Role of the new rural cooperative medical system in alleviating catastrophic medical payments for hypertension, stroke and coronary heart disease in poor rural areas of China

BMC Public Health

Jun A Liu²  Qing Luo²  Zu X Lu²  Huan Liu²  Qi Wang¹ 

[1] Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hankong Road, Wuhan 430030, Hubei Province, China;Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China

关键词: New rural cooperative medical system;    Coronary heart disease;    Stroke;    Hypertension;    Out-of-pocket payment;    Catastrophic impact;   

Others  :  1128075
DOI  :  10.1186/1471-2458-14-907

 received in 2013-11-13, accepted in 2014-08-28,  发布年份 2014

【 摘 要 】

Background

Hypertension, stroke and coronary heart disease (CHD) are common diseases that impose a heavy burden on patients and their families, particularly on those living in poor areas. This study examined catastrophic medical payments faced by patients with these diseases and the effectiveness of the new rural cooperative medical system (NRCMS) at alleviating the impact of the said diseases in fourth-class rural areas (i.e. those with annual income of less than RMB1500/$240.2 per capita) of China.

Methods

Data on medical payments, including out-of-pocket and NRCMS-reimbursed expenses were collected through self-administered questionnaires. The pre- and post-reimbursement (via the NRCMS) prevalence of household poverty, catastrophic medical payment (CMP) incidence (H_cat), mean CMP gap (G_cat), mean positive CMP gap (MPG_cat) and other determinants of CMP incidence were identified.

Results

Out-of-pocket payments for treatment of hypertension, stroke and CHD averaged RMB580.1/$92.9, RMB3028.4/$484.8 and RMB1561.4/$250.0 per capita, respectively, in 2008. H_cat, G_cat and MPG_cat due to the three diseases were 17.0%, 16.6% and 97.6%, respectively, and reimbursement through the NRCMS reduced them to 13.5%, 11.8% and 87.4%, respectively. The difference between pre- and post-reimbursement H_cat was not statistically significant. After adjusting the covariates for age [OR = 1.87, 95% confidence interval (CI) = 1.19-2.95], education (OR = 1.56, 95% CI = 1.07-2.27), marital status (OR = 1.67, 95% CI = 1.11-2.51), occupation (OR = 1.96, 95% CI = 1.34-2.85), annual income (OR = 4.95, 95% CI = 3.28-7.48), the multiple logistic regression analysis revealed that patients with stroke (OR = 3.94, 95% CI = 2.38-6.51) or CHD (OR = 2.25, 95% CI = 1.38-3.65) were more susceptible to CMP compared with patients with hypertension only.

Conclusions

Out-of-pocket medical spending on hypertension, stroke and CHD imposes a heavy financial burden on the residents of fourth-class rural areas of China. The NRCMS has some impact on reducing catastrophic medical payments associated with these diseases, but improvement of the reimbursement rate is necessary to further improve its effectiveness.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J: Global burden of hypertension: analysis of worldwide data. Lancet 2005, 365(9455):217-223.
• [2]Gu D, Reynolds K, Wu X, Chen J, Duan X, Muntner P, Huang G, Reynolds RF, Su S, Whelton PK, He J, InterASIA Collaborative Group. The International Collaborative Study of Cardiovascular Disease in ASIA: Prevalence, awareness, treatment, and control of hypertension in China. Hypertension 2002, 40(6):920-927.
• [3]Wu Y, Huxley R, Li L, Anna V, Xie G, Yao C, Woodward M, Li X, Chalmers J, Gao R, Kong L, Yang X, China NNHS Steering Committee; China NNHS Working Group: Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation 2008, 118(25):2679-2686.
• [4]Gu D, Kelly TN, Wu X, Chen J, Duan X, Huang JF, Chen JC, Whelton PK, He J: Blood pressure and risk of cardiovascular disease in Chinese men and women. Am J Hypertens 2008, 21(3):265-272.
• [5]Center for Health Statistics and Information, MOHC: An Analysis Report of the Third National Health Services Survey in China. Beijing: Peking Union Medical College Press; 2004.
• [6]Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, et al.: Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119(3):480-486.
• [7]Zhai Y, Hu JP, Kong LZ, Zhao WH, Chen CM: Economic burden of coronary heart disease and stroke attributable to hypertension in China. Chin J Epidemiol 2006, 27(9):744-747.
• [8]Wyszewianski L: Financially catastrophic and high-cost cases: definitions, distinctions, and their implication of policy formulation. Inquiry 1986, 23:382-394.
• [9]Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ: Household catastrophic health expenditure: a multicountry analysis. Lancet 2003, 362(9378):111-117.
• [10]Himmelstein DU, Warren E, Thorne D, Woolhandler S: Illness and injury as contributors to bankruptcy. Health Aff (Millwood) 2005, Suppl Web Exclusives:W5-W63. W65-73
• [11]van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, Karan A, Lee TJ, Leung GM, Lu JF, Ng CW, Pande BR, Racelis R, Tao S, Tin K, Tisayaticom K, Trisnantoro L, Vasavid C, Zhao Y: Catastrophic payments for health care in Asia. Health Econ 2007, 16(11):1159-1184.
• [12]Li Y, Wu Q, Xu L, Legge D, Hao Y, Gao L, Ning N, Wan G: Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bull World Health Organ 2012, 90(9):664-671.
• [13]Liu Y, Rao K, Hsiao WC: Medical expenditure and rural impoverishment in China. J Health Popul Nutr 2003, 21(3):216-222.
• [14]Ma J, Zhang X, Zhang L: Health related risk assessment on families victimized by chronic illness in poor rural areas. Chin Health Econ 2009, 28(2):29-31.
• [15]Ying XH, Jiang Q, Liu B, Li GH, Hu SL, Chen Z, LM Z: Impacts of household catastrophic medical payment on equity of health financing. Chinese J Hospital Administr 2004, 20(8):461-463.
• [16]Gertler P, Gruber J: Insuring consumption against illness. Am Econ Rev 2002, 92(1, Mar):51-70.
• [17]Abul Naga RH, Lamiraud K: Catastrophic health expenditure and household well-being. Paris: ESSEC Business School; 2011. [Research Center ESSEC Working Paper 10010]
• [18]World Bank: ‘China’s health sector-Why reform is needed’. Rural health in China: Briefing notes series. Washington, DC: World Bank; 2005.
• [19]Wang HQ, Liu ZH, Zhang YZ, Luo ZJ: Integration of current identity-based district-varied health insurance schemes in China: implications and challenges. Front Med 2012, 6(1):79-84.
• [20]Barber SL, Yao L: Health Insurance Systems in China: A Briefing Note. World Health Organization; 2010. [World Health Report (2010) Background Paper, No 37] http://www.who.int/healthsystems/topics/financing/healthreport/37ChinaB_YFINAL.pdf webcite
• [21]Ministry of Health, PRC: Annual report on the health reform and development in China. 2008. http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s6690/200902/39109.htm webcite
• [22]The State Council of the People’s Republic of China: Resolution on advancing rural health service made by the State Council. 2002. http://www.gov.cn/gongbao/content/2002/content_61818.htm webcite
• [23]World Health Organization: Implementing the New Cooperative Medical Schemes in Rapidly Changing China: Issues and Options. Beijing: Office of the World Health Organization Representative in China; 2004.
• [24]Wang L: 2002 Integrated Report: One Report on China National Nutrition and Health Survey. Beijing: People’s Medical Publishing House; 2005.
• [25]Wagstaff A, van Doorslaer E: Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998. Health Econ 2003, 12(11):921-934.
• [26]Li Y, Wu Q, Gao L: Analysis on causes of catastrophic health expenditure in rural China from perspective of system analysis. Chin J Health Policy 2012, 5(11):55-59.
• [27]Yu B, Meng Q, Collins C, Tolhurst R, Tang S, Yan F, Bogg L, Liu X: How does the New Cooperative Medical Scheme influence health service utilization? a study in two provinces in rural China. BMC Health Serv Res 2010, 10:116. BioMed Central Full Text
• [28]Zhang L, Cheng X, Tolhurst R, Tang S, Liu X: 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.
• [29]Yi H, Zhang L, Singer K, Rozelle S, Atlas S: Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China. Health Econ 2009, 18(Suppl 2):S119-S127.
• [30]Sun X, Jackson S, Carmichael G, Sleigh AC: Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ 2009, 18(1):103-119.
• [31]Ranson MK: Reduction of catastrophic health care expenditures by a community-based health insurance scheme in Gujarat, India: current experiences and challenges. Bull World Health Organ 2002, 80(8):613-621.
• [32]Xu K, Evans DB, Carrin G, Aguilar-Rivera AM, Musgrove P, Evans T: Protecting households from catastrophic health spending. Health Aff (Millwood) 2007, 26(4):972-983.
• [33]Su TT, Kouyate B, Flessa S: Catastrophic household expenditure for health care in a low-income society: a study from Nouna District, Burkina Faso. Bull World Health Organ 2006, 84(1):21-27.
• [34]Waters HR, Anderson GF, Mays J: Measuring financial protection in health in the United States. Health policy (Amsterdam, Netherlands) 2004, 69(3):339-349.
• [35]Kawabata K, Xu K, Carrin G: Preventing impoverishment through protection against catastrophic health expenditure. Bull World Health Organ 2002, 80(8):612.