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Ten-year impacts of China's rural health scheme: lessons for universal health coverage.

Publication ,  Journal Article
Zhang, Y; Dong, D; Xu, L; Miao, Z; Mao, W; Sloan, F; Tang, S
Published in: BMJ Glob Health
April 2021

China has made profound progress in advancing universal health coverage (UHC) over the past two decades. New Cooperative Medical Scheme (NCMS) was initiated in 2003 to provide health insurance coverage to rural population. Its benefit packages and cost-sharing mechanism have changed significantly over time. This study aims to assess the impact of changing NCMS policies on NCMS enrollees' service utilisation, medical financial burden and equity between 2003 and 2013. Data are from China National Health Services Survey (NHSS) which is conducted every 5 years. We used the subsample of NHSS that were enrolled in NCMS in 2003, 2008 and 2013. From 2003 to 2013, we found increased service utilisation and an elimination of inequity in service utilisation with respect to income. Contradicting prior findings of increasing financial burden after the NCMS implementation, we identified significant protective effect of NCMS against financial risks, and a reduction in percentage of households with high medical expenditure in the middle-income and high-income quintiles. The rural residents from the low-income groups have high financial risk, therefore, should be the priority target for future reforms. In pursuit of UHC globally, many countries struggle to provide good coverage to the disadvantaged rural population and balance between the competing priorities of various UHC dimensions. Our trend analysis revealed China's two-stage approach with NCMS reform that first focused on expanding population coverage, then on service coverage and financial risk protection. This path could potentially be replicated in other middle-income and low-income countries to pave the way for UHC.

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Published In

BMJ Glob Health

DOI

ISSN

2059-7908

Publication Date

April 2021

Volume

6

Issue

4

Location

England

Related Subject Headings

  • Universal Health Insurance
  • Rural Health
  • Insurance, Health
  • Humans
  • Health Expenditures
  • China
  • 4206 Public health
  • 4203 Health services and systems
 

Citation

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Chicago
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Zhang, Y., Dong, D., Xu, L., Miao, Z., Mao, W., Sloan, F., & Tang, S. (2021). Ten-year impacts of China's rural health scheme: lessons for universal health coverage. BMJ Glob Health, 6(4). https://doi.org/10.1136/bmjgh-2020-003714
Zhang, Yaoguang, Di Dong, Ling Xu, Zhiwen Miao, Wenhui Mao, Frank Sloan, and Shenglan Tang. “Ten-year impacts of China's rural health scheme: lessons for universal health coverage.BMJ Glob Health 6, no. 4 (April 2021). https://doi.org/10.1136/bmjgh-2020-003714.
Zhang Y, Dong D, Xu L, Miao Z, Mao W, Sloan F, et al. Ten-year impacts of China's rural health scheme: lessons for universal health coverage. BMJ Glob Health. 2021 Apr;6(4).
Zhang, Yaoguang, et al. “Ten-year impacts of China's rural health scheme: lessons for universal health coverage.BMJ Glob Health, vol. 6, no. 4, Apr. 2021. Pubmed, doi:10.1136/bmjgh-2020-003714.
Zhang Y, Dong D, Xu L, Miao Z, Mao W, Sloan F, Tang S. Ten-year impacts of China's rural health scheme: lessons for universal health coverage. BMJ Glob Health. 2021 Apr;6(4).

Published In

BMJ Glob Health

DOI

ISSN

2059-7908

Publication Date

April 2021

Volume

6

Issue

4

Location

England

Related Subject Headings

  • Universal Health Insurance
  • Rural Health
  • Insurance, Health
  • Humans
  • Health Expenditures
  • China
  • 4206 Public health
  • 4203 Health services and systems