title: Protecting patients with cardiovascular diseases from catastrophic health expenditure and impoverishment by health finance reform.
abstract: OBJECTIVE
  To compare the incidences of catastrophic health expenditure (CHE) and impoverishment, the risk protection offered by two health financial reforms and to explore factors associated with CHE and impoverishment among patients with cardiovascular diseases (CVDs) in rural Inner Mongolia, China.
  
  
  METHODS
  Cross-sectional study conducted in 2014 in rural Inner Mongolia, China. Patients with CVDs aged over 18 years residing in the sample areas for at least one year were eligible. The definitions of CHE and impoverishment recommended by WHO were adopted. The protection of CHE and impoverishment was compared between the New Cooperative Medical Scheme (NCMS) alone and NCMS plus National Essential Medicines Scheme (NEMS) using the percentage change of incidences for CHE and impoverishment. Logistic regression was used to explore factors associated with CHE and impoverishment.
  
  
  RESULTS
  The incidences of CHE and impoverishment under NCMS plus NEMS were 11.26% and 3.30%, respectively, which were lower than those under NCMS alone. The rates of protection were higher among households with patients with CVDs covered by NCMS plus NEMS (25.68% and 34.65%, respectively). NCMS plus NEMS could protect the poor households more from CHE but not impoverishment. NCMS plus NEMS protected more than one-fourth of households from CHE and more than one-third from impoverishment.
  
  
  CONCLUSIONS
  NCMS plus NEMS was more effective at protecting households with patients with CVDs from CHE and impoverishment than NCMS alone. An integration of NCMS with NEMS should be expanded. However, further strategies to minimise catastrophic health expenditure after this health finance reform are still needed.
authors.affiliation: Department of Health Economics, School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
authors.forename: Tippawan
authors.initials: T
authors.lastname: Liabsuetrakul
authors.affiliation: Department of Health Economics, School of Health Management, Inner Mongolia Medical University, Inner Mongolia, China.
authors.forename: Yancun
authors.initials: Y
authors.lastname: Fan
authors.affiliation: Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
authors.forename: Edward
authors.initials: E
authors.lastname: McNeil
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics*; D002388:Catastrophic Illness; D002681:China; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005380:Financing, Government; D018166:Health Care Reform / Q000191:economics*; D005102:Health Expenditures; D006801:Humans; D007182:Income; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008986:Mongolia; D011203:Poverty; D012424:Rural Population
keywords: catastrophic health expenditure; financial risk; health financial reform; impoverishment; rural