| ObjectiveTo understand the development and current operating situation of medical assistance in Wanquan District,Zhangjiakou City of Hebei Province,so as to provide evidence for improving and perfecting the relative policies of medical assistance in Hebei Province.MethodsRelevant information on medical assistance polices and data related to poor popupalationand medical assistance were collected from domestic and international academic websites,and from official websites of all level governments and relevant departments.Data of Wanquan District was gathered from officially published statistical yearbooks and reports.A questionnaire survey was conducted among the general people and poor population for their knowledge and degree of satisfaction to medical assistance.Interviews on the current operating situation of medical assistance were carried out among the government officers and village cadres who are responsible for medical assistant.Results(1)The medical assistance funds mainly come from the medical insurance funds of financial expenditures of Wanquan Distirct.From 2012 to 2013,funds used for medical security system grew at a rate significantly higher than fiscal revenue,and the growth rate of medical aid funds was the highest.Since 2014,the funds for medical assistance have been seriously insufficient.In 2017,as the govenment strived to alleviate the poverty,the funding for medical assistance was raised again.The medical aid funds mainly include two parts: the payment of basic medical insurance premiums for urban and rural low-income individuals,and payment of medical expense for patients eligible for medical assistance.The medical expenses were paid directly to the hospital using funds of medical assistance,which was referred to as “one-stop” settlement service.(2)From 2013 to 2017,there were on average 30,000 individuals eligible for medical assistance each year in Wanquan District.All of the eligible individuals have received assistance for paying basic medical insurance,but only 4.15%-34.64% of them have accepted medical assistance for paying clinical fees.During 2013-2016,a total of 12,118 patients received medical assistance for clinical use.The patients who received medical rescue were mainly in the middle-aged and elderly population.Among them 22.60%,18.86%,15.44%,10.18%,6.46%,4.18% and 3.64% patients suffer from cerebrovascular disease,malignant tumor,heart disease,lung disease,hypertension,gastrointestinal disease or diabetes respectively.The annual assistance ratio varies according to the change in rescue funds.The proportion of medical assistance was 40-50% in 2013,and was reduced to 20%-30% in 2014 and 2015.The proportion of assistance increased to 60% in 2016,and increased again to 60-80% in 2017.(3)During 2012-2016,a total of 498 patients received medical assistances for catastrophic disease in Wanquan District.As to 2017,more than 22 diseases were included as major illnesses,which could be treated through catastrophic disease medical assistance.The number of diseases and the number of actual aids increased year by year.The age of the patients was mainly concentrated in the range of 41-70 years old;malignant tumors,Uremia,cerebrovascular disease,leukemia,myocardial infarction and organ transplantation are the main diseases,and the number of patients with these disease accounted for 51.00%,30.92%,6.02%,4.62%,3.82% and 1.00% of the total number of aids respectively;The median annual medical expenses of patients were 87.4,61.2,73.2,155.9,70.8 and 188.1 thousand RMB yuan respectively.The assistance fund for patients with serious illness varies from 12.4 to 21.2 thousand RMB Yuan,deducting the basic medical insurance,so that personal self-payment was reduced by 9.50-62.81%.(4)The awareness rate of of urban and rural residents for medical assistance policies was 21.53%,varying across different age groups(χ2 = 25.409,P <0.05).The awareness rate was higher in adults aged 18-60 than in other age groups.The awareness rate of medical assistance policies is different for people with different educational levels,as the rate of awareness tends to increase with educational level(χ2 = 66.904,P <0.05);awareness rate of the non-poverty group is higher than that of the improverished group(χ2 = 4.384,P = 0.036).Within the improvished group,lower educational level also correspons to lower awareness rate(χ2 = 7.944,P = 0.047).(5)All the patients who received medical assistance were satisfied with the reimbursement speed,the complexity of reimbursement procedures,the overall qualityof medical assistance,and its capacity in solving the difficulties of the patients.The satisfaction level is relatively low for the reimbursement of medical expenses,38.89% patients rated “somewhat satisfied”and 61.11% “neither satisfied nor unsatisfied”.The satisfaction level of patients who have received medical assistance was higher than that of the general residents(χ2 = 31.244,P <0.05).Conclusions(1)Since the start of medical assistance in Wanquan District,the district govement has issued a series of documents to improve the medical assistance system.The proportion of medical aid funds in government expenditure has significantly increased.The scope of disease relief has been expanding,and the number of people receiving medical assistance has continued to increase.Medical assistance has effectively reduced the medicaland economic burden of the poor population,and residents are overall satisfied with current medical assistance policies.(2)There have been some problems in medical assistance in Wanquandistrict,including unstable and discontinuous capital investment,low coverage of medical assistance objects,and relatively narrow scope of medical assistance.These problems have lowered residents’ level of satisfaction with medical assistance policies.Recently,the "one-stop" settlement in the use of funds has led to excessive consumption,resulting in the waste of medical assistance resources.Therefore,the medical assistance policy and implementation still need to be improved.(3)At present,the awareness rate of ordinary urban and rural residents regarding medical assistance policies is still low,especially for the population with the low educational level,and the elderly poor.Theses groups of people are also the most in need for medical assistance.In the future,medical assistance work should focus on strengthening publicity and improving awareness,especially among the elderly and poor population.This would allow the groups that are in need of medical assistance to seek assistance timely. |
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