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.

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 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.

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.

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.

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.

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.

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.

基于Ordinal logistic回归的陕西省某县新农合大病补助满意度影响因素研究

目的了解陕西省某县新农合大病补助满意度情况,探讨其影响因素。方法采用分层整群随机抽样方法,选取4个行政村进行问卷调查。应用SPSS16.0统计软件进行单因素和多因素分析,建立Ordinal logistic回归模型探讨参合农民对新农合大病补助满意度的影响因素。结果 86.2%(647/751)的参合者对大病补助制度满意,按影响力由大到小排序后的5个影响因素依次是:大病补助范围、大病报销比例、医院技术水平、政策宣传和年龄。结论陕西省某县参合农民对本地实行的新农合大病补助制度满意度较高,但仍可通过合理扩大补助范围、提高报销比例、提升定点医院技术水平、加强相应政策的宣传来进一步提高。

人口老龄化背景下农村医养结合服务的现状与对策——以唐山市乐亭县为例

以唐山市乐亭县农村医养结合服务模式和现状为例,针对目前农村地区医养结合服务存在的供需失衡、“医”与“养”资源融合不足、设施落后、缺乏专业服务人员等问题,提出完善政策体系和保障制度,强化医养衔接,开展多层次医养结合服务,加强人才队伍建设,构建医养结合信息化系统的对策建议,从而推动农村医养结合的发展。

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。

基于PEST模型的我国农村医养结合养老服务发展策略研究

我国老龄人口比例逐年攀升,尤其是农村地区,老龄化现象更为严重。文章对我国农村医养结合养老服务的发展状况进行梳理,运用PEST分析模型对其在政治、经济、社会和技术4个方面所面临的困境进行分析研究。在借鉴国外医养结合养老服务实践经验的基础上,针对性地提出加强政策支持、拓宽资金来源、增强宣传和社会参与,以及完善信息建设与人才培养等方面的发展策略,以期对我国农村医养结合养老服务的后续研究与实践提供参考。

基于社会资本理论的农村失能老人医养结合型互助照护体系研究

目的:基于社会资本理论,提出构建农村失能老人医养结合型互助照护体系的可行方案。方法:以西部某村的实践为典型案例,从“资源-关系-信任”维度,分析该村失能老人互助照护的做法和成效。结果:案例中,村民自发形成的互助照护模式充分挖掘了农村资源、关系和信任资本,是解决农村照护人力资源稀缺、照护资源可及性差和康复成本高等多重困境的有效手段。结论:在农村构建失能老人医养结合型互助照护体系,具有较强的可行性。通过协同整合挖掘农村现有医疗资源与人力资源的潜力,并适度补贴,形成层次性医养结合型互助照护体系,可缓解农村失能老人照护困境。

大病保险、医疗服务升级与农民健康

“健康中国2030”规划纲要明确了健康对经济社会发展的重要作用,在新型农村合作医疗制度未能显著改善农民健康的背景下,研究农民健康水平的提升机制具有重要意义。本文聚焦2012年8月开始试点实施的城乡居民大病保险制度,基于2011—2015年中国健康与养老追踪调查(CHARLS)数据,以样本所在城市是否试点实施农村大病保险作为依据构造“农村大病保险”参保变量,运用计量模型实证检验农村大病保险对农民健康的影响效应及机制。实证结果显示,试点农村大病保险使农民自评健康显著提高0.08个单位,并且在对健康水平和农村大病保险等变量进行重新调整的情形下,实证结果依然稳健。异质性分析结果显示,农村大病保险对低收入群体的健康促进作用更大,并且对社区内有医疗点的群体影响效果更为显著。机制分析结果显示,对于需住院群体而言,农村大病保险通过促进农民做出住院决策进而改善了健康;而对于住院群体,农村大病保险通过促进农民选择级别更高的县区级医院进而改善了健康。为进一步提高农民健康水平,应丰富农村大病保险的筹资主体,引入个人缴费和财政补贴,在扩大大病保险基金规模的前提下,进一步提升大病保险待遇水平;同时,应改善农村基层医疗资源分配,提高农民基层医疗服务可及性和服务水平。

都市圈新城区乡村医疗服务中心地网络结构及其影响因素研究——以武汉市新城区为例

医疗服务是维护居民健康的重要保障。基于修正引力模型和社会网络分析法,分析武汉市6个新城区乡村医疗服务中心地空间网络结构及其影响因素。研究表明:(1)新城区乡村医疗服务中心地呈现网络结构,多中心层级化共存。医疗服务网络密度整体上处于初级阶段,总体关联度偏低,且大部分联系限于各区内部,整体节点聚集度较低。医疗服务中心地的网络非均衡性明显,形成了不同尺度的空间嵌套格局。(2)医疗服务中心地可分为6个子群,并呈现由内到外的圈层结构。6个子群的空间关联网络由北向南形成层次分明的板块,而且呈现出小团体现象。特别需要指出的是,子群的划分表现出鲜明的邻近指向特征,地理邻近关系对医疗服务中心地关联强度的影响比较明显。(3)空间邻近性、农业产值、第二产业企业注册资本、人口数量、城镇化水平、道路密度和交通可达性对新城区乡村医疗服务中心地空间关联网络强度的提高具有显著影响,而第三产业企业的影响并不显著。

农村慢性病老年人医养结合型照护模式实现路径

目的:通过实地走访广东省某村,调查慢性病老年人的照护现状,并探讨实现农村慢性病老年人医养结合型照护模式的可行性对策。方法:选取广东省某村慢性病老年人照护实践作为研究案例,采用案例分析法,对村民间互助照护的实践做法及其成效进行深入分析与评价。结果:农村地区存在较为紧密的社会关系网络。案例村通过动员闲置劳动力资源,有效缓解了慢性病老年人的照护压力,减轻了家庭照护负担。同时,病人通过共同购买康复辅助器具,实现了成本分摊,降低了康复治疗费用。共同的康复需求促使病人频繁聚集,有利于促进彼此的身心健康,形成了一种有效的医疗互助照护模式。结论:医养结合型互助照护模式可以在一定程度上缓解基层慢性病老年人的养老困境,有助于解决农村养老照护人力资源短缺、照护服务水平低下以及康复成本高昂等问题。

病有所医、病无所恐:我国农村合作医疗制度发展历程、运行逻辑与未来进路

新中国成立70多年来,国家一直在探索如何更好地为农村人口供给可负担、高质量的医疗保障,在经历了从传统农村合作医疗到新型农村合作医疗的不间断探索后,形成了中国特色社会主义制度下的农民医疗保障全覆盖模式,这种连续性、从未间断的合作医疗形成了新中国治理变迁的独特经验,是形成国家发展的“中国奇迹”的一种基础保障力量。以历史变迁的长镜头观之,我国合作医疗历经了从“集体福利”“个体消费”“民生服务”走向基本公共服务均等化的实践轨迹,各个阶段都努力在现实需求与资源约束的矛盾运动下最大限度保证农民群众“人人看得起病”。为了在更高水平上保障农民“病有所医、病无所恐”,未来需要继续大力推动城乡居民基本医疗保障制度的一体化改革,扩展农民群众医保报销范围、降低个人承担份额,最终实现城乡居民人人享有健康权利的国家战略规划,迈向以人民为中心的社会主义“共同健康”之路。