Study On The Out Of Pocket Payment And Catastrophic Payment In A Region Of Eastern Xinjiang

Objective:To analysis the Out of Pocket payment, and the Family Rick and catastrophic payment and its influencing factors of 2013 in a region of Eastern Xinjiang, to explore the influence of government health policy, to provide a basis for policy formulation for the financing of health. Method:By using relevant data of 2013 Hami area health service survey data in the family living expenses, health expenditure, family income, demographic characteristics, family health care and family member health, and according to the health equity financing methods of out of pocket payment and catastrophic payment analysis and family risk method to calculate the poverty rate, poverty gap, the incidence of catastrophic payment, the average gap, the relative gap and the family disease economic risk in Hami area. Result:1. The government health expenditure accounted for 27.34%, the social health expenditure accounted for 42.17% of residents, health expenditure accounted for 30.49% in the health financing structure of Hami area in 2013.Compared with the health financing structure "three four three" ideal model, the government also should increase investment in the health field, continue to reduce the health care payment.2. Under the national poverty line standard, the poverty occurrence rate before and after the city OOP were 3.21% and 5.04%, poverty impact increased 1.83%, the poverty gap increased 17.24 yuan; the poverty incidence of the rural residents increased by 3.38%, the average poverty gap increased 25.11 yuan; under the Hami poverty line standard, before and after the OOP the occurrence of the poverty rate increased by 2.58%, the average poverty gap rose from 50.34 yuan to 78.67 yuan; the poverty rate after OOP in rural area was 9.47%, increased 2 percentage than before, the poverty gap rose 24.99 yuan.3. The poorest 20% people’s effect of out of pocket was most remarkable, the poverty rates of the city poorest 20% residents under standard 1 and standard 2 were 3.77% and 4.61%, the incidence rates of rural residents respectively were 12.88% and 5.69%.4. In 15%, 25% and 40% thresholds, the city family catastrophic incidence rates were 29.42%, 16.16% and 7.11%, the average gaps were 5.11%, 2.93% and 1.23 %, the relative gaps were 17.37 %, 18.13 % and 17.29 %; the rural resident’s catastrophic payment result was same to the city that the catastrophic incidence and gap decreases as the defining standards improve, but its impact on households was higher than that of city area. The catastrophic results in different levels of economic development of rural were similar to the results of OOP, but the results in city area of the secondary rich 20% people change. Catastrophic payment concentration index results also indicated that both in the city and in the countryside, the occurrence of catastrophic payment was more inclined to poor families.5. The low FR in the city and rural households accounted for 94.61% and 84.41%, the proportion of rural extreme FR is higher than the city around 5 percentage point. Along with the economic level improved, more families at the low risk, extreme risk families reduce, extreme FR poorest 20% population of city and rural the rates were 4.43% and 25.54%.6. The influence factors of Cat analysis found the family number of participating in medical insurance and household culture degree are negative correlation with Cat, they were the protective factors. Hospitalization and the number of chronic patients a were the main factors that influence the occurrence of catastrophic payment both in the urban and rural families, then the rural was the economic income, the city area was the number of elderly. Conclusion:1. The financing structure have improved in Hami area health relatively to the Autonomous Regions, the proportion of OOP is relatively reasonable, health financing structure tends to be the ideal model.2. The poverty occurrence rate gap in Hami area after OOP is still relatively large.3. After the new medical reform, the Cat occurrence rate and gap in Hami is still relatively high, the family number of chronic patient, the number of in patients,the number of the olders and family income are the important factors of catastrophic payment which the number of in patients and chronic patients are the most important factors.