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The Effect of New Cooperative Medical Scheme on Health Outcomes and Alleviating Catastrophic Health Expenditure in China: A Systematic Review

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  • Xiaoyun Liang
  • Hong Guo
  • Chenggang Jin
  • Xiaoxia Peng
  • Xiulan Zhang

Abstract

Background: In 2002, the Chinese government launched a new rural health financing policy to provide health insurance (New Cooperative Medical Scheme, NCMS) for its rural population. NCMS, jointly financed by governments and individual households, aims to protect households from impoverishment due to catastrophic health expenditure. In 2011, NCMS covered more than 96% of the rural population. We have systematically searched and reviewed available evidence to estimate the effects of NCMS on health outcomes and on alleviating catastrophic health expenditure. Methods: PubMed, Web of Science with Conference Proceedings, ProQuest Digital Dissertations, CMCI, CNKI, and VIP were searched. We also obtained literature from colleague communications. Quasi-experimental studies regarding the effect of NCMS on health outcomes and catastrophic health expenditure were included. Two independent reviewers screened the literature, extracted the data, and assessed the study quality. Results: Fifteen studies out of the 6123 studies in the literature fulfilled criteria and were included in this review. Twelve studies identified the relationship between NCMS and health outcomes, among which six studies measured sickness or injury in the past four weeks, four measured sickness or injury in the past two weeks, and five measured self-reported health status. Four studies focused on the relationship between NCMS and alleviating catastrophic health expenditure. However, the results from these studies were in conflict: individual studies indicated that NCMS had positive, negative, or no effect on health outcomes and/or the incidence of catastrophic health payments, respectively. Conclusions: We still have no clear evidence that NCMS improves the health outcomes and decreases the alleviating catastrophic health expenditure of the China’s rural population. In addition, the heterogeneity among individual studies reminds us that provider payment method reforms, benefit package and information systems around NCMS should be improved in the future.

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  • Xiaoyun Liang & Hong Guo & Chenggang Jin & Xiaoxia Peng & Xiulan Zhang, 2012. "The Effect of New Cooperative Medical Scheme on Health Outcomes and Alleviating Catastrophic Health Expenditure in China: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-11, August.
    • Handle: RePEc:plo:pone00:0040850
    DOI: 10.1371/journal.pone.0040850
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    3. Hu, Shu & Das, Dhiman, 2019. "Quality of life among older adults in China and India: Does productive engagement help?," Social Science & Medicine, Elsevier, vol. 229(C), pages 144-153.
    4. Lewis Husain & Gerald Bloom & Yue Xiao, 2023. "Building policy capacity for managing rapid, complex change in China’s health system," Policy and Society, Darryl S. Jarvis and M. Ramesh, vol. 42(1), pages 28-48.
    5. Baozhong Su & Gatwaza Hategekimana Thierry & Qihui Chen & Qiran Zhao, 2017. "The New Cooperative Medical Scheme and Self-Employment in Rural China," Sustainability, MDPI, vol. 9(2), pages 1-10, February.
    6. Jiajing Li & Yanran Huang & Stephen Nicholas & Jian Wang, 2019. "China’s New Cooperative Medical Scheme’s Impact on the Medical Expenses of Elderly Rural Migrants," IJERPH, MDPI, vol. 16(24), pages 1-11, December.
    7. Xiaolei Xiong & Zhiguo Zhang & Jing Ren & Jie Zhang & Xiaoyun Pan & Liang Zhang & Shiwei Gong & Si Jin, 2018. "Impact of universal medical insurance system on the accessibility of medical service supply and affordability of patients in China," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-20, March.
    8. Yue Zhou & Haishaerjiang Wushouer & Daniel Vuillermin & Xiaodong Guan & Luwen Shi, 2021. "Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 463-471, April.
    9. Yuan, Beibei & Jian, Weiyan & Martinez-Alvarez, Melisa & McKee, Martin & Balabanova, Dina, 2020. "Health system reforms in China a half century apart: Continuity but adaptation," Social Science & Medicine, Elsevier, vol. 265(C).
    10. Runguo Wu & Niying Li & Angelo Ercia, 2020. "The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review," IJERPH, MDPI, vol. 17(6), pages 1-21, March.
    11. Kankeu, Hyacinthe Tchewonpi & Ventelou, Bruno, 2016. "Socioeconomic inequalities in informal payments for health care: An assessment of the ‘Robin Hood’ hypothesis in 33 African countries," Social Science & Medicine, Elsevier, vol. 151(C), pages 173-186.
    12. Lin Gong & Juan Chen, 2023. "Disparities in Social Insurance Participation and Urban Identification Among In-situ Urbanized Residents in China," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 18(3), pages 1269-1289, June.
    13. Xiuxia Yin & Lucille Aba Abruquah & Ya Ding, 2019. "Dynamics of Life Satisfaction Among Rural Elderly in China: The Role of Health Insurance Policies and Intergenerational Relationships," Sustainability, MDPI, vol. 11(3), pages 1-19, January.
    14. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    15. Yan Jiang & Yu Wang & Le Zhang & Yang Li & Xiaojun Wang & Shuangge Ma, 2013. "Access to Healthcare and Medical Expenditure for the Middle-Aged and Elderly: Observations from China," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-10, May.

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