title: China's new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey.
abstract: BACKGROUND
  China's New Cooperative Medical Scheme (NCMS) was brought to life in 2003 in response to the deterioration in access to health services in rural areas. Despite its fast expansion, the scheme's impacts on access to health care have raised growing concerns, in particular regarding whether and to what extent the scheme has reduced inequity in access to health care in rural China.
  
  
  METHODS
  This study examines income-related inequity in access to health care from 2004 (before the national rollout of NCMS) to 2009 (after the expansion of NCMS across the rural China) by estimating Concentration Indices over both formal health care (outpatient care, prevention care) and informal health care use (folk doctor care). Data were drawn from a longitudinal household survey dataset - China Health and Nutrition Survey (CHNS).
  
  
  RESULTS
  The study suggested that the level of inequity remained the same for outpatient care, and an increased favouring-poor gap in terms of folk doctor care was observed. In terms of preventive care, a favouring-rich inequity was observed both in 2004 and 2009, but the effects of inequity were narrowed. The NCMS had some effects in reducing income-related health inequity in folk doctor care and preventive care, but the contribution was rather small. The study also found that the rural better-off had started to seek for commercial insurance to cover possible financial risks from the burden of diseases.
  
  
  CONCLUSIONS
  The study concludes that the impacts of the NCMS on improving access to formal care for the poor are limited. Without a more comprehensive insurance package that effectively targets the rural poor, the intended equity goals expected from the scheme will be difficult to realize.
authors.affiliation: Department of Social Policy, LSE Health, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. w.yang2@lse.ac.uk
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D003299:Cooperative Behavior; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000458:organization & administration*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult