In Jinan City, County, The Chronically Ill Seeking Behavior And The Economic Burden Of Disease Study

With the advancement of society and the improvement of people's living standards, diseases gradually transferred the focus from contagious disease prevention and control to the treatment of chronic disease and acute injury. Chronic diseases exercise great influence on the society:In 2005,7,471,000 people nationwide died from chronic diseases. In 2006, the Ministry of Health declared malignant tumour as a major cause of death for urban and rural residents, and the death rate due to malignant tumour increased by 18.6 percent compared with 2005 for 30 urban cities and 78 rural areas.The above statistics show that chronic diseases played a more significant role in health of all the residents. To reduce the peasants'phenomenon of "illnesses cause by poverty and illnesses lead to poverty", in October 2002, the National Rural Health Conference required all districts and departments to learn and implement the spirit of Sixteenth CPC National Congress and The CPC Central Commitwe and the State Council On Further S(?)engthening the Work of Rural Health Decisions (hereinafter referred to as the Decisions. the decision clearly states: Governments at all levels should actively guide the farmers to establish new rural cooperative medical system; mainly focus on peasants' poverty problems caused by major illnesses such as contagious diseases, endemic diseases. At present, the new rural cooperative medical system in rural areas is the main form of medical insurance. The new rural cooperative medical system has been operated for nearly five years since the demonstration pilot in 2003, and has covered all the agricultural population of the rural counties, cities, districts, the number of participants reaching 833 million. Whether it can relieve the burden of the patients of chronic diseases and whether it can affect the choosing of the medical institutions for the patients with chronic diseases remains to be seen.Objective:By analyzing the situation of chronic disease patients, the cost of medical treatment and the affecting factors in three countryside of Shandong Province in 2008, the research aims to discuss the chronic disease situation and the level of medical insurance, and to further share the severe economic burden of the patients and to improve their health Service availability and strengthen the equality of the use of medical service, and to provide the basis for the policy formulation of rural cooperative medical management of chronic diseases.Methods:This study used a stratified sampling method. According to the economic development level, three countryside of Jinan City were selected for investigation and analysis, including relatively developed zhangqiu, moderately developed changing and relatively undeveloped PingYin. Twenty rural households were selected from thirty families from six random villages from three random rural towns from these three cities. Finally, the study's samples amount to 3701 to analyze the prevalence of chronic diseases, medical costs and affecting factors of three counties'residents. The analysis methods are mainly descriptive analysis, univariate analysis and multiple linear regression analysis.The main results:(1)prevalence rate; Female prevalence rate is slightly higher than male prevalence; The diseases which are prevalence increased as age increase are as follows:hypertension, coronary heart disease, lumbar disc, diabetes, cerebral thrombosis, heart disease. However, the prevalence of different diseases increased significantly in different age groups. There is a high increase of cervical spondylosis, arthritis after 40 years old. The backache and leg hurts prefer the people who are more than 50 years old. The prevalence rate of high income group is higher than low income group. Factors that affect the prevalence of chronic diseases are area, gender, age, marital status, education level, career and self-evaluation economic income. (2)Health services utilization:Hospital patients with chronic diseases in rural areas go mainly to the village health organizations (28.5%), and to county-level medical institutions(27.6%). (3)Economic burden of chronic disease patients:Only 45.3% of the patients were able to fully assume the burden of medical costs, but the hospitalization costs of less than 4000 RMB accounted for 58.6%Conclusion:(1)Different income groups use different health service organizations and the economic situation are the main factors for rural residents to choose health service organizations. (2)The new rural cooperative medical care is of little effect on economic burden of chronic patients; however, the rural cooperative medical care guides residents to choose medical institutions and the first choice goes to primary health care institutions, which reduces the economic burden of patients. (3)The fundamental way to reduce the economic burden of patients in chronic disease is to for the new rural cooperative medical increase the compensation to the chronic patients. and take charge of patients who are in chronic diseases.Suggestions:(1)Village clinic and rural hospitals are the main medical services departments for the rural residents, so there should be corresponding policies and measures to improve the two departments'medical environment, personnel quality, and the level of medical diagnosis.(2) The new rural cooperative medical care system can affect the doctor-choosing flow of rural residents, so it is necessary to strengthen and improve the effect, to ensure the common ailment to disappear with the help of basic medical department.(3) The financing level of the new rural cooperative medical care system determines the weak ability of solving rural residents poverty from disease, so this system needs o be connected with medical assistance syst m and require effective implementation of corresponding policies. (4) Issue relevant policy or system to promote the establishment of chronic management system to monitor the whole being of chronic patients nd reduce the family economic burdens caused by chronic disease.