Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked

Zhou, Maigeng; Liu, Shiwei; Bundorf, M. Kate; Eggleston, Karen; Zhou, Sen

doi:10.1377/hlthaff.2017.0135

Cited by 8 publications

(13 citation statements)

References 18 publications

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“…Evidence on health insurance and mortality in middle-and low-income countries is limited [7]. Some retrospective cohort studies conducted in China showed that uninsured people have higher mortality than insured people [27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Private coverage has been demonstrated as being associated with lower all-cause mortality [3,6]. Additionally, one recent study also showed that publicly-financed health spending was associated with lower mortality rates in middle-income and low-income countries [7]. However, few studies evaluate the association of private coverage with cardiovascular disease (CVD), cancer and other cause-specific mortalities, including mortality from Alzheimer's disease, kidney disease, influenza and pneumonia and chronic lower respiratory disease (CLRD).…”

Section: Introductionmentioning

confidence: 99%

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The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study

Song

Wang

Chen

et al. 2020

IJERPH

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The purpose of this study was to evaluate the association of insurance status with all-cause and cause-specific mortality. A total of 390,881 participants, aged 18–64 years and interviewed from 1997 to 2013 were eligible for a mortality follow-up in 31 December 2015. Cox proportional hazards models were used to calculate the hazards ratios (HR) and 95% confidence intervals (CI) to determine the association between insurance status and all-cause and cause-specific mortality. The sample group cumulatively aged 4.22 million years before their follow-ups, with a mean follow-up of 10.4 years, and a total of 22,852 all-cause deaths. In fully adjusted models, private insurance was significantly associated with a 17% decreased risk of mortality (HR = 0.83; 95% CI = 0.80–0.87), but public insurance was associated with a 21% increased risk of mortality (HR = 1.21; 95% CI = 1.15–1.27). Compared to noninsurance, private coverage was associated with about 21% lower CVD mortality risk (HR = 0.79, 95% CI = 0.70–0.89). In addition, public insurance was associated with increased mortality risk of kidney disease, diabetes and CLRD, compared with noninsurance, respectively. This study supports the current evidence for the relationship between private insurance and decreased mortality risk. In addition, our results show that public insurance is associated with an increased risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study

Song

Wang

Chen

et al. 2020

IJERPH

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“…This is a government-run, voluntary, county-based and cost-sharing medical insurance program, which aims to improve access to healthcare services for rural residents (15). By 2012, the NCMS had become available to almost all residents in rural China (16).…”

Section: Introductionmentioning

confidence: 99%

Identification of cancer patients using claims data from health insurance systems: A real-world comparative study

Tian

et al. 2019

Chinese Journal of Cancer Research

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ObjectiveTo evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.MethodsWe chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records (EMRs) as well as the New Rural Cooperative Medical Scheme (NCMS) claims records for cancer patients in Hua County People’s Hospital (HCPH) and Anyang Cancer Hospital (ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value (PPV) were calculated taking the EMRs as the gold standard.ResultsThe sensitivity of NCMS was 95.2% (93.8%−96.3%) and 92.0% (88.3%−94.8%) in ACH and HCPH, respectively. The PPV of the NCMS was 97.8% (96.7%−98.5%) in ACH and 89.0% (84.9%−92.3%) in HCPH. Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%, respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than non-common cancers were detected in HCPH and ACH separately (P<0.01).ConclusionsIdentification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.

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“…A series of quasi-experimental studies assessing the health consequences of the scheme also produced mixed results [7,19,20,21]. Using data from twenty-two provinces, the scheme was estimated to be associated with a 9.4% reduction in three-year mortality among seniors in the eastern region [20].…”

Section: Introductionmentioning

confidence: 99%

“…However, for the sample as a whole, changes in mortality rates were more modest (3.7%) [20]. The most recent study, using nationally representative data from the Disease Surveillance Point system of the Chinese Center for Disease Control and Prevention, found no statistically significant correlation between the implementation of NCMS and reductions in mortality [21]. However, the large standard errors of the estimated NCMS coefficients indicate that it is still possible the scheme had a positive effect on mortality.…”

Section: Introductionmentioning

confidence: 99%

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China

Wu¹,

Deaton²,

Jiao³

et al. 2018

PLoS ONE

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ObjectiveThe New Rural Cooperative Medical Scheme (NCMS) is a universal healthcare coverage plan now covering over 98% of rural residents in China, first implemented in 2003. Rising costs in the face of modest gains in health and financial protections have raised questions about the cost-effectiveness of the NCMS.MethodsUsing the most recent estimates of the NCMS’s health and economic consequences from a comprehensive review of the literature, we conducted a cost-effectiveness analysis using a Markov model for a hypothetical cohort between ages 20 and 100. We then did one-way sensitivity analyses and a probabilistic sensitivity analysis using Monte Carlo simulations to explore whether the incremental cost-effectiveness ratio (ICER) falls below 37,059 international dollars [Int$], the willingness-to-pay (WTP) threshold of three times per capita GDP of China in 2013.FindingsThe ICER of the NCMS over the lifetime of an average 20-year-old rural resident in China was about Int$71,480 per quality-adjusted life year (QALY) gained (95% confidence interval: cost-saving, Int$845,659/QALY). There was less than a 33% chance that the system was cost-saving or met the WTP threshold. However, the NCMS did fall under the threshold when changes in the program costs, the risk of mortality and hypertension, and the likelihood of labor force participation were tested in one-way sensitivity analyses.ConclusionThe NCMS appears to be economically inefficient in its current form. Further cost-effectiveness analyses are warranted in designing insurance benefit packages to ensure that the NCMS fund goes toward health care that has a good value in improving survival and quality of life.

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Mortality In Rural China Declined As Health Insurance Coverage Increased, But No Evidence The Two Are Linked

Cited by 8 publications

References 18 publications

The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study

The Association between Health Insurance and All-Cause, Cardiovascular Disease, Cancer and Cause-Specific Mortality: A Prospective Cohort Study

Identification of cancer patients using claims data from health insurance systems: A real-world comparative study

The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China

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