Study On Health Risk Model And Management For Rural Poor Families In Western China

Objectives:In analyzing the health risk features of impoverished rural families (IRFs) in Western China, setting up risk models and constructing a multi-party interactive social interference pattern therein, theoretical basis are furnished in this dissertation, for providing: management tools and practical paradigms; prevention, mitigation and coping strategies; and rationales for decision-making of governments at all levels for health risk management of IRFs.Methods:Data Source: All data originate from field investigation and questionnaires. Typical sampling method is employed to locate two National-level poverty counties (areas), within which sample villages are selected randomly. All the IRFs thereof (as confirmed by the documentations of local Civil Sectors) are subjected to investigation and control groups are equally and randomly drawn from Non- IRFs within the same natural villages. Accordingly Qianjiang Area of Chongqing City and Guiding County of Guizhou Province are located as sample areas, 1109 rural families are sampled within 11 villages, which consists of 559 IRFs, 550 Non- IRFs, and a grand sum of 4024 family members.Statistical Analysis methods include—Descriptive Statistics:Mean and S.D. for interval scaled data; nominal scales'frequency and descriptives; Univariate Analysis:T-test and Mann- Whitney U-test for interval scaled data; Chi-square for variable data; Multivariate Analysis:Unconditional Multiple Logistic Regression; Two Step Cluster Analysis, etc. All data are processed by SPSS for Windows 12.01. Results:Fortnight and chronic disease Morbidity-rate of IRFs outpace significantly that of Non- IRFs, whereas the doctor-seeking behavior of the former is significantly lower in proportion than that of the latter, therefore the comparatively high health demands of IRFs are under-satisfied. Medical expenditure and hospital-going transportation fares of the IRFs are significantly lower than that of the Non- IRFs. Significant difference emerges between financing structure of IRFs and Non- IRFs, IRFs significantly draw fewer savings and heavier government and collective relief funds and debts. In comparative economic risk evaluation, when the proportion of health expenditure accounts for more than 20% of the total family avenue, both IRFs and Non- IRFs are faced with excessive health economic risk(RR>1.0). Occurrence rate of catastrophic health expenditure in IRFs is significantly higher than that of Non- IRFs. Multiple Logistic Regressions have shown that the occurrence of catastrophic health expenditure is significantly correlated with factors like family structure, householder literacy, and chronic disease, etc.Through Two Step Cluster Analysis, the whole sample is divided into 2 clusters: Cluster 1 consists of 626 families and, 434 for Cluster 2. Results of the Cluster feature analysis have nominated Cluster 1 as high-stake risk group, Cluster 2 as low-stake risk group. Multiple Logistic Regressions further elaborates that protective factors for high- stake risk status include: male householder, householder literacy, householder profession as farmer or private entrepreneur, high minor-person proportion, high normal residents proportion and outflow of laborers; risk factors include: divorce or spouse bereavement, high average chronic disease burden, high average disability burden, high Fortnight Morbidity-rate and per diem/ per capita in-hospital disease burden.Health risk cognition and behavior analysis reflect that IRF householders recognize risks'causes mainly as"malnutrition, poor physiological condition", followed only by"bad luck or predestinarianism". To prevent health risk events, commonly adopted measures are"prohibiting from working under high risk environment, cultivating hygienic habits, securing sufficient nutrition and rest for family members". 88.9 percent of IRF householders regard the negative impact of scanty capital to cope with health risk as most worrisome: when health risk accounts for more than 1/5 of total family revenue, a total of 86.5% of IRF householders proclaim this as insufferable. 81.4% of householders evaluate the New Rural Cooperative Medical scheme (RCMS) as"has some effect"or even be of greater help.Investigations for 188 families that has annual hospitalization record has shown that IRFs draw $834.54 in average from savings while Non- IRFs draw $3161.30, which is significantly higher than that of IRFs. Facing health risks, 69.3% IRFs and 57.6% Non- IRFs resort to borrowing, no difference of statistical significance is detectable. As for newly-added average debt, IRFs and Non- IRFs have $ 1424.69 and $ 744.16 respectively, the difference of which enjoys highly marked statistical significance. Markedness of difference applies also to selling-off rate for curing disease, with IRFs resorting to this approach more heavily. While in receiving donations and presents, IRFs and Non- IRFs amount to $501.75 and $1084.41 respectively(Highly significant difference). As for time taken for family members to look after the patient, IRFs and Non- IRFs have 14.56 days and 13.57 days respectively in average (with Marked statistical significance). 48.3% of the IRFs quit their Children from schooling, contrasted by 22.4% of the Non- IRFs (with Marked statistical significance). To families participated in New RCMS (Rural Cooperative Medical Scheme) and Medicaid for Destitute Families, IRFs can receive an average reimbursement of $269.10, compared with $403.17 that of the Non- IRFs. Meanwhile, IRFs have fewer acquaintances of higher social status than that of the Non- IRFs, this is a refraction of their comparatively lower possession of"social capital". In 188 families investigated, IRFs spend annually $433.95 in present-giving, Non- IRFs spend $1136.50(with Marked statistical significance). The result of social network analysis has shown that IRFs'social network function falls far behind that of the Non- IRFs while coping with hospitalization.Conclusions:1. The health status of IRFs members is worse than that of the Non- IRFs, as a result the IRFs call for much greater health demands. On the contrary, the comparatively high health demands of IRFs are under-satisfied. As an aftermath the negative health events of IRFs are prone to be postponed and, in accumulation to a certain degree, i.e., when diseases were dragged to most severe status, IRFs are obliged to resort to in-hospital services that are even more unaffordable. This prevailing phenomenon has deploringly aggravated the vicious circle of disease-poverty transmutation.2. As described in three dimensions: frequency, intensity and correlation, health risk of IRFs in Western China has the following characteristics: current morbidity rate and morbidity occurrence rate of IRFs > Non- IRFs, with chronic disease taken the lion's share; significant features of the aforesaid negative health events in IRFs are: they have greater expenditure/income ratio, i.e., higher comparative intensity; as a whole, correlations among health risks are moderate and even weak, but in impoverished areas of Western China, infectious, endemic and natural epidemic diseases still pose great threats of breaking out and spreading.3. From the economic perspective, IRFs of Western China have more scanty financial resources than that of the Non- IRFs in dealing with grave negative health events, which in turn has significantly more smashing impact on IRFs than on Non- IRFs.4. The occurrence of severe health risk status in Western Rural areas of China has apparent correlation with various socio-economic, ethnographic factors, health demands and health service utilization factors, which encompass: gender of householders, literacy and education, profession, marital status, family structure, chronic disease, the handicapped and disabled, fortnight outpatient and in-hospital medical treatment utilizations, etc.5. IRF householders do harbor misconceptions with respect of the causality of health risk events, informal and formal health risk-sharing modes co-exist in IRFs.6. Handling behaviors of Health risks in IRFs of Western China could be generalized into a"Tripartite Handling Mode"in which: First Handling denotes the reshuffling of family resources and the consumption of savings after the occurrence of negative health events, this process has no substantial impact on the family's future productive activities; on the level of the Secondary Handling process, IRFs have to trade-off between giving up the patient and buffering the future impact of diseases; Tertiary Handling requires the IRFs to either migrate to obtain sustenance and work, or reset the family in disregard of the suffered.7. In light of the Framework Health Risk Management and the characteristics of Health Risk Management strategies and approaches, a poverty-relief-oriented, comprehensive Health Risk Management Model is in great need for the IRFs in Western China. This pattern calls for multiple parties or bodies: government, market, NGOs as well as families; informal and formal Health Risk Management approaches, and a combination of prevention, mitigation and coping strategies. The primary principles of this model or paradigm are poverty-reduction, sustainability, interactivity and dynamic development. Taking into full consideration of the interactions among management strategies and concrete approaches, this framework enjoys high flexibility in accommodating the shift of active parties and changing management strategies and approaches. In this framework, health, agricultural, civil, social security sectors, together with market institutions, NGOs and families will shoulder their corresponding responsibilities and maintain a harmonious coordination.