| Objective Describe the basic situation of rural residents participated in NCMS of the project counties(Haiyuan and Yanchi) in Ningxia. Analyze the influence of the adjustment of the New Rural Cooperative System to utilization of health services and benefit distribution among the different income group of project counties. Evaluate the effect of the adjustment of NCMS to equity in health service and put forward policy recommendations for perfect development of NCMS.Methods Using the stratified random clusters sampling and homemade questionnaires, select participants of the project counties and collect research data. Using the equity methods of analysis, such as income five-packet method, the concentration index and the index of dissimilarity and so on, to analyze the fairness of health services utilization and benefit distribution of outpatient and inpatient in Haiyuan and Yanchi Counties. Adopt the Multiple Linear Regression model to analyze the main factors of compensation cost of NCMS.Results(1) In Haiyuan county, two-week consultation rates were 10.65%, 10.23%, 7.19% and 6.14% repectively, and two-week consultation rates CI value were 0.1042, 0.0573, 0.0412 and 0.0148 respectively. The CI value was positive, that out-patient utilization of health services was mainly concentrated in the higher income group. However the absolute value of the concentration index decreases gradually, out-patient health services was tend to fair. In Yanchi county, two-week consultation rates were 9.24%, 6.69%, 9.80% and 10.11% repectively, and two-week consultation rates CI value were 0.0251, 0.0029,-0.0096 and-0.0006 repectively. The CI values in 2012 and 2015 were negative, that out-patient utilization of health services was mainly concentrated in the lower income group. Out-patient health services was tend to better fair.(2) In Haiyuan county, the hospitalization rates were 8.47%, 8.82%, 9.44% and 14.51% repectively, and hospitalization rates CI value were 0.0789, 0.0698, 0.0754 and 0.0491 repectively. The CI value was positive, that in-patient utilization of health services was mainly concentrated in the higher income group. In Yanchi county, the hospitalization rates were 10.28%, 9.52%, 11.08% and 15.65% repectively, and hospitalization rates CI value were 0.0023, 0.0153, 0.0125 and 0.0106 repectively. Compared with the baseline survey, the absolute value of the concentration index increased, but the absolute value from 2011 to 2015 has a tendency to decrease.(3) In Haiyuan county, the proportion of out-patient compensation were 4.94%, 47.84%, 50.27% and 51.81% repectively, and the proportion of out-of-pocket were 94.50%, 71.49%, 74.92% and 63.61% repectively. In Yanchi county, the proportion of out-patient compensation were 3.64%, 54.55%, 56.54% and 55.14% repectively, and the proportion of out-of-pocket were 96.43%, 71.95%, 73.44% and 66.68% repectively.(4) In Haiyuan county, the proportion of in-patient compensation were 65.05%, 68.26%, 72.70% and 92.89% repectively, and the proportion of out-of-pocket were 74.03%, 52.90%, 60.39% and 57.46% repectively. In Yanchi county, the proportion of in-patient compensation were 69.23%, 76.14%, 77.12% and 90.89% repectively, and the proportion of out-of-pocket were 73.00%, 65.92%, 75.13% and 56.57% repectively.Conclusion Since the NCMS adjusted, the utilization of health services of rural residents has generally increased, and the utilization of health services is overall better fairness. The health service utilization fairness of out-patient is better to that of in-patient, and the health service utilization fairness of Yanchi is better to that of Haiyuan. The compensation rate of the NCMS has increased. Low-income groups benefit more from the New Rural Cooperative System. The compensation fairness of out-patient is more apparent than that of in-patient. In-patient compensation fairness remains to be further improved. Compared with the baseline survey, the proportion of out-of-pocket of out-patient and in-patient in the project counties has significantly reduced. However, the actual compensation rate is still low, and the actual out-of-pocket costs are still high, comprehensive measures should be taken to reduce the medical cost and improve the cost compensation. Policy recommendations(1)Strengthen publicity to raise farmers' understanding of the new health reform project.(2)Improve the compensation package of NCMS to improve the farmers benefit fairness.(3)Increase input to strengthen the capacity of primary care service.(4)Control hospitalization costs to improve the actual compensation rate of rural residents.(5)Support policies and measures led by government to perfect the NCMS. |
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