A Study On The Equity Of Medical Health Service In The Experimental Region Of New-type Rural Cooperative Medical System In JiangXi Province

Objective:Dynamically evaluate the equity of medical health service in the experimental region of new-type rural cooperative medical system's condition and dynamic changes in Jiangxi province.Deeply analyse unfair appearances,explore the reasons and provide correlated strategy to offer scientific references for improving the scheme of the new-type rural CMS.Methods:The multi-phase stratified random sampling has been adopted to select 3 sample counties, 9 townships, 27 administrative villages in Jiangxi province.Randomly select about 70 families from each village as the object of study.Do household survey for four consecutive years. Put the four surveys'results grouped by economic status for a longitudinal comparative study separately from health services'providing, health service utilization, health output and health service's financing four aspects. Use the concentration index (CI),slope index of inequity (SII) ,Kakwani index and use/need ratio to evaluate the equity.Use the comprehensive index method to evaluate comprehensively on the the equity of medical health service of new-type rural cooperative medical system's condition and dynamic changes in Jiangxi province.Results:1 There are more than half of peasants'hospitalize distances less than 1 kilometer in the four investigations. There are more than half of peasants'who are satisfied with the service attitude and quality of fixed-point medical institutions of the new-type rural CMS. Their CI are all close to 0, but the absolute values of the CI and SII all show ascendant tendency year by year.2 The proportion of persons going to hospital in two weeks, proportion of persons not going to hospital for financial difficulties, proportion of persons who are not in hospital, proportion of persons who are not in hospital for financial difficulties all show descending tendency. The proportion of persons not going to hospital in two weeks and the proportion of persons who are in hospital in a year show ascendant tendency. In addition the CI absolute values of the proportion of persons not going to hospital for financial difficulties and the persons who are not in hospital of 2008 are less than 0.3, the other indicators are all less than 0.2.But the CI and SII absolute values of the proportion of persons not going to hospital in two weeks, proportion of persons not going to hospital for financial difficulties, proportion of persons who are not in hospital, proportion of persons who are not in hospital for financial difficulties all show ascendant tendency. The Use/need ratio show ascendant tendency but the use/need ratios of the higher income groups are higher than the lowest income group both in 2007 and 2008.3 Two weeks prevalence rate, half years chronic diseases prevalence rate, two weeks working (studying) suspended rate of four surveys all show descending tendency. The CI absolute values of two weeks prevalence rate, half years chronic diseases prevalence rate are less than 0.2 and of two weeks working (studying) suspended rate and days, two weeks bed rate and days are less than 0.3. The SII absolute values of two weeks prevalence rate,two weeks working (studying) suspended rate and days all show descending tendency, but the CI and SII absolute values of half years chronic diseases prevalence rate show ascendant tendency.4 The annual self-funded outpatient clinic expenses per capita, the annual self-funded expenses per capita in hospital and the the annual self-funded total medical cost per capita both show ascendant tendency, But their percentage that they occupy the annual pure income per capita both show descending tendency. The expenditure proportion that the outpatient clinic expenses,hospital expenses and the total medical cost occupy the annual pure income per capita all have inverse correlation to economic status significantly. The four surveys'Kakwani indexes of the hospital expenses and the total medical cost show descending tendency, but all Kakwani indexes are negative.5 After the implementation of the new-type rural CMS, the overall composite index of farmers in various economic levels on health services all have risen.From the perspective of equity, the CI in four surveys all less than 0.2.The survey which the overall equity of health services is the best is in 2007, CI is -0.0019, 2008 is the worst year, CI is 0.0891. All the values of CI on the equity of health services providing in four surveys are positive.The absolute values of the CI show ascendant tendency.2007 is the best year and 2008 is the worst;In addition to the CI of the baseline survey on the equity of health service utilization is negative, the rest are positive. The absolute values of the CI show ascendant tendency.The worst is in 2008, it's CI has reached 0.1687; The CI on the equity of health output is 0.0126 in 2008 which is the lowest absolute value but is positive; The absolute values of the CI on financing equity show descending tendency, which is the best in 2008, the CI is -0.0215.The CI is also negative in 2007, the former two surveys are positive.Conclusions:1 It has been convenient for peasants to receive medical treatment since the new-type rural CMS'implementation. The satisfaction degree of health services provided by fixed-point medical institutions is high,the equity of health services providing is good but should pay attention to prevent the increase of the inequity phenomenon.2 Since the implementation of the new-type rural CMS, the peasants'equity health service utilization is good. But we should pay more attention to the problem of poor farmers'health service utilization equity.3 The peasants'health output equity is good. The implementation of the new-type rural CMS has some effect on peasants'health output equity, mainly in positive effects.4 The implementation of the new-type rural CMS reduces some medical burden and eases some financing pressures for farmers, the ststus of the financing equity improved a little, but it doesn't change the regressive state of the financing mechanism. The financing equity of the new -type rural CMS should be strengthened in future.5 Results of the composite evaluation show that since the implementation of the new-type rural CMS,the overall level of medical and health services has improved;the equity of health services is good in general.However, the ascendant tendency of inequities on health service utilization need to pay high-level attention.