title: Evaluation of the impact of a chronic disease scheme reimbursing medical costs of patients with diabetes in Anhui province, China: a follow-up study.
abstract: Although many studies have investigated the relationship between the introduction of the New Cooperative Medical Scheme (NCMS) in rural China in 2003 and increased use of medical services, the effect on health status, objectively measured, is seldom reported. In Anhui Province a chronic disease scheme (CDS) for reimbursing part of the cost of outpatient care is designed to improve management of those with chronic conditions, including diabetes.
  
  
  
  A follow-up study was designed in which patients with diabetes aged 40-70 years who had recently (in 2010) been granted a chronic disease card were individually matched on age, sex and village with a patient with diabetes not yet in the scheme. Each subject gave a fingertip sample of blood to give the concentration of glycosylated hemoglobin (HbA1c), a measure indicating blood glucose control during the previous 3 months. This measure was made on recruitment and at 12 month follow-up: information on use of health services, quality of life and financial burden was also collected at the two contacts.
  
  
  
  Of 602 pairs initially recruited, 528 pairs were contacted at follow-up and are the subject of this report. To distinguish between outcomes associated with application and those of membership of the scheme, the primary analysis was of 256 pairs in which one had been a member of the CDS throughout and the other never applied. No difference between pairs on HbA1c was found either at recruitment or follow-up but those in the CDS reported more hospital visits, more tests and more use of high level hospitals. However they had poorer scores on quality of life scales (SF-12, EQ-5D) and were more likely to report that the financial costs were very burdensome. Those recently applying for the scheme, or being accepted since recruitment, had lower HbA1c scores.
  
  
  
  On-going membership of the CDS was associated with increased use of services but this did not appear to result in better management of blood glucose or improved quality of life. Those who had recently joined the scheme had signs of improvement, suggesting a need for active follow-up to maintain and reinforce early gains.
authors.affiliation: School of Public Health, Anhui Medical University, Anhui, China.|School of Health Management, Anhui Medical University, Anhui, China.
authors.forename: Qicheng
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: School of Health Management, Anhui Medical University, Anhui, China.|National HIV/AIDS Center, Anhui, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Jiang
authors.affiliation: Anhui Provincial Hospital, Anhui, China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Xin
authors.affiliation: Division of Preventive Medicine, University of Alberta, 5-22 University Terrace, 8303-112 St, Edmonton, AB, T6G 2 T4, Canada. ncherry@ualberta.ca.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cherry
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002681:China; D002908:Chronic Disease; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058996:Quality Improvement; D011788:Quality of Life; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: China; Chronic disease scheme; Diabetes; NCMS; Quality of life