An Assessment On Cooperative Medical Care System In Zhejiang Rural Areas

Background & ObjectiveRural cooperative medical care system is an effective form of healthy ensuring system in villages, and is also an important part of social security system. After several decades' exploration and practice, great advances have been made in cooperative medical care system. Rural cooperative medical care system is now playing a more and more important role in protecting health of rural residents. In the new period, new occurrences and problems are constantly emerging. It is urgent for us to improve and perfect our cooperative medical care system to adapt to continually changing situations. As one of the four pilots, Zhejiang province of new rural cooperative medical care system has been exploring and practicing new pattern of rural cooperative medical care system for nearly half a century. It has formed its own characteristics and accumulated some experiences. In order to systematically review and sum up the experience and lessons on the practice of the traditional and new rural cooperative medical care system in Zhejiang province and assess the management system and operating mechanism as well as social impact of rural cooperative medical care system, we conducted this survey which can provide foundation to improve the new rural cooperative medicalcare system.Materials & MethodsMain methods that we applied to our research including literature analysis, interview within household, special topic, field investigation, comparison analysis and so on. By means of these methods, we evaluated the management system of the traditional rural medical care cooperation and pilot programme of new rural cooperative medical care system in Zhejiang province. With regard to the research of traditional rural cooperative medical care system, retrospective researches and historical literature reviews on relevant data, documents, literature and associated books on medical insurance theory, health service study and health economics were adopted. With regard to the research of the new rural cooperative medical care system, field investigation including institution questionnaire survey, personal questionnaire survey and typical area survey. Survey data and report data were inputted into Epidata 5.0. Through further transformation by Statatransfer 7.0, the data was analyzed with the software of SPSS for windows in the end.ResultsTraditional rural cooperative medical care system largely adopted the pattern of overall planning by village. Fund raising mainly came from village collective and individual farmers. In 2002, the government subsidy to every farmer who took part in medical care cooperation system were only 3.7 Yuan. Due to the breakup of rural collective economy, the fund raising of rural cooperative medical care system transferred to farmers themselves, which resulted in less funds and lower participating rate. Combination with small benefit coverage and seriously overspent funds, traditional rural cooperative medical care system was unable to sustain. The new rural cooperative medical care system was set up in 27 pilot counties in Zhejiang province in August 2003. After one year of practice, it had covered 10.40 million of rural population and benefitted 8.865 million of rural population (86.74%). Pilot counties with different economic levels constructed their own management and operating mechanism of new rural cooperative medical care system which accorded with theirlocal situations. Accumulated amount of medical treatment funds reached 534.81 millions Yuan, of which government financing was 296.61 millions Yuan, and individual financing was 60.33 Yuan on an average. The accumulated expenditure of medical treatment funds was 395.25 millions Yuan, including hospitalization expenditure (362.33 millions Yuan), outpatient expenditure (12.81 millions Yuan) and physical examination expenditures (2.31 millions Yuan). Total number of beneficiaries had expanded to 1.15 million people (including inpatient service, outpatient service and free physical examination) and the benefit incidence rate was 12.91%. The average rate of reimbursement was 21.06%. 27 pilot counties all set up administration committees of new rural cooperative medical care system at country level and established special fund account for medical treatment funds.ConclusionThe traditional rural cooperative medical care system has the characteristics such as low grade of overall planning, inadequate government investment, single channel for raising funds and small benefit coverage. While the new rural cooperative medical care system has the characteristics such as a higher participation rate, adequate government support and multiple channels for raising funds, diverse modes of reimbursement and efficient funds use. The new rural medical care cooperation system has reduced farmers' disease economic risk and prevents them getting into poor to some extent. But the equity and benefit coverage of new rural cooperative medical care system still needs further enhancement, and the sustainable development of cooperation system is subjected to further studies.