| Objective According to Ningxia "innovative payment system, improve the healthbenefits of implementing reform" project, understand the project after the implementation ofpilot counties and change in control system, the factors affecting the county farmers and thepatient to health services, medical expenses, in order to evaluate the effect of the projectimplementation, for my area rural sustainable development and promote the farmers seekingbehavior change, improve the health of farmers to provide data to support, to providereference basis for the policy goal of medical and health system reform.Methods Thebaseline survey by using the method of two stage stratified random sampling, the pilot county(Yanchi County, Haiyuan county) and control (Tongxin County, Xiji County, Pengyangcounty) survey of rural residents, in2012and2011, investigation. Single factor analysis ofvariation tendency of the pilot county and county hospital outpatient control three years,health service needs and utilization index, patient, medical expenses, using multivariateLogistic regression model analysis and control pilot county county farmers clinic and healthservice utilization were main influence factors.Results2009against the county surveypopulation as the standard population standardized, there were significant differences betweenthe standardized prevalence of two weeks of a three-year pilot counties and the controlcounties, the pilot counties higher than the control counties, pilot counties by the baselinesurvey21.0%to17.3%; difference between a three-year pilot counties and the control countiesstandardized prevalence of chronic diseases is also a significant pilot counties is higher thanthat of the control counties; self-inductance mild disease and economic hardship is a two-week prevalence of untreatedthe main reason, compared with the2009baseline survey,pilot counties and the control counties in the follow-up survey, the proportion of untreated dueto economic difficulties have declined. The difference was between a three-year pilot countieswith the control counties the standardized two weeks attendance rate was statisticallysignificant and higher than that of the control pilot counties County, the the pilot countiesbaseline survey two weeks of treatment compared with follow-up investigation. Year, gender,ethnicity, age, marital status, educational level, presence or absence of chronic disease arefactors that affect the pilot counties and the control counties of rural residents outpatienthealth services utilization. Outpatient treatment patient flow changes, baseline survey,two-week prevalence treatment agencies to county hospitals and township hospitals basedtracking survey, two-week prevalence treatment agencies in village clinics and townshiphospitalsbased; The difference between a three-year pilot counties and the control countiesstandardized hospitalization rates were statistically significant, the pilot counties comparedwith the control county pilot counties in2012standardized hospitalization rate is higher thanthe baseline survey. The reasons should be hospitalized and remained hospitalized mainly toeconomic difficulties, relative to baseline survey, due to financial difficulties but not decreasethe proportion of hospital; years, gender, nationality, age, marital status, education, there is noslow disease is the effect of rural residents three years of hospitalization health serviceutilization. Baseline survey of county hospital is the main mechanism of residents surveyedhospital choice, in the follow-up survey in2011and2012, go to the hospital at or above thecounty level and above the county level hospital ratio has increased, and the rate ofhospitalization in township hospitals and other medical institutions by the fall, inpatient floware unreasonable. Compared with2009,2010and2011, the township and county hospitaloutpatient second all expenses increased, while the proportion of compensation of townshiphealth centers increased significantly decreased slightly, the proportion of compensation ofCounty Hospital; medical institutions at all levels of hospital second all expenses are rising trend, the proportion of compensation, the county hospital and County township healthhospital has increased, especially the rural township hospital, county hospital and hospitalcompensation ratio decreased.Conclusion Since the "innovative payment system, improvethe health benefits of implementing reform" project, the demand and utilization of healthservices of rural residents in the pilot county changed, outpatient and inpatient reimbursementproportion increased, to rural residents to feel the benefits, making them more trust in NCMS,which actively choose to participate in the new rural cooperative medical system, new ruralcooperative medical care rate rises year by year. The publicity of government healthknowledge, increase the farmers’ awareness of health and disease, so that the farmers healthconditions have improved, the out-patient service of rural residents in pilot counties needcontent was higher than the control counties, due to economic difficulties of untreated ratioalso declined, the NCMS reimbursement ratio increased in a certain extent reduce theemergence of rural residents because of a medical and economic burden. The farmer burdenremains high, although the medical expenses of the township and county hospitalcompensation ratio increased, but the per capita average costs are still rising; Proposals tostrengthen the county, township, village medical institutions and service system of three levelsnetwork construction, and strengthen the supervision on medical institutions, theestablishment of strict service process and result of monitoring system, improve the serviceability and level of the medical staff, to guide residents to increase the use of rural two healthservice, reduce the medical cost. |
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