Research On The Impact Evaluation And Improvement Of The New Rural Cooperative Medical Scheme

Chinese government established and promoted the New Rural Cooperative Medical Scheme (hereafter referred to as "NRCMS") in2003to tackle farmers’overburdened medical services caused by the rapid rise of medical costs. However, for farmers, medical services are still characterized by "one highness and one lowness":"Highness" refers to the relatively high medical costs, i.e. typically hospitals charge almost similar medical expenses for medical services from urban and rural residents, but as urban-rural income gap is getting larger, farmers undertake significantly high medical costs;"lowness" refers to the relatively low level of medical care, that is, medical service for urban workers and residents is obviously better than farmers."One highness and one lowness" naturally results in the fact that farmers actually bear heavier medical costs, leading to the frequent treatment withdrawal or illness-related poverty, thus the health equality rights of farmers cannot be effectively guaranteed. Meanwhile, the precautionary savings behavior that farmers take in order to reduce health economic risks lead to the rise of household savings rate, which reduces the basic driving force of expanding farmers’domestic demand. Therefore, whether from the perspective of economic development or health equality rights, government must strive to perfect the NRCMS, which is a health security mechanism.The political aims of the NRCMS are to solve the difficulty of expensive medical treatment problems, and improve the medical services accessibility and efficiency. The improvement of unequal status in medical services is also the goal of the NRCMS. In addition, the final goal is to improve the standard of peasants’health. During the ten years which is from the establishment, promotion to universal coverage, the experts corrected and completed the system constantly in the aspect of financial system and the compensating mechanism and so on. So, as a public product, what is the degree of influence about the NRCMS on the difficulties of getting medical services and high cost? Whether did it already improve the unequal utilization status of the farmers’medical services or not? Did the farmers really satisfied with the NRCMS? And if the government did not reach the goals, what is the reason?On account of the above deliberations, this dissertation mainly adopts the theory of policy evaluation and improvement. In accordance with the paradigm of modern economics and management science from "literature reviewâ†'policy-testing system construction â†'empirical testâ†'system redesign", through combining the survey data of Liaoning province and Dalian City, as well as the accessibility, utilization, satisfaction of medical services in three dimensions, the author examines the effects of reform of the NRCMS in detail. Then the author ultimately puts forward the thinking to make the NRCMS becoming the main means of farmers’health risk management.This dissertation comprises of eight chapters, in which the first chapter proposes problems; the second chapter constructs the framework for the comprehensive analysis of the effects of the NRCMS; the third chapter analyze the effects of reform and policy testing of the NRCMS comprehensively; the fourth, fifth and sixth chapters focus on empirical analysis of policy testing respectively; the seventh chapter concentrates on deliberations of redesigning of the NRCMS from the perspective of health risk management; and the eighth chapter serves as the summary of this dissertation.Chapter one is the Introduction. The author states the theory and the practical significance of this thesis. Also the innovation of this thesis is illustrated on the base of the analysis of research status at home and abroad. In addition, the author also states the ideas and analytical framework, introduces the main research methods, and determines the goal and the content of this thesis.Chapter two, the author establishes the comprehensive framework of the examination of the NRCMS reforming effect. This part first summarizes the policy effect evaluation and improvement theory which providing the theoretical support for integrated analysis framework. Then, it specific analyze the mechanism of the NRCMS in various dimensions, and preliminarily clarify the theory logic thinking of the comprehensive analysis framework. Finally the author clear and specify the research content of each dimension, and establishes the comprehensive framework of the examination of the reforming effects finally.Chapter three is the comparative analysis of implementation effect of NRCMS. Based on the real situations of the country, provincial, district and local conditions, the paper will comb the implementation effect of the NRCMS in the process by using cross-sectional data and time series data. The paper also analyzes the impaction of NRCMS on the accessibility and utilization of medical service and the possible problems from the perspective of country, provincial and local conditions. This section provides realistic basis for the evaluation of the policy implementation in later chapters. Chapter four analyzes the impacts of the NRCMS on the accessibility of medical services. This chapter is the first part of the evaluation of the effect on policy implementation, which tests its impacts on the accessibility of medical services on the basis of survey data of Dalian City. Due to the diversity of farmers feel the differences on health services accessibility, the author further analyzes the influencing factors the accessibility of medical services.Chapter five elaborates on the impacts of the NRCMS on the utilization and equality of medical services, which is the second part of the evaluation of the effect on policy implementation. The author first evaluates the inequality of medical service utilization by combining with survey data of Liaoning Province. Then, the author verifies whether there is a logical relationship of "the NRCMSâ†'improvement of accessibility of medical servicesâ†'promotion of medical service utilization and equality" by using the data of Dalian City.Chapter six focuses on the comprehensive analysis of satisfaction evaluation of the NRCMS, which is the third part of the evaluation of the policy implementation. This chapter will use three sub-dimensions to further analyze farmers’ evaluation of satisfaction of the NRCMS, namely, analysis of influencing factors of satisfaction evaluation, analysis of participation behaviors and willingness to join the NRCMS, and analysis of influencing factors of welfare recognition.Chapter seven is about the amelioration of NRCMS based on health risk management. This section is a continuation of the evaluation of the policy implementation. Combined with the survey data of Liaoning Province, a preliminary identification of the factors that affect farmers’ health risks could be made. The NRCMS could be decomposed with the health risk management process, and the difference between supply and demand could be found from the perspective of the system’s supply and demand. On this basis, the author puts forward the concrete thinking to make the NRCMS as an effective means for health risk management of the farmers.Chapter eight comes to the main Conclusions, suggestions and Research Prospects. The chapter summarizes the paper and comes to the conclusion, presents suggestions for ameliorating the NRCMS in light of intra-policies and extra-policies and finally points out the deficiencies and the prospects of the research.Main conclusions of this dissertation include: (1) Overall, the effective implementation of the NRCMS enhances the accessibility of medical services, and promotes the efficiency and the utilization inequality of medical service to a certain extent. The farmers are more satisfied with the NRCMS than ever before.(2) The accessibility of medical services influences by farmers’ personal characteristics significantly. The difficulty of expensive medical treatment problems differs from man to man. Overall, farmers are more concerned about the expense, rather than the difficulty of getting medical service. The farmers have deeper feelings to the difficulty of expensive medical treatment problems.(3) The difficulty of getting medical treatment problems mainly focus on the major disease treatment to the farmers. This embodies in the scarcity of hospital health resources in towns, the limited ability of hospital diagnosis and treatment in countries, and the scant medical resources in cities. While the difficulty of medical treatment problems lies in the high cost of the treatment of a serious illness, and the low actual reimbursement.(4) The unequal status in medical services exists in rural areas, and medical services are not configurated by the demand. Although the NRCMS improves the unequal status and the utilization of medical services, the income level is still the major factor in inequality utilization of medical services.(5) The medical services accessibility and efficiency influence the utilization of medical services. It verified the logical relations between the accessibility and the utilization of medical service. Therefore, the relieved feelings to the difficulty of medical treatment problems will improve the efficiency of rural medical service.(6) The actual benefit influences the evaluation of farmers’subjective satisfaction directly. And the efficiency of medical service, instead of the income, becomes a major factor. The welfare of the peasant’s identity is related to many factors such as personal information cognition, the degree of reimbursement and etc. The welfare identity of the people who has a poor health is worse. This explains the reason why the policy support for poor should get increased and further improves their welfare.(7) From the perspective of the health risk management system, the compensation range of the NRCMS needs expansion, the compensation level needs deepen, and the compensation mechanism needs to be perfect. Society needs to establish a healthy concept of risk management gradually, and the concept transformation which disease treatment to disease prevention should be emphasized. At the same time, the government should pay attention to the health risk of the poor especially.Main innovations of this dissertation include:(1) Construction of the framework of a comprehensive analysis for testing the effects of the NRCMS policy. On the basis of the reforming target and the mechanism analysis of the NRCMS, and in accordance with the logical relationship of "the NRCMSâ†'improvement of accessibility of medical servicesâ†'promotion of medical service utilization and equalityâ†'enhancement of farmers’ satisfaction", the first attempt is made to build a specific framework of a comprehensive analysis for the NRCMS policy testing in the three dimensions of accessibility of medical services. From the perspective of farmers demand, the analysis framework enriches the evaluation system of the NRCMS policy effect by using the related survey data, which is helpful to find the problems, and further improve the system of the NRCMS constantly.(2) This paper clarifies the meaning and the measurement of the medical services accessibility, extends the concept of it. The evaluation of medical services accessibility is the key content of the existing researches about the NRCMS. While the studies about the accessibility still give priority to the qualitative analysis, instead of the quantitative analysis. At the same time, the measurement of the medical services accessibility is limited in objective evaluation, while the criterion of the objective evaluation often comes with subjective tendency. Therefore, the specific measurement of accessibility still needs to deepen. This paper attempts to measure the accessibility by using the farmer’s feeling to the difficulty of medical services from the angle of the farmer’s subjective evaluation. The most direct result that caused by bad "buyer’s accessibility" is the high cost of medical services, and the bad "supplier’s accessibility" results in the difficulty of getting medical services. Since the medical service accessibility is closely related to personal feelings, therefore, this method not only reflects the profound individual characteristics, but also deepens the relative researches on accessibility. Such as both the analysis of the influencing factors on the accessibility and analysis about the relationship between accessibility and medical services utilization in this paper have a certain practical significance.(3) The author adds the health risk management into the analysis of the NRCMS, broadens the application of health risk management theory, and provides a new way for the improvement of the NRCMS. Although the NRCMS is the farmer’s main health security mechanism, the existing researches are mainly emphasis on the health economic risk instead of the disease prevention. Health risk management not only studies the response to the health risk, but also studies the recognition and evaluation of it. So it is a comprehensive review of the health risk. The author finds out the difference between supply and demand could be found from the perspective of the system’s supply and demand in the process of the health risk management, and further puts forward the concrete thinking to improve the NRCMS.The paper not only deepened the health risk management theory in the application of the NRCMS, but also provides a new way for the reformation of the NRCMS.(4) The welfare analysis of the NRCMS further enriches the satisfaction evaluation. The existing researches study the farmers’evaluation of satisfaction of the NRCMS and the participation willingness to join the NRCMS separately. This paper not only combines of these two aspects, but also further introduces the concept of welfare identity, regards the NRCMS as a part of the farmer’s welfare, and then expands the satisfaction evaluation from the perspective of welfare economics. All of this not only enriches the satisfaction evaluation system, but also analyzes of farmer’s satisfaction and the influencing factors from multiple perspectives, further provides the reference for farmer’s satisfaction.Restrained by the data-obtaining possibility, the paper is still in lack of the research on the influence of the NRCMS" on the quality of medical care services.In addition, coherent and continued data are urgently needed to dynamically follow the reform outcome of the NRCMS. The reform of the NRCMS constitutes an important part of China’s reform of medical care system and overall arrangements are demanded centering on the top-level design of the medical and health care system reform. The fusion of sound risk management and the NRCMS is a preliminary try of the paper, but the formation of concrete mechanism still requires innovation in theory and continuous tests by practices.