title: How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China.
abstract: BACKGROUND
  Many countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China.
  
  
  METHODS
  Using multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey.
  
  
  RESULTS
  NCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location.Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital.High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization.
  
  
  CONCLUSIONS
  Outpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low income group. While providing financial protection against catastrophic medical expenditure is the principal focus of NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development. NCMS policy should also be more equity oriented to achieve its policy goal.
authors.affiliation: Centre for Health Management and Policy, Shandong University, 44 Wenhua Xi Road, Jinan, 250012, Shandong, China.
authors.forename: Baorong
authors.initials: B
authors.lastname: Yu
authors.forename: Qingyue
authors.initials: Q
authors.lastname: Meng
authors.forename: Charles
authors.initials: C
authors.lastname: Collins
authors.forename: Rachel
authors.initials: R
authors.lastname: Tolhurst
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
authors.forename: Fei
authors.initials: F
authors.lastname: Yan
authors.forename: Lennart
authors.initials: L
authors.lastname: Bogg
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Liu
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics; D005380:Financing, Government; D005382:Financing, Personal; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D016015:Logistic Models; D012111:Residence Characteristics; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data*; D035141:Voluntary Programs
references.citation: Health Policy Plan. 2009 Sep;24(5):324-34
references.pmid: 19429698
references.citation: BMC Health Serv Res. 2008 Apr 10;8:81
references.pmid: 18402704
references.citation: Soc Sci Med. 1999 Nov;49(10):1349-56
references.pmid: 10509825
references.citation: Soc Sci Med. 1993 Feb;36(4):385-91
references.pmid: 8434263
references.citation: Lancet. 2004 Oct 9-15;364(9442):1365-70
references.pmid: 15474141
references.citation: J Health Econ. 2009 Jan;28(1):1-19
references.pmid: 19058865
references.citation: BMC Health Serv Res. 2006 Nov 02;6:146
references.pmid: 17081303
references.citation: Lancet. 2008 Oct 25;372(9648):1493-501
references.pmid: 18930531
references.citation: Med Care. 1998 Dec;36(12):1639-59
references.pmid: 9860054
references.citation: J Clin Epidemiol. 2002 Jan;55(1):60-6
references.pmid: 11781123
references.citation: Health Policy Plan. 2002 Dec;17 Suppl:20-9
references.pmid: 12477738
references.citation: J Am Board Fam Med. 2008 Sep-Oct;21(5):398-407
references.pmid: 18772294
references.citation: Soc Sci Med. 1995 Oct;41(8):1111-8
references.pmid: 8578334
references.citation: Health Policy Plan. 2009 Jan;24(1):63-71
references.pmid: 19004861
references.citation: Soc Sci Med. 2009 Jan;68(2):201-9
references.pmid: 19019519
references.citation: Soc Sci Med. 1999 Apr;48(7):961-72
references.pmid: 10192562
references.citation: Health Econ. 2009 Jan;18(1):103-19
references.pmid: 18283715