Study On Impact Of New Rural Cooperative Medical Scheme On Distribution Of Rural Residents’ Choices Of Medical Institutions

BackgroundThe New Rural Cooperatives Medical Scheme (NCMS) is an item of welfare policy which is the government introduced. As a medical insurance system, its direct policy goal is to provide the medical safeguard for the general rural residents, and to reduce the risk of causing and returning to poverty due to illness; Its indirect policy goal is to guide the rural residents to form rational medical seeking behaviors through the compensation system, two-way referral system, access system, and the regulatory system, etc. Contrasting the fourth, third as well as the second National Health Service Survey results, it is found that after the implementation of NCMS, the distribution of rural residents’choices of medical institutions has changed to some extent. Actually, it is of great significance to quantify the impact of NCMS on rural residents’choices of medical institutions, both for the NCMS sustainable development and the formation of the pattern of rational distribution of rural residents’ choices of medical institutions.ObjectiveThe main purpose is to quantify the impact of NCMS on the distribution of rural residents’choices of medical institutions, so as to provide the basis for the reasonable formulation and adjustment of NCMS policy, on the basis of clarifying the operation condition of NCMS in the seven years and figuring out the relevant provisions of guiding people to choose medical institutions rationally in the NCMS. The specific objectives are:(1) to clarify the operation condition of NCMS in2004～2011;(2) to figure out the relevant provisions of guiding rural residents to form rational medical seeking behaviors in the NCMS;(3) to analyze the impact of the implementation of NCMS on the distribution of rural residents’choices of medical institutions;(4) to make policy recommendations for promoting the sustainable development of NCMS and achieving its role of guiding rural residents to form rational medical seeking behaviors.MethodsThe materials come from the China Health and Nutrition Survey (CHNS) as well as secondary data such as the China Health Statistics Yearbook and the NCMS policy documents, etc. CHNS is a longitudinal follow-up investigation, using a multi-stage stratified cluster random sampling method. Taking county as the basic unit of analysis, a total of five periods in2000,2004,2006,2009and2011of rural areas in nine provinces in CHNS were chosen as the study sample. After merging and screening,180counties,14405households and37614respondents were finally obtained.Descriptive statistical analysis was used to describe the NCMS operation from2004to2011and related indicators of sample counties. Secondary data analysis was used to sort out the relevant provisions of guiding rural residents to form rational medical seeking behaviors in the NCMS. A difference-in-difference (DID) estimation method based on the panel data fixed model was mainly used to quantify the impact of NCMS on rural residents’choices in county, township and village levels of medical institutions.Main Results(1) The implementation of NCMS rose1.20to1.70percent of the proportion of rural residents to the village clinic for treatment, but not statistically significant;(2) The implementation of NCMS rose1.84to2.13percent of the proportion of rural residents to the town-level medical institution for treatment, and the time trend suggested that the impact was sustainable;(3) The implementation of NCMS declined3.87to5.94percent of the proportion of rural residents to the county-level medical institution for treatment, and time trends showed that the impact was also sustainable.ConclusionsThe NCMS has played a positive role in promoting rural residents to grassroots medical institutions for treatment, especially the town-level medical institutions. However, the effect is not very significant. Such an outcome is mainly due to the NCMS own defects and deviations in the policy implementation process.Policy Suggestions(1) Increase the reimbursement ratio of NCMS in the county appropriately, giving full play to the guiding role of the NCMS;(2) Implement and improve the two-way referral system;(3) Improve the management and the access and exit mechanism for medical institutions;(4) Strengthen the policy advocacy, training rural residents to form rational awareness of medical institutions choosing.