The Influence Of New Rural Cooperative Medical System To Health Use And Benefit Distribution Of Different Groups

The early 80s of last century, with profound changes in socio-economic system, cooperative medical care system which has played an important role in the rural gradually disintegrated.For re-establishing in the whole health care system in rural areas, in 2002 central government make the report of "Central Committee and State Council on Further Strengthening Rural Health Work of the Rural" in Rural Health Conference. The report states that the gradual establishment in rural areas, government organizations, guidance, support farmers voluntary, individual, collective and multilateral financing for the Government to seriously ill co-ordinate-based rural health aims at treating system, that the new rural cooperative medical system, referred to as the new rural cooperative(NCMS). After the development of seven or eight yeas, NCMS has become the most important form. It played an important role of protection of rural residents access to basic health services and alleviate the poverty caused by the diseases and returning to poverty due to illness.Fair is an important symbol of progress of human civilization. As a starting point and destination of a health policy and health management, it has been identified as an important objective of health reform. At present, the new rural cooperative medical system has been basically established. To improve the fairness of the new rural cooperative medical system has become the main objectives. Analysis of the new rural cooperative medical system in different income groups the impact of health service and the new rural cooperative funds flow between different income groups can not only find the policy in the operation of defects and deficiencies can also provide the basis for future policy adjustments.Main Objective: This paper analyzes the use of health services in different income groups of the survey area before and after the new cooperative program to adjust, as well as the new rural cooperative fund distribution among different income groups. We want to know whether it is conducive to equity in health service and puts forward policy recommendations.Methods:This study used stratified sampling method, we selected three counties (cities) in Shandong and three counties (cities) in Ningxia. According to the socio-economic development and geographical distribution, in Shandong Province we chose Zhangqiu which is relatively developed, Changle which is medium developed and Donge which is less developed; in Ningxia we chose Qingtongxia which is relatively developed, Yongning which is medium developed and Zhongning which is less developed. At the same time the townships and villages were randomly selected corresponding according to the level of economic development in each county.We used quantitative data to analyze the utilization of health service and the compensation of NCMS in 2006 and 2008. Some qualitative information was used to the interpretation of the results of quantitative data.Numerical variable information is mainly used to describe both the health utilization and the compensation of NCMS of 2006 and 2008. Classification data is used to explain the outcome. The mean is used to describe the numerical date. The rate and the proportion is used to describe the classification data. Univariate statistical analysis is used to compare group differences between the various indicators. The independent samples T-test is used to compare the means of two samples. Pearson chi-square test was used to compare the disorder classified data. The logistic regression model analysis is used to analyze the utilization probability of in-patient and out-patient services. Also the equity methods of analysis are used, including Range Method, The Index of Dissimilarity, concentration index, concentration curve and Kakwani index.The main results:1) the participation rate of NCMS to investigate regional:the participation rate in 2006 was 88.3%. The participation rate in 2008 increased to 94.6%. The participation rate increased by 6.3%. The out-of-pocket proportion of low-income people in 2006 was 12.4%, the proportion decreased by 7.7% in 2008 but still higher than other income groups.2) The treatment-seeking rate in four weeks of rural residents in 2008 was 23.48%, increased 12.46% compared to 2006. The treatment-seeking rate of low-income people was 12.90%, higher than other income groups. The hospitalization rate of rural residents in 2008 was 6.83%, increased 1.47% compared to 2006. Low-income group population increased 3.19%, rising higher than other income groups.3) The benefit rate of outpatient in 2008 was 35.09%,14.78% higher than in 2006. The benefit rate of inpatient was 73.49%, 26.17% higher than in 2006. The concentration index for outpatient compensation was 0.082 in 2006 and -0.072 in 2008. The concentration index for inpatient compensation was 0.107 in 2006 and 0.002 in 2008.4) The incidence rate of catastrophic health expenditure after the reimbursement declined by 7.9% in 2006. In 2008 the rate was 21.2%. The decrease of catastrophic health expenditure was much higher in 2008 than in 2006. The proportion of OOP to income of different groups in 2006 was 110.22%,19.11%,9.81%,7.39%and 3.43%. The proportion of OOP to income of different groups in 2008 was 131.42%,26.39%,13.03%,10.09%and 3.63%.Conclusion:1) The coverage rate of rural residents steadily increased, the ratio dropped at their own expense. The positivity of rural residents participating in NCMS improved. We also found more and more rural residents realize the advantage of NCMS and build up the awareness of disease risk gradually. They participate in NCMS to protect their own economic interests which also be the chief reason.2) Rural residents have increased health services utilization. The treatment-seeking rate in four weeks of different income groups has increased. The rate of low-income group was 31.72%, significantly higher than other income groups. The hospitalization rate in 2008 was 6.83%, improved 1.47% compared to in 2006. The rate of low-income group population increased 3.19%, rising higher than other income groups.3) The benefit equity of NCMS improved. The concentration index of inpatient compensation was -0.072, it was a value of negative, the out-patient compensation distribute more in low-income people. The fairness of out-patient compensation has improved. The concentration index of outpatient compensation was 0.002, smaller than in 2006. The fairness of in-patient compensation has improved. Concentration index of total compensation was 0.099 in 2006 and -0.052 in 2008. Total compensation equity has improved compared with baseline.4) The low-income group still has a heavy economic burden. The effect of NCMS on reducing the catastrophic health expenditure is significantly higher in 2008. As the inpatient fees rising, it is difficult for NCMS to reduce the risk of catastrophe happens. Compensation of NCMS is important to effectively reduce the occurrence of catastrophic health expenditure. It is even more important to reduce medical costs.Policy recommendations:1) to take measures to ensure participation rate of rural residents. While the Government should step up publicity to raise awareness of rural residents in the risk of disease, on the other hand, we should remove the obstacles of the participation to NCMS to increase the final participation rate to reach all the rural residents were covered by the NCMS.2) Increasing the level of financing to increase the ability of risk sharing of NCMS. We should improve the compensation package of NCMS. Gradually raise the level of government subsidies, while rural residents pay more for insurance and improve the new rural cooperative's risk-sharing capacity. In the compensation package, we should improve the proportion of out-patient costs, in compensation change the family account to the outpatient co-ordination gradually. Appropriate setting cap line to prevent the new rural cooperative funds were accounted for by a few serious diseases and to maintain benefits and benefit levels of a balanced face. Also, follow the classification regressive compensation system to improve compensation ratio of primary health care institutions in medical expenses, to expand the gap of compensation rate between medical institutions of different levels to guide the use of primary health care institutions.3) To strengthen the capacity of primary care service. On the one hand improve the level of technology of primary health care institutions. On the other hand strengthen the primary health care sector of hardware facilities, improving the medical conditions.4) To control the increasing medical costs, effectively reducing the financial burden of health care of rural residents. The government can strengthen the reform of supply-side institutions to control the rising health care costs and decrease the economic burden of farmers.5) To do series of work to support policy reform and implementation. To implement the first diagnosis of primary health care institution system. It can help to reduce the demand for tertiary health care and excessive use of and to reduce health costs and economic burden of disease. Actively promote the joining of NCMS and medical assistance. To establish the medical assistance channel in which government investment as the main funding. To melt the medical assistance system into the NCMS. To form a management system and operational mechanism which NCMS oriented and medical assistance system supplement to bring the function of "Fairness" of medical assistance into play.