scholarly journals Analysis of the Effect of Rural Residents Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China:A Case Study in Jinzhai County

2020 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Economic Burden ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Medical Insurance ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Out Of Pocket Expenses ◽  
Annual Average Number ◽  
Technology Level

Abstract Background In 2003, China established a New Rural Cooperative Medical System(NRCMS) for rural residents, which had alleviated the burden of medical expenses of rural residents, but the reimbursement for high medical was insufficient. Therefore, China had gradually established a Serious Illness Insurance System (SIMIS) on the basis of NRCMS. After the payment of NRCMS, patients who met the requirements of SIMIS policy would be given a second payment to further alleviate the economic burden of patients with high medical expenses in rural areas. The purpose of this study is to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County. Methods Based on the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province from 2013 to 2016. We adopt descriptive and regression discontinuity (RD) method to analyze the payment effect of SIMIS. The RD analysis object (n = 7353) was the patients whose annual serious illness expenses were between CNY 10,000 and CNY 30,000, and the descriptive analysis object (n = 2720) was the patients compensated by SIMIS. Results The results of RD showed that the actual medical insurance payment proportion (AMIPP) increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion (IMSPP) increased by about 2% (lwald = 0.020, P < 0.10), outside medical insurance self-payment proportion (OMISPP) decreased by about 1.6% (lwald = -0.016, P < 0.05). The descriptive results showed that the serious illness patients mostly chose to go to hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out of pocket medical expenses were still high. Conclusion The medical technology level of Jinzhai County could not meet the needs of seriously illness patients, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of rural residents was insufficient. The high out of pocket expenses increased the possibility that people with good economic conditions could enjoy the reimbursement of SIMIS, resulting in inequity.

scholarly journals Analysis of the Effect of Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China: A Case Study in Jinzhai County

2020 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Economic Burden ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Medical Insurance ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Out Of Pocket Expenses ◽  
Annual Average Number ◽  
Technology Level

Abstract Background: In 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County.Methods: The study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7,353) whose annual serious illness expenses were between CNY 10,000 (1,414 USD) and CNY 30,000 (4,242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720).Results: The results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P <0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P <0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = -0.016, P <0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high.Conclusion: The medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.

scholarly journals Analysis of the Effect of Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China: A Case Study in Jinzhai County

2020 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Economic Burden ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Medical Insurance ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Out Of Pocket Expenses ◽  
Annual Average Number ◽  
Technology Level

Abstract Background: In 2003, China established a New Rural Cooperative Medical System (NRCMS) for rural residents to alleviate the burden of medical expenses among rural residents. However, its reimbursement for high medical costs was insufficient. Therefore, China gradually established the Serious Illness Insurance System (SIMIS) based on NRCMS. After receiving payment through NRCMS, patients in rural areas who met the requirements of SIMIS policy would receive a second payment for their high medical expenses. This study aimed to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County. Methods: The study used the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province, from 2013 to 2016. We adopted descriptive and regression discontinuity (RD) methods to analyze the payment effect of SIMIS. The RD analysis targeted patients (n = 7,353) whose annual serious illness expenses were between CNY 10,000 (1,414 USD) and CNY 30,000 (4,242 USD), whereas the descriptive analysis was used for data of the patients compensated by SIMIS (n = 2720). Results: The results of RD showed that the actual medical insurance payment proportion increased by about 2.5% (lwald = 0.025, P <0.01), inside medical insurance self-payment proportion increased by about 2% (lwald = 0.020, P <0.10), and outside medical insurance self-payment proportion decreased by about 1.6% (lwald = -0.016, P <0.05). The descriptive results showed that patients with serious illnesses mostly chose to go to a hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out-of-pocket medical expenses were still high.Conclusion: The medical technology level of Jinzhai County could not meet the needs of patients with seriously illnesses, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of the rural residents was insufficient. The high out-of-pocket expenses increased the possibility that only people with good economic conditions could benefit from the reimbursement of SIMIS, resulting in inequity.

scholarly journals Analysis of the Effect of Rural Residents Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China:A Case Study in Jinzhai County

2020 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Economic Burden ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Medical Insurance ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Out Of Pocket Expenses ◽  
Annual Average Number ◽  
Technology Level

Abstract Background In 2003, China established a New Rural Cooperative Medical System(NRCMS) for rural residents, which had alleviated the burden of medical expenses of rural residents, but the reimbursement for high medical was insufficient. Therefore, China had gradually established a Serious Illness Insurance System (SIMIS) on the basis of NRCMS. After the payment of NRCMS, patients who met the requirements of SIMIS policy would be given a second payment to further alleviate the economic burden of patients with high medical expenses in rural areas. The purpose of this study is to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County. Methods Based on the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province from 2013 to 2016. We adopt descriptive and regression discontinuity (RD) method to analyze the payment effect of SIMIS. The RD analysis object (n = 7353) was the patients whose annual serious illness expenses were between CNY 10,000 and CNY 30,000, and the descriptive analysis object (n = 2720) was the patients compensated by SIMIS. Results The results of RD showed that the actual medical insurance payment proportion (AMIPP) increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion (IMSPP) increased by about 2% (lwald = 0.020, P < 0.10), outside medical insurance self-payment proportion (OMISPP) decreased by about 1.6% (lwald = -0.016, P < 0.05). The descriptive results showed that the serious illness patients mostly chose to go to hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out of pocket medical expenses were still high. Conclusion The medical technology level of Jinzhai County could not meet the needs of seriously illness patients, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of rural residents was insufficient. The high out of pocket expenses increased the possibility that people with good economic conditions could enjoy the reimbursement of SIMIS, resulting in inequity.

scholarly journals Analysis of the Effect of Rural Residents Serious Illness Medical Insurance on Relieving the Economic Burden of Rural Residents in China:A Case Study in Jinzhai County

2020 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Economic Burden ◽  
Rural Areas ◽  
Descriptive Analysis ◽  
Medical Insurance ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Out Of Pocket Expenses ◽  
Annual Average Number ◽  
Technology Level

Abstract Background In 2003, China established a New Rural Cooperative Medical System(NRCMS) for rural residents, which had alleviated the burden of medical expenses of rural residents, but the reimbursement for high medical was insufficient. Therefore, China had gradually established a Serious Illness Insurance System (SIMIS) on the basis of NRCMS. After the payment of NRCMS, patients who met the requirements of SIMIS policy would be given a second payment to further alleviate the economic burden of patients with high medical expenses in rural areas. The purpose of this study is to analyze the effect of the implementation of SIMIS on alleviating the economic burden of rural residents in Jinzhai County. Methods Based on the inpatient reimbursement data of NRCMS in Jinzhai County, Anhui Province from 2013 to 2016. We adopt descriptive and regression discontinuity (RD) method to analyze the payment effect of SIMIS. The RD analysis object (n = 7353) was the patients whose annual serious illness expenses were between CNY 10,000 and CNY 30,000, and the descriptive analysis object (n = 2720) was the patients compensated by SIMIS. Results The results of RD showed that the actual medical insurance payment proportion (AMIPP) increased by about 2.5% (lwald = 0.025, P < 0.01), inside medical insurance self-payment proportion (IMSPP) increased by about 2% (lwald = 0.020, P < 0.10), outside medical insurance self-payment proportion (OMISPP) decreased by about 1.6% (lwald = -0.016, P < 0.05). The descriptive results showed that the serious illness patients mostly chose to go to hospital outside the county. The annual average number of hospitalizations was 3.64. The reimbursement mainly came from the NRCMS. The payment amount of SIMIS was relatively small, and the out of pocket medical expenses were still high. Conclusion The medical technology level of Jinzhai County could not meet the needs of seriously illness patients, the number of beneficiaries of SIMIS was small, and the ability to relieve the burden of medical expenses of rural residents was insufficient. The high out of pocket expenses increased the possibility that people with good economic conditions could enjoy the reimbursement of SIMIS, resulting in inequity.

scholarly journals Research On Medical Insurance Policies Against Serious Illness Among Urban And Rural Residents In Shanghai Based On Micro-Simulation

2021 ◽  
Author(s):  
Yang Li ◽  
Guangfeng Duan ◽  
Linping Xiong
Keyword(s):  
Institutional Arrangement ◽  
Medical Insurance ◽  
National Guidelines ◽  
Rural Residents ◽  
Serious Illness ◽  
Medical Expenses ◽  
Urban And Rural Residents ◽  
Micro Simulation ◽  
Insured Person ◽  
Basic Medical

Abstract Background: Urban and rural residents’ basic medical insurance (URRBMI) is an institutional arrangement for rural residents and unemployed urban residents in China. The serious illness medical insurance system (SIMIS) was established to provide additional medical cover. There are two ways in which medical expenses are covered. One is based on large expenses and provides proportional compensation for the individual’s own expenses after the URRBMI payment; the other is to pay for the treatment of some serious diseases after the URRBMI payment. At present, the SIMIS payment method in China is based on large expenses, and only a few areas, such as Shanghai, pay according to the treatment of serious diseases. This study aims to simulate and analyse the effect of the two payment methods on SIMIS in Shanghai. Methods: We developed a micro-simulation model to predict the number and characteristics of SIMIS participants among urban and rural residents in Shanghai and to simulate the process of medical treatment, medical consumption, and medical insurance payments for each insured person from 2020 to 2025. We then summarised and analysed the payment compensation effect, and compared it with Shanghai’s current policies.Results: Under the current financing standard, the payment of SIMIS according to high expenses is not sustainable and the compensation is insufficient and cannot effectively prevent or alleviate poverty.Conclusions: The policy of designing SIMIS according to national guidelines does not meet the development needs of Shanghai. Shanghai should take the current policy of paying compensation according to the treatment of serious illness as the policy basis, consider the security needs of patients with large medical expenses outside the scope of protection, and adjust policies appropriately to prevent poverty caused by illness.

scholarly journals Burden of visual impairment associated with eye diseases: exploratory survey of 298 Chinese patients

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030561
Author(s):  
Xiaodong Guan ◽  
Mengyuan Fu ◽  
Fanghui Lin ◽  
Dawei Zhu ◽  
Daniel Vuillermin ◽  
...  
Keyword(s):  
Visual Impairment ◽  
Economic Burden ◽  
Rural Areas ◽  
Health Utility ◽  
Medical Insurance ◽  
Direct Costs ◽  
Eye Diseases ◽  
Chinese Patients ◽  
Utility Value ◽  
Annual Household Income

ObjectivesTo explore the economic burden, prevalence of catastrophic healthcare expenditure (CHE) and the quality of life (QoL) of Chinese patients with visual impairment (VI) associated with eye diseases.DesignA questionnaire survey from March to May 2016 by structured face-to-face interviews of patients with VI.Participants302 patients who were diagnosed with moderate VI or worse in both eyes (visual acuity <6/18) were included, and 298 patients (98.7%) who completed the survey questionnaires were eligible for the study.Outcome measuresThe economic burden was estimated by calculating participants’ direct costs covered in 2015 and the definition of CHE was out-of-pocket (OOP) costs exceeding 30% of annual household income. QoL was weighed by health utility value using time-trade-off valuation techniques.ResultsAnnual average direct costs per patient caused by VI were US$6988.6±US$10 834.3, and 70.3% were direct medical costs of which only 26.9% were reimbursable by medical insurance. 32.2% of households that suffered from CHE, in particular, were less wealthy patients with VI living in rural areas and without medical insurance. The health utility value was rated at 0.65 on average, and patients with VI aged 51–57, living alone and insured by commercial medical insurance had relatively less QoL.ConclusionOur study explored the economic burden and QoL of VI associated with patients with eye diseases in China, indicating a substantial economic burden and poor QoL. Preferential medical insurance policies should be designed in relation to people with VI to further reduce the health inequalities, avoid CHE and promote QoL.

scholarly journals Assessing the Distribution of Household Financial Contribution to Health System: A Case Study of Iran

2016 ◽  
Vol 8 (10) ◽  
pp. 233 ◽  
Author(s):  
Amir Abbas Fazaeli ◽  
Mohmmad Hadian ◽  
Aziz Rezapour
Keyword(s):  
Health System ◽  
Rural Areas ◽  
Medical Insurance ◽  
Poverty Line ◽  
Financial Contribution ◽  
Medical Expenses ◽  
Urban And Rural Areas ◽  
Contribution Index ◽  
Redistributive Effect ◽  
Effect Index

<p><strong>Background</strong><strong>: </strong>Throughout the world, financing the healthcare system through households' financial contribution is a challenging issue in evaluating performance of healthcare systems. The purpose of this paper is illustrating the consequences of Iranian household to health system financial contribution in terms of burden and incomes approaches.</p><p><strong>Method:</strong> The Data derived from an annual survey by Statistics Center of Iran (SCI) on expenditure-income of 36,551 households in 2012 was used to analyze countrywide distribution indicators of households' medical expenses<strong> </strong>by measuring indices of Income and burden approaches based on World Health Organization (WHO) and World Bank recommended methodologies.</p><p><strong>Results</strong><strong>: </strong>The fairness in financial contribution index was 0.85 and 0.82, and the income redistributive effect index was 0.54 and 0.3 in urban and rural areas, respectively. The fairness in financial contribution index was found 0.84 and 0.83 and the income redistributive effect index was 0.48 and 0.25 for households with and without medical insurance, respectively.</p><p>The percentages of household with catastrophic health payments were 2.4% and 4% and the change in the number of household falling below the poverty line due to health system payments was 0.4% and 2% in urban and rural areas, respectively. The percentages of household with catastrophic health payments were 2.8% and 3% and the change in the number of household falling below the poverty line due to health system payments was 0.008 and 0.011 for households with and without medical insurance, respectively.</p><p><strong>Conclusion</strong><strong>: </strong>Distribution indicators of medical expenses were more favorable in urban areas compared to rural areas and Medical insurance has declined impoverishment risks and number of people suffered due to catastrophic health expenditure.<strong> </strong></p><p>In addition, the result showed that there are different approaches for analyzing the distribution of out of pocket payments which used to complement each other in respect of formulation and development policy making in health system.<strong></strong></p>

scholarly journals The impact of living arrangements and intergenerational support on the health status of older people in China: are rural residents disadvantaged compared to urban residents?

2021 ◽  
pp. 1-26
Author(s):  
Yazhen Yang ◽  
Maria Evandrou ◽  
Athina Vlachantoni
Keyword(s):  
Life Satisfaction ◽  
Older People ◽  
Adult Children ◽  
Rural Areas ◽  
Living Arrangements ◽  
Psychological Wellbeing ◽  
Urban Residents ◽  
Intergenerational Support ◽  
Rural Residents ◽  
The Impact

Abstract Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons’ wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people's living arrangements and intergenerational support provision/receipt on their physical and psychological wellbeing, focusing on rural–urban differences. The results show that receiving economic support from one's adult children was a stronger predictor for higher life satisfaction among rural residents compared to urban residents, while grandchild care provision was an important determinant for poor life satisfaction only for urban residents. Having weekly in-person and distant contact with one's adult children reduced the risk of depression in both rural and urban residents. Older women were more likely than men to receive support and to have contact with adult children, but also to report poor functional status and depression. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological wellbeing of urban older residents, such as with the early diagnosis of depression.

scholarly journals Strategies for Disseminating and Implementing the COVID-19 Vaccines in Rural Areas

2021 ◽  
Author(s):  
Beth Prusaczyk
Keyword(s):  
United States ◽  
Health Disparities ◽  
Urban Health ◽  
Rural Areas ◽  
The United States ◽  
Urban Residents ◽  
Rural Residents ◽  
Vaccination Programs ◽  
Vaccine Information ◽  
Roll Out

Abstract The United States has well-documented rural-urban health disparities and it is imperative that these are not exacerbated by an inefficient roll-out of the COVID-19 vaccines to rural areas. In addition to the pre-existing barriers to delivering and receiving healthcare in rural areas, such as high patient:provider ratios and long geographic distances between patients and providers, rural residents are significantly more likely to say they have no intention of receiving a COVID-19 vaccine, compared to urban residents. To overcome these barriers and ensure rural residents receive the vaccine, officials and communities should look to previous research on how to communicate vaccine information and implement successful vaccination programs in rural areas for guidance and concrete strategies to use in their local efforts.

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