Health care in China is highly inequitable

The old age health security in rural China: where to go?

Introduction

The huge number of rural elders and the deepening health problems (e.g. growing threats of infectious diseases and chronic diseases etc.) place enormous pressure on old age health security in rural China. This study aims to provide information for policy-makers to develop effective measures for promoting rural elders’ health care service access by examining the current developments and challenges confronted by the old age health security in rural China.

Methods

Search resources are electronic databases, web pages of the National Bureau of Statistics of China and the National Health and Family Planning Commission of China on the internet, China Population and Employment Statistics Yearbook, China Civil Affairs’ Statistical Yearbook and China Health Statistics Yearbooks etc. Articles were identified from Elsevier, Wiley, EBSCO, EMBASE, PubMed, SCI Expanded, ProQuest, and National Knowledge Infrastructure of China (CNKI) which is the most informative database in Chinese. Search terms were “rural”, “China”, “health security”, “cooperative medical scheme”, “social medical assistance”, “medical insurance” or “community based medical insurance”, “old”, or “elder”, “elderly”, or “aged”, “aging”. Google scholar was searched with the same combination of keywords.

Results

The results showed that old age health security in rural China had expanded to all rural elders and substantially improved health care service utilization among rural elders. Increasing chronic disease prevalence rates, pressing public health issues, inefficient rural health care service provision system and lack of sufficient financing challenged the old age health security in rural China.

Conclusions

Increasing funds from the central and regional governments for old age health security in rural China will contribute to reducing urban–rural disparities in provision of old age health security and increasing health equity among rural elders between different regions. Meanwhile, initiating provider payment reform may contribute to improving the efficiency of rural health care service provision system and promoting health care service access among rural elders.

Utilization of delivery care among rural women in China: does the health insurance make a difference? a cross-sectional study

Background

Since 2003, the New Cooperative Medical Scheme (NCMS) has been implemented throughout rural China, usually covering delivery services in its benefit package. The objective of this study was to compare the difference of utilization of delivery services, expenditures, and local women's perceived affordability between women with and without reimbursement from NCMS.

Methods

A cross-sectional survey was carried out in two rural counties in Shaanxi province, China, during December 2008-March 2009. Women giving birth from April 2008 to March 2009 were interviewed by a structured questionnaire to collect information on utilization of delivery services. Multivariable analyses were used to compare the differences in outcomes between women with and without reimbursement from NCMS.

Results

Of the total 1613 women interviewed, 747(46.3%) got reimbursement to cover their expenditure on delivery care (NCMS group) and 866(53.7%) paid delivery services entirely out of their own pocket (Non-NCMS group). Compared with the Non-NCMS group, the NCMS group had significantly more women who delivered at hospital. The rate of Caesarean section (CS), proportion of women seeking higher level services, and length of hospitalization were similar between the two groups. The total hospital costs for delivery services in the NCMS group was significantly smaller and after being reimbursed, the out-of-pocket payment in the NCMS group was less than a half of that in the Non-NCMS group. Fewer women in the NCMS group than in the Non-NCMS group considered their payment for delivery services expensive.

Conclusions

There was no evidence of overuse delivery services among the women reimbursed by NCMS. Total hospital costs and women's costs for delivery services were found lower in the NCMS group, subsequently alleviation on women's perceived financial affordability.

Access to healthcare services makes a difference in healthy longevity among older Chinese adults

The positive impact of access to healthcare on health and survival among older adults is well-documented in Western societies. However, whether the pattern still holds in developing countries where healthcare coverage is more limited is largely unknown. China, a developing country with the largest population in the world, has been transforming its antiquated healthcare system during the past few decades in response to rapid population aging. Yet, in recent years the lack of access to healthcare has been identified as the top concern by most citizens in China. We used the Chinese Longitudinal Healthy Longevity Survey and the community-level data sources from the National Bureau of Statistics of China to examine the impact of current as well as childhood access to healthcare services on subsequent three-year survival and healthy survival at old ages from 2002 to 2005 under a multilevel context. Healthy survival was measured by a cumulative deficit index calculated from thirty-nine variables pertaining to various dimensions of health. Our analyses showed that access to healthcare at present and during childhood improved the odds of subsequent three-year survivorship by 13-19% and 10%, respectively, controlling for various confounders. But the effect of access to healthcare at present was no longer statistically significant once baseline health status in 2002 was controlled for. Access to healthcare at present increased odds of healthy survival by 22-68%, while access to healthcare in childhood increased odds of healthy survival by 18%. All patterns held true for both men and women, for urban and rural areas, across ages, as well as across socioeconomic statuses. Our findings suggested that positive inputs such as access to healthcare services over the life course make a substantial difference in healthy longevity, which has implications for the establishment of the universal healthcare system.

Factors associated with enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme program in six study areas in rural Beijing

OBJECTIVE

This study examines the factors associated with the enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme (NCMS) program in six study areas in rural Beijing.

METHODS

Data come from a sample of 890 persons aged 15-88 from 890 households who were randomly interviewed from six rural counties/districts in Beijing.

RESULTS

Findings from multi-level models indicate that gender, socioeconomic status, adequate knowledge about the policy, subjective premium contribution, subjective co-payment rates, and need are significantly associated with enrollment. We further find that the sustainability of the NCMS program is only significantly related to knowledge about the policy and satisfaction with the overall performance of the program.

CONCLUSION

The NCMS program should be further promoted through different media avenues. It is also necessary to expand the types of services to include basic medical care and other specialized services to meet the different needs of the rural population. In addition, supervision of the system's performance should be enhanced and characteristics of the local community should be considered in the implementation of the NCMS.