Has NCMS improved equity in access to healthcare for the Chinese rural population? - An assessment based on the framework “benchmarks of fairness”

Abstract

Introduction: The collapse of the previous medical insurance made most of the rural population restricted to healthcare services. The launching of NCMS since 2003 has been expected to help change this severe situation. Based on the framework “benchmarks of fairness” from Daniels, Light, and Caplan (1996), this thesis aims to evaluate whether and how the new medical insurance scheme—NCMS—has been improving the equity in access to healthcare services for the rural population. Methods: Of this framework, five benchmarks which aim to evaluate the dimension “equity” were chosen, and criteria for each benchmark were further refined in order to be measured practically. Findings from relevant existing empirical studies and officially registered statistics by governments were used as data sources for this thesis. Each benchmark for the case of NCMS was evaluated separately. Through a chronological review on evidence/material for each criterion, the change was caught to indicate each criterion. Findings: NCMS has managed to cover over 98 percent of the rural population, despite its voluntary participation. NCMS has completed the universal coverage by 2008 without delay. The intercity reimbursement ratio has been still lower; The launching of NCMS has increased the density and qualification for the medical facilities and personnel. However, still fewer rural population has sufficiently known crucial information of NCSM; The benefits package of NCMS has covered more reimbursable medicine and services, such as more anti-cancer drugs. Inequalities on benefits and coverage in NCMS still exist, but lower deductible for reimbursement, lower coinsurance as well as higher payment cap might narrow these inequalities; The premium of NCMS is community-rated. As well, NCMS has been proposing ways to reduce some “back-ends” instantly like payment-cap and co-payment; Although the healthcare financing system in rural China has been still regressive, the situation has been improved, and NCMS could contribute to this improvement. Conclusion: To some extent, NCMS has managed to equalise access to healthcare for the rural population by eliminating financial/nonfinancial barriers, expanding benefits coverage as well as sharing financial burden equitably. However, in each of those respects, NCMS has still much space to improve.