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How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China

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Yu, Baorong, Meng, Qingyue, Collins, Charles, Tolhurst, Rachel, Tang, Shenglan, Yan, Fei, Bogg, Lennart and Liu, Xiaoyun (2010) 'How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China'. BMC Health Services Research, Vol 10, Issue 116.

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Abstract

Background: Many countries are developing health financing mechanisms to pursue the goal of universal coverage.
In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since
2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health
service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China.
Methods: Using multistage sampling processes, a cross-sectional household survey including 6,147 rural households
and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test,
Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization
of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual
interview and focus group discussion were applied to explain and complement the findings from the household
survey.
Results: NCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant
association with outpatient service utilization regardless of income level and location.
Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low
income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient
services more frequently, while members from Shandong had a longer stay in hospital. High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization.
Conclusions: Outpatient service utilization has not significantly changed under NCMS. Although utilization of
inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low
income group. While providing financial protection against catastrophic medical expenditure is the principal focus of
NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development.
NCMS policy should also be more equity oriented to achieve its policy goal.

Item Type: Article
Uncontrolled Keywords: China, utilisation, health insurance
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 20.5 Research (General)
Digital Object Identifer (DOI): https://doi.org/10.1186/1472-6963-10-116
Depositing User: Faye Moody
Date Deposited: 10 Feb 2011 10:24
Last Modified: 22 Feb 2018 15:54
URI: https://archive.lstmed.ac.uk/id/eprint/1739

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