| Objective: On the basis of analysing the necessity of the catastrophic health care system from two angles: the current burden and impact of our country's catastrophic health expenditure, the shortage of basic health care system for catastrophic health care; researching and analyzing the catastrophic health care system model of foreign countries and some typical areas in China. This paper will explore a new catastrophic health care system, including coverage, financing mechanism, payment style, provision manner, which is seasoned with the development of our society, then put up feasibility demonstration and reasonable proposal, give some relevant countermeasures, so as to alleviate economic and social stress lead by catastrophic health expenditure, reduce impoverishment.Methods: Adopting WHO's definition about catastrophic health expenditure, analyze the model and characteristics of catastrophic health care system in different countries and typical areas in China, finally put up a new catastrophic health care system which is seasoned with the development of our society. Finding out the consequences and existing problems of basic health care system through empirical study, and evaluating our country's catastrophic burden through the following data and methods: health care survey of Liaoning province in 2006, 43 hospitals'costs of Liaoning province in 2006, the research report of China total health expenditure in 2008 and the fourth national health service research; the five income groups, catastrophic health expenditure, focus curve and so on.Results: As the coverage of basic health care system increase, the OOP (out-of- pocket) percentage decrease. According to the fourth national health service research, the reimbursement for urban workers participation in the supplementary health care is 66.2%; for urban residents participation in basic health care, it's 49.2%; for rural residents participation in NCMS (new corporation medical system), it's 34.6%.With the change of population aging and disease, the catastrophic health expenditure burden is increasing. The data of 43 hospitals of Liaoning province in 2006 shows that, the average hospitalization costs accounting for sub-urban disposable income per capita is 97.48% and it's 187.54% accounting for rural disposable income per capita.The health service research of Liaoning province in 2006 shows, the incidence of catastrophic health expenditure of Liaoning Province is 8.9% (8.5% for urban area and 9.3% for rural area). Income five groupings and focus curve description shows, the occurrence of catastrophic health expenditure focus on low income groups, so current catastrophic health expenditure is preferred to occur in impoverished family. The analysis of disease and economic risks also shows, policy makers should pay more attention to low income groups.The basic health care system can reduce the incidence of catastrophic health expenditure, but have different consequences to different group between different systems. The safeguard effect for urban workers is better, the OOP can be low to 38%; and the NCMS is not as good as that, it only can lower the burden by 24.8%. The health service research of Liaoning province in 2006 shows, the OOP percentage should be controlled below 50%, so that the incidence of catastrophic health expenditure should be in a relatively lower level, and NCMS has a long way to go.Conclusion: The research shows, the basic health care system of our country reduce the incidence of catastrophic health expenditure, alleviate the burden of catastrophic expenses. But the impact is limited, especially about the poor. the high medical costs and the level of the current heath care system, decides the necessity of a new catastrophic health care system.The model and characteristics of catastrophic health care system in different countries provides valuable experiences for the establishing of our country's system. At the moment, we should adopt a multi-level health care system, and with the accomplishment of heath care for all, we should establish a separate catastrophic health care system. |
