Financial protection of rural health insurance for patients with hypertension and diabetes: repeated cross-sectional surveys in rural China.
The New Cooperative Medical Scheme (NCMS) in rural China has been expanding in both population coverage and benefit package. China has also established an essential medicine policy in recent years to further reduce patients' medical expenditures and financial burden. This study aims to evaluate the impact of these policies on reducing medical expenditures and financial burden of patients diagnosed with hypertension and diabetes.



This study used repeated cross-sectional surveys in 2011 and 2012 in three counties of Shandong Province. Outpatient and inpatient service expenditures and catastrophic health expenditures (CHE) were measured and analyzed.



Medical expenditures for outpatient services significantly increased for hypertensive and diabetic patients within a 1 year period, while inpatient service expenditures remained unchanged. Although NCMS increased its reimbursement rate, hypertensive and diabetic patients still heavily suffered CHE from both outpatient and inpatient services. Outpatient services were more important factors than inpatient services contributing to non-communicable chronic diseases (NCD) patients' financial burden.



The effects of NCMS expansion have been offset by the rapid escalation of medical expenditures. More attention should be paid to the design of NCMS benefit package to cover NCD outpatient services. There is also an urgent need to reform the current Fee for Service to other provider payment methods in order to control the escalating NCD medical expenditures.
China Center for Health Development Studies, Peking University, Beijing, China. xliu@bjmu.edu.cn.
Xiaoyun
X
Liu
Center for Health Management and Policy, Shandong University, Jinan, China.
Xiaojie
X
Sun
China Center for Health Development Studies, Peking University, Beijing, China.
Yang
Y
Zhao
China Center for Health Development Studies, Peking University, Beijing, China.
Qingyue
Q
Meng
D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005380:Financing, Government / Q000191:economics*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012423:Rural Health / Q000191:economics*; D019035:Rural Health Services / Q000191:economics*; D012424:Rural Population; D011795:Surveys and Questionnaires
China; Financial protection; Medical expenditure; New Cooperative Medical Scheme; Non-communicable chronic disease