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The Dilemma of Medical Reimbursement Policy in Rural China: Spatial Variability between Reimbursement Region and Medical Catchment Area

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  • Yongqing Dong

    (College of Management and Economics, Tianjin University, Tianjin 300072, China
    Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China)

  • Liping Fu

    (College of Management and Economics, Tianjin University, Tianjin 300072, China
    Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China)

  • Ronghui Tan

    (College of Management and Economics, Tianjin University, Tianjin 300072, China
    Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China)

  • Liman Ding

    (College of Management and Economics, Tianjin University, Tianjin 300072, China
    Center for Social Science Survey and Data, Tianjin University, Tianjin 300072, China)

Abstract

Since the initiation of the New Rural Cooperative Medical Scheme (NCMS) in 2003 in China, medical reimbursement plays an increasingly important role in reducing the familial burden of critical illness healthcare in rural China. However, the current medical reimbursement system is operated based on prefecture-level administrative boundaries, which may prevent some residents from accessing higher-quality medical resources. Using a reliable and high-accuracy geographic information system (GIS) dataset, this study investigates whether this reimbursement system restricts rural residents from freely seeking out medical services in the Hubei Province by employing a two-step floating catchment area (2SFCA). Results show that there are spatial differences between the catchment area of different graded medical centers and prefecture-level administrative boundaries. Spatial reimbursement boundaries should be readjusted so that most rural residents receive equitable coverage by the system and reimburse their medical expenses in a more convenient way. Therefore, we argue that the local government should delineate the spatial region of the medical reimbursement for rural residents according to an assessment of their spatial accessibility to different graded medical centers beyond prefecture-level boundaries. We also discuss potential methods for designing reimbursement boundaries and reimbursement management strategies that the Chinese central government could adopt.

Suggested Citation

  • Yongqing Dong & Liping Fu & Ronghui Tan & Liman Ding, 2019. "The Dilemma of Medical Reimbursement Policy in Rural China: Spatial Variability between Reimbursement Region and Medical Catchment Area," IJERPH, MDPI, vol. 16(16), pages 1-18, August.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:16:p:2867-:d:256622
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    References listed on IDEAS

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    1. Bai, Chong-En & Wu, Binzhen, 2014. "Health insurance and consumption: Evidence from China’s New Cooperative Medical Scheme," Journal of Comparative Economics, Elsevier, vol. 42(2), pages 450-469.
    2. Jing Luo & Guangping Chen & Chang Li & Bingyan Xia & Xuan Sun & Siyun Chen, 2018. "Use of an E2SFCA Method to Measure and Analyse Spatial Accessibility to Medical Services for Elderly People in Wuhan, China," IJERPH, MDPI, vol. 15(7), pages 1-17, July.
    3. Xiaoyan Lei & Wanchuan Lin, 2009. "The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 25-46, July.
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