| The new rural cooperative medical scheme is the medical mutual redress scheme for rural people, which is organized, guided and supported by the government, participated voluntarily by rural residents, funded by multiple parties including the individual, the collective and the government, focused on compensating catastrophic diseases. Based on our basic national conditions, the establishment of NCMS is a major measure to deal with the problem of peasants'difficulties in receiving medical services. It plays an important role in promoting the peasants'health level, relieving poverty caused by diseases, planning the overall development of urban and rural areas and fulfilling the mission of constructing a well off society. As one of the 25 new pilot counties in 2006, Zunhua started NCMS in 2005. However,in order to find out whether NCMS can radically relieve the peasants'difficulties in receiving medical services, further assessment of its implementation effects is needed. As a key part in evaluating the effects, the benefit attribution analysis is not only a useful tool but also a focus of people's attention.Objective: This research takes the benefit equity under NCMS among the different income groups in Zunhua as the core and tries to find out the causes and the influencing factors for inequity by using equity method. The research will provide policy basis for improving the benefit equity from NCMS and promoting the fulfilment of the NCMS goals. At the same time it can also provide reference for the sustainable and effective development of NCMS in Zunhua.Methods: (1) descriptive analytical methods: mainly to get informed with the cost compensation status and the benefit rate under NCMS. (2) comparative analytical methods: to know the benefit situation of different income groups under NCMS. (3) single factor analysis: including t test and variance analysis, to analyse the influencing factors in the participants'benefit. (4) multi-factor regression analysis: to find out the major influencing factors.Results: In 2007, the clinic and hospital cost compensation under NCMS in Zunhua were respectively $10 and $798.9 per time. The clinic service has wider benefit coverage than hospital service. Compensation of middle and low income groups takes up only 15.2% of the total compensation proportion, while the richest group take up 39.4% of the total compensation proportion. The concentration index for clinic subsidy and hospital subsidy are respectively 0.4032 and 0.4654. From the view of absolute equity, the benefit distribution from NCMS is unfavourable for the poor and the rich have taken up too much of the NCMS funds. Patients'general benefit conditions coincide with the compensation rate in different medical institutions: the compensation rate in non-regional institutions is lower than that in regional ones, and the compensation rate in township health centres is higher than that in county medical institutions. Despite of the low benefit rate, some still prefer the high level medical institutions.The total hospitalization expenditures, sex, marital status, income, awareness and the convenient degree of the compensation are all the important influencing factors. Among them, the major factors are sex, marital status and the awareness about whether the costs can be compensated. When it comes to controllable factors, the awareness of whether the cost can be compensated is the most important influencing factor.Discussion: (1) the benefit coverage is small: in 2007, only 42.4% of the participants have received compensation from NCMS in Zunhua. (2) the compensation rate is low: only 7.9% of the clinical costs and 14.36% of the hospital costs were compensated. (3) the NCMS funds were mainly used by the rich: according to the survey in Zunhua, the richest 20% participants have taken up 39.4% of the total hospital cost compensation, while the poorest 20% take up only 5.2%. (4) the participants have a high rate of health service utilization: both the two-week clinic rate and the hospitalization rate are higher for NCMS participants indicating that, to some extent, NCMS is helpful in promoting the health service utilization. (5) procedures in getting the compensation is proportional to benefit. (6) the benefit degree of the old is higher than that of others , indicating that on one hand NCMS is successful in protecting the old, on the other hand, the influence of aging on NCMS should be well acknowledged. (7) the compensation rate of medical service in other areas is low: although it is favourable in expense control , it can hardly satisfy people's anticipation to cure serious diseases.Suggestions: (1) ensure that the participants can truly benefit from NCMS by enlarging the benefit coverage and increasing the compensation rate. (2) increase the compensation rate for the poor. (3) perfect the procedures in getting the compensation, simplify the compensation methods in order to enhance the benefit equity for NCMS participants. (4) based on the aging process in Zunhua, regulate the balance rate as soon as possible to ensure the smooth and sustainable operation of NCMS. |
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