| BackgroundChina is a country with a population of1.3billion,80%of the population lives in rural areas. China’s rural health service system is vulnerable because of Long-term dual economic structure and unitary health insurance system. From the revenue side, the slowly income growth of farmers and rapidly rising of health expenses departured from the situation don’t make the health of most farmers effectively protected, especially when farmers in serious disease, the medical expenses is unbearable. The New Rural Cooperative Medical System (referred to as the NRCMS) is organized、 guided and supported by China’s governmental, farmers are voluntary, multi-government co-funded to farmers with serious disease. So far, the NRCMS have been launched for nine years, achieved national coverage, the problems had been alleviated to some extent, but there are still some problems to be solved.In Guangdong, the participation rate of the NRCMS is95.21%. However, the development of the NRCMS (especially in the north of Guangdong and west wings) still lagged behind the development of socio-economic,which was out of tune. So, the development of health services in rural still need to further accelerate and study, building a new countryside health services is an inevitable requirement for social and economic development. Accelerating health services in rural is to improve the NRCMS. The satisfaction of the NRCMS is an important and an sustainable development indicator of the NRCMS. So we investigated the satisfaction of the NRCMS, and made recommendations for further improvement of the NRCMS.ObjectiveThe survey was a cross-sectional study,which investigated the NRCMS in Guangdong, such as the general condition, participation and influence factors, cognition, the satisfaction of the related policies and future prospects. Then we explored problems and deficiencies of the NRCMS in the actual situation, to provide a scientific suggestions and better implement for Ministry of Public Health.MethodsThe survey includes:office staff, medical staff and farmers (>18years old). The2628survey questionnaires were actually paid, a total of2373were effective (which1587were farmers, workers and medical staff of384copies,403copies). Among them,762people were selected from the high economic conditions (including504farmers,121staffs,137medical staffs),755from medium level (including513farmers,120staffs,122medical staffs),857from poor regions (including570farmers,143staffs,144medical staffs).This topic was a cross-sectional study, stratified convenience sampling method. According to the world bank classification standard, Guangdong will be divided into four classes:per capita GDP below75%in the provincial levels as the least developed countries, and75%～100%for underdeveloped regions, and100%150%for more developed regions, more than150%for developed regions. This study refered to this standard, and merger the more developed regions and developed regions for developed regions, Guangdong were divided into the high, medium and low3layer region, the convenience sampling method was used from every layer.438 Nursing college undergraduates were served as investigators during summer vacation, each one was served for6questionnaire (which is four a farmer questionnaire, one medical staff and the government staff.Through the extensive literature review at home and abroad, with the aim of the study and design the questionnaire, after the pre-survey questionnaire improvement and adjustments which Included the basic information, the factors on the senate of participants, the cognitive, the satisfaction.Generally it included sociological characteristics of the population, such as gender, age, marital status, education, per capita income, per capita expenditure and other diseases. The second part involved in the way of publicity, the methods of joining, capital contribution, Cognitive part included to submit an expense account model, place, the doctor reimbursement program, fund management. The NRCMS policies, including the cognitive part of the reimbursement model, the way of treatment, reimbursement procedures, fund management. Satisfaction including medical service, medical quality, level of charges, convenience of medical, reimbursement, the low line of reimbursement, the cap line of reimbursement, reimbursement procedures, the range of reimbursement disease, propaganda, financing, service, operation and management, supervision and mode, overall satisfaction. The last part was the future development of the NRCMS.After checking all the information collated and processed by SPSS13.0software.5Option of Satisfaction score is classified as3score (that is"very satisfactory, satisfactory," were identified as "satisfactory" assignment of1score,"General" are assigned2score,"not very satisfactory, very dissatisfactory "were identified as" unsatisfactory" assignment of3score). In this study, General information were processed by descriptive analysis, classification datas were compared by the R×C table data χ2test, univariate analysis was significantly difference in the NRCMS co-participation and satisfaction, and then factors were used two Logistic Regression Logistic Regression models and multi-model analysis, a=0.05.Result1. A total of2628questionnaires were issued,2461were recovered, and the recovery rate was95.4%, filling out the questionnaire without missing entries was valid, valid questionnaires2373, and the effective rate was92.0%.2. Farmers behavior of standard medical treatment were significantly different after the illness in different economic areas. The behavior of standard medical treatment was the highest rate of64.5%in high Economic areas, medium and low economic was52.5%,52.8%.The behavior of medical treatment were significantly different in different diseases. The behavior of medical treatment was of non-standard (45.7%) with the most common diseases, followed by chronic diseases, Farmers with the emergency was non-standard rate of25.6%.3. The NRCMS had carried out eight years old, Nearly ninety percent farmers participated in the NRCMS. Participation rate of farmers were significantly different in the different economic regions. Low economic level had the highest participation rate (88.9%), followed by the middle region (88.1%), high economic areas had the lowest participation rate (81.5%). Farmers had relatives with the medical staff and government staffs, whose participation rate were not significantly different, in any areas of economic level.4. The existing publicity and the recognition publicity were significantly different amonge different crowds, indicating that the current publicity were not suitable. The tripartite participants recognized publicity by television, Internet, radio and other media> cadres explaining from house to house> distributing propaganda material> propaganda meeting> other..5. The main three parties all considered the central should contribute to the NRCMS most.6. The main tripartite participants is still lacking the awareness of the NRCMS policies.31.8%farmers knew that "reimbursement model";67.3%farmers knew that "the provisions of the NRCMS treatment place";39.6%knew "reimbursement program" of the NRCMS;37.0%aware of the NRCMS "Fund Management mode".7. The main participants on the satisfaction of the NRCMS were significantly different. Farmers selected the "satisfaction" accounted for18.0%-38.0%.The medical staff selected the "satisfactory" rate were41.2%-73.4%. The government staff selected the "satisfactory" rate were39.6%-62.5%,8. The main participants evaluating prospects of the NRCMS were significantly different.73.7%,78.6%medical staff and government staff confirmed the NRCMS prospects will be well, but only47.2%farmers confirmed the NRCMS prospects will be well.9. The influencing factors of participation:Through two classification Logistic regression analysis, the influencing factors of farmers participation were generally (region, the marriage, the average per capita GDP, medical treatment after the illness), propaganda (the way of government propaganda, reimbursement model, reimbursement program, medical place, fund management), agency orgnaization (reimbursement line, service attitude, reimbursement range) and the prospect of development.10. The influencing factors of satisfaction:After Multinomial Logistic regression analysis, the influencing factors of farmers were reimbursement ratio, reimbursement line, reimbursement program, reimbursement range, service attitude and the ways of supervision. |
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