BACKGROUND: This study was the first of its kind to analyze the finance protection in New Rural Cooperative Medical Scheme in China using a claim database analysis. METHODS: A claim database analysis of all hospitalizations reimbursed from the New Rural Cooperative Medical Scheme between January 2005 and December 2008 in Panyu district of Guangzhou covering 108,414 discharges was conducted to identify the difference in real reimbursement rate among 5 hospitalization cost categories by sex, age, and hospital type and to investigate the distributions of hospital-type choices among age and hospitalization cost categories. RESULTS: The share of total cost reimbursed was only 34% on average, and increased with age but decreased with higher hospitalization cost, undermining catastrophic coverage. Older people were more likely to be hospitalized at lower level hospitals with higher reimbursement rate. The mean cost per hospitalization and average length of stay increased whereas the real reimbursement rate decreased with hospital level among the top 4 diseases with the same ICD-10 diagnostic code (3-digit level) for each age group. CONCLUSIONS: Providing better protection against costly medical needs will require shifting the balance of objectives somewhat away from cost control toward more generous reimbursement, expanding the list of treatments that the insurance will cover, or some other policy to provide adequate care at lower cost facilities where more of the cost is now covered.
BACKGROUND: This study was the first of its kind to analyze the finance protection in New Rural Cooperative Medical Scheme in China using a claim database analysis. METHODS: A claim database analysis of all hospitalizations reimbursed from the New Rural Cooperative Medical Scheme between January 2005 and December 2008 in Panyu district of Guangzhou covering 108,414 discharges was conducted to identify the difference in real reimbursement rate among 5 hospitalization cost categories by sex, age, and hospital type and to investigate the distributions of hospital-type choices among age and hospitalization cost categories. RESULTS: The share of total cost reimbursed was only 34% on average, and increased with age but decreased with higher hospitalization cost, undermining catastrophic coverage. Older people were more likely to be hospitalized at lower level hospitals with higher reimbursement rate. The mean cost per hospitalization and average length of stay increased whereas the real reimbursement rate decreased with hospital level among the top 4 diseases with the same ICD-10 diagnostic code (3-digit level) for each age group. CONCLUSIONS: Providing better protection against costly medical needs will require shifting the balance of objectives somewhat away from cost control toward more generous reimbursement, expanding the list of treatments that the insurance will cover, or some other policy to provide adequate care at lower cost facilities where more of the cost is now covered.