Institution Intent Of Out-patient In County Hospital In The Background Of New Rural Cooperative Medical Scheme

New Rural Cooperative Medical System (NCMS) influences the health care utilization in rural areas through the health care provider and consumer norms. Designated medical institutions provide residential care to patients after the out-patient service. Institution intention of out-patient reflects the treatment flow of out-patient to a certain extent. In recent years, there are some behavior studies of health care utilization of the rural out-patients at domestic and overseas, but there are less study to explore institution intent of out-patient in the background of NCMS.The study aimed to provide some suggestions for improving rational rural health care utilization by analyzing outpatient choice on health care provider in the background of NCMS.According to the purpose the study, we had selected Rushan City, Huantai County, Zoucheng City and Weishan County in Shandong Province as our sample of counties. We had selected a local general hospital in the county as the study site in each sample county (city), and then extracted outpatients as the research entity from every sample hospital. In total,811 patients were investigated. We had investigated the framework and operation of the county general hospitals in the implementation of NCMS through the method of using self-administered survey. The main contents of this survey had included as follows:â‘ the status of population, economy, health resources and the implementation of rules and regaulations of NCMS policy of the sample county;â‘¡the demographic characteristics, income and health status of out-patient being investigated;â‘¢the health care utilization of out-patient being investigated (institution intent, disease type, cost and satisfaction, etc.).The analysis methods had included as follows:â‘ descriptive analysis the differences of sociological characteristics of outpatients;â‘¡analysis patients satisfaction factors with NCMS by the x2 test;â‘¢analysis the impact that sociological characteristics of the population, income and health status had affected out-patients on choosing health care provider by the x2 test and multiple classification logistic regression.Main results(1) NCMS of the sample counties had worked well generally, for example, the raised funds have been put in place on time, and county general hospital had established the system co-related NCMS. There were still existing the following problems:first, the figure that annual precipitation fund accounted for the proportion of total fund in Huantai County and Weishan's County was high (30.41%and 31.64%) above the rugulation; second, the data of comprehensive hospital drug list outside the usage was high (20%,31.41%and 22.15%) above the rugulation in Huantai County, Zoucheng City and Weishan City.(2) In this survey, the composition of institution choice was as follows:â‘ the proportion that the county patients took their fist choices to the community health service stations,the pharmacies and the county-level hospitals was 5.6%.21.2%and 66.1%.â‘¡the proportion of that the rural patients took the their fist choices to village health clinic,rural hospitals,the pharmacies and the county-level hospitals was 51.5%,9.2%,6.5%and 30.5%. There was lower proportion that the patients took their fist choices to primary health care institutions and higher proportion that the patients took their fist choices to county-level hospital, compared with the survey data of 2008 national health services.(3) The factors that affected the fist intention of county general hospital outpatients on institutions were as follows:patient's income, health insurance type, health status and the prices, quality and accessibility of health care.The irrational factors that affected the fist intention of county general hospital outpatient on institutions were as follows:the poor quality of health care of rural primary health care sector, and the ineffective regulatory that health insurance affected the fist intention of the outpatient on institutions.(4)Out-patients'satisfaction with the proportion of NCMS compensation was the lowest in the system (0.512 points), because the proportion of NCMS compensation was far behind their expectations. The low proportion of out-patient benefited from the NCMS compensation made the function of guiding outpatients to approprivate health care provider lower.Suggestions(1) Edit the new compensation package of NCMS to improve the quality of the running funds.(2) Improve the assessment index system of the designated medical institutions to control the rising unreasonable medical expense.(3)Establish the technology helping mechanism between county-level hospitals and primary health care sector to enhance the capacity of primary health care agency orgnizations.(4) Consumate health care network that county-level medical institutions are the lead and township hospitals are the centers in rural areas.Conclusions:The proportion that the patients took their fist choice on rural township hospitals and community health service stations is low. There is not prominent effect that NCMS lead the outpatients to approprivate health care provider reasonablely. Therefore, the government should pay more attention on actual effects that NCMS had affected on the outpatient intention, when they adjust the NCMS policy. They should explore the effective measures to reduce the burden of medicines and improve the health of our farmers.