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The Effects of NCMS on the Equity of Health Service Utilization in China

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Author(s): Zhongliang Zhou | Jianmin Gao

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 248;
Date: 2011;
Original page

Keywords: NCMS | PSM | health service utilization | equity

ABSTRACT
Background: Equity of health service utilization, which means health care ought to be distributedaccording to need, rather than willingness and ability to pay, is a goal pursued by policy-makers in allcountries, and China is no exception. In order to improve people’s health utilization equity, Chinaimplemented NCMS (a community based health insurance scheme) in rural area since 2003, from whichthe benefit package only covers hospitalization, and for outpatient service, household saving account isestablished. However, very few studies provided scientific evidence on whether people’s health utilizationequity is improved by NCMS.Aim & Objectives: This study aims to investigate the effect of NCMS on the income-related equity ofhealth service utilization in rural China and make recommendations on improving China’s healthinsurance system.Methods: The data came from the National Health Services Survey in Shaanxi province in 2008, fromwhich 8010 NCMS enrollees and 459 uninsured residents were interviewed by using a questionnairedesigned by the Health Ministry of China. In order to estimate the effect of NCMS on health utilizationequity, the Propensity Score Matching (PSM) was firstly employed to match the insured and uninsuredresidents in this study. Then, based on the matched data, methods like concentration index anddecomposition of concentration index were employed to calculate the residents’ horizontal-inequity indexof health service utilization.Results: The pro-rich outpatient utilization inequity (with the same need, the rich use more outpatientservice than the poor) was increased by NCMS, from which the horizontal-inequity index of probabilityof outpatient visit was increased from -0.0419 to 0.1525 and the horizontal-inequity index of outpatientvisits was increased from 0.0499 to 0.2266. Different from outpatient service, the pro-rich inpatientutilization inequity was reduced by NCMS. For the insured and uninsured residents, the horizontalinequityindexes of probability of inpatient visit were 0.1676 and 0.2005 respectively, and the horizontalinequityindexes of inpatient visits were 0.2350 and 0.2998 respectively.Study limitations: As there is a precondition of using PSM—that is, that selection bias is eliminated bycontrolling for observables, the conditional independence assumption was made in this article.Conclusion: The household saving account established in NCMS decreased the outpatient utilizationequity and the benefit package which covers hospitalization in NCMS improved the inpatient utilizationequity, which suggests that not only inpatient service but also outpatient service should be covered byNCMS.
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