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The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system
Zhejiang University, Center for Health Policy Studies, China.
Zhejiang University, Center for Health Policy Studies, China.
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska institutet, Global health, Sweden.ORCID iD: 0000-0003-0368-050X
Zhejiang University, Center for Health Policy Studies, China.
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2016 (English)In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 31, no 1, 36-48 p.Article in journal (Refereed) Published
Abstract [en]

In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.

Place, publisher, year, edition, pages
2016. Vol. 31, no 1, 36-48 p.
Keyword [en]
new rural cooperativemedical care system; financing contribution; copayment; China
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-25998DOI: 10.1002/hpm.2259ISI: 000373068500008Scopus ID: 2-s2.0-84961240025OAI: oai:DiVA.org:mdh-25998DiVA: diva2:749333
Projects
European Union grant “261304” and the China Medical Board research grant “09-989”
Funder
EU, European Research Council, 261304
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2016-12-22Bibliographically approved

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