title: Role of the new rural cooperative medical system in alleviating catastrophic medical payments for hypertension, stroke and coronary heart disease in poor rural areas of China.
abstract: BACKGROUND
  Hypertension, stroke and coronary heart disease (CHD) are common diseases that impose a heavy burden on patients and their families, particularly on those living in poor areas. This study examined catastrophic medical payments faced by patients with these diseases and the effectiveness of the new rural cooperative medical system (NRCMS) at alleviating the impact of the said diseases in fourth-class rural areas (i.e. those with annual income of less than RMB 1500/$240.2 per capita) of China.
  
  
  METHODS
  Data on medical payments, including out-of-pocket and NRCMS-reimbursed expenses were collected through self-administered questionnaires. The pre- and post-reimbursement (via the NRCMS) prevalence of household poverty, catastrophic medical payment (CMP) incidence (H cat), mean CMP gap (Gcat), mean positive CMP gap (MPG cat) and other determinants of CMP incidence were identified.
  
  
  RESULTS
  Out-of-pocket payments for treatment of hypertension, stroke and CHD averaged RMB 580.1/$92.9, RMB 3028.4/$484.8 and RMB 1561.4/$250.0 per capita, respectively, in 2008. H cat, Gcat and MPG cat due to the three diseases were 17.0%, 16.6% and 97.6%, respectively, and reimbursement through the NRCMS reduced them to 13.5%, 11.8% and 87.4%, respectively. The difference between pre- and post-reimbursement H cat was not statistically significant. After adjusting the covariates for age [OR = 1.87, 95% confidence interval (CI) = 1.19-2.95], education (OR = 1.56, 95% CI = 1.07-2.27), marital status (OR = 1.67, 95% CI = 1.11-2.51), occupation (OR = 1.96, 95% CI = 1.34-2.85), annual income (OR = 4.95, 95% CI = 3.28-7.48), the multiple logistic regression analysis revealed that patients with stroke (OR = 3.94, 95% CI = 2.38-6.51) or CHD (OR = 2.25, 95% CI = 1.38-3.65) were more susceptible to CMP compared with patients with hypertension only.
  
  
  CONCLUSIONS
  Out-of-pocket medical spending on hypertension, stroke and CHD imposes a heavy financial burden on the residents of fourth-class rural areas of China. The NRCMS has some impact on reducing catastrophic medical payments associated with these diseases, but improvement of the reimbursement rate is necessary to further improve its effectiveness.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Huan
authors.initials: H
authors.lastname: Liu
authors.forename: Zu X
authors.initials: ZX
authors.lastname: Lu
authors.forename: Qing
authors.initials: Q
authors.lastname: Luo
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China. lja10_11@163.com.
authors.forename: Jun A
authors.initials: JA
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003327:Coronary Disease / Q000191:economics*; D017281:Cost of Illness; D005191:Family Characteristics; D005260:Female; D005381:Financing, Organized / Q000379:methods* / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000191:economics*; D007182:Income; D007354:Insurance, Major Medical / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D015397:Program Evaluation / Q000379:methods; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D020521:Stroke / Q000191:economics*; D011795:Surveys and Questionnaires; D055815:Young Adult