Study On Medical Security System For Rural Poor Population Based On Disease Economic Risk

Objectives:Collected the information in health service demand and utilization, medical cost and compensation of the rural poor and non-poor after they participating in medical security system through a site investigation. Adopted the measure indicators of disease economic risk, comparatively evaluated the effect of current rural medical security system in resisting the disease economic risk of the rural poor and non-poor and its influencing factors were analyzed. Based on this, the study proposed the improvement strategies of the rural poor medical security system to improve the ability of medical security system in resisting disease economic risk of the rural poor.Methods:1. Literature research methodsSystematically reviewed and analyzed the related theory and empirical researches on risk management, health poverty and medical security. Emphatically concerned summarized the related technological method and system design on the assessment, coping and intervention of disease economic risk.2. Delphi methodDelphi method had been used in screening the assessment dimensions and indicators. This study had adjusted and determined the assessment dimensions and indicators of disease economic risk through selecting experts to openly appraise and discuss on the preliminary assessment framework.3. Site investigationTo take multiple stages randomly stratified cluster sampling method, according to regional distribution and social economic situations, Zhejiang Province (Wenling City, Jiande City and Wencheng County), Hubei Province (Jingshan County, Gongan County and Xianfeng County) and Chongqing City (Jiulongpo District, Fuling District and Qianjiang District) were chosen as the sample county.100impoverished rural families (IRFs) and100Non-IRFs were sampled and investigated in each county and the IRFs were confirmed by the subjective recognition of local village doctors or cadres.1697rural families were investigated in the actual site investigation, of which592families in Chongqing,673families in Hubei and432families in Zhejiang. The investigation finally received1661valid questionnaires, which consisted of815IRFs and846Non-IRFs. A grand sum of6502rural residents was included, which consisted of3240poor and3262non-poor.4. Statistical analysis methodsMathematical calculation:calculate incidence, intensity and concentration index through the formula; Descriptive analysis; Descriptive Statistics:Mean and S.D. for variable data; frequency and description for attribute data; Univariate Analysis:T-test, One-Way ANOVA, Mann-Whitney U-test and Kruskal-Wallis H-test for variable data; Chi-square for attribute data. All mathematical calculation was processed by Microsoft Office Excel2007and statistical analysis was processed by SPSS for Windows12.01.Results:1. This study had summarized and determined the assessment dimensions and indicators of disease economic risk of rural residents. The finally determined assessment framework of disease economic risk mainly included two dimensions:absolute economic risk and relative economic risk, of which absolute economic risk was based on the natural attribute of risk and assessed separately from probability and intensity, relative economic risk was based on the social nature of risk and assessed respectively from the relative risk, catastrophic health care costs and impoverishing health care costs.2. Adopting the determined assessment dimensions and indicators of disease economic risk, this study had conducted comparatively assessment on the status of disease economic risk of the rural poor and non-poor. The results showed that:(1) from assessment on the absolute economic risk of rural residents, in risk probability, the chronic diseases morbidity and probability of hospitalizing because of chronic diseases of the poor were significantly higher than the non-poor. But in health services utilization, the probability of non-treat in sick of the poor was significantly higher than the non-poor, and level of outpatient service institutions of the poor was relatively lower. Further analysis had concluded that health services utilization behavior of the poor was more vulnerable to economic restriction. And in risk intensity, fortnight self-treatment cost of the poor was significantly lower than the non-poor while the probability and limit of lending because of outpatient service utilization of the poor was significantly higher than the non-poor.(2) from assessment on the relative economic risk of rural residents, in relative risk, the disease economic risk of the poor caused by total medical expenses in the last year was3.25times of the non-poor; In the catastrophic health care costs, the incidence of catastrophic health care costs of the IRFs caused by total health expenses in the last year was1.81times of the Non-IRFs. The total health expenses in the last year of the IRFs that had been exposed to catastrophic health care costs was3.37times of their economic income; And in impoverishing health care costs, the incidence of impoverishing health care costs of the poor was4.31times of the non-poor and the average poverty gap was1.87times of the non-poor, the incidence of impoverished by disease and excessive health expenses in the IRFs was3.22times and1.88times of the Non-IRFs respectively. And what found from the analysis on disease economic risk caused by different sources of health expenses, was that the outpatient treatment cost of chronic diseases and inpatient treatment cost were main sources of disease economic risk of the patients and their families. 3. This study had comparatively analyzed the effect of current rural medical security system in resisting the disease economic risk of the rural poor and non-poor. The results showed that:(1) from the perspective of absolute disease economic risk, the current rural medical security system had a negligible impact on the disease risk probability of rural residents. There were not significant differences in the compensation for self-treatment and inpatient service expenses between the poor and non-poor.(2) from the perspective of relative disease economic risk, the incidence of catastrophic health care costs of the IRFs and Non-IRFs was respectively reduced by11.67%and19.05%after the compensation of medical security system, and the incidence of impoverishing health care costs was respectively reduced by10.60%and26.22%. So the compensation of medical security system was in favor of the non-poor in general. And the new rural cooperative medical system (NCMS) appeared a same situation on its compensation effect and showed reverse compensation tendency in some degree. At the same time, the sole compensation of medical assistance system (MA) and joint compensation of MA and NCMS all had not played a due positive role in resisting disease economic risk of the rural poor.4. This study had analyzed the potential influence factors that could be intervened based on the features of site investigation data. The results showed that:There were significant differences on the overall compensation proportion for inpatient service expenses among different medical insurance systems. The compensation effect of NCMS was significantly worse. There were significant differences on the compensation proportion for inpatient service expenses among different flows of patients who had joined NCRS, the compensation proportion gradually reduce with the level of inpatient ascending. The proportion of expenses not being compensated because of some drugs not being included in the insurance list in the poor was significantly higher than the non-poor. Although the excessive inpatient expenses had not great influence on the disease economic risk of the sample, it would still strengthen the poverty intensity of rural residents especially the poor. Conclusions:1. The disease economic risk of the IRFs was obviously greater than that of the Non-IRFs before getting compensation. The outpatient expenses on chronic diseases and inpatient expenses were the main source of disease economic risk.2. The general effect of current rural medical security system in resisting disease economic risk of the poor was obviously worse than that of the non-poor what reflected obvious unfair.3. The design and operation of medical security system were direct influence factors of the ability and effect in resisting disease economic risk. At the same time, the behavior of the patients and doctors also could indirectly infuence the effect of medical security system in resisting disease economic risk.4. This study proposed improvement strategies of the rural medical security system from optimizing internal system design and improving external operating environment. The strategies in optimizing internal system design included that emphatically enhancing support ability of the main rural medical security system, well dealing with the fairness between the main rural medical security system and others and encouraging and supporting development of the rural commercial medical insurance. While the strategies in improving external operating environment included that accelerating the construction of rural basic medical service system and strengthening intervention of the patients'and doctors' behavior.Innovations:1. This study had established multiple evaluation dimensions and indicators of disease economic risk based on roundly reviewing and summarizing related preliminary evaluation researches to systematically evaluate the disease economic risk from multiple dimensions and angles.2. This study had discussed the actual effects and influencing factors of multiple security system in resisting the disease economic risk of the rural poor, so as to improve the current medical security system and promote the effective connection between them.3. By researching the behavior of both the supplier and demander, this study thought about the improvement strategies of medical security system from the effective integration between medical security system and medical service mode.Limitations:1. The recognition of IRFs and the definition of the scope of family may bring some biases in information statistics.2. The data source could be affected by memory biases and there possibly were some biases in the evaluation of the effects of medical security system in resisting disease economic risk based on the cross-sectional data.3. There were some flaws in chronic diseases survey in the questionnaire that made the statistical caliber of information about chronic diseases treatment narrowed compared with previous studies.4. The definition of excessive medical behavior could greatly undervalued the excessive medical behavior caused by doctors and patients especially doctors inducing.5. The analysis on influence factors of the effects of rural medical security system in resisting disease economic risk in this study was still extensive relatively and had not established the quantitative relationship between the various specific influence factors and the ability of medical security system in resisting disease economic risk.6. The scope of analysis on disease economic risk in this study was only limited to the part of direct economic burden and some other risk coping ways except medical security system were also not been analyzed in this study.