Medical insurance policy organized by Chinese government and the health inequity of the elderly: longitudinal comparison based on effect of New Cooperative Medical Scheme on health of rural elderly in 22 provinces and cities

International Journal for Equity in Health

Peiyi Lu¹  Ying Liang² 

[1] School of Communication and Design, Sun Yat-sen University, Guangzhou, People’s Republic of China;Department of Social Work and Social Policy, School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, 210023, People’s Republic of China

关键词: Chinese government;    Longitudinal comparison;    CLHLS;    Rural elderly;    Health;    New Cooperative Medical Scheme;    Basic medical insurance policy;   

Others  :  802417
DOI  :  10.1186/1475-9276-13-37

 received in 2014-02-21, accepted in 2014-04-28,  发布年份 2014

【 摘 要 】

Background

The alarming progression of the aging trend in China attracts much attention in the country and abroad. In 2003, the Chinese central government launched the New Cooperative Medical Scheme (NCMS) to resolve the inequity problem of health in regions with inadequate infrastructure and relative poverty. The rural elderly are the main beneficiaries of this policy; the improvement of their health through the medical insurance policy require exploration.

Methods

This study used data obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2005 and 2008. Elderly people living in rural areas and aged 60 and above were screened for the investigation. A total of 8658 and 9904 elderly people were selected from 2005 and 2008, respectively. By establishing models and employing multi-logistic analysis, stereotype logistic analysis, we examined the effect of NCMS organized by Chinese government on three domains of the health of the rural elderly.

Results

A total of 948 and 6361 elderly people participated in NCMS in 2005 (n = 8658) and 2008 (n = 9904), respectively. With regard to the independent variables, the number of participants in NCMS increased, whereas province distribution, gender, and years of education only slightly changed. As for the dependent variables, the rural elderly in 2005 had poor general health but good psychological health. Differences were found between different moods. Old people who engage in much outdoor activity can take care of themselves. After three-year promotion of NCMS, the differences between 2005 and 2008 indicate that the physical function of the rural elderly worsen, whereas the general health and psychological health improves.

Conclusions

(1) In the 2005 data and 2008 data, result shows that NCMS participation can promote the self-rated quality and health change of the elderly. (2) After three years, the alleviation effect on anxiety and loneliness changed from insignificant to significant. Participants in NCMS have a stronger sense of uselessness, which weakens with time. (3 )NCMS participation passes the significance test in “outdoor activities” and “pick a book up from the floor” model. Elderly participants indicated higher frequencies of outdoor activities.

【 授权许可】

   
2014 Liang and Lu; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Woo J, Kwok T, Sze FKH, Yuan HJ: Ageing in China: health and social consequences and responses. Int J Epidemiol 2002, 31(4):772-775.
• [2]Jiang Z: Phenomenon of population aging in China and its Countermeasures. Qiushi Theor 2005, 6:41-43.
• [3]Zeng X: A comprehensive analysis of the health of China’s elderly population. Popul Econ 2010, 5:80-85.
• [4]Strauss J, Lei X, Park A, Shen Y, Smith JP, Yang Z, Zhao Y: Health outcomes and socio-economic status among the elderly in China: Evidence from the CHARLS Pilot. J Popul Ageing 2010, 3(3-4):111-142.
• [5]Yin D: Review and Prospect of Elder’s Health Research in China. Northwest Popul J 2006, 5:2-8.
• [6]Hu S, Tang S, Liu Y, Zhao Y, Escobar M, Ferranti D: Reform of how health care is paid for in China: challenges and opportunities. Lancet 2008, 372(9652):1846-1853.
• [7]The State Council: The State Council forwards the notice released by the Ministry of Health regarding the establishment of the New Cooperative Scheme for rural areas. 2003. the URL is here. [ http://www.gov.cn/zwgk/2005-08/12/content_21850.htm webcite]
• [8]Fang Y, Mao W, Gao R, Su P: Support model for the aged in rural China. Chin J Gerontol 2012, 32(4):881-883.
• [9]Liu M, Zhang Q, Lu M, Kwon CS, Quan H: Rural and urban disparity in health services utilization in China. Med Care 2007, 45(8):767-774.
• [10]Li X, Xiao Z, Xiao S: Suicide among the elderly in mainland China. Psychogeriatrics 2009, 9(2):62-66.
• [11]Deng J, Hu J, Wu W, Dong B, Wu H: Subjective well-being, social support, and age-related functioning among the very old in China. Int J Geriatr Psychiatry 2010, 25(7):697-703.
• [12]Chen F, Short SE: Household context and subjective well-being among the oldest old in China. J Fam Issues 2008, 29(10):1379-1403.
• [13]Leung KK, Chen CY, Lue BH, Hsu ST: Social support and family functioning on psychological symptoms in elderly Chinese. Arch Gerontol Geriatr 2007, 44(2):203-213.
• [14]Silverstein M, Cong Z, Li S: Intergenerational transfers and living arrangements of older people in rural China: Consequences for psychological well-being. J Gerontol Ser B Psychol Sci Soc Sci 2006, 61(5):S256-S266.
• [15]Liang Y, Wang P: Influence of Prudential Value on the Subjective Well-Being of Chinese Urban–Rural Residents. Soc Indic Res 2013, 1:19. doi:10.1007/s11205-013-0471-z (Published online: 16 October 2013)
• [16]Liu Y, Rao K, Hsiao WC: Medical expenditure and rural impoverishment in China. J Health Popul Nutr 2011, 21(3):216-222.
• [17]Zimmer Z, Kwong J: Socioeconomic status and health among older adults in rural and urban China. J Aging Health 2004, 16(1):44-70.
• [18]Zeng Y, Vaupelly JW: Association of late childbearing with healthy longevity among the oldest-old in China. Popul Stud 2004, 58(1):37-53.
• [19]Zeng Y, Gu D, Land KC: The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China. Demography 2007, 44(3):497-518.
• [20]Li LW, Zhang J, Liang J: Health among the oldest-old in China: which living arrangements make a difference? Soc Sci Med 2009, 68(2):220-227.
• [21]Liu G, Zhang Z: Sociodemographic differentials of the self-rated health of the oldest-old Chinese. Popul Res Policy Rev 2004, 23(2):117-133.
• [22]Zhu H, Xie Y: Socioeconomic differentials in mortality among the oldest old in China. Res Aging 2007, 29(2):125-143.
• [23]Zeng Y, Gu D, Purser J, Hoenig H, Christakis N: Associations of environmental factors with elderly health and mortality in China. Am J Public Health 2010, 100(2):298-305.
• [24]Wang Y: Development of the new rural cooperative medical system in China. China World Econ 2007, 15(4):66-77.
• [25]Liu Y: Development of the rural health insurance system in China. Health Policy Plan 2004, 19(3):159-165.
• [26]Zhou H, Li W: Problem analysis facing new rural medical cooperative system. Chinese Health Econ 2005, 24(5):5-8.
• [27]: Ministry of Health, Agriculture, Finance, China Food and Drug Administration, All China Federation of Supply and Marketing Cooperatives. Prospectus (draft) of cooperative medical scheme for rural areas 1979. http://www.110.com/fagui/law_111866.html webcite
• [28]Xu H, Short SE: Health Insurance Coverage Rates In 9 Provinces In China Doubled From 1997 To 2006, With A Dramatic Rural Upswing. Health Aff 2011, 30(12):2419-2426.
• [29]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.
• [30]Wagstaff A, Lindelow M, Gao J, Xu L, Qian J: Extending health insurance to the rural population: An impact evaluation of China’s new cooperative medical scheme. J Health Econ 2009, 28(1):1-19.
• [31]You X, Kobayashi Y: The new cooperative medical scheme in China. Health policy 2009, 91(1):1-9.
• [32]Lei X, Lin W: The new cooperative medical scheme in rural China: Does more coverage mean more service and better health? Health Econ 2009, 18(Suppl 2):S25-S46.
• [33]Qiu P, Yang Y, Zhang J, Ma X: Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China. BMC Public Health 2011, 11(1):520.
• [34]Brown PH, Theoharides C: Health-seeking behavior and hospital choice in China’s New Cooperative Medical System. Health Econ 2009, 18(2):S47-S64.
• [35]Qian D, Pong RW, Yin A, Nagarajan KV, Meng Q: Determinants of health care demand in poor, rural China: the case of Gansu Province. Health Policy Plan 2009, 24(5):324-334.
• [36]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(1):116.
• [37]Cheng L, Zhang Y: The New Rural Cooperative Medical Scheme: Financial Protection or Health Improvement? J Econ Res 2012, 1:120-133.
• [38]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? Tropical Med Int Health 2010, 15(4):468-475.
• [39]Cheng Z, Luo X: A Literature Review on China’s New Rural Co-operative Medical System. J Jishou University (Social Sciences Edition) 2009, 30(6):52-57.
• [40]Zeng Y: Chinese longitudinal healthy longevity survey(1998-2012) and related policy research review (part 1). Sci Res Aging 2013, 1(1):65.
• [41]Zeng Y: Introduction to the Chinese Longitudinal Healthy Longevity Survey (CLHLS) Chapter 2. Healthy longevity in China. Netherland: Springer Netherlands 2008, 20:23-38.
• [42]Zeng Y: Reliability of age reporting among the Chinese oldest-old in the CLHLS datasets Chapter 4. Healthy Longevity in China Netherland: Springer Netherlands 2008, 20:61-78.
• [43]Yip W, Subramanian SV, Mitchell AD, Lee DTS, Wang J, Kawachi I: Does social capital enhance health and well-being? Evidence from rural China. Soc Sci Med 2007, 64(1):35-49.
• [44]Chen D, Tang KK, Zhao L, Zhang Y: Will China’s Cooperative Medical System fail again? Insight from farmer satisfaction survey. Health Promot Int 2013, 1:13. doi:10.1093/heapro/dat032 (Published: May 12 2013)
• [45]Yi Z, Vaupel JW: Functional capacity and self–evaluation of health and life of oldest old in China. J Soc Issues 2002, 58(4):733-748.
• [46]Chan SWC, Chiu HFK, Chien W, Thompson DV, Lam L: Quality of life in Chinese elderly people with depression. Int J Geriatr Psychiatry 2006, 21(4):312-318.
• [47]Liang Y, Chu P, Wang X, Liang Y, Chu P, Wang X: Health-Related Quality of Life of Chinese Earthquake Survivors: A Case Study of Five Hard-Hit Disaster Counties in Sichuan. Soc Indic Res 2013, 1:24. doi:10.1007/s11205-013-0525-2 (Published online: 18 December 2013)
• [48]Liang Y, Wang XK: Developing a new perspective to study the health of survivors of Sichuan earthquakes in China: a study on the effect of post-earthquake rescue policies on survivors’ health-related quality of life. Health Research Policy and Systems 2013, 11:41-53.
• [49]Liu Q: Logistic regression model ans its research development. J Prev Med Inf 2002, 18(5):417-419.
• [50]Li J: Social support and quality of life of the elderly in China. Popul Res 2007, 31(3):50-60.
• [51]Lall R, Campbell MJ, Walters SJ, Morgan K, MRC CFAS Co-operative: A review of ordinal regression models applied on health-related quality of life assessments. Stat Methods Med Res 2002, 11(1):49-67.
• [52]Ahn J, Mukherjee B, Gruber SB, Sinha S: Missing Exposure Data in Stereotype Regression Model: Application to Matched Case–Control Study with Disease Subclassification. Biometrics 2011, 67(2):546-558.
• [53]Verkuilen J: A Review of Analysis of Ordinal Categorical Data. J Educ Behav Stat 2010, 35(5):603-604.
• [54]Abreu MNS, Siqueira AL, Cardoso CS, Caiaffa WT: Ordinal logistic regression models: application in quality of life studies. Cadernos de Saúde Pública 2008, 24:581-591.
• [55]Long JS: Regression models for nominal and ordinal outcomes. Regression Models 2012. the URL is here: http://www.indiana.edu/ webcite~jslsoc/files_research/cdanor/Long%20-%20Nominal%20Ordinal%20Regression%20Models%20-%202012-05-29.pdf
• [56]Lunt M, Unit A R C E: Stereotype ordinal regression. Stata Tech Bull 2001, 10(61):1-10.
• [57]Wang H, Yip W, Zhang L, Hsiao WC: The impact of rural mutual health care on health status: evaluation of a social experiment in rural China. Health Econ 2009, 18(Suppl 2):S65-S82.
• [58]Liang Y, Guo M: Utilization of Health Services and Health-Related Quality of Life Research of Rural-to-Urban Migrants in China: A Cross-Sectional Analysis. Soc Indic Res 2014, 1:19. doi:10.1007/s11205-014-0585-y
• [59]Gao S, Jin Y, Unverzagt FW, Liang C, Hall KS, Ma F, Murrell JR, Cheng Y, Matesan J, Li P, Bian J, Hendrie HC: Correlates of depressive symptoms in rural elderly Chinese. Int J Geriatr Psychiatry 2009, 24(12):1358-1366.
• [60]Chan SW, Shoumei JIA, Thompson DR, Yan HU, Chiu HFK, Chien W, Lam L: A cross-sectional study on the health related quality of life of depressed Chinese older people in Shanghai. Int J Geriatr Psychiatry 2006, 21(9):883-889.
• [61]Liu LJ, Guo Q: Loneliness and health-related quality of life for the empty nest elderly in the rural area of a mountainous county in China. Qual Life Res 2007, 16(8):1275-1280.
• [62]Benjamin D, Brandt L, Fan JZ: Ceaseless toil? Health and labor supply of the elderly in rural China. 2003. http://deepblue.lib.umich.edu/handle/2027.42/39965 webcite
• [63]Pang L, De Brauw A, Rozelle S: Working until you drop: The elderly of rural China. China J 2004, 52:73-94.
• [64]Lorig KR, Ritter P, Stewart AL, Sobel DS, William BB, Bandura A, Gonzalez VM, Laurent DD, Holman HR, Lorig KR, Ritter P, Stewart AL, Sobel DS, William BB, Bandura A, Gonzalez VM, Laurent DD, Holman HR: Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care 2001, 39(11):1217-1223.
• [65]Fries JF, Koop CE, Sokolov J, Beadle CE, Wright D: Beyond health promotion: reducing need and demand for medical care. Health Aff 1998, 17(2):70-84.
• [66]Liang Y, Lu W, Wu W: Are social security policies for Chinese landless farmers really effective on health in the process of Chinese rapid urbanization?: a study on the effect of social security policies for Chinese landless farmers on their health-related quality of life. Int J Equity Health 2014, 13(1):5.
• [67]Yeh SCJ, Liu YY: Influence of social support on cognitive function in the elderly. BMC Health Serv Res 2003, 3(1):9.
• [68]Wu Z, Schimmele CM: Psychological disposition and self-reported health among the ‘oldest-old’in China. Ageing Soc 2006, 26(1):135-151.
• [69]Paganini-Hill A, Kawas CH, Corrada MM: Activities and mortality in the elderly: the leisure world cohort study. J Gerontol A: Biol Med Sci 2011, 66(5):559-567.
• [70]Sugiyama T, Thompson CW: Environmental support for outdoor activities and older people’s quality of life. J Hous Elder 2006, 19(3–4):167-185.
• [71]Verghese J, Lipton RB, Katz MJ, Mindy JK, Charles BH, Carol AD, Gail K, Anne FA, Martin S, Herman B: Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003, 348(25):2508-2516.
• [72]Ravaglia G, Forti P, Lucicesare A, Pisacane N, Rietti E, Bianchin M, Dalmonte E: Physical activity and dementia risk in the elderly Findings from a prospective Italian study. Neurology 2008, 70(19):1786-1794.
• [73]Karp A, Paillard-Borg S, Wang HX, Silverstein M, Winblad B, Fratiglioni L: Mental, physical and social components in leisure activities equally contribute to decrease dementia risk. Dement Geriatr Cogn Disord 2006, 21(2):65-73.
• [74]Rantakokko M, Mänty M, Iwarsson S, Törmäkangas T, Leinonen R, Heikkinen E, Rantanen T: Fear of moving outdoors and development of outdoor walking difficulty in older people. J Am Geriatr Soc 2009, 57(4):634-640.
• [75]Wang X, Wang X: Study of the influence of outdoor activities on the subjective happiness level of urban solitary aged people. Med Soc 2012, 25(8):69-71.
• [76]Shimada H, Uchiyama Y, Kakurai S: Relationship between lifestyle activities and physical functions in elderly persons utilizing care facilities. Nihon Ronen Igakkai zasshi Japanese journal of geriatrics 2002, 39(2):197-203.
• [77]Zhang T, Chen Y: Meeting the needs of elderly people in China: Community health care is a good idea but unsatisfactorily implemented. BMJ 2006, 333(7564):363.
• [78]Liang L, Wu W: Exploratory analysis of health-related quality of life among the empty-nest elderly in rural China: An empirical study in three economically developed cities in eastern China. Health and Quality of Life Outcomes 2014, 12:59.
• [79]Liang Y, Cao R: Employment assistance policies of Chinese government play positive roles! The impact of post-earthquake employment assistance policies on the health-related quality of life of Chinese earthquake populations. Soc Indic Res 2014. doi:10.1007/s11205-014-0620-z
• [80]Liang Y, Cao R: Is the health status of female victims poorer than male s in the post-disaster reconstruct ion in China: a comparative study of data on male victims in the first survey and double tracking survey data. BMC Women's Health 2014, 14:18.
• [81]Liang Y, Li S: Landless female peasants living in urban villages in China have poorer quality of life than males: results from a household study in the Yangtze River Delta region. Health and Quality of Life Outcomes 2014, 12:71.