Effect of NCMS on catastrophic health expenditure and its equity

Objective To study the effect and equity of the New Rural Cooperative Medical Scheme（ NCMS） on hospitalization-induced catastrophic health expenditure（ CHE） after health care reform. Methods Three counties（ Zhangqiu,Changqing and Pingyin） of Ji’nan municipality were selected with stratified random sampling and 2 029 households were surveyed. The 263 households which participated in NCMS and with hospitalized patients were selected as subjects.The study analyzed the incidence and intensity of the CHE before and after reimbursement of NCMS in 2011. Using methods of concentration index and decomposition of concentration index,the equity of CHE and influence factors were analyzed. Results The incidence of CHE before and after reimbursement was 44. 11% and 23. 19%,respectively,decreased by 47. 43%. The mean gap was 10. 50% and 4. 07%,respectively,decreased by 61. 24%. The concentration index of incidence and mean gap was 0. 064 and- 0. 006 after reimbursement. The concentration index for hospitalization reimbursement ＞ 0. 4,duration of hospitalization ≥ 15 days and choosing institution above county level were- 0. 035,0. 235 and 0. 239,respectively,and the contributions to concentration index were all positive. Conclusion The role of NCMS in reducing CHE has improved,but is still limited; the rich group has higher incidence,but there was a relatively large impact on low-income group.