Study On The Policy Of Continuable Development Of New Rural Cooperative Medical System In Xishan District Of Kunming

ObjectivesTo study the current situation of policy of new rural cooperative medical system (NRCMS) in Xishan county of Kunming. To understand the executive of new rural cooperative medical policy in Xishan district. To gain the real idea of NRCMS among rural residents, party and government cadres, and co-management office staff, medical and health personnel. To analyze recent three years'implemented status in order to guide NRCMS practice.MethodsField epidemiology was used in this research. From 2007 to 2009, the NRCMS data was collected from annual report forms and questionnaires that included the documents of implementary planning, the proportion of participants of NRCMS among the population and financing funds. Stratified sampling and cluster sampling method were used and according to the economic situation to select Tuanjie town, Haikou town and Biji town, a total 10 villages of 526 rural residents. Meanwhile, medical staff and participants of NRCMS who selected through stratified cluster sampling and simple random sampling, were interviewed for their comments and attitude toward NRCMS by using a questionnaire. Some important persons, such as the main governor who was in charge of NRCMS, director of district health bureau, director of NRCMS administrated office, personnel of township health centers, etc. were interviewed. The data of basic status, health service, health index, NRCMS status, service ability, traffic, communications, outpatient recipe, etc. in the medical organization of town and village were collected. All data were analyzed by using SPSS statistical software package.Results1. NRCMS and operating mechanism were established in Xishan Disctrict of Kunming. Based on the efforts of local government and the participant of residents, a great achievement of NRCMS was gained. This system was consisted by the leadership of government, administration of health bureau, operation of relevant department, service of health care organization and participation of rural residents. As the development of NRCMS, there were great promotion could be found among the NRCMS supervisal system, medical service, supply of medicine and health care technique.2. Reduced fund finance support of NRCMS and the increase of compensation. The analysis of the situation of finance support and compensation showed that with the increased awareness of health among rural residents, the benefit rate of compensation fund increased every year. Out-patient benefit rate and hospital benefit rate of compensation in the first half year of 2009 separately increased 5.5% and 0.37%, compared with that of 2008. Many people participated in urban basic medical insurance thus finance support of NRCMS reduced, because of urban development,land using increased expanding of urban resident changed with rural resident.3. Appraisal of different people to NRCMS The NRCMS basic knowledge among the staff of different levels of party and government were not good. The knowledge among staff of NRCMS administrative department was significant higher than the leaders, saying 100% compared with 23.4%. The health awareness among farmers before and after took part in NRCMS was different. Before they registered with NRCMS they would not go to hospital until the symptom turned to serious; after they registered they would like to see doctor when they felt uncomfortable. However, the sinking health care practice was not dramatic change among pregnants before and after registered NRCMS. Participation of farmers at all levels of the new medical institutions change was significant (P<0.003). Overall, the district levels had improved, and township and village level changes were not evident. Staff at all levels of the NRCMS had low awareness of the compensation package. The majority of party and government cadres (= 80.0%) considered that it was necessary to establish public supervise system to accept and handle the complaint of participation rural resident. About the problem of funds collapse, many leaders of party worried about it, the reason was attendance rate was too high and compensation paid line is too low. It was suggestion that strengthen the propaganda about knowledge and compensation package of NRCMS and enhancing the awareness rate of knowledge and compensation package about it to different levels of party and government4. Fairness appraisal of different people to NRCMS Above 5.0% of Party and government cadres considered that the poor one help the rich one. About 12.0% of Party and government cadres thought the current phenomenon was fair.60.0% of Party and government cadres,66.7% of 3 township medical staff of medical institutions, 70.5% of three township participation farmers suggest that all the people should hand in the same money whatever their economical situation.5. Support rate appraisal of different people to NRCMS. Party and government cadres at all levels, three district-level medical person of medical institutions,3 township medical staff of medical institutions and three township participation farmers supported NRCMS. The support rates were at the rang of 93.3% to 97.3%,90.5%to 100.0%,59.7%to 100.0%,90.6to 94.8% respectively. Party and government cadres at all levels, three district-level medical person of medical institutions, supported that AIDS should include NRCMS. Support rates were at the rang of 79.3% to 100.0%,76.2%～95.0%. Support rate of BiJi township medical staff of medical institutions was 80% higher than other two townships.75% of persons considered NRCMS could ease rural residents the situation of "impoverished by hospitalization, and the illness into poverty once again" in some degree.ConclusionsThe NRCMS of Xishan District runs well. The policy of compensation was available. The collect funds method was acceptable. NRCMS participation rate was high than the average rate of Yunnan. The farmers'attitude towards NRCMS was positive. But XiShan funds rate was not high, a large number of fund precipitation phenomena, out-patient and hospital benefit were too low. Patients and compensation funds primarily flowed to the county level medical institutions and control expenses conservative below the average level of the province. The actual compensation was lower than the standards of compensation. It is necessary to relief work in village clinics in order to appropriately adjust compensation package and increase the benefit of farmers. In addition, all levels of party and government cadres, especially the grass-roots party and government cadres and medical personnel on the new IICA also relatively lack of knowledge. But staff at all levels thought that the situation of "did not go to hospital until serious symptoms" was improved, which also showed that NRCMS played a positive role health awareness among rural residents. We suggested that the complain box and hotline should be established as soon as possible to receive and handle complaints from farmers. Medical institutions at all levels in the construction of NRCMS ought to be promoted. Medical institutions at all levels in the new compensation program IICA awareness is not high, should strengthen propaganda work. In fairness, cadres at all levels and local people have different perspectives and ideas, suggested that the government should have a better communication with population, in order to increase the fairness. All of defference levels' people hold a supportive attitude towards NRCMS. The knowledge of AIDS awareness was low among basic departments and low education people, therefore, the AIDS knowledge should be propagandized among above groups.In 2009, due to farmers turned to non-farmer, the number of participation has reduced while funds was decreased. Based on the results of regression analysis, we suggested that in 2010, local financial assistance ought to add 20 yuan to increase the local financial assistance to reach 90 yuan per person per year, so that The new rural cooperative fund-raising reach 150 yuan per person per year.In summary, Xishan's NRCMS should insure the finance for main serious diseases and consider the unserious diseases. According to the actual situation of Xishan propagandize the knowledge of NRCMS among the villagers and staff of government, it ought to improve its cover rate. The appropriate adjustments of compensative policy of NRCMS are needed. The finance support from local government should be increased to make more benefit for residents. The training of basic health care technique should be hold to improve the service quality. The development of NRCMS need to mobilize different kinds of persons to take part in.