Fundamental Issues for Sustainable Development of the New Rural Cooperative Medical System in China
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We reviewed the studies of the effects of NCMS at different counties and identified fundamental issues for the sustainable development of the scheme.


I wrote a paper about the China’s New Rural Cooperative Medical System (NCMS) in 2010 and updated it 2011. It was published in Chinese originally (Xie, 2012). I present this article in English in my website (www.xiex.ca). The English version and Chinese version are slightly different.      

 

 

Xie X. Fundamental Issues for Sustainable Development of the New Rural Cooperative Medical System in China. Chinese Health Service Management. 2012; 29 (suppl): S74-7 (in Chinese)

 

  

 

Title: Fundamental Issues for Sustainable Development of the New Rural Cooperative Medical System in China

 Authors: Xuanqian Xie MSc

Technology Assessment Unit, McGill University Health Centre, Montréal, Quebec, Canada

 

  

 

Abstract:

Background: To relieve the economic burden of catastrophic illness, the Chinese government launched a voluntary New Cooperative Medical System (NCMS) in 2003.

Methods: We selected four dimensional indicators, health status of population, medical service, medical expenditure and health resource to assess the impact of NCMS from 2003 to 2009 at the national level. We reviewed the studies of the effects of NCMS at different counties and identified fundamental issues for the sustainable development of the scheme.

 

Results: The number of enrollees dramatically increased from 80 million in 2004 to 833 million (enrollment rate: 94.2%) in 2009. The number of inpatients in 2009 (38.1 million) was more than twice as high as in 2004 (16.0 million), and the health status of the rural population continued improving. But out-of-pocket payment for medical service still increased rapidly, and the reimbursement rates were low. The essential problems included the absence of long-term financing mechanisms, patients’ preference for high-level hospitals, a lack of protection for migrant workers outside their officially registered provinces, etc.

 Conclusion: The NCMS improved the accessibility of costly health care services, although its financial protection was far from adequate. Presently the urgent step is to legalize NCMS and impose a financial mechanism.


Key words: New Cooperative Medical System, NCMS, funding, health insurance, rural China.

 

 


Background:

The Cooperative Medical System (CMS) for the rural population emerged in 1950s in China. CMS was mainly funded by the collective agricultural production team. Rural residents received basic health services with minor out-of-pocket payments. Under the political environment of the Chinese Culture Revolution, CMS spread to the whole country quickly from 1966 to 1976, extending to over 90% of villages in 19761. The market-oriented economic reforms in China were started in the early 1980s. The collective production team in rural areas disappeared simultaneously, and CMS collapsed within a few years in most villages, mainly because of insufficient financial support mechanisms1. Central government attempted to re-establish a insurance system for the rural population in the late 1980s and in the 1990s, but those plans did not have any significant impact2. Therefore, in the subsequent two decades after the economic reforms the majority of rural households had to pay all health care services by themselves. A national survey showed that 87.3% of rural households did not have any medical insurance in 19983.

 

The Chinese government launched the voluntary New Cooperative Medical System (NCMS) in 20034. The primary purpose of NCMS is to relieve the economic burden of catastrophic illness5, rather than supporting a comprehensive basket of  health care services. Rural residents enroll in NCMS in their officially-registered counties, and the enrollment unit is a family, instead of individuals. Compared with the old CMS, the NCMS has some new features. First of all, the central government plays a more important role in its financing, particularly in underdeveloped provinces, the western regions4, 6. The central government provided general macro policies and guidelines; the provincial government set up more detailed rules and regulations. The NCMS is administered at the county level, thus increasing the risk pool, compared with the village level in the old CMS. In terms of financing, subsides from the central government made  up  about 40% of total funding5. This varied among provinces, according to economic levels of development of each province. In the underdeveloped provinces, such as Ningxia, Qinghai and Xinjiang, the central government, local (both provincial and municipal) governments and individuals contributed roughly 40%, 40% and 20% to the total fund, respectively. For some poor residents, the financial aid can cover the self-payment part. The per capita premiums have been increased gradually from about 50 RMB per rural resident in 2003 to 113 RMB in 20093 (RMB: Chinese monetary unit. 1 RMB≈ 0.121 US$, or 0.114 Euro in 2003 and 1 RMB≈ 0.146 US$, or 0.100 Euro in 20097).

 

The enrollment rate of the NCMS reached 94.2% (833 million residents) in 20093, suggesting almost all rural households have been covered by some type of health insurance plan, as a small proportion of rural households are covered by other health insurance packages. Not surprisingly, quite a few problems appeared following the implementation of NCMS. The aim of this study is to evaluate the impact of NCMS at the national level and in individual counties, and identify some of the fundamental issues for the sustainable development of NCMS.     

 

 

Methods

 

The impact of NCMS at national level

All data were drawn from the Annual Statistical Yearbook on National Health Care from 2004 to 20103, and the China statistical book from 1996 to 20108. National statistics were derived from combined data in 31 provinces, autonomous regions and municipalities in Mainland China, or from nationwide surveys. We briefly describe the implementation process of the NCMS, in terms of the number of enrolees, enrolment rate, per capita premiums, etc. To assess the impact of NCMS, we arbitrarily selected four dimensional indicators:

Ø  Health status of the population: maternal mortality, neonatal mortality and infant mortality.

Ø  Medical service use: Number of outpatient visits and episodes of hospitalization.

Ø  Medical expenditure: out-of-pocket payment per resident, per capita net income and the proportion of out-of-pocket payments of net income.

 

Ø  Health care resource use: total number of health workers, the number of health workers per 1 000 rural residents and the number of beds per 1 000 rural residents. 

We present the annual statistics of those indicators in rural China from 2003 to 2009, as well as historical data in 1980, 1985, 1990, 1995 and 2000 as comparators. All costs were expressed in RMB in the respective calendar years, without any adjustment.

 

 

The effect of the NCMS in different regions and the fundamental issues for sustainable development of the NCMS

We reviewed all guidelines, announcements and reports on the NCMS between 2002 and May 2011 by the State Council, Ministry of Health and Ministry of Finance. A comprehensive literature search of articles in Chinese and English was performed using electronic databases, i.e. Wanfang and PubMed. Wanfang Data is one of the largest databases in China, including more than 6,000 Chinese journals, 1.89 million Master’s, Doctoral and post-Doctoral theses, and so on. We used key words (New Cooperative Medical System) OR (New Cooperative Medical Scheme) OR (NCMS) OR (health insurance AND rural AND China). We also searched news, investigations and comments about the NCMS in web sites by the search engines of Google and Baidu using the same key words.

 

We summarized the studies of the influence/effect of NCMS at different counties/provinces. Since the underdeveloped regions are the bottleneck of the implementation of NCMS, we focused on problems in those areas, in the western and centre regions of China. On the basis of common problems found in underdeveloped regions and national statistics, we recognized a number of essential issues for sustainable development of the NCMS.

 

Results

 

 

The impact of NCMS at national level

The implementation process of NCMS is summarized in Table 13. The number of enrollees dramatically increased from 80 million in 2004 to 833 million (enrollment rate: 94.2%) in 2009. The per capita premiums also have increased gradually from 50 RMB to 113 RMB in 2009. Seven hundred fifty-nine million (91%) out of 833 million enrollees received reimbursement in 2009.

We used 4-dimensional indicators of health and health care to illustrate the impacts of the NCMS (See Table 2)3, 8. The health status of rural residents has improved since 1990s, and continued to improve from 2003 to 2009 (indicators: maternal mortality, neonatal mortality and infant mortality). The number of inpatients in 2009 (38.1 million) was more than twice as high as in 2004 (16.0 million), while the number of outpatients increased moderately from 681 million in 2004 to 877 million in 2009. The net income and out-of-pocket payment for medical service increased remarkably since 1985, and the health spending as the proportion of net income increased slightly from 4.5% (131 of 2 936 RMB) in 2004 to 5.6% (288 of 5 153 RMB) in 2009. The total number of health workers in rural China decreased from 1.5 million in 1980 to 0.87 million in 2003, and then increased gradually to 1.05 million in 2009. Note: The number of health professionals in urban China increased markedly at the same period, 2.8, 3.9, 4.5 and 5.5 million in 1980, 1990, 2000 and 2009, respectively3.

 

 

The effect of NCMS in different regions

Several studies assessed the effects of NCMS in different locations in rural China, using different study designs and various measurements2, 5, 9-12. However, most studies drew a similar conclusion that NCMS provided some financial risk protection for rural residents, but the protection was not adequate. The reimbursement regulations varied amongst provinces, and most regions subsidized both inpatient and outpatient services. In recent years, roughly 65-90%3 of enrollees benefited from the NCMS, but the reimbursement rates were rather low, around 15-30% for inpatient and 6-20% for outpatient services in most provinces 2, 9-11. Some studies concluded that NCMS did not have significant effects on out of pocket payment9, 13, utilization of medical service5, 12, and so on.

 

Fundamental issues for sustainable development of NCMS

 

1. Long-term financing mechanisms

There is no legal framework for the NCMS14, although central government has subsidized NCMS for 9 years. The central government never proposed any long-term financial plan. In reality, the financial plan of NCMS was usually determined by the central government in the preceding year. The reimbursement policies largely depended on ad-hoc funds raised. Due to the uncertainty of these funds, stable reimbursement regulations cannot be established in most provinces15. Both local and central governments have waived the agriculture taxes for farmers since 2006, so the tax deduction plan for health insurance cannot be applied. In some regions, local government has been under high financial pressure for subsiding NCMS, since except subsidies from the central government, no other important sources are available. In summary, the NCMS does not have any legal safeguard, lacks structural financial resources, and usually relies on subsidies from governments in power.

 

2. Costs of raising funds and administration

 

Central and local governments carried out extensive publicity campaigns to introduce NCMS. But for many reasons a certain proportion of rural households were still not willing to join the NCMS. In some regions, the local officials and health workers had to visit rural residents many times to persuade them to enroll in or continue with the NCMS. Thus, the costs of administration increased markedly, in company with the high enrollment rates. Furthermore, administering NCMS, establishing and managing archives of enrollees, etc. was also costly. In 2005, the administrative expenses in the eastern, central and western regions contributed 26%, 58% and 49% of the funds raised, respectively16.     

 

 

3. The large fund surplus

Zhang et al. found that 5 out of 6 counties in 2 provinces held large fund surplus, whereas the enrollees were only partially reimbursed11. The accumulated fund surplus reached 36 billion,14% of 254 billion in the whole NCMS fund in 20093. Due to the uncertainties of future subsides, many local NCMS officials prefer to keep some funds to avoid a shortage of financial aid in the future. Also, although the central government provided a transparent subside plan, there were no clear timeline for the appropriation. Usually, thefiscal appropriation funds were not available until the second half of the fiscal year, but the local NCMS departments need to pay the enrollees during the whole year. So, local NCMS sectors have felt the need to hold the fund in last part of the year to allow making payments in the subsequent year.

 

 

4. Adverse selection

 

A couple of articles observed that unhealthy people showed greater interest to enroll in the NCMS17, 18. Governments do not allow dumping any rural residents who are willing to join. Individuals with pre-existing health conditions, such as cancer or renal diseases, pay the same amount of money as the healthy population; and the older and younger pay the same amount. Basically, there is no special medical aid program for unhealthy people, as all rural residents share one pooled fund. This policy protects the unhealthy persons, but due to this reason, some healthy residents are unwilling to join.  

 

 

5. Migrant workers outside their officially registered provinces

According to national statistics in 2010, around 153 million rural residents worked in cities or other counties19 out of their own provinces, and it was estimated that an additional 10 million rural residents move to cities annually. Although migrant workers live and work in cities, according to current Chinese law, most people are not allowed to register officially in cites where they work. Most of them are engaged in seasonal, temporary or informal positions, and are excluded from the urban health insurance20. They may enroll in NCMS at their villages with other family members (the enrollment unit is the family), however usually health care expenses outside registered provinces are not reimbursed for many reasons. For instance, small NCMS funds are insufficient to support the health expenditures in cities, and the authenticity of diseases and treatments in other provinces is difficult to verify.

 

6. Mobility of health workers in counties

Since 1980 the number of health professionals increased in the urban China; in contrast, it dropped in rural areas (See Table 2). Currently, some medical students cannot obtain job offers in urban hospitals, but they are still not willing to work in poor regions, which are still short of health workers. Also, there is a tendency for the experienced and well-educated health worker to move from rural health centers to higher-level health institutes21. Because of lower income, inferior living conditions and bad welfare, the rural health centers can hardly recruit and keep professionals.

 

 

7. Patients’ preference for high-level hospitals

 

Compared with the rural health care sector, the high-level hospitals in cities have the advantages of well-trained health professionals and the availability of advanced medical technologies. With the improvement of transportation system, it is convenient for rural residents to travel to cities for visiting doctors. Martineau et al. found many rural residents directly went to the hospitals in cities, not their local clinics22. For the same services, the charges in higher grade hospitals are much higher than those in the lower level facilities. For example, the average costs of acute appendicitis, cataract extraction and cesarean section in national and county level hospitals are 7 033 and 3 069 RMB, 7 061 and 2 398 RMB, and 6 798 and 3 241 RMB, respectively3. It is not clear whether the national hospitals can provide relatively higher quality services. But, visiting high level hospitals is absolutely associated with higher health expenditures. It is critical to integrate different levels of hospitals and clinics, and clarify the responsibilities of each of them.  

 

 

8. Protection of catastrophic illness or universal beneficiaries

Ideally, a good health system should provide comprehensive health care services to all. However, it cannot be achieved for most Chinese rural residents now or in the near future. A large proportion of enrollees (65-91%) benefited from NCMS (See Table 2), but the reimbursement rates were rather low9, 10. If only inpatients or costly outpatients (estimating around 2-3% of all enrollees23) were eligible for financial supports, the protection of those patients could be enhanced significantly. Probably, elevating the minimum level of reimbursement may result in lower enrollment rate. But, to enhance the protection of catastrophic illness of individuals, we have to trade off between an extensive insurance package and protection for the financial consequences of receiving treatment for severe conditions.

 

9. Insurance induced costs

 

Although the NCMS has paid 217 Billion RMB to rural residents from 2004 to 20093, the out of pocket per resident still increased rapidly in this period, from 131 RMB in 2004 to 288 RMB in 20098. A couple of studies at the county level documented over-prescribing behavior of village doctors24, most likely an example of supply-induced demand of health care services25. As a consequence, there are significant increases of medical expenses under the NCMS26. Bogg et al. found a dramatic increase of cesarean delivery (CD) rate with the implement of NCMS27, and cost of CD service was accounted for 72%-85% of total delivery fee revenue in 5 counties investigated. CD rate is one of indicators of the standards of delivery services and the CD rate should not exceed 15%, perhaps no more than 5%27. However, the CD rate reached 18.6%-60% in those 5 counties. Health expenditure control is one of the most important tasks in rural China in next a couple of years.     

 

 

Discussion:

National statistics shown that NCMS had the significant impact in medical services and health status of population, but some studies at individual counties found that the effects of NCMS were limited, in terms of income equity28, out of pocket5, 9, utilization of medical service5, and reimbursement rate2, 9, 10. NCMS did not deal with redistributions of income or wealth directly. The per Capita premiums were only about 50 to 100 RMB in most provinces. Thus, we cannot expect the small fund to change the Lorenz curve or Gini coefficient substantially, the common measures of inequity. Also, the small fund cannot provide the comprehensive protection to all. Partially due to the introduction of NCMS, increase of the health care expenditure was not controlled well in the rural China, whereas it also happened in the urban areas of China, as well as worldwide. When introducing types of insurance, somehow the moral hazard is impossible to be avoided completely, such as adverse selection and supply-induced demand. However, the primary purpose of the NCMS is to protect rural residents for the consequences of catastrophic illness. The number of inpatients in 2009 was more than twice that in 20033, suggesting that the accessibility of costly health care services was improved greatly, in spite of a rather low reimbursement rate. Furthermore, the health status of the rural population continued improving in this period3 (indicators: maternal mortality, neonatal mortality, etc.). We therefore conclude that the NCMS was successful in achieving its primary goal.

 

The NCMS was implemented in a very complex social economic environment and constrained by a limited budget. Behind the high enrollment rates, there was much effort from local officials and health workers. In reality, some obstacles for the sustainability of NCMS were beyond the liability of the health sector. For instance, different from the Mao’s era from 1949 to 1976, all citizens have the freedom to select the locations of working and living in China now. Therefore, the government cannot force health professionals to affiliate themselves with rural health centers, irrespective of the shortage of health staff and facilities in underdeveloped areas. Also, the financial pressure for hiring health professionals was not a big problem in the old CMS before the 1980s, because some local governments paid health workers by a non-monetary term, GongFen, which was the same as farmers paid at that time1. (GongFen: Unit was used to count workload in the rural collective economy in China. After harvest season, based on the amount of GongFen earned, farmers distributed the profits and farm products of their work team.) But, the salaries of health workers must be the currency, other forms are not accepted now. For another instance, the gap between urban areas and rural areas are still huge in health care presently. The per Capita premiums were 917 RMB and 113 RMB for urban and rural residents in 20093, respectively. However, the prevailing system in urban China is an employer-provided insurance, while the fund of NCMS largely relied upon subsidizes by governments. We cannot expect the subsidized-based NCMS to provide high level health care services.

 

Some researchers9, 12, 13, 17, 28 investigated the effect of NCMS in different perspectives, such as financial protection, health resource use, expenditure control and prescribing behaviour in different regions using sophisticated models to control confounders. But, it is difficult, if not impossible, to apply standard methods to measure the impact of NCMS at a national level, since NCMS regulations vary among different regions by local governments and change over time. In reality, we have not found any study attempting to do so. Thus, we arbitrarily selected four dimensional indicators, health status of the population, medical service use, medical expenditure, health care resource use to assess the impact of NCMS at a national level, and used historical data as comparators. We knew that those indicators were not perfect, since they were associated with the socio-economic development, but we did not find more relevant factors at that time.

 

It is important to note that although nearly all rural residents are covered by NCMS nominally, most rural residents who work out of their own provinces (153 million) are not receiving any protection in practice, because usually health care expenses outside registered provinces are not reimbursed by NCMS. Most municipal governments have established a wage floor, unemployment insurance benefits, basic health insurance, pension plan etc. for their local urban residents, but the welfare system is still very preliminary for rural residents. Due to the huge gap between urban and rural areas, as well as big cities and small towns, the government has not allowed low-skilled laborers to register officially at the place where they reside. If rural residents were allowed to register in the cities they live and enjoy the equal benefit package as urban citizens, almost all rural residents would immigrate to big cities. However, the current welfare and security system in cities cannot afford all populations. Unplanned massive population mobility would absolutely cause a series of severe social problems. Therefore, the Chinese government proposed some policies to control the scale and speed of transient population, including the regulations to restrict the number of registered city residents. The long term goal of the Chinese government is to eliminate, or at least reduce, the unbalanced development between cities and countryside, and among different

regions.   

 

 

Conclusion:

The NCMS improved the accessibility of costly health care services and population’s health status in rural China. But, its financial protection was far from adequate, the gap of health care between urban areas and rural areas is still huge, and more importantly, many rural residents who work and/or live out of their own provinces are not covered by the current scheme. To solve these problems, integrated efforts must be made by several departments of central and local governments. As the uneven economic and social development between urban and rural regions has existed for a long time and will continue in the near future, presently the urgent step is to legalize NCMS and impose a financial mechanism.

 

 

Acknowledgement: I am very grateful to Dr. Hindrik Vondeling, Department of Health, Technology and Services Research, University of Twente, Enschede, the Netherlands, and Department of Health Economics, University of Southern Denmark, Odense, Denmark, for encouraging me to complete this study and valuable suggestions. I would like to thank my colleague, Lorraine Mines, for her help in English proofing. 

 

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the views of the Technology Assessment Unit, McGill University Health centre.

Conflict of interest: None declared.

Financial support: None.


 

 

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4. Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q. Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme. J Health Econ 2009;28:1-19.

5. Lei X, Lin W. The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health? Health Econ 2009;18:S25-S46.

6. Huong DB, Phuong NK, Bales S, Jiaying C, Lucas H, Segall M. Rural health care in Vietnam and China: conflict between market reforms and social need. Int J Health Serv 2007;37:555-572.

7. X-rate.com. Exchange rate for Chinese Yuan (RMB). [http://www.x-rates com/d/CNY/table.html]; 2011.

8. National Bureau of Statistics of China. China Statistical Yearbook. [http://www. stats.gov.cn/english/statisticaldata/yearlydata/]; 2011 (in Chinese).

9. Sun X, Jackson S, Carmichael G, Sleigh AC. Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province. Health Econ 2009;18:103-119.

10. Yi H, Zhang L, Singer K, Rozelle S, Atlas S. Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China. Health Econ 2009;18:S119-S127.

11. Zhang L, Cheng X, Liu X et al. Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces. Int J Health Plann Manage 2010; 25: 96-118.

12. Shi W, Chongsuvivatwong V, Geater A et al. The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China. Int J Equity Health 2010;9:7.

13. Sun X, Sleigh AC, Carmichael GA, Jackson S. Health payment-induced poverty under China's New Cooperative Medical Scheme in rural Shandong. Health Policy Plan 2010;25:419-426.

14. Cheng C, Li S, Jia X, Su J. Problems of establishing legal system for New Rural Cooperative Medical Scheme. Chinese Health Service Management 2007;(9):617-619 (in Chinese).

15. Mao Z. Standardize and improve New Rural Cooperative Medical Scheme. [http://news. cctv.com/society/20080624/102190 shtml]; 2008 (in Chinese).

16. Gao J. Problems and solutions in promoting the New Rural Cooperative Medical Scheme in the rural areas of western China. Theory Front 2008; 36-37 (in Chinese).

17. Zhang L, Wang H. Dynamic process of adverse selection: evidence from a subsidized community-based health insurance in rural China. Soc Sci Med 2008;67:1173-1182.

18. Li X. Investigations of enrollment rate of New Rural Cooperative Medical Scheme in Beijing. Southern Rural 2008; 30-33 (in Chinese).

19. National Bureau of Statistics of China. Statistical Communiqué of National Economic and Social Development on 2010. [http://www.stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20110228_402705692.htm]; 2011 (in Chinese).

20. Zhao Y, Tan S, Xin X, Wang Y. Research on migrant workers' health insurance in Heilongjiang province. Journal of Social Science of Jiamusi University 2007; 25:53-54 (in Chinese).

21. Meng Q, Yuan J, Jing L, Zhang J. Mobility of primary health care workers in China. Hum Resour Health 2009;7:24.

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Table 1: The implementation process of New Co-operative Medical System in rural China3 (2004 – 2009)

 

2004

2005

2006

2007

2008

2009

N of counties involved

333

678

1 451

2 451

2 729

2 716

N of enrollees (M)

80

179

410

726

815

833

Enrollment rate (%)

75.2

75.7

80.7

86.2

91.5

94.2

Total fund raised (B RMB) #

4.0

9.3

24.5

42.8

78.5

94.4

Payout (B RMB) #

2.6

6.2

15.6

34.7

66.2

92.3

Per Capita premiums (RMB) #

50

42

52

59

96

113

N of beneficiaries from reimbursement (M)

76

122

272

454

585

759

 N= number; M=million; B=billion; RMB=Ren Min Bi, Chinese currency.

#: All RMB was expressed at the calendar year, without any adjustment.

 

 

Table 2: Indicators of Health and Health Care in rural China3, 8 (1980 – 2009)

 

 

 

1980

1985

1990

1995

2000

2003

Health Status of Population

 

 

 

 

 

 

Maternal mortality per 100 000 live births

--

--

113

76.0

69.6.

65.4

Neonatal mortality(‰)

--

--

37.9*

31.1

25.8

20.1

Infant mortality (‰)

--

--

58.0#

41.6

37.0

28.7

Medical Service

 

 

 

 

 

 

N of outpatient visits (M)

--

1 100

1 065

938

824

691

N of Inpatient (M)

--

17.7

19.6

19.6

17.1

16.1

Medical Expenditure

 

 

 

 

 

 

Out-of-pocket per resident (RMB) #

--

7.7

19

42

88

116

Per Capita Net Income (RMB) @ #

191

398

686

1 578

2 253

2 622

Health spending as % of net income

--

1.9

2.8

2.7

3.9

4.4

Health Resource

 

 

 

 

 

 

Total N of health workers (M)

1.5

1.3

1.2

1.3

1.3

0.87

N of health workers per 1 000 residents

1.79

1.55

1.38

1.48

1.44

0.98

N of beds per 1 000 residents

0.95

0.86

0.81

0.81

0.80

0.76

  

 

2004

2005

2006

2007

2008

2009

Health Status of Population

 

 

 

 

 

 

Maternal mortality per 100 000 live births

63.0

53.8

45.5

41.3

36.1

34.0

Neonatal mortality(‰)

17.3

14.7

13.4

12.8

12.3

10.8

Infant mortality (‰)

24.5

21.6

19.7

18.6

18.4

17.0

Medical Service

 

 

 

 

 

 

N of outpatient visits (M)

681

679

701

759

827

877

N of Inpatient (M)

16.0

16.2

18.4

26.6

33.1

38.1

Medical Expenditure

 

 

 

 

 

 

Out-of-pocket per resident (RMB) #

131

168

192

210

246

288

Per Capita Net Income (RMB) @ #

2 936

3 255

3 587

4 140

4 761

5 153

Health spending as % of net income

4.5

5.2

5.4

5.1

5.2

5.6

Health Resource

 

 

 

 

 

 

Total N of health workers (M)

0.88

0.92

0.96

0.93

0.94

1.05

N of health workers per 1 000 residents

1.00

1.05

1.10

1.06

1.06

1.19

N of beds per 1 000 residents

0.76

0.78

0.80

0.85

0.96

1.05

N= number; M=million; B=billion; RMB=Ren Min Bi, the Chinese currency.

*: Based on statistics in 1991, since national statistics were not available in 1990.

#: All RMB was expressed at the calendar year, without any adjustment.

@: The net income equals to the total income minus inputs and taxes. It comprises of both monetary income and goods not for sale.

 

 

 

 

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