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首页> 外文期刊>International journal for equity in health >The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China
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The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

机译：农村医疗保障计划对中国农村地区卫生利用和家庭贫困的影响：来自中国中西部地区家庭调查的数据

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Background The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes. Methods A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview. Results NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment. Conclusion The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.
机译：背景技术2003年为中国农村地区建立了新农村合作医疗计划（NRCMS，自愿医疗保险）和医疗财政援助（MFA，财政救济计划）。这项研究的目的是记录他们的覆盖面，评估他们在获得住院治疗和预防因医疗支出造成的经济灾难和家庭贫困方面的有效性，并确定使用或不使用这些计划的预测贫困的因素。方法采用多阶段抽样技术，于2008年在河北，陕西，内蒙古自治区进行了家庭横断面调查。通过访谈收集有关个人人口统计特征，慢性病状态，医疗保健使用，家庭支出和家庭健康支出的信息。结果新农合覆盖了90.8％的研究对象，在指定的贫困人口中，有7.6％的保险费由MFA支付。在面试前一年被转诊住院的人中，有34.3％的人没有遵守规定，主要是由于经济上的限制（80.2％）。拥有新农合的投保人与未投保的未满足入学需求之间无显着差异。报销前，灾难性医疗费用（家庭医疗支出超过家庭支付能力的40％）和医疗贫困（家庭人均收入由于医疗费用而下降到贫困线以下）的发生率分别为14.3％和8.2％。新农合使9.9％的家庭免于金融灾难，使7.7％的家庭免于贫困，而外交部仅使一户家庭免于贫困，对金融灾难没有影响。家庭人均支出和家庭慢性疾病比例（患有慢性疾病的家庭成员的比例）是未满足入学需求，贫困风险和因贫困而得不到救助的机会的最重要决定因素。结论农村地区的新农合覆盖率很高，但不足以改善就医机会，并不能防止因医疗保健支出而造成的经济灾难和家庭贫困，特别是对于穷人和慢性病患者。此外，外交部几乎没有发挥任何作用;因此，目前的方案有待改进。

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