Patient Triage Mechanism Of The New Type Of Rural Cooperative Medical Care System

The new type of rural cooperative medical care system (hereinafter referred to as NCMS) is farmers medical help each other in all aid system with the focus on comprehensive arrangement for serious disease. It is organized, guided, supported by government and receives multilateral financing from individuals, collective, and government. The fundamental aim for our country to carry this policy out is to relief farmers' medical burden; solve the farmers' problem of "become poor because of illness, return to poverty due to illness". The realization of such aim can't be done without a series of specific goals. This paper studies one of the specific goals which is transition of patients shunt logic. The NCMS aims to make the patients shunt logic switch from economic-ability-dependent mode to severity-of-illness-dependent mode and finally achieve reasonable shunt.According to the relevant statistical data, this paper found:the rural patients shunt logic in reality hasn't switched to severity-of-illness-dependent mode since the implementation of the NCMS. Based on related theory analysis and former studies, this paper established a model diagram for mechanism of farmer patients shunt in NCMS. This model diagram is complex of rural health service system with three main parts:NCMS, medical institutions, farmers participated in NCMS. The interior characters of the three parts and their interaction contribute to the present rural patients shunt logic.This research takes Zhongfang County of Hunan province as an example to empirically study the mechanism of patient shunt under NCMS on the ground of theoretical analysis, and discusses in three dimensions:NCMS, medical institutions, farmers participated in NCMS. Findings:(1) Since the application of NCMS, the farmer patients' shunt logic basically switched from economic-ability-dependent to severity-of-illness-dependent in terms of ideology and cognition. But due to weak implementation and lax oversight of the NCMS, medical institutions could escape the system and engage in acts of non-standard treatment, resulting in farmers do not gain real benefits, with view to concrete action, this kind of switch is not obvious. Not only the number of people who see doctor in basic-level medical institution did not increase, but there is a trend of decrease. Economic ability still is an important factor that restricts farmers' choice of medical institution. (2)In our country, the rural medical service system isn't consummate, and medical institutions of all levers don't perform their duties, which restrict the reasonable shunt of the patients. (3) The patients shunt is related to the diagnosis and treatment of the medical institutions. Diagnosis and treatments for profit make patients more on economic ability, while diagnosis and treatments for public interest lead patients to count more on the severity of illness. In the market economy, the diagnosis and treatments of the medical institutions have significant demands for profits, which also restrict the reasonable shunt of the patients. (4) Age or education has no significant effect on the patient shunt. As to social economic level, it has little effect on the patient shunt of the patients with minor illness moderate illness. But economic ability becomes the major factor when encounter some severe illness.The reasonable shunt of the patients is beneficial for making full use of the medical resources in medical institution at all levels, and it can also help patients get effective and economical treatment. NCMS should be modified in terms of its policies. It also should work together with medical institutions and farmers to give play to their common guidance to patient shunt so that the logic of patient shunt change to severity-of-illness-dependant for real and finally solve the difficult problem of rural residents in seeing a doctor.