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.

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.

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）,

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.

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.

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.

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.

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.

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.

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.

The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients

Background:Tuberculosis(TB)is still a major public health problem in China.To scale up TB control,an innovative programme entitled the'China-Gates Foundation Collaboration on TB Control in China was initiated in 2009.During the second phase of the project,a policy of increased reimbursement rates under the New Cooperative Medical Scheme(NCMS)was implemented.In this paper,we aim to explore how this reform affects the financial burden on TB patients through comparison with baseline data.Methods:In two cross-sectional surveys,quantitative data were collected before(January 2010 to December 2012)and after(April 2014 to June 2015)the intervention in the existing NCMS routine data system.Information on all 313 TB inpatients,among which 117 inpatients in the project was collected.Qualitative data collection included 11 focus group discussions.Three main indicators,non-reimbursable expenses rate(NER),effective reimbursement rate(ERR),and out-of-pocket payment(OOP)as a percentage of per capita household income,were used to measure the impact of intervention by comprising post-intervention data with baseline data.The quantitative data were analysed by descriptive analysis and non-parametric tests(Mann-Whitney U test)using SPSS 22.0,and qualitative data were subjected to thematic framework analysis using NvivolO.Results:The nominal reimbursement rates for inpatient care were no less than 80%for services within the package.Total inpatient expenses greatly increased,with an average growth rate of 11.3%.For all TB inpatients,the ERR for inpatient care increased from 52 to 66%.Compared with inpatients outside the project,for inpatients covered by the new policy,the ERR was higher(78%),and OOP showed a sharper decline.In addition,their financial burden decreased significantly.Conclusions:Although the nominal reimbursement rates for inpatient care of TB patients greatly increased under the new reimbursement policy,inpatient OOP expenditure was still a major financial problem for patients.Limited diagnosis and treatment options in county general hospitals and inadequate implementation of the new policy resulted in higher inpatient expenditures and limited reimbursement.Comprehensive control models are needed to effeaively decrease the financial burden on all TB patients.

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.

中美公共医疗保险制度的比较研究——以美国Medicaid计划和我国新农合制度为实证研究对象

Medicaid计划系美国主流公共医疗保险项目,用以针对性补偿中低收入人群的医疗费用。自1965年推行以来,Medicaid计划的覆盖率和筹资额度保持较快增速,有效缓解了中低收入人群的就医压力。经过多年发展,Medicaid计划形成了较为成熟的筹资和补偿机制,值得我国新农合制度借鉴。

新医科背景下基于校院合作的妇产科护理学混合式教学模式的构建研究

目的探讨新医科背景下基于校院合作的混合式教学模式在妇产科护理学课程中的应用与效果。方法选择我校2019级110名护理本科生为对照组、2020级113名护理本科生为观察组。对照组采用传统教学模式,观察组采用新医科背景下基于校院合作的妇产科护理学混合式教学模式。课程结束后,比较两组的期末考试成绩、自我导向学习能力、评判性思维能力和教学满意度。结果观察组的期末考试成绩及优良率高于对照组(P<0.05)。观察组的自我导向评定量表各维度得分及总分均高于对照组(P<0.01)。观察组的评判性思维能力各维度得分及总分均高于对照组(P<0.05)。观察组的各项教学满意度评分均高于对照组(P<0.05)。结论新医科背景下基于校院合作的妇产科护理学混合式教学模式能有效提高学生的学习成绩、自我导向学习能力和评判性思维能力,进而能提高护理本科生整体教学质量。

Chengdu-Montpellier Medical Cooperation Moves Up to New Level

On the morning of May 22, Dr.Cong Huiquan, international project leader under the French Health Ministry’s Medical Service, led a delegation from Montpellier University Hospital on a visit to Chengdu. During the visit, the cooperation MOU was renewed with the

医工结合、校企合作 打造基础医学实验教学新平台

教育部提出新医科示范性本科专业建设,给医学教学带来了新的机遇和挑战。从教学实践出发,从在线实验教学平台建设、信息化实验室建设、实验设备和器材的改良、创新创业教育四个方面介绍了医工结合和校企合作在基础医学实验教学中的应用,针对传统教学模式中遇到的困点、难点,分别在上述四个方面进行了创新性实践,结合校外企业在实验教学中的软件、硬件的研发投入,共同打造适应未来医学教育发展的新平台。

城乡基本医疗保险制度实施对家庭消费的影响效应及作用机制

基于1988—2018年中国家庭收入调查数据,以城乡基本医疗保险制度实施为准自然实验,采用双重差分法考察了城镇基本医疗保险与新型农村合作医疗保险(即新农合)对家庭消费率的影响及其机制。结果显示:相较于未参保家庭,参加城镇医保的家庭消费率显著高出1.01%,但新农合的影响不显著;机制分析发现,城镇医保促进了参保家庭的总消费和分项消费支出,但新农合对消费支出无显著影响,同时,城镇医保和新农合对总收入和大部分分项收入无显著影响,这与基准回归结果一致;异质性分析表明,城镇医保更多地提升了中老年、非富裕、不健康群体,以及西部地区的家庭消费率。对此,应当充分发挥基本医疗保险制度对提振家庭消费率的积极作用,对“大水漫灌”式的财政补助应进行反思;改变基本医保“户保分离”“业保分离”的现状;加强针对特定人群的医保政策;注重提高参保青年和健康群体的获得感。

新时代背景下高等医学教育改革与发展的挑战与策略研究

随着社会的快速演变和科技的不断进步,新时代对高等医学教育的改革与发展提出了新的挑战和机遇。文章旨在探讨在新时代背景下,高等医学教育所面临的主要挑战,并提出相应的策略以促进教育的创新和发展。首先,文章概述了新时代背景下医疗领域的变革,包括疾病谱的转变、医疗模式的重塑以及信息技术的融入,这些变化要求医学教育与之相适应。其次,文章探讨了传统教育模式所面临的限制,包括课程设置的僵化、教学方法的单一以及跨学科能力的缺乏,并针对性地提出了一系列应对策略,如更新教学方法以培养创新能力、促进跨学科合作以拓宽学生视野等。此外,文章还强调了培养医学生终身学习能力和人文关怀素养的重要性,以适应多元化和全球化的医疗环境,旨在为新时代医学教育的未来发展提供参考。