Urban-rural differences in healthcare utilization among beneficiaries in China’s new cooperative medical scheme

Background The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. Methods Data for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group. Results Our regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables – 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures – all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits. Conclusions For both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.

Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure ( P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service ( P < .001, P = .020) and choose low-level medical institutions for treatment ( P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure ( P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

Heterogeneous Impacts of Basic Social Health Insurance on Medical Expenditure: Evidence from China’s New Cooperative Medical Scheme

This paper examines the effects of China’s New Cooperative Medical Scheme (NCMS) on medical expenditure. Utilizing the quasi-random rollout of the NCMS for a difference-in-difference analysis, we find that the NCMS increased medical expenditure by 12.3%. Most significantly, the good-health group witnessed a 22.1% rise in medical expenditure, and the high-income group saw a rise of 20.6%. The effects, however, were not significant among the poor-health or low-income groups. The findings are suggestive of the need for more help for the very poor and less healthy.

Urban and Rural Disparities in Healthcare Utilization and Expenditures Among Rural Hukou Beneficiaries of New Cooperative Medical Scheme in China

Background The New Cooperative Medical Scheme (NCMS) is a social health insurance available to rural Chinese residents. Over time, several concerns to this system have been raised, including disparities among healthcare utilization and expenditures. Most studies only discuss disparities in general in NCMS, with few studies concentrating on comparing disparities between urban and rural regions. Moreover, this issue has an increasing importance due to the rapid population growth of rural migrants. Therefore, we conducted our study to explore urban and rural disparities among NCMS beneficiaries.Methods Our study is based on Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our targeted sample is individuals with rural hukou and only covered by NCMS. We define and use influential factors in our logistic regressions and descriptive tables to compare urban and rural disparities among these NCMS beneficiaries. Results In terms of inpatient care, urban beneficiaries have a lower probability (OR=1.013, P=0.892) and frequency (1.39 vs. 1.47, P=0.131) of having an inpatient visit than rural beneficiaries. However, urban beneficiaries have higher out-of-pocket (OOP) expenditures among inpatient visit (￥6788.98 vs. ￥6163.92, P=0.470) and medicine (￥3907.30 vs. ￥2649.67, P<0.01). In addition, urban beneficiaries were found to have higher reimbursement of inpatient visit (￥4457.66 vs. ￥4127.83, P<0.001) and medicine (￥2466.93 vs. ￥1774.55, P<0.05). In terms of outpatient care, urban beneficiaries have less possibility (OR=1.074, P=0.384) and frequency (2.15 vs. 2.26, P=0.225) of an outpatient visit than rural beneficiaries. Moreover, compared to rural beneficiaries, urban beneficiaries have less out-of-pocket (OOP) expenditures of outpatient visit (￥709.80 vs. ￥ 710.98, P=0.608) and drugs (￥448.68 vs. ￥ 522.95, P=0.645), and less reimbursement of outpatient visit (￥296.03 vs. ￥ 344.51, P=0.808) and drugs (￥99.25 vs. ￥ 114.60, P<0.05).Conclusion In terms of healthcare utilization, rural beneficiaries have both higher probability and frequency of inpatient and outpatient visits. In terms of healthcare expenditures, urban beneficiaries get more inpatient reimbursement with higher inpatient expenditures, while rural beneficiaries get more outpatient reimbursement with higher outpatient expenditures. Both situations have not solid answer yet, and therefore require further research.