title: The effect of NCMS on catastrophic health expenditure and impoverishment from tuberculosis care in China.
abstract: Health expenditure for tuberculosis (TB) care often pushes households into catastrophe and poverty. New Cooperative Medical Scheme (NCMS) aims to protect households from catastrophic health expenditure (CHE) and impoverishment in rural China. This article assesses the effect of NCMS on relieving CHE and impoverishment from TB care in rural China.
  
  
  
  Three hundred fourty-seven TB cases are included in the analysis. We analyze the incidence and intensity of CHE and poverty, and assess the protective effect of NCMS by comparing the CHE and impoverishment before and after reimbursement.
  
  
  
  After out-of-pocket (OOP) payment for TB care, 16.1 % of non-poor fall below poverty line. The NCMS reduces the incidence of CHE and impoverishment by 11.5 % and 7.3 %. After reimbursement, 46.7 % of the households still experience CHE and 35.4 % are below the poverty line. The NCMS relieves the mean gap, mean positive gap, poverty gap and normalized positive gap by 44.5 %, 51.0 %, US$115.8 and 31.6 % respectively.
  
  
  
  The NCMS has partial effect on protecting households from CHE and impoverishment from TB care. The limited protection could be enhanced by redesigning benefit coverage to improve the "height" of the NCMS and representing fee-for-service with alternative payment mechanisms.
authors.affiliation: Department of Social Medicine and Health Service Management, School of Public Health, Shandong University, Jinan, China.|Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Shandong University, Jinan, China.|Key Laboratory of Health Economic and Policy Research, NHFPC, Shandong University, Wen-hua-xi Road No. 44, Jinan City, 250012, China.
authors.forename: Chengchao
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Global Health Research Center, Duke Kunshan University, Kunshan, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Long
authors.affiliation: School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
authors.forename: Jiaying
authors.initials: J
authors.lastname: Chen
authors.affiliation: School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xiang
authors.affiliation: School of Public Health, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Global Health Research Center, Duke Kunshan University, Kunshan, China.|Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Shenglan
authors.initials: S
authors.lastname: Tang
authors.affiliation: National Center for TB Control and Prevention, China CDC, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Huang
authors.affiliation: Key Laboratory of Health Economic and Policy Research, NHFPC, Shandong University, Wen-hua-xi Road No. 44, Jinan City, 250012, China. qiangs@sdu.edu.cn.|Center for Health Management and Policy, Shandong University, Jinan, China. qiangs@sdu.edu.cn.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Institute of Development Studies, Sussex University, Brighton, UK.
authors.forename: Henry
authors.initials: H
authors.lastname: Lucas
authors.affiliation: Bill & Melinda Gates Foundation Beijing Office, Beijing, China.
authors.forename: Shitong
authors.initials: S
authors.lastname: Huan
mesh_terms: D002388:Catastrophic Illness; D002681:China / Q000453:epidemiology; D005191:Family Characteristics; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D011203:Poverty; D012424:Rural Population / Q000706:statistics & numerical data*; D014376:Tuberculosis / Q000453:epidemiology* / Q000628:therapy*
keywords: Catastrophic health expenditure; China; Impoverishment; NCMS; Tuberculosis