Systematic Evaluation On New Type Rurual Cooperational Medical System In Zhejiang Province

1. BackgroundThe results of the third national health services survey show thatthere are 79.0% of rural residents without any form of health insurance.Rural residents always anxiety "poverty caused by catastrophic disease"(PCCD). To improve the level of health insurance for rural residents, theCPC Central Committee promulgated" the decision on further strengtheninghealth care work in rural areas" in 2002, in which the government startedto develop the new rural cooperative medical system(NRCMS) in 2003, andthey want the NRCMS to cover all the rural residents in 2010. Among theexperimental provinces, Zhejiang is one of the first four experimentalprovinces in the country.In the experimental period, there is an urgent need for a systematicevaluation, in order to promptly identify problems and find the reasons,then make suggests to improve the system, and generalize the NRCMS andkeep it sustainable development in the country. Depending on the domesticexisted evaluation researches, most of them focused on the structure andprocess of the new rural cooperative medical system, researches in theview of the results were limited, and the systemic evaluations were scarce.There are gaps in research, such as the ability of the NRCMS for ruralresidents to reduce medical risks, alleviate poverty due to illness,promote social equity, therefore, in this study we choose ZhejiangProvince as sample areas, launched systematic evaluation.2. ObjectivesWith the results of the evaluation on Zhejiang NRCMS, this study willindicate the effect, issues, and strategies of the experimental provinces.Specific objectives including; (1) Indicating the implementation of theNRCMS in Zhejiang; (2) Demonstrating the extent the NRCMS policy goalsreached, including the effect of reducing hospitalization economic risk,the extent of solving the PCCD, the promoting strategies and the role ofimproving the social equity; (3) Studying the improving strategies of theNRCMS to focus on the equity of the low-income rural residents; (4) Analyzing the sustainability of the NRCMS.3. Contents and Methodologies3. 1 Indicating the implementation of the NRCMS in ZhejiangAccording to the four dimensions of publicizing, structure,organization and implementation, this study evaluated the implementationof the Zhejiang NRCMS.3.2 Demonstrating the extent that the NRCMS policy goals reachedThe indicator of Relative risk (Relative Risk, RR) is used to measurehospitalization economic risk, analyze the changes of hospitalizationeconomic risk after the compensation of the NRCMS among general people,high-risk people, and poor people, and evaluate the effect of reducinghospitalization economic risk. Using the concept of the threshold ofhospitalization economic risk, this study analyzes the changes of theratio of PCCD and evaluate the effect of relieving PCCD after the new typeof rural cooperative medical compensation in the sample rural residents.By the Use of GINI coefficient and concentrated index (CI) to analysisthe changes in the distribution of disposable in crowd between beforefinancing, after Financing, after medical expenses, after compensationfor medical expenses. Else wise, evaluating the role of the new ruralmedical cooperative system to promote social justice.3.3 Studying the improving strategies of the NRCMS to focus on theequity of the low-income rural residentsTo analyze the medical institutions, the types of disease and medicalexpense of low-income rural residents, and comparing with the people whois focused by the NRCMS. Based on these, the study simulated anddemonstrated the theory of "the main compensation of the NRCMS focus onlow-income residents' medical institutions, types of diseases andmedical expenses, in order to achieve the policy in favor of low-incomeresidents."3.4 Analyzing the sustainability of the NRCMSUsing game theory, this study analyzed the changes of the interestsamong all the interest groups in the NRCMS experiments of Zhejiang, findthe main causes of "chun ban qiu huang" and the changes after the implementation of the NRCMS. Then we will make the comprehensive judgmentof the sustainability about the NRCMS in Zhejiang.4. Data sources and collecting methods4.1 SampleSample divided into two categories. First, in the second half of 2003,Zhejiang launched the NRCMS in the 27 pilot counties; second, accordingto the economic level, we chose Xiuzhou and Kaihua County. Xiuzhou Countyis a typical representative of the wealthy, and Kaihua County is a typicalrepresentative of underdeveloped,areas. Meanwhile, we selected ChangshanCounty as contrast. In the three counties, in accordance with theprinciple of stratified we randomly sampled residents.4.2 Survey methodThe statement reports of 27 counties.For the three counties, firstly, the views and wishes about the NRCMSof all the stakeholds were investigated by the conferences, letters, andthe structured questionnaires. Secondly, we launched the household survey,using a structured questionnaire, including the sociologicalcharacteristics of the family members, such as gender, age, occupation,educational level and type of health insurance; Before the investigationwithin two weeks the number of illness, severity, and the duration ofrepair work, and go back to bed days; the hospital, the times, and theexpense of the illness due to the two weeks before the survey, the NRCMSrelief; the hospitals, the times, the expense of the hospitalization ina year before the survey, and the number of not hospitalized, and the NRCMSexemptions; evaluating the NRCMS.4.3 Data collectionIn a specified time, the recovery of 27 counties in Zhejiang completedrecovery of the 26 counties. Xiuzhou, Kaihua, Changshan County collected233 copies of the three questionnaires. In the household survey, weinvestigated 1447 households, 5713 residents in Xiuzhou; 2359 households,8254 residents in Kaihua; 2572 households, 9167 residents. 3. counties(cities) investigated atotal of 16,083 households and 23,134 residents.We collected questionnaires, 80.4% of Xiuzhou, Kaihua 87.4%, 95.3% Changshan.5. Research results5.1 In Zhejiang Province, the implementation of NRCMS was good, theparticipating rate of the rural households reaches more than 80%. Thefunding rate of all levels of financial departments was close to 100%.5.2 The NRCMS played a role in reducing the hospitalization economicrisk. After the compensation of the NRCMS, Hospitalization economic riskreduced 14.3% averagely; compensation of inpatient is far better than therole of outpatient compensation, and the higher-level the hospitals are,the greater the role of reducing hospitalization economic risk is.5.3 The NRCMS played a role in reducing "PCCD". Xiuzhou reduced 72.7%,Kaihua 75.0%.5.4 The NRCMS financing evaded income and the corresponding level offunding, and weaken the equity. GINI coefficient of Xiuzhou and Kaihuaincreased 2.5% separately.5.5 The NRCMS can effectively improve the income equity among themedical expense groups. The initial GINI coefficient of per capita netincome of rural residents in Xiuzhou is 0.4310; After the payment ofmedical expenses increased by 0.0815, then after the compensation of theNRCMS dropped by 0.0371. NRCMS role is 45.5%. The initial GINI coefficientof per capita net income of rural residents in Kaihua is 0.4795; Afterthe payment of medical expenses increased by 0.0858, then after thecompensation of the NRCMS dropped by 0.0303. NRCMS role is 35.3%.Changshan is 7.6%.5.6 The compensation model of the NRCMS for should change theprogressive into firstly the progressive then retire compensation to careabout the low-income people. Research shows that "PCCD" rate of low-incomepeople is highest, reaching 0.54%. However, with progressive compensationmodels of the NRCMS, the main beneficiaries are the middle-income people,their "PCCD" rate fell 66.7%, and low-income people could not benefit fromthem. When changing the compensation model, the NRCMS will enable makethe "PCCD" rate of low-income people fell 14.3%.5.7 This study shows that technical problems had became the key problem of the NRCMS, and the important factors for the sustainable developmentof the NRCMS.5.8 This study explored some theory problem of the NRCMS, put forwardthe developing strategy of the NRCMS.6. Inovation6.1 Various evaluation methods were employed to review theimplementation of NRCMS. Study results would provide timely and valuableevidences to support the policy adjustment of NRCMS in Zhejiang province.6.2 The indicator of Relative Risk(RR), ratio of PCCD, GINIcoefficient concentrated index were employed to demonstrate and makesure the positive effectiveness of NRCMS.6.3 The coupled calculating function of Excel software was employedto establish a kind of quantitative relationship and argue the necessityof firstly the progressive then retire compensation way for NRCMS, whichwould contribute to improve the equity of medical security of ruralresidents.6.4 Some theories, original policy ideas and suggestions weresysmaticly concluded and developed to perfect NRCMS.