Thursday, 29 November 2012

Rural health insurance scheme favours the wealthy

Rural health insurance that covers outpatient treatment helps the poor
by Michael Woodhead

China's rural health insurance scheme often favours wealthier patients by covering inpatient but not outpatient services, a new report has concluded.
A review of almost 10,000 people covered by the New Rural Cooperative Medical Schemes (NRCMS)  found that health insurance was more likely to benefit the poor if  used to provide insurance that covers both outpatient and inpatient services rather than just inpatient services.
The analysis found that in areas where medical insurance cover was comprehensive and covered both outpatient and inpatient services rather than inpatient services only, there was significantly greater use of village-level and township-level outpatient services.
These services were used much more by poorer rural residents, whereas wealthier rural residents tended to use county-level inpatients services, the analysis found.
According to the researchers, poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s.
However, health insurance coverage for outpatient services at the village and township levels increased the access to outpatient services among people with lower incomes. In contrast, the increased use of the county-level outpatient services among the people with higher incomes suggests that the policy effect at the county-level was more "pro-rich" than pro-poor.
"Our findings suggest that health insurance that only covers inpatient services may result in reductions in outpatient utilisation, particularly at the village and township levels and among people with lower income," the report authors say.
"This result is consistent with concerns voiced by the WHO that people who are provided insurance only for inpatient service may delay critical outpatient and preventive services that can protect their longer-term health and reduce catastrophic illness. Chinese government at various levels are the major contributors to the New Rural Cooperative Medical Schemes premiums; these investments are more likely to benefit to the poor if they are used to provide insurance that covers both outpatient and inpatient services rather than just inpatient services," they conclude
Read more: PLOS One

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