An Evaluation Research On The Effectiveness Of Medical Assistance Implemented In Chengdu

Background: With China's reform goes on, people's living level has a great improvement as the consequence of the progress of the social economic. But for many other reasons, the problem that it is difficult and expensive to see doctors among residents especially the urban poverty has not been solved radically. It is a prevalent phenomenon in the poor population that impoverished by illness and return to poverty because of illness. This is not the burden of the poor families but also increase many unstable factors to the society. By the establishment of economic and efficient community health service system, UK-China urban health and poverty project (UHPP) aims to improve the health service accessibility of urban residents especially of urban poverty and the vulnerable groups, to explore the possibility to establish medical assistance mechanism of urban poverty and the vulnerable population, to establish and perfect the medical assistance system for the urban poverty, and to supply experiences for solving the problems that impoverished by illness and induced disease by poverty. Research purposes: This research makes a systematical conclusion and evaluation on the process and outcome of the UHPP program carried out in Chengdu. It supplies policy suggestions for further perfecting medical assistance mechanism and benefit other cities by providing related experience. The concrete research purposes include; 1) describe the effort of medical assistance program; 2) evaluate the effectiveness of medical assistance; 3) analyze the related factors which influenced the effectiveness of medical assistance.Conclusion: 1.improve the utility of health service in the poor population. As UHPP do no limit the utility of clinical and in-patient service into special diseases, most of the low-insurance population could get the assistance. 2. reduce the economic burden of disease in the poor. The analysis about average cost of medical assistance shows that in the second program year the average cost of clinical medical assistance of Wuhou and Jinjiang is 48 yuan and 44 yuan, the percentage of medical assistance is 79% and 85%. 3. possess very good social benefits. First, with the program carrying out in the poor population, the medical economic burden was greatly reduced; second, as the patients break with poverty resulted from medical factors, the adverse consequences of poverty such as neighborhood disputes, social dissention and pilfer decreased a lot. This benefits the stability of the society; third, ameliorate the relationship between community cadres and the residents, lift their reputation in the commonage; next, ameliorate the relationship between doctors and patients, enhance the health conscience in civilians; last, cultivate many research personnel and management personnel, including project management, community health service management, chronic condition management etc. 4. guide reasonable flow direction and referral of patients, accelerate reasonable location of health facilities, promote the development of the community health facilities. First, the implementing of UHPP influence the government's opinion of community health service, as a result the government pay more attention to the community health service and supply more support; second, realize the effect of community health facilities in basic medical insurance; third, carry out family health care contact, chronic condition assistance management and health education through this program, extend the extent community health centers influenced, enhance the residents' confidence to community health center, ameliorate the relationship between doctors and patients. 5. the establishment of medical assistance scheme built innovative assistance mechanism, mainly including: the establishment of medical assistance structure; the cooperation and function definition of related department; First Contact Care in community health facilities, bidirectional referral, assistance application according to the classification of the assistance object, including assistance to critical poor population and floating population; dual assistance; family bed assistance; prepayment. 6.family bed assistance. 7.promote the cooperation of different departments, boot the government to focus on UHPP, carry out the medical assistance in a sustainable and feasible way, benefit the community health policy and Medicaid policy.Main problems and measures: 1. further campaign of medical assistance is still needed. 2. limited funds can not radically solve all the basic medical problems in low-insurance population, especially can not afford the substantive medical cost. 3. the sustainable of dual assistance. Dual assistance is that assist patients with serious diseases again if there is spare fund at the end of the year, but the problem is that if there is no fund left, dual assistance could not carry out. 4.the problems in assisting floating population. 1) floating population is difficult to recognize, and the instability is another problem;2) some pregnant women among floating population do not deliver their children in hospitals because of economic problems, which lead to pregnant women die. Suggest pregnant women deliver in hospitals and pay subsidies as help. 5.regulate the medical behavior. According to the analysis before, the adjust of the assistance scheme leads to a increase of the utility of health service, at the same time, the average clinical cost and average in-patient cost show the increase to some extent. Although whether there is induced demand still need further proof, this phenomena alerts us we should regulate the health providers' behavior when we improve the utility of health service.