| Chronic disease has played an important role of general health status of us.To some extent,the level of health status depends on the success of prevention and control of chronic diseases.The prevalence of chronic became larger yearly and the economic burden became heavier to the patients.Because of the economic reason,efficient need has changed. Depend increased,but need decreased.More and more people choose self-therapy.In order to decrease the burden of the rural residents.In October of 2002, on the meeting about rural health works.The government decided to build the New Cooperative Medical Schemes.Now,the NCMS has become the main health insurance in rural area.The NCMS started in 2003.It has run for five years.But we don't know if it can release the burden of chronic patients and if it can effect the choice of health institution.Purpose:The main purpose of dividing the total diseases into systems is to analyse the economic burden of chronic.To know the effect of NCMS on burden decrease and health-seeking behavior.Supply evidence to the policy of rural chronic management.Methodology:In this study,stratified sampling is used to select samples in Shandong Province and Ningxia Hui Municipality.According to the development levels of society and economic and the geographical distribution,Zhangqiu City(high economic level),Changle County(middle economic level),and DongE County(low economic level) in Shandong provice; and Qingtongxia(high economic level),Yongning County(middle economic level),and Zhongning County(low economic level) in Ningxia Hui Municipality are selected.The corresponding townships and villages are also selected by the same method.Quantity and Quality data are collected. One-way,descriptive and binary logistic statistical methods are used in the analysis.The major results include:1) Prevalence:the prevalence of female is higher than the male.Prevalence increased according to age.But the prevalence of different disease changed obviously in different age groups. The prevalence of higher economic groups is lower than the low economic groups.The factors that about chronic disease prevalence is area,age,gender,marriage,education,occupation and the economic status in the village that access by the rural residents.2) The main health institution that patients choose is village clinic and township hospital. There is an obvious difference between Shandong and Ningxia in choosing health institution.Higher economic groups tend to choose higher health institutions.The members of NCMS choose the designated health institutions as the first choice.Gender,age,occupation NCMS member or not and the economic status in the village that access by the rural residents affect the choice of cure or not.3) Economic burden of disease: Economic burden of Endocrine system disease and Recirculating system disease are heavier than other systems.In Shandong province,the total medical cost of Endocrine system disease one year is 1627.80yuan.The Recirculating system disease is 975.75yuan.In Ningxia the figure is 1761.86yuan和1277.49yuan.The low economic groups's burden is heavier than the high economic group.The burden of non-NCMS members is heavier than the NCMS members.In Shandong the NCMS's reimbursement is 11.81%, and Ningxia is 9.05%.The cost of hospitalization is the catastrophic expenditure for families of chronic patients.The cost of hospitalization is 3708.76yuan in Shandong.The figure is 3425.74yuan in Ningxia.The cost takes 74.91%and 57.74%of the income in the two provinces.Conclusion includes:1)NCMS has changed the health institution choice of rural residents.Different disease chooses different institutions. Endocrine system disease tends to choose higher health institutions.We can make different reimbursement ratio to induct chronic patient choose the right institution.2)The choice of health institution is different between different economic groups.Economic status is the main factor on choice of health institution.3)NCMS effect the burden of disease merely.But it can lead the rural residents choose the right institution. Choosing the village clinics can decrease the disease economic burden effectively.4)The effective way of decrease the economic burden is to increase the reimbursement ration and manage the chromic patients. Policy recommendations are as follows:1)Village clinics and township hospitals are the main institution that rural resident often choose. Making policy improve the condition of the medical environment,the ability of the staff and improve the level of diagnosis.2) Reinforce the effect of NCMS that lead the patient choose the right institution.Make sure the common diseases are cured in the village clinics and township hospitals.3)NCMS should act the role of third party of insurance.Supervise the health institutions and control the cost.So it can release the economic burden of rural residents.4) The ability of decreasing the economic burden of chronic is very feebleness of NCMS.So it's important to combine between Medicaid and NCMS.It should make some policy to implement.5) In order to decrease the heavy economic burden of chronic,the government need to make some policies to found chronic management. |
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