| Since 2003, the pilot project of the New Rural Cooperative Medical System (NCMS) in Jiangxi Province, had achieved remarkable results. The NCMS of standard management and operation mechanism had taken shape. The fund operated in a security place, the utilization of medical services had been significantly improved by farmers, medical burden was alleviated somewhat more and more farmers recognize the benefits of the new rural coopeertative and the participation rate increased every year. At present, the NCMS in Jiangxi was in a overall stage. However, for lack of comprehensive research and macroeconomic coordination, the NCMS had an inadequate security level and weakness in anti-risk ability of illness. Moreover, the rural health resource allocation was unreasonable, the regulatory mechanism of cooperative medical care not sound and the rising health care costs were difficult to control. All these factors would have a significate impact on the sustainable development of the NCMS in Jiangxi.Objective:From the reality of economic and social in the rural area of Jiangxi Province, series achievements of the NCMS in Jiangxi were summarized systematicly and comprehensively. Through field investigation, the policy and recommendations to ensure the NCMS that we made would provide the theoretical basis for long-term sustainable development of the NCMS and also the eference basis for the government to decision-making.Methods:In this study, the main source of information and data comes from three areas: literature review, related documents, statistical information, on-site surveys and group interviews. Qualitative analysis was used to explore the feature of the NCMS in Jiangxi Province. In the use of large amounts of data to quantitatively analyze the effects and problems that appeared in different parts of the NCMS, which provide quantitative basis for sustainable development for the NCMS.1,The arragement and analysis of the related document and statisticsThough the arragenment and analysis of the related document and statistics and from a macro point of view, a comprehensive summary of achievements and problems appeared in the NCMS of Jiangxi Province was made.2,On-site surveys and group interviewsStrong practice and problems that we encountered in the NCMS need us to have the filed survey in villages. Since 2003, the Public Health School of Nanchang University had taken continuous tracking survey of the NCMS for many years in Jiangxi Province, which provided a lot of first-hand information for the subject and comprehensively and thoroughly analyzied the respects and issues appeared in the NCMS.Results:1,The general situation of the NCMSThe participation rate of NCMS in Jiangxi Province in 2009 increased 3.87% (95.19%> 91.32%) than that in 2008, and higher than 92.15% in the central region in 2009 and 94.00% nationwide. The NCMS funds rate has increased compared with 2008 (92.38%> 82.97%); the NCMS benefit coverage was up to 41.98%.2,Needs and utilization of farmer's health serviceTwo-week prevalence survey in 2008 decreased (85.91‰<91.41‰)than that in 2007; two weeks visiting rate to the number of people as 61.88‰, with the number counted as 106.39‰; two weeks of illness no doctor was 29.81% , compared to 2007 were not statistically significant. Hospitalization rate in 2008 to count as 53.57‰, with the number counted as 66.31‰, than the increase in 2007; require hospitalization hospitalization rate is not decreased slightly (10.86% <12.62%); two weeks of bed rest rate has dropped (10.74‰<13.29‰); two weeks off work (school) rate of 20.47‰, compared to 2007 decreased significantly (χ2 = 16.78, P value = 0.00). Outpatient visits choice of location on the village health clinic, who are most in 2008 was 67.45 percent, down from over 07 (χ2 = 15.63, P value = 0.00). 2008 survey 426 farmers in 23 hospitalized patients were discharged early, compared to 5.40%, compared to 2007 decreased by 4.1 percentage points (χ2 = 4.96, P value = 0.03); early discharge the same major and 2007, are as can not pay the fees, accounting for 56.52% (in 2007 accounted for 63.89%). In 2008 did not seek treatment because of financial difficulties compared to 18.90%, significantly lower than the 2007 survey results (χ2 = 51.05, P value = 0.00); not hospitalized due to financial difficulties for the 78.72 percent ratio, a slight decrease from 2007.3,Medical expenses of farmers08 farmers per capita medical costs have risen higher than in 2007 (484.60 yuan> 397.72 yuan), the main increase in hospitalization costs per capita (234.70 yuan> 160.66 yuan), which plays above the county level hospitals were outpatient and hospitalization costs were up significantly. Cost farmers in the village health clinic two weeks accounted for a heavier weight (39.57%); county hospitals and hospital charges, the largest proportion (45.01%); the proportion of hospitals above county level increased (41.80%>27.74% ). Hospitalization frequency distribution in 1000 dollars, maximum (50.00%), 0 per segment decreased sharply from 2007 (23.59% <33.33%); hospital charges are mainly distributed in 10,000 ~ per segment (50.19%). Reimbursement of all patients hospitalized sub-hospital expenses increased (3321.27 yuan> 2775.39 yuan); views are his own expense increased slightly (2270.59 yuan> 2106.69 yuan); actual reimbursement increase (31.62%> 24.09%).4,The NCMS influence on farmers send and return poor because of sickness.The survey of poverty rate is higher than 2007 (4.49%> 2.79%). The main reason is poverty caused by the sickness, accounting for 48.81%, lower than the 2007 survey results.5,Farmers on the subjective understanding of the NCMSReimbursement to the hospital when the staff attitude rating for the better accounted for 81.28 percent more than, less than 2007's 88.22% (Z value =-2.96, P value = 0.00), quality evaluation of medical institutions account for 69.98%, lower than in 2007 for 77.16% (Z value =- 3.89, P value = 0.00), the attitude of the medical evaluation to better account for more than 77.35% lower than in 2007 for 85.55% (Z value =- 4.50, P value = 0.00), that the proportion of medical expenses up 18.12% lower than in 2007 for 37.69% (Z value of =- 13.55, P value = 0.00). In 2008 that state for each farmer participating in the NCMS funding for 24.57%, lower than the 2007 survey 36.43% (χ2 = 61.94, P value = 0.00); know how the NCMS reimbursement of hospitalization expenses accounted for 44.23% , less than 07 of 55.62% (χ2 = 48.38, P value = 0.00); that reimbursement had been around the hospital charges, 70.62 percent ratio, lower than the 2007's 83.18% (χ2 = 82.85, P value = 0.00); reimbursement for hospital costs had accounted for 29.75%, higher than 2007's 24.08% (χ2 = 14.72, P value = 0.00). 2008 survey listed the benefits of the two previous serious illness followed by certain health protection and medical expenses may be reimbursed some of the farmers on the NCMS concern, the answer "do not know" the first account, the proportion of all concerned that Sorting and 2007 survey did not change significantlyConclusion:1,The main achivements the NCMS in Jiangxi proviceGovernment responsibility in the NCMS had unceasingly strengthen and the relevant mechanism was gradually improving; the NCMS participation rate steadily increased and realized to cover every people in rural area; the NCMS illness protection for farmers significantly improved, more convenient and efficient for farmers reimbursement; the NCMS to some extent alleviate the farmers shake off poverty, to change health care behavior of farmers; the NCMS has been the support of farmers and recognitio, which promoted the rapid development of rural health services and primary care health service system had been strengthened.2,The main restraining factor in sustainable development of the NCMSThe NCMS for farmers due to illness caused by (back) the role of the poor are still limited, the level of protection to be improved; the shortage of resources of management are more serious, management capacity-building should be strengthened; medical costs rising, the supervision of medical institutions to be strengthened; farmers irrational structure of health care providers, primary health care institution-building should continue to strengthen; new demand side of agricultural co-existence of "adverse selection" problem; the NCMS policy advocacy is not in place, farmers awareness of the new rural cooperative medical system needs to be deepened.3,The relevant policy recommendations of sustainable development of the NCMSTo further improve the NCMS compensation package is principle of the NCMS for sustainable development; vigorously promote the construction of rural health services, improve the ability of primary care services is the foundation; strengthen new rural cooperative management handling institutional capacity-building improve the monitoring service capability is the key; strengthen NCMS supervision, control unreasonable medical expenses up is the core; improve the rural medical and health institutions and mechanisms of compensation mechanisms for the protection and to strengthen the work related to supporting the construction of a NCMS sustainable development are the necessary conditions. |
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