Policy Analysis Of New Rural Cooperative Medical Scheme On Tuberculosis In Henan Province

BackgroundHenan is one of the provinces with large population.TB patients in Henan occupy 10%of all the TB patients in China,and nearly 80%of them live in rural areas.As one of the earliest New Rural Cooperative Medical Scheme(NCMS) pilot provinces in 2003,the government at each level has paid much more attention to NCMS.The pilot has been implemented smoothly.Given the direct link between TB and poverty, some of the counties in Henan integrated TB into this scheme in 2005,which means that those who have got TB can get reimbursement from NCMS when they go to see the doctors in the designated TB institutions.This is an innovative way to improve TB control and provide a chance for continuation of TB control.But,systemic report and overall evaluation has not been available so far.Based on the above,this study is proposed.ObjectivesThis study will be conducted from the following three aspects,(1)to understand the detailed reimbursement model,operating and management mechanism of this policy; (2)to evaluate the satisfaction of policy-maker,supplier of TB control service and the demand side for this reimbursement policy through qualitative and quantitative methods;(3)to provide suggestions for the continuation of this policy. MethodsThe different methods are used according to the objectives and contents of this study, (1)to describing the policy through document and literature review,comparison and classification,analysis and synthesis;(2)to evaluating the satisfaction degree and provide suggestions for its continuation through qualitative and quantitative studies, field investigation and literature review.Results and Conclusions1.Policy Decision-making.(1)to integrate TB into NCMS meets with the essential requirement of NCMS;(2)the theoretic foundation are the official guideline documents on NCMS issued by CCCPC and the State Council respectively in 2002 and 2003;(3)to integrate TB into NCMS should be on the premise of the smooth development and increasing financing standard of NCMS.It is also the essential requirement for the further development of NCMS.This will be a great complement to current National TB Program.2.Policy Implementation.(1) Influence on TB service providers.â‘ This has increased the business income of local TB institutions.It has also improved the local capacity building and professional skills.â‘¡According the the comparison of Yongcheng and Taiqian,it shows that the effect of this policy has a tight relationship with the coverage of NCMS,type of local institutions and the government commitment.(2) Influence on TB service demanders.â‘ It has stimulated the demand of TB patients and increased the utilization of TB service.But there were some evidences which showed the supplier-induced demand.And this also alleviated the financial burden of TB patients.â‘¡But this effect of alleviating the financial burden was very limited due to high co-payment ratio. (3) Influence on TB Control work.â‘ To some extent,it has improved the early case detection,timely diagnosis and regular treatment.â‘¡It has also standardized local referral of TB patients from general hospitals to TB institutions.â‘¢NCMS also provided a creative way for the propaganda of TB in rural area.3.Satisfaction Investigation.The overall satisfaction degree of TB patients for this policy is relatively very high(79.6%),especially for the service attitude,professional skills and environment of TB institutions.But for reimbursement of NCMS,there is still a gap between the actual and the patients' expected.Policy Recommendations1.To further perfect this policy with a focus on the equity,continuity,stability and the service package.2.To standardize related mechanism and management,including but not limited framing the standard of admission to hospital and discharge,specifying the examination and treatment for TB inpatients,strict control of the cost of outpatients.3.To systemically summary the good experiences and implement them in good manner to provide better service for TB patients.4.To insist on multi-sectors' cooperation and mobilize all the available resources to improve NCMS and TB control program.