Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA :...

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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

Xuefei Gu, Xiaoguang Fu, M. Hafizur Rahman, David H. Peters, Zhengzhong Mao

2卫生部卫生经济研究所

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CHEI Background

ο In late 2002, Chinese government resolved to introduce

the New Rural Cooperative Medical Scheme (NCMS) and

Medical Assistance (MA) to prevent "illness induced

poverty"

low utilization of health services

poverty

illness & injury NCMS+MA


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CHEI Content

ο Background

ο Methodology

ο Results

ο Discussion


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CHEI Background

ο NCMS targets all rural communities

ο MA targets the poor in rural and urban areas

ο MA finances are principally directed at funding

poor farmers’ contributions to NCMS

ο In terms of inpatient services, the poor pays a

lower proportion of medical care expenses OOP

than better off


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CHEI Background

ο Some previous researches showed that farmers’

use of health services, particularly inpatient

services, had risen dramatically under NCMS

ο But the poor used less than non-poor

ο Why?

Deductible 100-300 CNY

Ceiling: about 20,000 CNY

NCMS subsidies40%-60%

NCMS subsidies40%-60%

MA subsidies 30%-50%

MA subsidies 30%-50%

Co-pay 10%-20%

Co-pay 10%-20%

6

NCMS and MA inpatient reimbursement

6

MA pays for the part under the deductible

line

MA pays for the part under the deductible

line


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CHEI Background

ο Except the high co-payment, complicated

reimbursement procedure was another

important reason

ο NCMS is administered by health authorities and

MA is charged by the Ministry of Civil Affairs

ο The poor needs to pay all hospitalizing expenses

and then get subsides from NCMS and MA


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CHEI

NCMS administration

office

discharge from hospital

pay all hospitalizing

expenses

Bureau of Civil Affairs

get subside from NCMS

get subside from MA

long time


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CHEI Research Question

ο The linkages between two programs including

scheme design and management level became a

big problem

ο A few counties had done some experiments on it

ο The study attempts to answer if the inpatient

services utilization by the poor can be improved

under the linkage between NCMS and MA


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CHEI Assumption

ο There is difference among different income

groups on the utilization of health services

ο 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


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CHEI Methodology

ο 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

ο 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

ο One or more admissions last year was coded as 1, and

no admissions as 0


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CHEI Methodology

ο The study population was divided into 5 groups

by wealth status

ο Wealth index was used as a proxy for poverty

variable and other sociodemographic

characteristics were considered

ο Logistic regression was used to analyze the

association between inpatient service utilization

and socio-economic status


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CHEI Results

低中低中中高高0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

2006年

2007年

poorest 20%

2nd poorest 20%

middle 20%

richest 20%

2nd richest 20%

Persons without hospital admission within twelve months


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CHEI Results: 3 counties

OR P 95% CI

wealth quintile

1(poorest) 1

2 1.11 0.7 0.65-1.91

3 1.42 0.246 0.78-2.60

4 2.6 0.006 1.31-5.15

5(richest) 2.9 0.009 1.31-6.40

year

2006 1

2007 1.3 0.233 0.84-2.04


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CHEI Results: County A

OR P 95% CI

wealth quintile

1(poorest) 1

2 0.77 0.677 0.23-2.58

3 0.73 0.555 0.25-2.09

4 1.9 0.251 0.63-5.71

5(richest) 7.24 0.023 1.32-39.87

year

2006 1

2007 1.02 0.961 0.44-2.37


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CHEI Results: County B

OR P 95% CI

wealth quintile

1(poorest) 1

2 2.07 0.198 0.68-6.31

3 2.98 0.095 0.83-10.71

4 9.39 0.002 2.22-39.63

5(richest) 5.32 0.011 1.47-19.31

year

2006 1

2007 0.94 0.901 0.36-2.43


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CHEI Results: County C

OR P 95% CI

wealth quintile

1(poorest) 1

2 0.93 0.860 0.43-2.02

3 2.80 0.090 0.85-9.19

4 1.67 0.470 0.42-6.67

5(richest) 0.43 0.314 0.08-2.21

year

2006 1

2007 1.94 0.079 0.93-4.09


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CHEI Results

ο 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

ο Compared to 2006, the odds of hospital admission for all

farmers is increased by 30% in 2007 (not significant)

ο Separate analysis shows that the poorest quintile in county

A used inpatient services more than the 2nd and third

quintiles


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CHEI Discussion

ο Why county A’ result is better?

county scheme design management linkage level

A MA pays for the part under the deductible line; the poor’s copayment rate is less than 15%

the poor can get reimbursement from NCMS and MA at same time when discharge from hospital

high

B the poor needs to pay deductible; MA only covers few catastrophic diseases

the poor needs apply for MA and maybe get reimbursement every six months

low

C NCMS cancel the deductible in 2007

the poor can get reimbursement from NCMS when discharge from hospital and then go to bureau of civil affairs to apply for MA, generally can get reimbursement two months later

middle


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CHEI Discussion

ο 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

ο We could increase the poor's inpatient service

utilization by improving the linkages between

NCMS and MA


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CHEI

Thank you!

Analysis of Inpatient Services Utilization by Wealth Classes Under the Linkage Between NCMS and MA :...

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