Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices.
BACKGROUND
In 2003 the Chinese government introduced voluntary cooperative medical schemes (CMS), soon to be in place throughout rural China. Families who chose to enroll do so as a single unit and nothing is known about any differential effect of these new schemes on family members. This study evaluates the impact of one pilot CMS in Anhui Province on health care use by girls aged less than 5 years and women 65 years or older, and on the pattern and cost of prescriptions.


METHODS
Health care records were extracted covering a 10 year period, before, during and after the pilot CMS in 4 townships, one with the intervention and 3 comparison townships without. The impact of the intervention on the age and gender distribution of patients presenting for health care and on the prescription of certain drugs was assessed by logistic regression. The cost of prescriptions before, during and after the intervention period was also assessed.


RESULTS
203,058 registration and 643,588 prescription records were identified. During the intervention there was a reduced likelihood overall that a patient was female (OR = 0.92: 95%CI 0.87-0.97) at the intervention site. Girls aged < 5 years had an increased likelihood of health care (OR = 1.41: 95%CI 1.23-1.59) during the CMS, but women ≥ 65 years were relatively disadvantaged (OR = 0.84: 95%CI 0.75-0.95). The use of antibiotics and systemic steroids increased disproportionately at the intervention site for patients ≥ 5 years. Prescription costs at the township hospital also increased at the intervention site, particularly for older men.


CONCLUSIONS
This evaluation suggests that all family members did not benefit equally from the pilot CMS and that women ≥ 65 years may be disadvantaged by the newly available reimbursements of health care costs through the CMS. It points to the need, in future evaluations, to use individuals rather than families as the unit of analysis, in order to determine whether such health care inequalities are wide-spread and persistent or are reduced in the longer term. The results also support earlier concerns about the influence of new funding resources on prescription practices and the need for regulation of for-profit prescribing.
School of Health Administration, Anhui Medical University, Meishanlu 81, Hefei, Anhui, China.
Qicheng
Q
Jiang
Zhen
Z
Jiang
Ming
M
Zhao
Jie
J
Tao
Chunsun
C
Ling
Nicola
N
Cherry
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002681:China; D003299:Cooperative Behavior; D016527:Drug Costs / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D055553:Prescription Drugs / Q000145:classification / Q000191:economics; D012111:Residence Characteristics; D019035:Rural Health Services / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D012737:Sex Factors; D012959:Socioeconomic Factors; D013256:Steroids / Q000627:therapeutic use; D035141:Voluntary Programs
D000900:Anti-Bacterial Agents; D055553:Prescription Drugs; D013256:Steroids
N Engl J Med. 1998 Jun 4;338(23):1678-83
9614260
BMC Public Health. 2007 Feb 08;7:19
17288593
Lancet. 2004 Oct 9-15;364(9442):1365-70
15474141
Health Policy. 2008 May;86(2-3):239-44
18054112
Soc Sci Med. 2009 Jan;68(2):201-9
19019519
Lancet. 2008 Oct 25;372(9648):1493-501
18930531
Soc Sci Med. 2008 Feb;66(4):952-62
18158210
Health Econ. 2009 Jan;18(1):103-19
18283715
Health Econ. 2009 Jul;18 Suppl 2:S65-82
19267321
Health Econ. 2009 Jul;18 Suppl 2:S7-23
19551753
Health Policy. 2009 Jun;91(1):1-9
19121873
Lancet. 2008 Nov 22;372(9652):1846-53
18930520
J Health Econ. 2009 Jan;28(1):1-19
19058865
Health Econ. 2009 Jul;18 Suppl 2:S25-46
19551752
Soc Sci Med. 2009 May;68(10):1775-9
19342138
Am J Public Health. 2004 Mar;94(3):400-5
14998803