Study On The Relationship Between NCMS And Health Service Utilization, Cost And Effects Of Rural Elderly Population

BackgroundThe New Rural Cooperative Medical System (NCMS) is a great reform of China’s rural health system in recent years, which aims to solve farmers’problems like poverty and back to poverty caused by serious diseases. Since NCMS is gradually established,the policy has been adjusting and changing constantly. According to the final survey of national health service in 2003 and 2008,the utilizing ratios of rural outpatient and inpatient service were growing year by year,while the growing speed of utilization of inpatient service exceeds that of outpatient’s(which is 1.8% and 3.4% separately).Meanwhile,the financial burden of rural medical services also aggravated,the average costs of outpatient and inpatient per time increased by 3.9% and 3.6% separately.The family’s medical costs on disease increased to 13.6% and 15.1%.After the medical reform in 2009,while NCMS’s coverage and level have been increasing year by year,it should be asked what efforts of health service’s utilization and residents’ financial burden on illness are.Does NCMS really decrease the risk of farmers’ poverty caused by disease?Apart from costs and utilization,how much does it improve in terms of health,fairness and satisfaction?That’s the key whether NCMS could realize its objectives.China has become an aging society since 2009. Compared with cities,the problem of aging caused by residents’ increased expected life, low reproductive rate,young workforce’ left and so on is especially serious.In rural areas,with the elderly population,the degree and speed of aging aggravating, the improvement of NCMS has a significant influence on the elderly health. With the establishment of NCMS,the security level and compensating rate have been improving. Meanwhile,different regions perfected the compensating rate, deductible and ceiling of different hospitals according to their medical and economical development level.Thus, with the practice of a series of health policy’s influence on the promotion of health service utilization, the control of costs,the present of fairness and the improvement in health outcome and satisfaction has become the key focused on evaluating the effect of NCMS generally.Although researchers in and abroad have adequate researches and abundant achievements on China’s NCMS policy and its influence on health service utilization and costs,this study focuses mainly on:Firstly, not only does it focus on the change of costs and utilization,but it also focuses on the harmonized relationship between utilization and costs,and the health and satisfaction results caused by NCMS.Individual differences and explanationof policy factors contribute to the reasonable adjustment and explanation health policy,which has a profound theoretical and practical significance; Secondly, the analysis of existing NCMS policy is mainly investigated from the view of the per capita, which ignores the urbanization construction and the progress of the aging influence on rural society,economy and health. Soin this study the elderly group becomes the major group of NCMS policy,which is essential and has practical significance; Finally,the current researches are short of strict balanced personal level panel and the data analysis,individualized balanced panel data in this study can eliminate the economic level difference between individual and society,which makes the conclusion more convicible.ObjectivesThe overall purpose of this study is to analyze the effects of rural elderly residents health services and health condition caused by NCMS, thus to provide policy recommendations for improving the health level and health service level of rural residents. The specific objectives:to build the theoretical analysis framework for the evaluation of NCMS; to analyze the changing trend and influencing factors of the health level and health service level of rural residents; to discuss the mechanism how NCMS policy influences the health level and health service level by qualitative analysis; to analyze what factors play an important role in the process of policy influence conduction.Design and MethodsIn this study, the results of the household survey data from households in 2008 and 2012, the 2008 baseline survey, used the purposive sampling method. According to the level of economic development, select 3 counties in Shandong Province, respectively Pingyin relatively developed and Junan and Liangshan relatively undeveloped.Each county selected four villages, each village over 180 persons aged more than 50 years old.2012 is the follow-up investigation of the 2008 respondents, extracting the same county, the same village and the same family, if they are not the former families, other families would not be chosen as an alternative. The 2008 survey data is as the basis, to ensure that each individual survey twice a year on both the individual level select unbalanced panel data for the final study sample.There are 1148 samples of households in this research, including:347 households in Junan, accounting for 30.20%;396 households in Liangshan, accounting for 34.50%;405 households in Pingyin, accounting for 35.30%.Analytical methods used in this study are mainly descriptive statistical analysis, univariate and multivariate statistical analysis. Multivariate statistical analysis include: a random effect panel data model to build a bivariate Logistic model for the prevalence of chronic diseases, inpatient service utilization model, the incidence of catastrophic health expenditure model for NCMS impact of policy changes; the use of panel data with random effect linear model building perceived health score model, both times total inpatient cost model, both times at his own expense model, inpatient overall satisfaction model, medical price satisfaction model.Panel data model, the main observed variables as policy factors, indicators of compensation than deductible and ceiling; minor differences observed variables including personal characteristics of the individual and family characteristics; health outcomes in health status for the observation and explanatory variables.ResultsAnalyze the NCMS’s influence on health situation. After controlling other factors the compensating level has improved 1%,self-feeling health grades has increased by 0.901%.Both village and county’s deductibles have bad influence on health,but the influence is under control.If the deductible increases by 1%,the self-feeling grades would decrease by 0.029% and 0.067%.Among the personal observations,high-income, rural household registration and teenager’s group can get higher self-feeling grades.1.Analyze the NCMS’s influence on the utilization of inpatient service.Despite other conditions,only county and village’s compensating rate have active influence on inpatient rate.If compensating level increases by 1%,the compensating rate would increase by 0.124% and 0.123%.Similarly,family and personal economy conditions,health conditions,especially whether one has chronic diseases and medical insurance influence inpatient rate a lot.As for the choice of different degrees’medical institution,every NCMS’s level compensating rate influences a patient’s choice to health service directly. At the same time,both sides have opposite influence on each other.The increase of county’s compensating rate would decrease the village’s inpatient rate by 0.194%.Meanwhile the deductible has little influencein the researches.2. Analyze the NCMS’s influence on the inpatient cost.According to the research on the average inpatient cost is ensured by the linear model of random effect of panel data. After controlling the variables of people,the higher the county’s compensating rate is,the more money inpatient costs. Regression coefficient is138.497.Compared with private average inpatient cost,both county and village’s rates have opposite influence,and the county’s influences more.3. Analyzethe degree of satisfaction’s influence on NCMS in different dimensions. While controlling other factors,degree of satisfaction will increase 0.006 if compensating rate of county rises 1%.Then compensating rate of village doesn’t influence the degree of satisfaction much.Degree of satisfaction, county,village and city present rising trendand village’s degree of satisfaction about price of medical treatment rise fastest.Patients’degree of satisfaction to medical establishment will rise 0.005 when compensating rate rise 1%. Degree of satisfaction about accessibility is apropos of age and health level mainly.4. Health policy and disastrous health point out:By two years’panel data analysis that health policy declines the appearance of disastrous health potently in total. While for middle income masses and low and middle income masses, expense for disastrous health is increasing. Analyze synthetically the situation about the use of inpatient service, ability to pay has increased to a large extent. Mainly, it is due to the release of health service demands.Conclusions and Policy Recommendations(1)For health:This study finds that as the NCMS’s compensating rate rises, the chronic disease of rural elderly people declines and the score of health self-feeling rises. It suggests that NCMS plays a significant part in improvingrural elderly residents’health. In addition, this improvement has much influence on advanced age. It supplies significant valuable demonstrational gist and theoretical support for the improvement of NCMS, and makes sure the focus masses of compensating rate.(2)About inpatient service:NCMS leads a high inpatient rate in rural elderlyresidents than ever before.It indicates that NCMS has a positive influence on health service utilization and inpatient service. To propel NCMS, it is expected to realize the basic coverage, as well as serious diseases compensation. According to a certain proportion, this policy has reduced the inpatient cost. On the other hand, it has enhanced economic applicability for rural elderly people in inpatient services, which makes it more convenient and cheaper.(3)About the choice of health care organization:NCMS plays a vital role in guiding participants effectively to see doctors in primary health care center. Using health resources in a reasonable way, the policy can boost many people to choose diagnosis or treatment in basic organization.(4) About health care service costs:With the development of health services, it makes financing more difficult. For the present, the low level of financing limits compensating ability.Lower medical charges become one of effective methods to prevent patients from poverty. It is crucial for NCMS to regulate medical costs.(5)Under the circumstances of certain financing criteria:Comparing NCMS compensation project with real compensating proportion, the factor that has a great influence on is fund equalization. So to improve compensation project continuously is supposed to do now, at the same time, it should be combined with the scientific design of financing criteria, which is significantly important. And the changes are ought to put hospital compensating improvement into main position and make a reasonable deductible and ceiling.Innovations(1)This study is based on Anderson Model which is combined with Grossman Health needs theory to build the framework of NCMS influenceevaluating system. We bring individual health care experience, environment, and individual factors into influenceevaluating system with which we can form a new comprehensive system.(2) Systematic analysis of new health revision previously and presently, the policy of NCMShas influence in lots of aspects, Such as health condition, inpatient service, inpatient service charges, thesatisfactionofpatients and catastrophic health expenditure. Not only aim at economic target and health condition, but also reveal the policy of NCMS offset influencing the health and health service utilization comprehensively.(3)The statistics of study selects two years which in previous 2008and present 2012 new inpatient revision respectively. The 2008 year isthe baseline survey while the 2012 year is the tracing study. Selecting the same population and applying the statistics of personal level and eliminating the effect on different individual aim atthe results with time changing, controlling individual heterogeneity, increasing the reliability and authenticity of the results.Limitations(1) It is limited in materials. Thisstudy only analyzes the change of the compensating rate, deductible and ceiling and doesn’t adopt other NCMS policy and other policies of inpatient revision,such as the basic public health services and so on. This study cannot adopt model due to the little difference of ceiling.(2)The study uses the years which have long spanand it uses memorial research data. Although controlling the quality strictly, it is still hard to avoid the recall bias.