The Analysis On The Subject Behaviors Of New Rural Cooperative Medical Schemes

The new rural cooperative medical system is the most important one in Chinese rural medical security system. Since July 2003, pilot project of voluntary participation of rural households by the central government, local governments and farmers co-financing, and of subsidies to serious illness mainly has been spread out nationwide, and on the basis of initial success, the new rural cooperative medical care has been rapidly popularized in the vast rural areas. Farmer households, the designated medical institutions and government, as the new rural cooperative medical care actors, are not only the participants and beneficiaries in the process of implement the new rural cooperative medical system, but also are the dischargers relevant requirements and obligations. The options and preferences of the behavior of the three subjects can directly affect the new rural cooperative medical system in the effective operation and sustainable development. In the background that governments at all levels are in great efforts to strengthen and develop the rural health insurance policy, summarize and analyze the behavior and relation of different participation subjects are of great significance in the healthy operation and sustainable development of the new rural cooperative medical care.The main contents of this article:(1) Farmer household behavior and its influencing factors. On the basis of preliminary investigation and understanding of farmers in the town of Xi'an where the new rural cooperative medical care is implemented, "questionnaire of Shaanxi farmers' health security" has been designed, and in 10 counties (cities) of the South, North and Middle of Shaanxi province, farmers participating the new rural cooperative medical care and non-participants of participating are conducted stratified sample survey of equidistant, and the survey results are analyzed in order to identify behavior and influencing factors of household investment in health, renewal will and adverse selection. The results showed that health factors is the main one by which peasant household is willing to continue to participate in the new rural cooperative medical and reverse selection behavior, that is to say, the new rural cooperative medical care to some extent to help farmers improve the ability to withstand health risk; household income levels and the ability to obtain loans on farmers behavior is also important, although low-income households face serious health shocks, but the new rural cooperative medical care on the impact of their risk mitigation is also the largest; farmers' evaluation and the degree of cognitive have significant impact on the new rural cooperative medical care and behavior of households, that is, the more voluntary farmers are, the more new rural cooperative medical care system farmers are understanding, and they are more willing to continue to participate in health investment and the new rural cooperative medical care.(2) Satisfaction of participating farmers. By judging or measuring the satisfaction by farmers to explore and analyze the new rural cooperative medical care of the household behavior. Based on the drawing on the U.S. Consumer Satisfaction Index Measurement Model (ACSI), introduction of the "image of the government" and "farmer participation" concept, combined with the new rural cooperative medical system characteristics, trial putting forward and establishing a new type of rural cooperative medical farmers satisfaction index model, and making household as sample survey conducted for the sample structural equation model to reflect participating farmers satisfaction of the new rural cooperative medical care. The results show that there is a significant positive correlation between image of the government, farmers perceived quality, perceived value of farmers, farmers satisfaction and continued participation in the new rural cooperative farmers, the good image of the government is satisfied with the basis of farmers; but there is a negative correlation between the satisfaction of farmers and farmers expect; the newly introduced "new rural cooperative" to improve the quality factor on perceived quality of rural households are more significant direct positive impact; shortening waiting time, simplifying claims process, raising the level of medical services and strengthening the supervision of new rural cooperative funds will improve the perceived quality of farmers.(3) The behavior analysis of designated medical institutions. By summarizing documents and reviewing Chinese health statistics in recent years, combined with empirical investigate three new rural cooperative financial condition and the normative in the treatment of hospital medical records designated hospitals for three new rural cooperative financial condition and the treatment of hospital medical records in the Shaanxi province, city and county, analyzing designated medical institutions participating in the new rural cooperative medical care. The results shows that the medical service quality and the level of medical technology which is provided by designated medical institutions affects sustainable development of rural cooperative medical care directly, and the dual characteristics which are profitability and public welfare determines designated medical institutions act induced demand exists; once hospitals have new rural cooperative medical institutions designated qualification, with the number of registered doctors and the patients participating in the new rural cooperative increasing, hospital revenue growth rate more rapidly, and designated medical institutions have a degree of induced demand; with the use of cost - effectiveness analysis, that the fixed payment for single disease cost - effectiveness are lower than the balance sheet by the project group has been founded, which helps to reduce the degree of induced demand, and to control rising medical costs.(4) Government behavior. By summarizing the literature and reviewing the related health statistics of Shaanxi province and China in recent years, combined with county and township in Shaanxi Province's "Farmers of the construction of new rural cooperative medical system in view of government actions in the investigation," "New rural cooperative management of agency staff on the new construction of rural cooperative medical system of government investigations of behavioral problems "and the actual survey, government behavior and influencing factors in the new rural cooperative medical care are analyzed. The results shows that, at present, our government has many problems in the management, organizational security, the handling capacity of designated medical care, and supervision in the new rural cooperative medical care system; government's decision-making and implementation of actions is subject to a variety of factors in the new rural cooperative medical, and the pressure of higher levels of government and political assessment, the regional geographical and cultural environment under the jurisdiction, the lack of local revenue is not high and grass-roots cadres of factors are important reasons that affect government action.(5) Participants in the new rural cooperative medical game analysis. The relationship between three main participants which are farmers, designated medical institutions, and government are analyzed with game model, to clarify conditions and characteristics which achieve a balanced game between the government and farmers, between farmers and designated medical institutions, and between government and designated medical institutions. Results showed that in the new rural cooperative medical system in actual operation, if the government is adamant, financial and has regulatory ability to pay, designated hospitals having the same objectives and interests with farmers, government funding regulation, designated hospitals providing provide appropriate medical care, the farmers optimal strategy to participate in this model is portfolio; if there exists the lack of government regulation, and the differences between interests and goals of designated hospitals and farmers, government funding not controlling, designated hospitals over-providing medical care, and farmers in the system reporting, the model is the final security portfolio to continue to run the system.This thesis may be innovative in the following areas: using structural equation modeling, to investigate the basis of household data, based on household survey data, drawing on the U.S. Consumer Satisfaction Index Measurement Model, introducing "image of the government" and "farmer participation" concept, combined with characteristics of the new rural cooperative medical system, establishing a new rural cooperative medical household satisfaction index model, which is better explained the mechanism of satisfaction of farmers participating new rural cooperative medical farmers; using game models to analyze the relation of participating subjects which are farmers, governments, designated medical institutions in the new rural cooperative medical care, theoretically clarifying farmers and the government, farmers and designated medical institutions, and government and designated medical institutions achieve the conditions and characteristics of game equilibrium, proposing new rural cooperative operation of the tripartite combination of subject optimal policy mix and the final security portfolio; pointing out that the health factor is the main factors that farmers are willing to invest, to continue to participate in the new rural cooperative medical care, and to do adverse selection; meanwhile, the income level of farmers and the ability to obtain loans for farmers behavior is also important, and although the risk of disease has greater impact on low-income farmers, the new rural cooperative medical care is also the largest impact mitigation to the risk of these farmers.