A Comparative Study Of Medical Care Utilization Of Peasants Participating In The New Rural Cooperative Medical System In Some Poverty Counties In Hunan

ObjectivesThis studyanalyzesthe change of medical services utilization of peasants participating in the new rural cooperative medical system and fairness and the influence factors of medical services utilization of in in some poverty counties ofHunan Province before and after implementing "full reimbursement" reform. Through this we evaluatethe effects of this reformon improving the accessibility of medical service utilization, reducingthe burden and improvingthe health status of the peasants, find the problems existing in the reform, with the aim of providing decision-making basis for further promoting compensation system reformand improving the level of reimbursement ofnew rural cooperative medical system.MethodsConduct literature research to understand the development of compensation reform of health insurance system in China and foreign countries, then design a questionnaire about health status and medical services utilization, and conduct the baseline and final stage assessment survey in July2012and December2013respectively, collect the basic information of peasants such as social demographic characteristics, health status, medical service utilization, satisfaction degree to new rural medical cooperative system and so on. On the base of statistical description, use concentration index to analyze the fairness of medical service utilization and use logistic regression to analyze the factors influencing medical service utilization respectively.Results1. According to the health status of sample peasants, the age standardized two-week prevalence rate in2012was14.3%and30.4%peasants considered the ill was serious, while20.4%and18.3%respectively in2013. In2013, aging population prevalence rate was36.0%, children prevalence rate was39.2%and women prevalence rate was11.9%.2. According to the outpatient services utilization of sample peasants, the age standardized two-week consultation rate in2012was11.3%, the rate of visiting a doctor within two-week for patients was80.7%, the rate of visiting a doctor within two-week for elderly patients was81.8%, while16.8%,82.4%and75.9%respectively in2013. Among the patients who didn’t seek outpatient service, those due to economic difficulties accounted for22.2%in2012, while10.0%in2013.3. According to the inpatient services utilization of sample peasants, the age standardized hospitalization rate for total population in2012was13.3%, the rate for elderly population was26.7%, the rate for children was14.9%, while12.1%,25.4%and18.5%respectively in2013. The hospitalized patients treated at the county level medical institutions accounted for53.4%, those treated at township health centers accounted for35.1%, while64.1%and16.5%respectively in2013. Among the patients who should have sought inpatient service, those due to economic difficulties accounted for37.5%in2013.4. The concentration indexes of two-week prevalence rate, two-week consultation rate for patients, two-week non consultation rate for patients and hospitalization rate were respectively-0.0462,-0.0575,0.0560and-0.0167in2012, while-0.0295,-0.0147,-0.1039and-0.0806respectively in2013. The concentration indexes of the proportion of medical expense accounts for consumption expenditure and the distribution of catastrophic health expenditure were-0.0772and-0.1862respectively, while-0.0955and-0.1981respectively in2013.5. The overall satisfactory degree of sample peasants on the new rural medical cooperative system and the payment mode reform was81.6%in2012, while80.8%in2013.6. According to the impact factor analysis result of two-week consultation rate for patients, awareness degree of the policy is a statistically significant independent variable and its partial regression coefficient is0.253(P<0.05). According to the impact factor analysis result of hospitalization rate, age, education level, awareness degree of the policy and the evaluation of the out-of-pocket portion are the statistically significant independent variables, and the partial regression coefficients are0.018,-0.250,0.117, and0.165respectively (P<0.05).Conclusions1. From2012to2013, two-week prevalence rate of participantswas increased.2.The influence of economic difficulties to outpatient service was weakened.3. The rateof hospitalization service utilization was steady, while the distribution of clinical visit has changed significantly. 4. The fairness of health service utilization has been improved, however, the fairness of health financing was needed to improve.5. To peasants, the factors influenced satisfactory was not the new rural cooperative medical system itself.6. The health service utilization was associated with policies in quantity.Suggestions1. Set a reasonable self payment amount to further remove economic barriers.2. Set determination method for the self payment amount and improve the fairness of health financing.3. Secure the health service utilization for the disadvantaged.4. Further improve the serviceability of the rural primary medical institutions.5. Emphasize the compensation mode that implementing full reimbursement in the range of policy within the County.