A Study On Medical Aid For Urban Poor Of Chengdu City

Objective: To know the economic and health state of the urban poor through comparing the differences of health service demand and utilization, and attitude toward medical costs between the urban poor and the non-poor of Chengdu city; to know the status quo of medical aid for urban poor of Chengdu city by investigating the utilization and attitude toward medical aid for the urban poor; to provide scientific evidence and suggestions on the establishment of an excellent system for medical aid, to improve the health status of the urban poor.Methods: The questionnaire survey was conducted in twocommunities, with 176 households who had the lowest living security ,882 normal households. 97 households which were managed by RetireeDepartment in Chengdu Bureau of Labor and Social Security and 30households who had utilized hospital medical aid were also beinvestigated. Method of cluster sampling was used to acquire 176households who had the lowest living security, Method of stratifiedrandom cluster sampling was used to acquire other all subjects. Thissurvey investigated the demands and utilizations of health service,the attitude and utilization toward medical aid. Medical costsdata of about 5000 hospital cases (non-poor people) of 2003,randomly sampled from the medical insurance schemes database , werecompared with all 570 hospital cases who had utilized medicalaid(poor people).Results: 1.There were significant differences in household economic status between the non-poor and the poor. Living space, monthly income, education degree, employment state and occupation in poor household were worse than those in normal household, which suggests the social economic status of the urban poor is relatively low. Meanwhile, there was no significant difference of average medical costs between these two groups of people, so, medical burden produced tremendous economical pressure on the poor.2. Medical security levels in poor are lower than that in non-poor. As to the payment ways of medical costs, 51. 7% of the poor were self-paid (compare with 35.8% of the non-poor), except that there was no difference in taking socialized medicine, the percentage of purchasing social essential medical insurance and other social medical insurances in the poor was lower than that in the non-poor.3. There was no difference between the poor and the non-poor in prevalence rate of illness, however the symptoms of illness in the poor maybe more serious, for example, the off-days due to illness in the poor were longer than that in the non-poor. The survey indicated that no difference appeared in the biweekly untreatment rate and annual not-in-hospital rate between the poor and the non-poor, but the reason about it in poor residents was mainly financial difficulty. The percent of self-requesting to leave hospital because of economic difficulty in the poor was greater than that in the non-poor.4. As to the source of self-paid hospitalization costs, 47.70% of the poor needed to rely on debit or sustentation fund, and this percent was higher than that in the non-poor. Both poor residents and non-poor residents felt the medical costs afforded by themselves were relatively high in proportion, this inclination was more obvious among poor residents.5. As to the effect of medical aid, 69.9% poor households considered the aid benefited much for alleviating the financial difficulty caused by medical costs, 59.9% poor households considered that it assisted much to improve the health status.6. The urban poor and the poor utilized medical aid tended to use the community health service center. There was no the phenomena that the poor concentrated to the high grade hospital. The percentage of the poor choosing high grade hospital was obviously lower than that in the non-poor. Especially in policlinic utilization, 60.4% of the poor choosed the CHSC, only 9.4% of that went to high grade hospital. As to the reasons, the greatest attraction of community health service center to the poor were low expense and close distance, besides, the limit of fixed hospital was one of the reasons. However, the utilization of medical aid in the poor limited to the field of medical treatment service, the utilization of prevention and healthcare was lacking.Conclusion: The social and economic status in urban poor was low, but the medical expenses in urban poor was not lower than that in the non-poor, and the level of medical security in urban poor waslow, all of which led to low availability of health services; the implement of the policlinic medical aid from Urban Health Poverty Project and hospital medical aid from Chengdu Bureau of Labor and Social Security improved the health status of the poor; if the coverage area of the hospitalization medical aid is increased and it' s proportion increased properly , the financial burden of disease will decrease; if the poor take part in the social elementary medical insurance, it will be significant to lighten the burden of medical expenses.The well combination of the policlinic medical aid from Urban Health Poverty Project and hospital medical aid from Chengdu Bureau of Labor and Social Security will be the focal point of next study.