The Impact Of The Insurance Payment Reform To Needs And Utilization Of Health Services Among Rural Residents

Objective: By making comprehensive analysis and comparative study on the rural resident's health services needs and utilization, hospitalization expense both before and after regulating the New Rural Cooperative System in Yanchi and Haiyuan County, Ningxia Hui Autonomous Region,Analysis of rural residents health services demand utilization, situation, tendency and influence factors of hospitalization expenses. Put forward targeted policy recommendations, The results would provide some scientific evidences and suggestions to perfect the medical health service system and improve the rural residents' health condition.Methods:Implementing rural household survey to farmers in Yanchi and Haiyuan County of Ningxia Hui Autonomous Region through Two-stage stratified random sampling method in 2009 as a baseline data and follow-up survey conducted in 2011, 2012 and2015.Using multivariate Logistic regression model analysis to describe health service needs and utilization among participants were main influence factors. multiple linear regression analysis the factors affecting inpatient expenses.Results:In the investigation of four years,in Yanchi county, the two-week prevalence rates were16.2%,8.9%,18.1%,17.3%;the chronic illness prevalence rates were14.4%,9.6%,17.0%,23.4%; in Haiyuan county, the two-week prevalence rates were 17.1%,16.4%, 11.8%,10.4%; the chronic illness prevalence rates were13.3%,9.7%,12.3%,16.2%.Prevalence of chronic diseases have a rising trend. In Yanchi county, Two-week consultation rates were9.1%,6.6%,9.8%,10.1%;the hospitalization rates were10.30%,9.54%,11.07%,15.43%. In Haiyuan county,Two-week consultation rateswere10.7%,10.2%,7.1%,6.3%;the hospitalization rates were8.48%,8.76%,9.39%,14.33%. The reasons of economic reasons and self-medication is residents did not see a doctor; Residents of hospitalization rate is rising,residents have not in the hospital because of economic difficulties.During the investigating many patients changed their visit medical institution from the from township hospitals to village clinics of the two-week prevalence, in 2009, the two-week prevalence mainly in choose the county hospital and the township hospitals,In follow-up survey,Clinic accounted for the proportion of rise,Patients firstly choose the county hospital as their hospitalization.Multivariate Logistic regression mode fitting result shows that main factors related to the prevalence of the rural residents in last two weeks and the chronic illness prevalence of the rural residents were gender, age, ethnicity, marital status,education level, economic level; main factors influencing participant received hospitalized treatment were whether or not suffering chronic disease and whether or not suffering two weeks sick; multiple linear regression analysis the factors affecting inpatient expenses were gender, age, ethnicity, marital status,education level, chronic disease, two weeks sick.Conclusion:The enforcing new scheme has to Improve the rural residents health services needs and demand, Chronic diseases become the main threat to the residents' health; and The enforcing new scheme has to Improve the rural residents health service utilization, Improve the allocation of health resources;Economic hardship is the main factor that hampered patients could not see a doctor,especially of hospitalization; rural residents health services needs to be influenced by gender, age, ethnic, education level and marital status, health education should be carried out for these people, raise awareness of the health care of rural residents, improve the health of rural residents.