygers G: Correcting the Concentration Index. J Health Econ. 2009, 28 (2): 504-515. 10.1016/j.jhealeco.2008.02.003.CrossRefPubMed
31.
Wagstaff A: Correcting the concentration index: A comment. J Health Econ. 2009, 28 (2): 516-520. 10.1016/j.jhealeco.2008.12.003.CrossRefPubMed
32.
Costa-Font J, Gil J: What lies behind socio-economic inequalities in obesity in Spain? A decomposition approach. Food Policy. 2008, 33 (1): 61-73. 10.1016/j.foodpol.2007.05.005.CrossRef
33.
Van de Poel E, O'Donnell O, Van Doorslaer E: Are urban children really healthier? Evidence from 47 developing countries. Soc Sci Med. 2007, 65 (10): 1986-2003. 10.1016/j.socscimed.2007.06.032.CrossRefPubMed
34.
Wagstaff A, Rutten F, Doorslaer EKAv: Equity in the finance and delivery of health care: an international perspective. Oxford medical publications. 1993, Oxford: Oxford University Press, 416-
35.
O'Donnell O, World Bank: Analyzing health equity using household survey data: a guide to techniques and their implementation. 220, Washington, D.C: World Bank, xi
36.
Allin S, Hernández-Quevedo C, Masseria C: Measuring equity of access to health care. Performance measurement for health system improvement: experiences, challenges and prospects. Edited by: Smith P. 2009, Cambridge: Cambridge University Press, 726-xxii
37.
Wagstaff A: The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005, 14 (4): 429-432. 10.1002/hec.953.CrossRefPubMed
38.
Chen Z, Roy K, Gotway Crawford CA: Evaluation of variance estimators for the concentration and health achievement indices: a monte carlo simulation. Health Econ. 2012, 21 (11): 1375-1381. 10.1002/hec.1796.CrossRefPubMed
39.
Mills JA, Zandvakili S: Statistical inference via bootstrapping for measures of inequality. J Appl Econometrics. 1997, 12 (2): 133-150. 10.1002/(SICI)1099-1255(199703)12:2<133::AID-JAE433>3.0.CO;2-H.CrossRef
40.
Chen Z, Roy K: Calculating concentration index with repetitive values of indicators of economic welfare. J Health Econ. 2009, 28 (1): 169-175. 10.1016/j.jhealeco.2008.09.004.CrossRefPubMed
41.
Van Ourti T: Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model. Health Econ. 2004, 13 (7): 705-724. 10.1002/hec.920.CrossRefPubMed
42.
Wagstaff A, van Doorslaer E, Watanabe N: On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econometrics. 2003, 112 (1): 207-223. 10.1016/S0304-4076(02)00161-6.CrossRef
43.
Wagstaff A: Reranking and Pro-poor growth: decompositions for China and Vietnam. J Dev Stud. 2009, 45 (9): 1403-1425. 10.1080/00220380902890227.CrossRef
44.
Sun X: Health payment-induced poverty under China's New cooperative medical scheme in rural Shandong. Health Policy Plan. 2010, 25 (5): 419-426. 10.1093/heapol/czq010.CrossRefPubMed
45.
Qian Y: Urban and rural household saving in China. Int Monetary Fund Staff Papers. 1988, 35 (4): 592-627. 10.2307/3867112.CrossRef
46.
Kraay A: Household saving in China. World Bank Econ Rev. 2000, 14 (3): 545-570. 10.1093/wber/14.3.545.CrossRef
47.
Wu Q: Research on the necessity of building a medical protection system for the poor population in China. 2001, Harbin Medical University: Harbin
48.
Citro CF: Measuring poverty: a new approach. 1995, Washington, D.C: National Academy Press
49.
Gravelle H, Morris S, Sutton M: Economic studies of equity in the consumption of health care. The Elgar companion to health economics. Edited by: Andrew M, Jones A, Jones M. 2006, Cheltenham: Edward Elgar, 565-xvii
50.
James CD: To retain or remove user fees?: reflections on the current debate in low- and middle-income countries. Appl Health Econ Health Policy. 2006, 5 (3): 137-153. 10.2165/00148365-200605030-00001.CrossRefPubMed
51.
Pokhrel S: Modelling the effectiveness of financing policies to address underutilization on of children's health services in Nepal. Bull World Health Organ. 2005, 83 (5): 338-344.PubMedCentralPubMed
52.
Sauerborn R, Nougtara A, Latimer E: The elasticity of demand for healthcare in Burkina Faso - differences across age and income groups. Health Policy Plan. 1994, 9 (2): 185-192. 10.1093/heapol/9.2.185.CrossRefPubMed
53.
Okeke TA, Okeibunor JC: Rural–urban differences in health-seeking for the treatment of childhood malaria in south-east Nigeria. Health Policy. 2010, 95 (1): 62-68. 10.1016/j.healthpol.2009.11.005.CrossRefPubMed
54.
Van de Poel E, Van Doorslaer E, O'Donnell O: Measurement of inequity in health care with heterogeneous response of use to need. J Health Econ. 2012, 31 (4): 676-689. 10.1016/j.jhealeco.2012.05.005.CrossRefPubMed
55.
Zhang L: How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?. Trop Med Int Health. 2010, 15 (4): 468-475.PubMed
56.
Somkotra T, Lagrada LP: Payments for health care and its effect on catastrophe and impoverishment: experience from the transition to universal coverage in Thailand. Soc Sci Med. 2008, 67 (12): 2027-2035. 10.1016/j.socscimed.2008.09.047.CrossRefPubMed
57.
Li C: Moving towards universal health insurance in China: performance, issues and lessons from Thailand. Soc Sci Med. 2011, 73 (3): 359-366. 10.1016/j.socscimed.2011.06.002.CrossRefPubMed
58.
Knaul FM, Frenk J: Health insurance in Mexico: achieving universal coverage through structural reform. Health Aff. 2005, 24 (6): 1467-1476. 10.1377/hlthaff.24.6.1467.CrossRef
59.
Harmsworth K, Lewith GT: Attitudes to traditional Chinese medicine amongst Western trained doctors in the People's Republic of China. Soc Sci Med. 2001, 52 (1): 149-153. 10.1016/S0277-9536(00)00124-6.CrossRefPubMed
60.
Howes MJR, Houghton PJ: Plants used in Chinese and Indian traditional medicine for improvement of memory and cognitive function. Pharmacol Biochem Behav. 2003, 75 (3): 513-527. 10.1016/S0091-3057(03)00128-X.CrossRefPubMed
61.
Xu W: Traditional Chinese medicine in cancer care: perspectives and experiences of patients and professionals in China. Eur J Cancer Care. 2006, 15 (4): 397-403. 10.1111/j.1365-2354.2006.00685.x.CrossRef
Metadata
Title
China’s new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey
Author
Wei Yang
Publication date
01-12-2013
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2013
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-12-20

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