Study On Mechanisms For Coordinating Medical Aid Program And Rural Cooperative Medical Scheme In Ningxia And Shandong Provinces, China

Since 2003, China's rural medical security system has been rapid reform and development. New rural cooperative medical Scheme (NCMS) and Medical Aid Program (MAP), to some extent, have had effectively improved the health care feasibility for the poor, and reduced the disease caused economic burden. But as a result that MAP has not been effectively converged with NCMS, the power of the social security system for the poor to resist the disease risk is not high, and health related poverty has been a vicious cycle. It has become one of the important factors affecting the social stability and social harmony. How to achieve seamless convergence between MAP and NCMS, in order that the rural medical security plays a role to benefit the poor, the practice is worth exploring and studying.With the data from European Union Project-Bringing health care to the vulnerable-developing equitable and sustainable rural health insurance in China and Vietnam, the running convergence systems between MAP and NCMS in the Ningxia Hui Municipality and Shandong Province was examined. The objective of the study was to analysis the characteristics and barriers of mechanisms for coordinating at the policy level, the program level, management level; to analysis the relevant interest groups on the existing understanding of convergence and evaluation system; to explore the two systems to provide seamless convergence of evidence and relatively feasible policy recommendations. In this study, stratified sampling is in Shandong Province and Ningxia Hui Municipality. Research object are the relevant person of the health system and non-health systems, including the managers and rural residents. Quantity and Quality data are collected through family survey and key person qualitative interviews.The major results: 1) Two provinces has basically established a funding system of rural MAP, government transfer payments are the main source of financing. There is a big gap between supply and demand of MAP funds, and differences exist in fund-raising and expenditure. 2) Two provinces has basically established mechanisms for coordinating MAP and NCMS, at the policy level, the program level, and service level.â‘ Policy levels: unified policy has been made in Ningxia Hui Municipality, but not Shandong Province. All the policies were not strictly carried out.â‘¡Program level: Ningxia Hui Municipality' MAP including financing the poor take part in NCMS, out-patient help and serious disease help, but only financing the poor take part in NCMS and serious disease help in Shandong Province. Not only the government but also the Red Cross and charity funded the poor take part in NCMS Shandong Province. There was high funding Participation ratio in Ningxia Hui Municipality, and lower in Shandong Province. Programs had high paying line and low ceiling line as well as low claim rate. Out-patient funds account for a larger proportion of MAP funds in Ningxia Hui Municipality, but serious disease help in Shandong Province. Low per capita aid funds actually in two provinces.â‘¢Management level: The effect of MAP advocacy was worse than NCMS. They did not share the same information management system and settlement window. MAP after treatment was employed. Controlling of medical expenses depended on NCMS. Costs of coordination of management are relatively high. 3) Health Department, Home Department, and the poor had inconsistent values. Personnel in Health Department knew very little about MAP. With low awareness of medical aid agency, most rural residents did not understand the contents of MAP. They got MAP information through television, village or township cadres' Door-to-door publicity, and they looked forward to better MAP. Policy recommendations: 1) Improve relevant policies, laws and regulations, including: the responsibility of governments at all levels, funds raise and management, program for Coordinating, the responsibility of public hospital. 2) Establish sustained and stable funding and management mechanism, emphasis fund-raising responsibilities of government at all levels, strengthen government and social organizations, set up special accounts of MAP, study the scientific and reasonable mechanism for distribution of funds. 3) Optimize Program for Coordinating MAP and NCMS, including: Free out-patient services, abolition of pay lines of out-patient and hospitalization, out-patient help including village health clinic and chronic disease; hospital help by disease, sub-object and pro-rata; increase sorts of serious disease, set reasonable pay line, cap line, and proportion in MAP; regular or occasional payment of a fixed payment or MAP cards, improve MAP coverage and benefit rates.4) Establish a new type of management for Coordinating MAP and NCMS. Put MAP and NCMS together to advocacy. Set up a classification management system with clear duty. Set up a comprehensive information system with MAP and NCMS card, in unit clearing window in one-time.