Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA : the Case of Three Counties in Rural China
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Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA : the Case of Three Counties in Rural China

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Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA: the Case of Three Counties in Rural China ...

Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA: the Case of Three Counties in Rural China

Presented at the International Health Economics Association meeting in Beijing July 2009

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Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA : the Case of Three Counties in Rural China Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA : the Case of Three Counties in Rural China Presentation Transcript

  • Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA -----the Case of Three Counties in Rural China
    XuefeiGu, Xiaoguang Fu, M. Hafizur Rahman, David H. Peters, Zhengzhong Mao
  • Background
     In late 2002, Chinese government resolved to introduce the New Rural Cooperative Medical Scheme (NCMS) and Medical Assistance (MA) to prevent "illness induced poverty"
    2
    low utilization of health services
    illness & injury
    poverty
    NCMS+MA
  • Content
    Background
    Methodology
    Results
    Discussion
    3
  • Background
    NCMS targets all rural communities
    MA targets the poor in rural and urban areas
    MA finances are principally directed at funding poor farmers’ contributions to NCMS
    In terms of inpatient services, the poor pays a lower proportion of medical care expenses OOP than better off
    4
  • Background
    Some previous researches showed that farmers’ use of health services, particularly inpatient services, had risen dramatically under NCMS
    But the poor used less than non-poor
    Why?
    5
  • NCMS and MA
    inpatient reimbursement
    Ceiling: about 20,000CNY
    Co-pay 10%-20%
    MAsubsidies 30%-50%
    NCMS subsidies
    40%-60%
    Deductible 100-300 CNY
    6
    6
    MA pays for the part under the deductible line
  • Background
    Except the high co-payment, complicated reimbursement procedure was another important reason
    NCMS is administered by health authorities and MA is charged by the Ministry of Civil Affairs
    The poor needs to pay all hospitalizing expenses and then get subsides from NCMS and MA
    7
  • 8
    long time
    Bureau of Civil Affairs
    NCMS administration office
    discharge from hospital
    pay all hospitalizing expenses
    get subside from NCMS
    get subside from MA
  • Research Question
    The linkages between two programs including scheme design and management level became a big problem
    A few counties had done some experiments on it
    The study attempts to answer if the inpatient services utilization by the poor can be improved under the linkage between NCMS and MA
    9
  • Assumption
    There is difference among different income groups on the utilization of health services
    Effective linkages between NCMS and MA (integration of NCMS and MA) could reduce the gap of health services use between the poor and non-poor
    10
  • Methodology
    The study is based on data collected from 2007 and 2008 household survey conducted in three counties located in China' Hubei, Anhui and Qinghai Province
    We assess self-reported inpatient services utilization by asking respondents the number of hospital admissions if s/he had major diseases and doctor suggested hospital admission in previous year
    One or more admissions last year was coded as 1, and no admissions as 0
    11
  • Methodology
    The study population was divided into 5 groups by wealth status
    Wealth index was used as a proxy for poverty variable and other sociodemographic characteristics were considered
    Logistic regression was used to analyze the association between inpatient service utilization and socio-economic status
    12
  • Results
    13
    Persons without hospital admission within twelve months
    poorest 20%
    2nd poorest 20%
    middle 20%
    2nd richest 20%
    richest 20%
  • Results: 3 counties
    14
  • Results: County A
    15
  • 16
    Results: County B
  • 17
    Results: County C
  • Results
    The odds of the 2nd poorest quintile getting inpatient services for major illnesses is 11% higher than the poorest quintile, and the odds of middle quintile is 42% higher than that of the poorest quintile, but are not statistically significant
    Compared to 2006, the odds of hospital admission for all farmers is increased by 30% in 2007 (not significant)
    Separate analysis shows that the poorest quintile in county A used inpatient services more than the 2nd and third quintiles
    18
  • Discussion
    Why county A’ result is better?
    19
  • Discussion
    The inpatient service utilization by the poor in county A is much higher compared to that in other two counties, the most important reason being the reimbursement procedure that is more simple and convenient for the poor
    We could increase the poor's inpatient service utilization by improving the linkages between NCMS and MA
    20
  • Thank you!
    21