| Objectives To describe the farmers'medical service-seeking behavior and population distribution in the district of Ouhai; to explore their satisfaction about the service of designated hospital and reimbursement policy of the new rural cooperative medical care system(NCMS), and find out the possible reasons among farmers who had participated the NCMS; to propose some recommendations and measures on how to improve the NCMS.Methods Subjects were selected from two or three villages from each of the areas in suburban, plains, or mountains which were selected by stratified cluster random sampling. A self-designed questionnaire was used in the study, and entering house survey method was adopted to collect the subjects'basic information and information concerning the participation of the NCMS, farmers'medical service-seeking behaviors and attitudes, and the satisfaction of the NCMS.Results A total of 647 people were included in this investigation, including 624 valid questionnaires (96.4%). 601 subjects (96.3%) were participants of the NCMS with 260 men(41.7%) aged 44.0±11.5 years old, and 364 women (58.3%) aged 46.8±12.1 years. The participants of the NCMS were satisfied with this new system as a whole. The majority of the participants(96.3%)joined the NCMS voluntarily, and they were convinced of the benefits concerned. 99.5% of the particpants planned to participant the next year. There was 23 nonparticipants who held the NCMS useless.Most of the nonparticipants were unmarried youth and had higher educational background.60% of the subjects took it as the first alternative to see doctors, as the second to buy some medicine at the drug store, or to persist in a few days or other ways when they got sick. The rate of seeing doctors and buying some medicine at the drug store was higher among participants than nonparticipant. 46.2% of the subjects chose private clinics as their first choice for medical service, followed by township hospitals(community health service centers) (25.5%). In terms of the hospitals they hope to be transferred to, 60% of the subjects preferred provincial hospital, followed by municipal or district ones. Of the inpatients, 45.2% preferred municipal hospitals, followed by provincial and district ones. Farmers'medical service-seeking behaviors was related to demographic characteristicsm. Those who were women, older and had low socio-economic status and lived in remote areas, were relatively poor in their medical initiative and they were likely to choose low grade hospitals.The rate of dissatisfaction for the service of the designated hospital of the NCMS was quite high among the farmers who participanted in the NCMS. This may attribute to the situation that the medical facilities construction mismatched with a relatively higher living standard in Ouhai district. Among the participants who had applied for reimbursement of medical expenses, 64% were satisfied with the reimbursement system of inpatient expenses in general. However, most of them thought to participanted in the NCMS it had no effect or little effect in alleviating the financial burden of farmers.Conclusion The NCMS has been highly recognized by the majority of farmers, but there is "adverse selection" phenomenon. It is necssary to titlt to the vulnerable groups or disadvantaged regions in the fairness of financing. The NCMS is benefit to improve the initiative of farmers'medical service-seeking behaviors. Farmers highly select township hospitals(community health service centers) as their first choice for seeking medical sevice, but the top list is still the private clinics. When referring or being inpatients, provincial and municipal hospitals is still their main choice. Farmers'medical service-seeking behavior is influenced by gender, age, socio-economic status and regions factors. The rates of satisfaction for the service of the designated hospital and reimbursement system of the new rural cooperative medical care are quite low among the farmers in Ouhai district. Therefore, it is suggested to be further improvement for the NCMS in constructing medical staff, the coverage of designated hospital, simplifying reimbursement procedures, and incresaing the medical treatment expenditures reimbursement. |
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