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

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 NRCM S. 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 = 7353) whose annual serious illness expenses were between CNY 10,000 (1414 USD) and CNY 30,000 (4242 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.

Access to innovative drugs and the National Reimbursement Drug List in China: Changing dynamics and future trends in pricing and reimbursement

“…Critical illness insurance was first implemented in 2012 [ 12 ]. As the Central Government provided only guidelines and a general framework for its implementation, the schemes are implemented differently in different regions [ 12 , 13 ]. In many regions, patients are eligible to receive additional reimbursement under the critical illness insurance scheme if their out-of-pocket expenses are more than the annual average disposable income per capita in the local area [ 12 , 13 ].…”

“…NRDL drugs are reimbursed at different rates according to whether they are included in Category A (essential and affordable drugs) or Category B (innovative and relatively more expensive drugs) [ 11 ]. For patients who meet a particular reimbursement threshold (which in many provinces is set at the local average per capita annual disposable income), additional reimbursement may be available via Critical Illness Insurance schemes, funded within the BMI schemes [ 12 , 13 ].…”

Perspectives and evaluation on the effect of financial burden relief of medical insurance for people with catastrophic diseases and its influencing factors

“…In contrast, supplemental medical insurance required a series of strict vetting processes and high admission criteria, and there were certain barriers for vulnerable people with catastrophic diseases to enter their coverage. Some studies have shown that major medical insurance has reduced the financial burden of patients with catastrophic diseases to some extent, and its coverage has been expanded compared to that of the basic medical insurance, but the coverage was still relatively small ( 20 ). Expanding medical insurance coverage coincided with Hallman’s proposed measures to address CHE and medical coverage for catastrophic diseases ( 45 , 46 ).…”

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance

“…CMI is more protective for low-income individuals, which may also be explained by their preference for health facilities when ill. Wagstaff et al discovered that the poor are more likely to seek treatment at low-level health facilities, putting less strain on their OOP expenditures [ 60 ]. Although, some research indicated that high OOP costs limit the ability of people in impoverished economic situations to benefit from the CMI and erode the CMI’s fairness [ 28 ]. CMI considers the needs of low-income residents during the gradual implementation process.…”

“…A study of rural residents discovered that CMI was insufficient in relieving rural residents’ medical burdens [ 27 ]. Due to the high out-of-pocket costs, individuals with better economic circumstances could receive CMI compensation, resulting in unfair benefits for CMI [ 28 ]. CMI increased patients’ inpatient and outpatient medical expenses, but also their out-of-pocket expenses [ 29 ].…”