A Study On The Accessibility And Satisfaction Of Medical Poverty Alleviation In Typical Poverty-stricken Areas

China’s poverty alleviation program has achieved remarkable achievements.From 1978 to 2019,the rural poor population decreased from 250 million to 5.51 million,and the incidence of poverty dropped from 30.7% to 0.6%.This is a huge contribution to the sustainable development and human rights protection all around the world.However,as the most important cause of poverty,disease-induced poverty still hinders the realization of comprehensive poverty alleviation.Its persistence and repetitiveness determine that medical poverty alleviation is still the main direction of poverty alleviation.In addition to the arduous and long-term characteristics of medical poverty alleviation,there are still large differences in the level of medical care and medical security between regions.Especially in concentrated and poverty-stricken areas,the supply of medical services is still difficult to meet the medical needs of the poor,and a low reimbursement rate cannot completely stop the people from falling into poverty.At present,many scholars have carried out related research on disease-induced poverty and medical poverty alleviation,which explored the impact and management system of disease-induced poverty,and the poverty reduction effect of medical security.However,few existing studies have included medical services and medical security in a unified framework for analysis.Meanwhile,the mechanism of disease-induced poverty and the optimal path of medical poverty alleviation remain to be analyzed.Therefore,Ningde City,which is a typical poor area located on the eastern coast of the coast,and one of the 18 concentrated and contiguous poverty-stricken areas in the 1980 s,was selected as study area.Based on economic and social statistics,questionnaire data,and spatial data,the methods,such as Cross-tabs Analysis,O-2SFCA,comprehensive evaluation,GWR and Logistic regression model,etc.,were used to analyze the poverty status of disease in typical poor areas,and discuss the accessibility and satisfaction of medical poverty alleviation from the perspective of supply and demand.Firstly,based on the analysis of the current situation of disease-induced poverty in Ningde City,the impact of disease-induced poverty was identified.Secondly,from the perspective of accessibility,the support ability for medical poverty alleviation was analyzed from two aspects of medical security system and medical service,so as to reveal the spatial difference of medical poverty alleviation.Thirdly,based on 526 questionnaire survey data,an indicator system for satisfaction of medical poverty alleviation is established from the three dimensions,i.e.,medical security,medical service quality and medical convenience.Then,the ordered logistic regression model is used to identify the key factors affecting the satisfaction.Finally,suggestions for optimizing medical poverty alleviation were put forward.Research indicates:(1)The six poverty-stricken counties in Ningde City are still severely affected by poverty and returning to poverty.There have differences in poverty status and capacity between different types of diseases,and also vary in populations and regions.Meanwhile,the mechanism of disease-induced poverty is complicated,which is mainly caused by excessively high self-financed medical expenditures and the loss of labor force of families to reduce income.In addition,the disease also cause poverty to a certain extent in terms of affecting social capital,physical capital,and family harmony.(2)The accessibility of medical security is high in Ningde,but there is still a certain gap between the medical security supply and the actual needs of poor people.The poor’s demand for critical illness insurance and critical illness assistance is still high.Medical security plays a certain role in reducing poverty,but its effect is limited;Second,There are differences in the space of medical service accessibility in Ningde City.Townships with poor overall accessibility of medical services are mainly located in remote mountainous and island areas.In the same time,there is a certain gap between the accessibility of primary medical institutions between counties.While the accessibility of general hospitals has a clear circle structure,the area with high accessibility is close to the county seat and the road network is dense;Third,the results of the geographic weighted regression model show that improving overall access to medical services has the effect of improving poverty in most areas.(3)The overall satisfaction level of medical poverty alleviation in Ningde City is relatively high,and vary in different dimensions and regions,and affected by multiple factors: The average satisfaction value of medical poverty alleviation in Ningde City reached 4.19,and the overall satisfaction rate was 81.6%;in terms of specific indicators,medical insurance costs,doctors’ service quality,and insurance reimbursement processes are relatively high,while village doctors’ diagnosis and treatment levels,and hospital visits are relatively low;there is a large difference between regions.The difference between the highest(Gutian)and the lowest mean(Pingnan)is 0.91,and the overall satisfaction rate is 33.2%;in addition,satisfaction is mainly affected by the ratio of medical insurance reimbursement,the effect of medical treatment,the medical measures understanding,the distance from the general hospitals,and the type of poverty-stricken households that due to illness.This study enriches the empirical cases of medical poverty alleviation.The effectiveness and deficiencies of medical poverty alleviation were analyzed from the perspective of supply and demand,and the optimization path of medical poverty alleviation was put forward,which provided a useful reference for the continued development of medical poverty alleviation in typical poverty-stricken regions.