An Impact Evaluation of Access to Health Care In Different Social Experiments of Rural China

Presenter: Qinxiang Xue, Xi'an Jiaotong University

Abstract

Rationale: Rural Mutual Health Care Scheme (RMHCS) and New Cooperative Medical Scheme (NCMS) both were community-based models in the rural western parts of China during 2003-2006. Two models had their own characteristics. They have differences from the scheme design, manage mechanism, financing and implementing etc. Comparing two models, and summarizing the experiences and lessons, the results could help to improve present NCMS and rural health reform.

Objectives: The objective of this paper is to compare and contrast two models for their impacts to promote health care access in pilot county Zhen’an Shaanxi China, and analyze the possible reasons for the results, put forward some on how to improve the health care access in western rural China.

Methodology: A binary logit model was used to estimate the probability of participation; To evaluate the impact of MHCS on financial protection of members between the participants and non-participants, two aspects shoud be taken into account: the probability of visiting a health care provider, and the out-of-pocket expenditure borne by individuals. Two-part model developed as part of the Rand Health Insurance Experiment in the United States was used to assess the probability of utilizations including visiting doctor and hospitalization, and estimate the level of out-of-pocket expenditures, conditioning on positive use of health care services: a logit model is used for utilization; log-linear model for health expenditure, of out-of-pocket, conditioning on positive use of health care services. Data collected from the household survey conducted in the Tiechang and Gaofeng townships, Zhen’an, Shaanxi,China in November 2005. The multistage stratified random sampling was used in the survey. The total number of households and interviewees were 1219 (570 in Tiechang, 649 in Gaofeng) and 4802 (2332 in Tie chang, 2470 in Gaofeng) respectively. The survey includes the income, socio-demographic characteristics, health status, one month and a 1-year recall period used for outpatient and inpatient care and out-of-pocket expenditure as well.

Results: The research shows that RMHC had the better effect on increasing health utilization and decreasing health out-of-pocket expenditure than NCMS based on the sampling data in Zhen’an Shaanxi, China;

Conclusions: Generally speaking, the same results for the two models are mainly that poor farmers are less likely to attend the scheme, and the families with higher illness ratio have higher possible for the enrolment; Compared with NCMS, people being the member of RMHC were more likely to use outpatient and inpatient services. The farmers who were the member of RMHC paid less when they participated the scheme, so the RMHC had the positive effect to lower out-of-pocket expenditure, mainly decrease the outpatient expenditure, the results were significant. For the inpatient fees, the both models did not show the function we expected, even in the NCMS with mainly for hospital reimbursements.