Influence Of New Rural Cooperative Medical System On Tb Health Service In Puyang City

ObjectiveBy investigating the different benefit clusters before and after the enactment of tuberculosis included into compensation scope new rural cooperative medical system (NRCMS)(2006 and 2008 year), the effects of NRCMS on TB control were analyzed and evaluated:1) Fundraising changes of tuberculosis patients; 2) Hospitalizing activeness of rural patients; 3) Changes of providing and utilizing of TB health service. The influence of this system on TB health service and TB control were assessed, and the difficulties and suggestions were summarized in system operation and provide scientific basis for further improving the health policy and TB control work.MethodsTen management cadres of TB institutions in Puyang city and counties,10 staffs of rural cooperative medical management department of five counties,15 medical personnel of TB institutions,20 TB patients and 170 TB patients registered in all TB institutions in 2006 and 2008 were randomly sampled and investigaed by questionnaires interview respectively. Service and finance data of TB institutions in 2006 and 2008, operating data of NRCMS management department were collected. We analyzed the qualitative investigation data with Excel software and the quantities investigation data with SPSS 12.0ResultThe proportion of medical expenditure in familiar income and expenditure were 15.7% and 24.3% respectively among investigated subjects in 2006,4.1% and 4.7% in 2008 respectively. Medical expenditure in 2008 was 63.9% less than that in 2006. Compared with 2006, rural TB patients' health goal was improved in 2008, behavior of hospitalizing was improved and the choice of hospitalizing behavior mode was more rational. The proportion of 'complete cure' was increased from 38.7% to 67.5%, regular medicine taking from 72.4% to 92.4%, accepting hospitalizing advice from 38.7% to 67.5%, active discharge from 36.8% to 18.6%.'Economic hardship' was a main reason for the TB patients negative hospitalizing in rural areas in 2006, while the "new rural cooperative reimbursement" is the main active hospitalizing for TB patients in rural areas in 2008. Compared with 2006, the TB institutions income of outpatient department and inpatient department was increased by 101.3% and 162.2% respectively in 2008, equipment expenditure increased 382.4%, personnel training expenditure increased 408.3%, the ratio of patient system management, new smear positive case detection, the heal rates of new smear positive patients were increased to 10.6%,16.0%,20.4% respectively. The rural TB patients' satisfaction to the proportion of the medical fee reimbursement and medical technology and service environment of TB institutions was significantly enhanced.99.4% investigated subjects was satisfied with TB included into NRCMS and 100% TB prevention and control agency interviewees approved this policy.ConclusionEconomic difficulties were the main barriers for TB patients to get health service in rural area. The NRCMS improved the fundraising situation of the TB patients so as to improve the situation of health service providing of TB institutions and the health service utilizing of rural TB patients.