Study On The Sustainable Development Of The New Rural Cooperative Medical System

As a crucial part of social security system, Medical care system is beneficial forstabilizing the harmonious development. China has a large number of peasants,accounting for more than 70 percent of total population. So if there is no richness ofpeasants, China won't be prosperous. And if there is no fairly comfortable life ofpeasants, the whole population won't have fairly comfortable life. Therefore, forhealth level, rural productivity, rural economic, rural social stability anddevelopment, improved rural medical care system will be important, which will favorthe quality of the whole people, construction of the well-off society and newsocialism countryside.Circular of the General Office of the State Council on Transmitting and Issuing theProposals of the Ministry of Commerce, Agriculture and Health for Constructing theNew Rural Cooperative Medical System (NRCMS) in January 2003, calling forexperimental tests in each province, autonomous region and municipality directlyunder the Central Government since2003. As one of the first four pilot provinces inChina, the government of Zhejiang Province started the NRCMS in 27 pilot countiesin August, 2003. Up to in February, 2006, the pilot counties involved all the 87counties having agricultural population. Three years have passed while somequestions should be answer, such as how well the NRCMS runs, what are theproblems mainly lies, and whether the system could be in the right road of sustainabledevelopment1. MethodsUnder the direction of evidence-based public health (EBPH) theory, systemicreview of literature and field investigation were used in this study by qualitative and quantitative methods.1.1 Literature reviewAs for literature review, the steps were as follows: firstly, define the topic, secondly,select the strategy, thirdly, search the newest and best evidence from the studies of therural medical care system. Relevant literature source was from Weipu ChineseScience & Technology Database, China Academic Periodicals Database, relatedinternet websites publicizing the information about the NRCMS, official documentson rural health from the Zhejiang Provincial Health Bureau, and results from NRCMSinvestigations carried out in 5 experimental counties during the study of rural publichealth service system in Zhejiang province.1.2 Field surveysFive sample counties differing in economic levels and geographical environmentwere chosen, including Tongxiang, Kaihua, Shaoixing, Chunan, and Taishun. In eachcounty, five towns located in the east, south, west, north and middle was selected bycluster randomized method; then, five villages in each were chosen randomizedly. 60families randomly selected from each vallege were surveyed. During June 4th to July4th in 2006, 4451 families were face-to-face interviewed, with the contents includingthe subjective opinion of NRCMS, medical charge and reimbursement, healthresource utilization and so on.2. Results2.1 Social and Economic Status of Zhejiang PeasantsIn the year of 2005, investigated families had the average cash income of 19432.63Yuan; on the other hand, family consumption cost 15806.90 Yuan, in which medicaland health consumption cost 1807.13 Yuan, occupied 13.76％. On the ability offamily on loan, investigated families could gather 2592.60 Yuan (median: 1000 Yuan).The main purposes of family savings were education, ordinary life and housing, withthe percent of 32.91, 24.29and 23.77 respectively. Moreover, money saving for agedtime had the percent of 11.05. Among these families, 3.57％were needy families,about 41.61％resulting from disease.2.2 Situation and Relavent Factors of the NRCMS ParticipationIn the year of 2005, the percent of families joined in the NRCMS was 88.87. 29.09％of families out of NRCMS was attributed to the poverty, in which 19.11％thought the benefit was too little, 15.24％thought it was not necessary to join in because oftheir healthy body. The people that joined in various social medical insuranceaccounted for 90.74 percent, in which most of people joined in the NRCMS, withpercent of 87.41.Among the people visiting a doctor in recent two weeks, 41.16 percent were awareof their medical expenses to be reimbursed, but 23.90 percent of people were not sure.72.75 percent of investigated families voluntarily joined in NRCMS and 89.52percent supported the national policies. If the income increasing, 34.86 percent wouldincrease the offspring education expenditure, and 6.72 percent would increase medicalexpenditure. 72.07 percent of families considered the NRCMS bring better medicalservice for them, 70.29 percent regarded it as a good way for deceasing medical costs.81.60 percent told that the cadres of the country request them for joining in and 78.02percent of family members call for participation.9.67％of families considered the insurance fee to be high or very high, 13.08％(575/4407) considered the fee to be low or very low. 4.23％dissatisfied the nationalpolicies on NRCMS, 20.16％thought reimbursement procedures was cumbersome.Among the people suffering from disorders during recent two weeks and everreimbursed, 1.47％thought reimbursement procedures was cumbersome, theproportion among the people ever reimbursed hospitalization fee was 6.25％.78.53％of investigated families believed that NRCMS would persist in running.When referred to the factors mostly influencing the participation, credibilityaccounted for the largest proportion, 25％, and the health status accounted for 10.49percent.2.3 Medical Costs and Reimbursements in NRCMSIn the year of 2005, average medical costs of rural residents reached 604.29Yuan(median: 100Yuan), and average hospitalization cost was 205.98 Yuan (median: 0Yuan). Residents suffering within two weeks cost about 652.31 Yuan (median: 150Yuan) per capita; hospitalized people cost 9432.54 Yuan per capita in the latest time,and the average indirect fee was 1121.44 Yuan.The average value of investigated people who ever payed for medical charge was3395.55 Yuan. 1484 had reimbursed, with the proportion of 11.58％. Among thesepeople, 90.21％reimbursed from the NRCMS, and the average reimbursed value were 545.70 Yuan(17.23％), reimbursed value for diseases within two weeks were 70.62Yuan (3.55％), and that of hospitalization were 1991.96 Yuan(22.37％). Among thepeople who ever reimbursed medical costs, the reimbursement rate for the four levelsof 0～, 2000～, 5000～and 8000～incomes classes accounted for 14.50％,14.17％,4.32％and 20.51％respectively, in which the reimbursement rate of highest incomegroup lied at the top.2.4 Health Service Demands and Utilization by PeasantsThe proportion of families claiming the nearest medical organization was villageclinic or community health service station was 55.41 percent, compared to 39.32percent with answer of township hospital or community health service center. The twotypes accounted for 94.73 percent. Families with distance between living place andthe nearest medical organization less in one kilometer were 55.68 percent, 22.63％between one kilometer and two kilometers, and 5.83％with more than five kilometers.72.05％of families can reach the nearest medical organization in ten minutes, andonly 6.50％should take more than 30 minutes. So, 90.25 percent considered itconvenient to visit the nearest medical organization.If caught a disease, 80.97％would visit a doctor, while 17.69％would buymedicine or gather Chinese herbs. 52.60％of people claimed going to village clinic orcommunity health service station, and 35.79％going to township hospital orcommunity health service center. And the distance seemed to be the main cause whenpatients chose a medical organization, with the percent of 56.38.Among the residents suffering from disorders during the last two weeks, 86.10％(545/633) received treatments, and 72.68％would visit a doctor; 37.41％ofpatients would choose township hospital or community health service center,followed with 26.86％, who chose the outpatient clinics. The proportion for choosingappointed cooperative medical institution was 69.86％, while 6.09％did not know.People suffering from disorders during the last two weeks but not seeing a doctoraccounted for 23.97％, in which, 46.15％was attributed to the economic dilemma.The total hospitalization rate of the investigated people was 2.67％, and the averagenumber of hospitalization was 1.08 per year. The main cause for hospitalization wasdisease with the percent of 64.18, followed with labor, 16.33％. The main hospitalization places were the county hospitals, accounting for 50.14％. The averagehospitalization time was 11.83 days. The hospitalized patients had 46.11％whoreceived an operation. Compared other systems, the diseases in digestive system hadthe highest hospitalization rate (18.71％); followed with 15.79％of labor, pregnancyand relative diseases, and moreover, the normal labor has the highest rate compared toothers.Patients that should be hospitalized but actually not accounted for 2.67％, economicfactor was the most important cause, with the percent of 71.25.3. ConclusionsThis study shows that the NRCMS in Zhejiang province has a favorable developingopportunity. The situations such as good policy environments, powerful materialguarantee, good history, public basis and running basis, improved informatizationconstruction and so on are creating fine condition for developing NRCMS. On theother hand, the NRCMS in Zhejiang province also have been facing various problemsand challenges. The proportion of people benefited from the NRCMS is low in level,so is the reimbursement rate. But the medical expenditure is high, so support ability islack, which results in a vicious circle in NRCMS. The system deficiency includingcatastrophic medical insurance, high co-payments and inequity are decreasing thedegree of trust. When participating in NRCMS, the retrained medical costs wouldrelease and the health resources would be overused, which will threat the normaloperation. Moreover, low level of rural residents' knowledge on health care andconsciousness on health is a big problem to NRCMS.Therefore, the following suggestions are made to deal with the issues andchallenges: promote innovation in financing mechanism, in order to guarantee fundfor running; Give priority to efficiency with due consideration to fairness, advocatethe model of reimbursing from both serious illness and minor illness; maximize theperformance of Medical Assistance System to construct the second defense; controlmedical costs, extend the risk pool, as to enhance the anti-risk ability in NRCMS;bring in the items of prevention and health care, and develop six in one model ofcommunity health service vigorously, which finally will satisfy rural residents' basicmedical and health demands, and ensure the sustainable development of NRCMS.