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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Health & Medicine

Published on July 27, 2009

Author: Samanthareddin

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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

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

www.futurehealthsytems.org

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

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