The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system.

In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives-government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level.

Household catastrophic health expenditure.

BACKGROUND: Fairness in financial contribution for health was determined by WHO (World Health Report, 2000) as the third goal of health systems which is measured by fairness in financial contribution index (FFCI). The aim of this study was to estimate FFCI and quantify extent of catastrophic household heath expenditures. METHODS: We conducted a descriptive study during May 2008. Subjects were chosen by "Systematic Random sampling" among residents of Maskan's population-based research center (Maskan Center) in Kermanshah, Iran. After completing informed consent form, we collected data using a questionnaire by interview with head of family. In order to describing data and estimating FFCI, we used descriptive statistics and WHO methodology, respectively. Households with catastrophic expenditures and impoverished households were defined as those with health expenditures over 40% and 50% of their ability to pay, respectively. RESULTS: The mean age of head of families was 48.96±12.86 years. From 189; 12.7% of household's heads were female. 75.1% of households were covered by at least one health insurance scheme. FFCI was 0.57. The proportion of households facing catastrophic health expenditures was 22.2% (95% CI=16.3%-28.1%) CONCLUSION: The rate of FFCI among participants implied an inequality in health financing contribution. In addition, many of households (22.2%) faced catastrophic health expenditures while according to WHO estimation, the figure in the whole country was 2% in 1999. Our study revealed the importance of protecting households against the costs of ill-health.