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.

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.

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.

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）,

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.

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。

乡村振兴视角下农民对新农合满意度影响因素研究——来自全国2152个农户的微观数据

人们对美好生活的向往是乡村振兴的关键衡量指标,农民对新农合满意度评价影响到农民对于乡村振兴建设的满意度。本文关注乡村振兴视角下,农民对新农合满意度影响因素,利用全国2152个农户入户调查数据,采用Eveiws软件对数据进行了有序Logistic回归分析,结果表明:整体上农民对新农合满意度高于不满意度比例,55%对新农合表示满意,37%则对新农合持有一般态度;年龄、文化程度、农民纯收入对新农合满意度具有显著正向作用,说明提升文化程度以及改善人民收入,有利于提升新农合满意度;通过网络获取医疗信息便利度对新农合满意度有显著正向影响,表明互联网的使用,强化了农民信息获取、便利了农民之间的交流,从而带动了人们对农村新农合的满意度;比照东北区域村庄,东部区域和中部区域村庄居民对新农合满意度要低一些。

农民参与新型农村合作医疗及满意度分析--基于3省245户农户的调查

调查数据表明,农民的新型农村合作医疗参合率高达93.33%。logistic模型实证发现,与周围的人大多不参与新农合的受访者相比,周围的人大多参与新农合的受访者的新农合参与率要高出314倍。通过其他方式宣传而参与的农户要低68%。高收入者参与新型农村合作医疗的可能性要高3.45倍。有90.3%的参合者对新型农村合作医疗制度总体表示满意,农民对各级医疗机构服务的满意程度均超过80%,但仍存在着新农合制度保障水平偏低以及基层卫生医疗服务在技术、态度、收费等方面不能满足农民需求等问题。

中国西部农村地区某县孕产期保健利用现状及对策研究

目的了解西部农村地区某县妇女孕产期保健利用现状及影响因素。方法对544名妇女进行问卷调查,对44名卫生服务管理者/供者以及42名妇女进行访谈。结果 70.6%的孕产妇参加了新型农村合作医疗(新农合),32.9%获得报销,未获报销的66.0%是因为超生。新农合缓解了具有产科危重症或并发症的孕产妇的经济负担。流动人口的报销手续复杂。卫生人力资源主要分布在县医院和妇幼保健院,在乡镇卫生院,中专以下学历占1/4。2005年至2008年的保健总收入中,政府拨款仅占妇幼保健总收入的5.0%。近1/5妇女的孕产期保健总费用超过家庭年收入的20%。选择县级医院、乡镇卫生院分娩的分别占39.8%和58.6%,服务质量和交通方便是选择的主要原因。偏远山区交通不便影响地理可及性。"坐月子"、重男轻女、为挑时辰而择时剖宫产、"方音岛"现象阻碍了孕产妇保健利用。结论新农合政策在一定程度上提高了该地区的孕产期保健的服务利用度,偏远乡镇的地理可及性亟须提高。目前尚有多种社会文化因素制约孕产妇保健利用。

新型农村合作医疗满意度及影响因素分析

目的了解山东省威海市农民对新型农村合作医疗制度满意度及影响因素,为进一步推行新型农村合作医疗制度提供科学依据。方法按照分层随机整群抽样的方法抽取威海市4303名农村居民,用多元Logistic回归分析满意度影响因素。结果对新型农村合作医疗的满意率为73.2%。满意度主要受是否参加过体检(P=0.024)和是否住院(P=0.002)因素影响。结论威海市农村居民对新型农村合作医疗制度的满意率较高,扩大体检覆盖率有利于提高新型农村合作医疗制度的满意率。

我国新农合重大疾病保障制度的政策分析

目的:回顾我国新农合大病保障制度的发展过程,分析政策执行现状和运行效果,为完善政策提供参考。方法:利用政策分析方法,分析新农合大病医疗保障政策的形成背景、执行与效果,其中定量资料用描述性统计方法进行分析。结果:自2010年政策启动,新农合大病保障的病种及试点范围稳步扩大,2012年全国大病保障有99.6万名患者受益,受益率为12.45人次/10万参合人口,东部地区受益率高于中部和西部地区;全国20种大病实际补偿比达65.39%,儿童两病等4类大病的实际补偿比超过70%,中部地区补偿水平略高于东部和西部地区。结论:新农合重大疾病保障政策推进良好,基本实现政策目标,但区域间保障待遇存在差异,保障受益面有待进一步提高,可持续发展也面临挑战。建议:多种方式提高新农合大病保障水平,处理好新农合大病与一般疾病保障的关系,促进保障工作的可持续发展,加强对政策实施的监督与评价。

陕西省新农合单病种定额付费改革的效果分析——基于镇安和旬邑两县的抽样调查

目的:实证分析陕西省单病种定额付费改革的实施效果。方法:选择陕西省镇安和旬邑两县作为研究对象。资料主要包括两县2008—2011年的新农合报表;同时对两县164名县级医院医务人员进行调查,了解他们对单病种定额付费的认知。定性资料主要采用焦点组访谈和个人深入访谈的方法,共访谈32人。利用SPSS13.0和EXCEL2007等软件进行数据分析。结果:单病种定额付费改革后医疗机构次均住院费用增速减缓,对医疗服务质量的影响尚不确定,对医务人员的满意度产生一定影响,提高了参合农民住院医疗服务的可及性,有助于引导患者合理就医,促进卫生资源有效利用;实施单病种定额付费患者的疾病负担缓解程度更加明显,也有助于降低新农合基金的风险。建议:科学制定支付标准,为顺利实施单病种定额付费改革奠定基础;建立健全针对供方的有效激励约束机制;加强单病种定额付费对医疗服务质量影响的研究和对定点医疗机构的监管。