Evaluation Study On New Cooperative Medical Scheme's Operating Mechanism And Its Determinants In Rural China

Background:The New Cooperative Medical Scheme (NCMS), a vigorous exploration to improve the health and medical insurance of peasants by Chinese government, is now at the pilot stage and with no efficient evaluation system. To explore a scientific and reliable evaluation system for the assessment of the NCMS and to analyse the determinants in the hope of putting forward some useful suggestions were significant to the promotion of the sustainable development of the NCMS, and to the construction of a new socialist countryside and a harmonious socialist society.Objectives:This study aimed to establish a scientific index system for assessing the operating mechanism of the NCMS and to use it to assess the operating mechanism of the NCMS in some pilot counties in Shandong province, hoping that in the process unfavorable factors impeding the operating mechanism could be found out and recommendations could be made for future policy-making to keep the NCMS to develop in a sustainable way.Methods:Based on the different objectives and different study contents, different methods were adopted. First, literature review was used to form the study guideline. Second, the analytic hierarchy process (AHP) and the hazard analysis and critical control point (HACCP) were used to construct the index system. Third, the Delphi Survey Method was used to perfect the system. Fourthly, the Cronbach's alpha coefficient and factor analysis method were used to test the validity and reliability. Finally, statistics method and comprehensive index method were employed to asses the sheme in the pilot counties and to analyze the determinants.Main Results:â… . The evaluation system was established which involved four levels of indexes and 47 initial indexes.â…¡. Five main results were generated by the experts consulted with the Delphi method: i) 20 experts were selected and 2 surveys were conducted. In the first survey, 20 questionnaires were sent to them and 18 were returned, and in the second survey, 18 questionaires were sent out and were returned as many. The active coefficient was respectively 0.9 and 1. ii) The authority coefficients of the 3 level-2 indexes were all above 0.8. iii) The Kendall W coefficients of concordance of the structure indexes, the process indexes, the result indexes and the initial indexes were calculated. The W coefficients of the importance in the two surveys were respectively 0.2600, 0.1577, 0.1886, 0.2017 and 0.3279, 0.2094, 0.1207, 0.2178, and the W coefficients of the operability in the two surveys were respectively 0.1300, 0.1482, 0.0778, 0.1441 and 0.2311, 0.1470, 0.0567, 0.1929. iv) The weight coefficients of every level's indexes were calculated too, and the weight coefficients of the structure, the process and the result indexes were 0.3319, 0.3369 and 0.3312. v) The standard values of the 47 initial indexes were calculated based on the consulting results.â…¢. The validity and reliability of the indexes system was high. The assessment showed that the 6 counties had different total indexes. Ranked according to the index, Weishan was the first, and down to Huantai, Zhangdian, Wendeng, Zoucheng, and Rushan as the last.â…£. The government support, establishment of providers, fund operation, management and supervision, benefits and satisfaction were the main influencing factors.Conclusions and Suggestions:â… . The evaluation system was established, and the weight coefficients and the standard values of the 47 initial indexes were calculated. The testing testified the validity and reliability of the indexes system was high.â…¡. 6 counties were assessed with the system established, and the assessment results showed the differences, the advantages and disadvantages.â…¢. The government support, establishment of providers, fund operation, management and supervision, benefits and satisfaction were the main influencing factors, and the specific factors would be found by further study.â…£. Suggestions were put forward as follows: i ) Revision and implementation of the system should be done as soon as possible, and in the process of implementation to perfect the system continuously to make sure the NCMS develop well. ii) Some measures regarding the influencing factors were suggested, including increasing government support, strengthening the establishment of the health service providers, devoting more attention to the fund operation and supervision and improving the benefits received by, and satisfaction of, peasants involved .