Study On The Effect Of The New Rural Cooperative Medical Scheme Adjustment On The Health Performance Of Rural Elderly

Objective To investigate the impact of the New Rural Cooperative Medical Scheme(NCMS)adjustment on the health status of the elderly in the pilot counties,adopting the data of the “Innovative Payment System and Improving Health Benefits” project to analyze subjective health and objective health of the elderly,and also evaluate the health net effect of the policy adjustment from the overall and different income levels,so as analyzing the impact and its magnitude of the policy adjustment on the health performance of the elderly,and providing the useful policy evidence for promoting the sustained development by medical security policies of the overall plans on urban and rural in Ningxia.Methods Using the panel data of four counties in 2009,2011,2012 and 2015 years,the elderly in the sample counties(residential 6 months and above)aged 60 and older were studied.Based on the matching of propensity scores,the Difference-in-Difference model(DID)was used to analyze the net effect of the NCMS on the health status of rural elderly.The multi-stage DID-Logit model has been applied into the study to further analyzeits dynamic changes of its multiple stages and the progressive effects on the health of different incomes in the implementation process,and the health performance of the NCMS adjustment for the elderly analyzed by calculating the marginal effect.Results (1)During the four survey years,the two-week prevalence rate of the elderly in the intervention group and the control group decreased.The prevalence of the elderlyamong the intervention group in 2009,2011,2012 and 2015 were 41.7%,27.6%,29.3% and26.0%,the control group were 31.4%,30.7%,25.5%,and 22.0%,respectively.By 2015,the two-week prevalence rate of the intervention group and the control group were reduced by15.7% and 9.4% than before.The prevalence of chronic diseases decreased in both groups after the intervention,and began to rise in 2012.the intervention group and the control group increased by 9.2% and 12.8% in 2015.respectively,compared with the baseline survey.In terms of self-evaluation health,the self-evaluation health rate of the county was unstable,and the intervention group showed a steady upward trend.(2)The DID results showed that the implementation of the policy reduced the prevalence of the two-week elderly in the project counties by 11.1%,5.5% and 5.7% respectively,in 2011,2012 and 2015.That is to say,the implementation of the policy has a sustained reduction in the two-week prevalence rate of the elderly in the intervention group,and the policy effect is effective;In terms of the prevalence of chronic diseases,the chronic disease prevalence of the elderly in the intervention group decreased after one year and three years of policy intervention,but the effect was not significant.After six years of intervention,the prevalence of chronic diseases increased.However,it is still not significant,indicating that the adjustment of policies has no significant effect on the prevalence of chronic diseases in the intervention group.In addition,the NCMS adjustment effect on the self-rated health of the elderly in the intervention group was not obvious at the initial stage of the policy implementation.After three years and six years of implementation,the elderly in the intervention group increased by 8.8% and 9.2%respectively compared with the control group,in terms of self-rated health,the policy effect has a certain lag.(3)For the elderly in different income groups,the adjustment of the NCMS improved the health of the elderly in middle-low income group,the middle-income group and the high-income group,and had no significant effect on the low-income group and the middle-high income group.The effect of the adjustment of the NCMS on the healthimprovement of the middle and low-income group is mainly reflected in the subjective health.As a result,the self-rated health of the group increased by 15.3%,25.0% and 14.9%respectively one year,three years and six years after the implementation of the policy.The adjustment of the NCMS to the health of the middle-income group is mainly reflected in the objective health effects,which reduced the two-week prevalence rate of the group by 18.0%,17.6% and 12.4% respectively one year,three years and six years after the implementation of the policy.For the high-income group of seniors,the two-week prevalence rate was reduced by 14.0% after the adjustment of the NCMS,and then no longer significant.However,as a result of the implementation of the policy,the rate of self-rated good health of the elderly in this group increased by 16.8% and 14.5% respectively three years and six years after the implementation of the project.Conclusion (1)After the adjustment of the NCMS,the two-week prevalence of the elderly in the intervention county decreased,and the policy effect was rapid and sustained.(2)The adjustment of the NCMS has no significant effect on reducing the prevalence of chronic diseases among the elderly in intervention counties.(3)The adjustment of the NCMS improved the self-rated health of the elderly in the intervention county,but the improvement effect gradually appeared after three years of intervention,reflecting the lagging effect of the policy adjustment on subjective health.(4)For the elderly with different income levels,the health performance of the NCMS is mainly reflected in the middle-low income,middle income and high income groups,and is not reflected in the low-income group and the middle-income group.