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Study on the Sustainable Development of the New Rural Cooperative Medical System

Author: ZhuMinJie
Tutor: ChenKun
School: Zhejiang University
Course: Public Health
Keywords: The new type of rural cooperative medical care Health resources Farmer Health protection Sustainable development
CLC: R197.1
Type: Master's thesis
Year: 2007
Downloads: 694
Quote: 2
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Abstract


The medical insurance system is an important part of the social security system, social harmony and development \A very large number of farmers in China, accounting for more than 70% of the population. Farmers are not wealthy, the entire country can not be rich and powerful; well-off farmers, there is no comprehensive well-off society as a whole. Thus, to establish and improve the rural medical security system to improve the health of farmers, protection of rural productivity, revitalization of the rural economy, and safeguard the overall interests of the rural social development and stability, and to improve the quality of the whole nation, and building a moderately prosperous society and the building of a new socialist countryside, are of great significance. In January 2003, the State Council forwarded the \three counties (cities) of the first pilot to gain experience and gradually extended. Zhejiang Province, as a province of the economically developed eastern coastal areas, the first pilot of one of the provinces in the country, to start the new type of rural cooperative medical work in 27 counties from August 2003 to February 2006, 87 pilot counties , covering all cities and counties have agricultural population, the first in the country to achieve a comprehensive coverage of the cooperative medical care, and the corresponding adaptation counties have established a medical assistance system. Starting from the pilot has been more than 3 years, and how the status of implementation of the new type of rural cooperative medical care in Zhejiang Province mainly what are the problems, sustainable development etc. These issues have been put on the agenda today. Research methods to the theory of evidence-based public health guidance of the combination of qualitative and quantitative studies \Literature demonstrate the concept of evidence-based, first determine the search topic, develop search strategies to collect comprehensive evidence of the latest research on the field of rural medical security, Zhejiang, literature and data from ① VIP Chinese Science and Technology database ; ② \Zhejiang rural public health service system \2, on-site research through expert demonstration, select a different level of economic development, five counties and cities in different geographical environment, Tongxiang City, Kaihua County, Shaoxing County, Chunan County and Taishun County samples County; in five samples County, South, West, North, and in each location of each extract a township; randomly selected five villages in the township is pumped; pumping in the village 60 households were randomly selected for the survey from June 4, 2006, to July 4, 2006, using a questionnaire household survey of 4451 households face-to-face family health interview survey to understand farmers' subjective view of the new type of rural cooperative medical care, medical expenses and reimbursement as well as the utilization of health resources and so on. The results, socio-economic conditions of the farmers in Zhejiang Province in 2005, survey of annual household cash income of 19,432.63 yuan after deducting costs, in-kind equivalent to annual income into RMB 3137.74 yuan. On the expenditure side, the average family expenditures 15,806.90 yuan, including medical and health expenses 1807.13 yuan, accounting for 13.76%; maximum borrowing capacity in the family, the family of the survey average borrow 2592.60 yuan (median 1000). Farmers savings use is education, cost of living and housing, respectively, accounting for 32.91%, 24.29% and 23.77%, pension savings accounted for 11.05%. 3.57 percent of poor households in the surveyed households, caused by damage due to disease, poverty accounted for 41.61 percent, the highest proportion. 2, to participate in the new rural cooperative medical situation and its influencing factors in 2005, 88.87% of the participation rate of the family unit, the survey of family units. In the cooperative medical care did not participate in the family, 29.09% of domestic households can not afford to pay the participation fee cause they do not participate in the new cooperative medical care, 19.11% think that benefit from surface too little, there are 15.24% believe that good health is not necessary to attend. Ratio of 90.74% on an individual basis, to participate in a variety of social health insurance, which the Senate combined ratio of the new type of rural cooperative medical care, to 87.41%. 41.16% of the patients through the crowd two weeks, to know their own medical expenses can be reimbursed, and 23.90% of the people do not know. , 72.75% of the family is completely voluntary participation, and 89.52% of national policy in favor of the families surveyed. The investigation on the assumption that users increased household income, 34.86% of the children cultural education spending will increase by 6.72% for medical expenditures. 72.07% of the households that participate in the new rural cooperative medical care to enjoy better medical services, 70.29% of all households back into poverty due to illness, can reduce the risk of poverty caused by the good for 85.65 percent of the households in rural masses, 72.53 % of households can reduce a family's medical expenses. 81.60% village cadres try to attend; 78.02% of the rest of the family try to attend. 9.67% of households that pay high levels of current or 13.08% (575/4407) that the payment level is very low or low. 4.23% of households in the countries now use the new cooperative medical policy are not satisfied or very dissatisfied; 20.16% of the households that reimbursement procedures is not convenient or inconvenient, the sick doctor claims over the crowd in two weeks, only 1.47 % of farmers believe that the ease of reimbursement is poor or very poor; in hospital reimbursement crowd, the 6.25% that ease of reimbursement status is poor or very poor. The families surveyed, 78.53% of people believe that or believe that the new type of rural cooperative medical care will insist gone out of existence. Influence next year's participating in the cooperative medical factors that cooperative medical trust Japanese big impact accounted for 25.09 percent, the largest proportion; think that the physical health of the impact of Japan only 10.49%. 3 farmers the cost of medicines and the new rural cooperative medical claims in the year 2005, individual farmers, medical expenses occurred an average of 604.29 yuan (median 100), an average of 250.98 yuan (median) cost of hospitalization occurred; in medical costs spent on the two-week prevalence farmers, with an average of 652.31 yuan (median 150); the hospitalized farmers last hospitalization medical expenses averaged 9432.54 yuan, the indirect costs of hospitalization averaged 1121.44 yuan. Survey of medical expenses in 2005, has already occurred, the average medical expenses 3395.55 yuan, 1484 can be reimbursed, accounting for 11.58%. In 90.21% of the population of reimbursement of medical expenses reimbursed from the new type of rural cooperative medical care. In the crowd from the cooperative medical reimbursement of medical expenses, the 2005 annual per capita medical expenses reimbursement amount to 545.70 yuan, the reimbursement rate of 17.23%; two-week prevalence reimbursement amount to 70.62 yuan, the reimbursement rate of 3.55%; hospitalized expense reimbursement amount is 1991.96 yuan, the reimbursement rate was 22.37%. Reimbursement of medical expenses in 2005, per capita income 0 ~ 2000 ~ 5000 ~ 8000 ~ ($) packet reimbursement of 14.50%, 14.17%, 14.32% and 20.51% of the high-income group from cooperation the largest proportion of medical reimbursement. 4, the farmers' demand for health services utilization in the medical institutions of the distance surveyed, 55.41% family medical units village health clinic or community health service stations, 39.32% of the households township hospitals or community health service center. The two institutions together 94.73% of the total response. 55.68% of the households within one km away from the nearest medical unit distance, 22.63 percent of households between 1-2 km, 5 km and above accounted for 5.83%; 72.05% households within 10 minutes to the nearest medical units. time required (including walk and ride), accounting for 6.50% of the more than 30 minutes; 90.25% of households from the nearest medical units or convenient. Sickness 80.97 percent will find a doctor, followed to the pharmacy to buy medicine or self-collected in the form of traditional Chinese medicine (TCM), accounting for 17.69%. 52.60% indicated that they would go to the village health clinic or community health service stations, and 35.79 percent to the township hospitals or health service center. Cause analysis on the choice of treatment units, accounting for 56.38% of users consider the medical unit of distance. Farmers in the two-week prevalence, 86.10% (545/633) of treatment, 72.68% of the patients to find a doctor treatment; 37.41% of patients choose the streets, hospitals and other primary care doctor, followed in all kinds of out-patient or health room visits, accounting for 26.86%. 68.96% seek treatment is the sentinel of the cooperative medical medical institutions, 6.09% were not sure. Farmers two weeks did not visit a ratio of 23.97%, the reasons for not visit and did not receive any treatment constitutes economic difficulties accounted for 46.15%. Survey hospitalization rate of 2.67%, hospitalization annual average hospital stay was 1.08 times. The primary cause of the disease, accounting for 64.18%, followed by childbirth, accounting for 16.33%. The highest proportion of hospitalization, hospitalized at the county and municipal hospitals, accounting for 50.14%; average hospital stay was 11.83 days; surgery by a ratio of 46.11%. Digestive diseases in the hospital were the highest, accounting for 18.71 ‰, followed by pregnancy, childbirth, and related diseases, accounting for 15.79%. Classified according to the names of diseases, the highest normal delivery, accounting for 13.74%. 61.13% of the discharge in discharged reason, the disease recovered and was discharged from the hospital the doctor asked, 25.82% of discharged their own requirements and discharged. Own request discharged, due to financial difficulties caused by discharges account for 68.93%. Should be hospitalized without hospitalization ratio of 2.67%; should be hospitalized without hospitalization causes economic reasons accounted for 71.25%. Third, the conclusions of this study show that the new type of rural cooperative medical care system in Zhejiang Province has a good opportunity for development, mainly in: build a favorable policy environment for the implementation and development of the new type of rural cooperative medical care system, has the ability to provide strong material security, a good historical basis, the mass base, run basis and gradually improve the informatization construction, to create good conditions for the development of a new type of rural cooperative medical system. At the same time, the new type of rural cooperative medical care system in Zhejiang Province, there are many problems and facing challenges. Farmers mainly for the benefit of face small benefit low and high medical costs, inadequate protection and the vicious cycle will result in a new type of rural cooperative medical care system; system design targeted at \the normal operation of the trust of the cooperative medical care system; suppressed demand for the release of medical and health services, may occur over-utilization of health care resources of the medical expenses that may occur threat, potential rise in the new rural cooperative medical system; farmers' health-care related knowledge low awareness pale Pu, incompatible with the economic development and hinder the development of a new type of rural cooperative medical care system. Therefore, this study suggests that: innovative financing mechanisms of the new type of rural cooperative medical care, to ensure a stable, adequate operating funds; advocated giving priority to efficiency with due consideration to fairness, \strong \basic health and health needs, in order to protect the sustainable development of the new type of rural cooperative medical care system.

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CLC: > Medicine, health > Preventive Medicine,Health > Health care organizations and career ( Health Management ) > Health care systems and institutions > Health care system
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