Issues concerning Migrant Workers' Participation in the New Rural Cooperative Medical System and Countermeasures——Based on the Survey in Wenjiang District and Jintang County, Chengdu City

We conduct questionnaire survey of migrant workers in Wenjiang District and Jintang County of Chengdu City,respectively,using the method of key-point investigation and the sampling survey. We describe the status quo of the sample migrant workers' participation in the New Rural Cooperative Medical System,analyze the issues concerning migrant workers' participation in the New Rural Cooperative Medical System,and put forward the countermeasures and recommendations as follows: using many types of medical insurance; establishing universal reimbursement points in strange land and premium-paying system for migrant workers; making the proportion of reimbursement open and transparent; establishing and improving medicare security system for migrant workers.

Development of the New Rural Cooperative Medical System in China

Based on a survey conducted by our research team at the Chinese Academy of Social Sciences, the present paper reports on the development of China＇s new rural cooperative medical system set up in late 2002. The new rural cooperative medical system is different from the old system in that it is organized, guided and supported by the government but that rural residents voluntarily participate in its administration. It is financed by individuals, collectives and the government. The new cooperative medical system focuses on serious disease planning and mutual aid and fraternily between rural residents in health care. The results of our survey indicate that the new rural medical system has been successful up to now but that it also has some problems. China needs to pay more attention to overcoming the difficulties and challenges it faces in terms of future medical needs so that a mechanism for its sustainable development can be established.

Government Responsibility in New Rural Cooperative Medical Care System from the Perspective of Equity and Efficiency

Equity and efficiency,as two essential parts of social security,always influence construction of China's new rural cooperative medical care system.The new rural cooperative medical care system is a rural social security system particularly intended to make it more affordable for the rural poor.It is a multi-channel fundraising system with fund of comprehensive arrangement for serious disease composed by the government,collectives and individuals.Since its implementation,it has made considerable achievements,but there are still many apparent and hidden problems.Through analyzing existing problems in the implementation of new rural cooperative medical care system,from the perspective of equity and efficiency,it reached the conclusion that government should take corresponding responsibilities.At the same time of constantly increasing efficiency,it is recommended to attach importance to the equity,so as to realize the objective of improving the security level of new rural cooperative medical care system.

Restraining Factors and Improving Paths for the Operation Mechanism of New Rural Cooperative Medical System in China

The new rural cooperative medical system has achieved periodical achievements since its establishment.Nevertheless,there are many factors hampering the development of the new system,such as the high cost,the difficulties in fund procurement,the lack of management,the narrow coverage of benefit,the ineffective constraint to the designated medical institutions,the high fund balance rate,and the poor medical facilities and services in rural areas.Countermeasures are put forward to solve these problems,including improving the system design,expanding the coverage of the system,expanding the fund sources,reducing the financing costs,strengthening the fund supervision,enhancing the supervision of designated medical institutions,and improving the capacity of health services in rural areas.

Research on the Problems and Countermeasures of New Rural Cooperative Medical System

Our country rural area has carried out broad practice on new model system of rural cooperative medical services, and the rural new medical treatment system has developed quickly. However, there are still many problems which needs us to solve. This article will analysis its present situation, problems and reasons, then give some suggestions to solve these problems. The new rural cooperative medical system has made great achievements since its implementation, which is a radical reform of the traditional medical systen. Lcd by thc govcmmcnt, trying to solve the majority of the Chinese population of the peasant groups to see the doctor difficult and expensive medical problems, and effectively protect the vital interests of farmers, so that people=oriented, establish and improve the rural medical service system. This paper analyzes the status quo of the new rural cooperative medical system, puts forward the problems, finds the reasons, and puts forward the corresponding countermeasures on the basis of this.

The impact of the New Rural Cooperative Medical Scheme on the“health poverty alleviation”of rural households in China

This study investigates the impact of the New Rural Cooperative Medical Scheme(NRCMS)on rural households to escape poverty.We employ the instrumental variable method,the IVProbit model,to analyze the national data from the rural-resident field survey by the China Family Panel Studies(CFPS)in 2016.Based on the large-scale data,we found that,first,the hospitalization of family members is the key factor in increasing the risk of the family falling into poverty.The NRCMS has significantly reduced the likely risk of falling into poverty.Second,the impact of the NRCMS on poverty alleviation varies among groups with different levels of income.There is no impact on the upper-middle and high-income groups;in contrast,the NRCMS has substantially improved the capacity of low-income rural families to prevent poverty due to illness,especially for the lower-middle-income group.Third,there exist significant regional differences in the impact of NRCMS on the health poverty alleviation of rural households in China.The NRCMS has successfully reduced the risk of rural households in the western region falling into poverty,simultaneously,no significant impact on those in the eastern and central regions.In order to diminish and eliminate poverty eventually and boost rural residents'capacity for income acquisition,we propose the following:raise the actual compensation ratio of the NRCMS,control the rising expense of NRCMS by promoting the payment method reform,construct the comprehensive healthcare system in the western region,strengthen the medical security for the poor in remote area,and enhance the living environment for rural residents.

The New Rural Cooperative Medical Scheme and Its Implications on Rural Labor Migration in China：Evidence from Longitudinal Surveys

In 2003, China initiated the New Rural Cooperative Medical Scheme （NRCMS） in order to provide basic health care coverage for the rural population. However, the NRCMS has had a marked impact on rural-urban labor migration as its current regulations present a barrier for cross-region participation in the NRCMS, and its reimbursement system is biased when the enrollees seek medical services outside their location of hukou, a household registration system in China. This paper performs a variety of empirical tests on a panel data set from the China Health and Nutrition Survey （CHNS） to study how the NRCMS affects rural residents＇ work location choices. We observed a ＂locking effect＂ on potential rural migrant workers and a ＂pulling effect＂ on existing ones. According to the results, the NRCMS has discouraged rural residents from working outside their location of hukou, lowering the probability of relocation by 3.52 percent. Meanwhile, the NRCMS system actually encourages existing migrant workers to return home. This paper concludes that the NRCMS has to some extent restrained the free flow of the labor force and exacerbated the migrant worker shortage.

Impact of the New Cooperative Medical Scheme on Health Care Service Utilization in Rural China

Using the 2000, 2004, and 2006 CHNS longitudinal survey data and econometric methods （random-effect probit regression model and DID methods）, this study conducted an empirical analysis to estimate the impact of NCMS. The major conclusions are as follows. First, predisposing factors, enabling factors, health care need factors, and lifestyle factors affect health care utilization. Second, results using DID methods indicate that NCMS did not affect health care service utilization （outpatient and inpatient） of individuals when ill, but it might increase the possibility of getting a health examination. Third, there is no difference in health care service utilization （both outpatient and inpatient） between the NCMS enrollment group and the non-enrollment group in both working age group （15-59） and the elderly group （60 and over）. Therefore, it can be said that NCMS did not affect the health care utilization in both the group. However, NCMS positively affects disease prevention behavior （visiting the hospital to receive a health examination） in the working age group, but the effect did not appear in the elderly group.

Optimized Reimbursement Scheme of China's New Cooperative Medical System Using Monte Carlo Simulation

China＇s Rural Cooperative Medical System collapsed alongside communal farming at the end of the Maoist period in 1976, leaving most farmers vulnerable[1]. In rural areas, where 80% of people have been without health insurance of any kind, illness has emerged as a leading cause of poverty[24]. To address the poor state of health care among the rural population, in 2003 the Chinese government launched the New Rural Cooperative Medical System （NCMS）,

The impact of the New Cooperative Medical Scheme in Sangzhi County,Hunan Province

In August 2011,the Sangzhi County government,Hunan Province,adopted a series of new health care policies as a national pilot of the New Cooperative Medical Scheme(referred to as 2011 NCMS).These policies were designed to further resolve illness-led poverty and the poor state of health care in the local area.The program had a positive impact and spread to other regions in Hunan Province.This paper will discuss the progress made as a result of the policies and several issues that challenge the scheme in practice.A total sample of 1212 individuals and 303 households were included in the analysis,and98 interviews were conducted with people related to the scheme.Our major findings indicate that the 201!NCMS has significantly reduced the out-of-pocket medical payment of rural residents,and also increased the township hospitals'patient flow.However,the medical scheme still faces many challenging issues during the implementation.With the increasing interest among the Chinese policy makers in strengthening and promoting the Sangzhi Model,the impacts of the scheme deserve greater attention in practice so as to further improve NCMS in rural China.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Summary:Throughout the duration of the New Cooperative Medical Scheme(NCMS),it was found that an increasing number of rural patients were seeking out-of^county medical treatment,which posed a great burden on the NCMS fund.Our study was conducted to examine the prevalence of out-of^county hospitalizations and its related factors,and to provide a scientific basis for follow?up health insurance policies.A total of 215 counties in central and western China from 2008 to 2016 were selected.The total out-of-county hospitalization rate in nine years was 16.95%,which increased from 12.37%in 2008 to 19.21%in 2016 with an average annual growth rate of 5.66%.Its related expenses and compensations were shown to increase each year,with those in the central region being higher than those in the western region.Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region(XI),rural population(X2),per capita per year net income(X3),per capita gross domestic product(GDP)(X4),per capita funding amount of NCMS(X5),compensation ratio of out-of^county hospitalization cost(X6),per time average in-county(X7)and out-of-county hospitalization cost(X8).According to Bayesian network(BN),the marginal probability of high out-of^county hospitalization rate was as high as 81.7%.Out-of^county hospitalizations were directly related to X8,X3,X4 and X6.The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors,economy factors,regional characteristics and NCMS policy factors was 95.7%,91.1%,93.0% and 88.8%,respectively.And how these factors affect out-of-county hospitalization and their interrelationships were found out.Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations,and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

On Rural Medical Care and Health Undertaking Development during New Medical Reform

Based on in-depth survey of township hospitals in Lushan County of Henan Province, this paper studies the development situations of rural medical care and health undertaking in the course of new medical reform. Results show that both rural medical institution and public health undertaking have considerable development in this course. Working capital situation gradually turns better. However, there are still problems and challenge of shortage of high quality medical care personnel, lack of employment mechanism, poor medical environment, and imperfect bidding and purchasing system of medicines. To further develop rural medical situation, it should improve medical environment, speed up informationization construction, and give prominence to functional orientation.

Research on Rural Public Service System Based on the Data of "The Eleventh Five-Year Plan"

Rural public service is the services provided to rural residents to fulfill the needs of agricultural production, development of rural economy and improvement of peasant's living standard. Improving rural public service system is good for promoting the development of rural economy, enhancing the quality of peasant's living standard, narrowing the gap between rural and urban areas and constructing socialistic harmonious society. Currently, our rural power grid construction can meet the essential needs of economic and social development in rural areas. Rural water conservancy structure also fulfills the needs of agricultural production and peasant's life. Rural traffic condition has an obvious improvement. Education, culture, medical care and other public services all have a general enhancement. However, comparing to the city, rural public service system still exists some problems including imperfect infrastructures, low-quality education and medical treatment, low-level living environment and so on. Therefore, it is needed to establish a long-acting system of rural public service to boost the reform of rural basic education, improve the facilities of rural medical treatment, promote the reform of rural cooperative medical service, enhance the management of rural governance and improve the quality of rural life and environment.

Non-professional Agricultural Production Villages Establishing a New Rural Cooperative

The article analyzes problems in the agricultural development of non-professional agricultural production villages of Fenghua City.Firstly,low technical and scientific content of production and low standardization level.Secondly,scattered sales and non-fixed marketing channels.Thirdly,difficulties in group cooperation of farm crops with special benefits.Fourthly,imperfect service of rural committees of non-professional agricultural production villages in Fenghua City.A new rural cooperative is to be founded to help villagers in non-professional agricultural production villages of Fenghua City to be engaged in agricultural production and management activities,and to improve their overall incomes.On the one hand,a perfect and scientific cooperative operating system is to be built specifically including three functions.Firstly,fully playing the leading and bridging role of rural primary organizations.Secondly,fully carrying out the pushing role of capable persons in the administrative village.Lastly,fully playing the role of active participation and cooperation of villagers.On the other hand,constructions of normalization,standardization and brand orientation with special emphasis should be achieved under the guidance of local governments.The key of building a cooperative of non-professional agricultural production villages in Fenghua City is discussed.One is that rural cadres should have strong awareness of serving the people.The other is that governments at all levels should energetically support the establishment and management of rural cooperatives.

40 Years of Rural Cooperative Medical Service

Our story dates from 40 years ago, on August 10, 1966, when China＇s first institution of rural medical service was inaugurated at a county called Changyang, Hubei Province, Central China, where people of Tujia, an ethnic minority group, live in compact communities. It was actually a clinic at a Dujia Village in the county, which charged itself with the task of making primary or basic medical care available and affordable-- to all the villagers. China has undergone tremendous changes since then, and now its economy becoming increasingly market-oriented. Despite that, rural cooperative medical service has kept expanding at Changyang though having experienced twists and turns over the past four decades. The county has been chosen by the central authorities to try out a new type of rural medical service, which in many ways is different from the old pioneered by Dujia in Changyang County.

Research on the path of medical service combination from the perspective of departmental cooperation

As an innovative mode of social endowment, combining medical care with modern medical care technology and old-age service is an important direction of a series of social problems caused by the deepening of aging and the intensification of aging process in China. It is the inevitable choice for the development of Chinese characteristics for the aged. At present, with the continuous development of the combination of medical care and rehabilitation, the process of combination of medical care and breeding is slow, and the problems of inter departmental cooperation, high cost of resource integration and low service efficiency have emerged. The paper puts forward that multi head management of different responsibility management body is a bottleneck problem that hinders the integration of medical care. From the objective and subjective two points of view, the administrative system level barrier and the inter departmental interest game are the important reasons that obstruct the medical support and break through the estrangement of the Department and realize the cooperation. Then, according to the theory of large part system reform, the author boldly proposes the idea of establishing a new comprehensive functional department that specializes in the management of pension related affairs.

Health Insurance and Its Reimbursement Arrangements： Policy Evaluation on New Cooperative Medical System in Rural China

Disease has been one of the top reasons accounting for impoverishment in rural China. The government subsidizes health care through the New Cooperative Medical System since 2003 （ NCMS ）. The paper studies the effectiveness of various reimbursement arrangements in reducing the financial burden caused by health care in rural China. Using data from China Health and Nutrition Survey（CHNS） , it finds that the severity of illness, the type of illness, medical cost and other costs of the treatment are significantly influencing the choice of a type of treatment. Based on the estimated demand function, the paper concludes that the reimbursement for inmpatient care only has little effect on reducing the financial burden and the incidence of catastrophic expenditure and that expending subsidies to outpatient care is a more effective policy.

Effects of New Rural Cooperative Medical Scheme on Medical Service Utilization and Medical Expense Control of Inpatients： A 3-year Empirical Study of Hainan Province in China

Background： The New Rural Cooperative Medical Scheme （NCMS） has been further adjusted and optimized to reduce the financial burden of rural residents and to achieve universal coverage for them. In this study, we aimed to explore the impact of NCMS on medical service utilization and medical expense of inpatients in recent years. Methods： The research data of Hainan Province were extracted from the Chinese NCMS platform from 2012 to 2014. Detailed information included total expenditure, average inpatients costs, average out-of-pocket payments, actual reimbursement rate, and average annual growth rate of the above indicators. Descriptive analysis was used to gauge the effects of NCMS. Results： In the utilization of medical services, NCMS inpatients in tertiary hospital decreased from 25.49% in 2012 to 20.39% in 2014, inpatients in county hospitals increased from 39.49% to 55.92%, simultaneously. The total expenditure in county hospitals rose steadily from 28.46% to 46.66%, meanwhile, the total expenditure in tertiary hospitals fell from 60.44% to 44.51%.The average out-of-pocket costs of rural inpatients remained stable over the years. Furthermore, the compensation fund ofNCMS inpatients grew significantly. The actual inpatient reimbursement rate at township health centers increased from 76.93% to 84.04%. Meanwhile, the rate at county hospitals and tertiary hospitals increased slightly from 59.37% and 46.10% to 61.25% and 47.71%, respectively. Conclusions： With the improvement of the reimbursement ability, especially after the new health care reform in 2009, the NCMS have been playing a prominent role in alleviating the economic burden of farmers＇ medical treatment. Meanwhile, more patients go to primary hospitals than tertiary hospitals, and the capability of primary hospitals has been greatly improved.