School of Health Administration, Anhui Medical University, Meishanlu 81, Hefei, Anhui, China.
BMC Public Health. 2011 Jan 24;11(1):50. doi: 10.1186/1471-2458-11-50.
In 2003 the Chinese government introduced voluntary cooperative medical schemes (CMS), soon to be in place throughout rural China. Families who chose to enroll do so as a single unit and nothing is known about any differential effect of these new schemes on family members. This study evaluates the impact of one pilot CMS in Anhui Province on health care use by girls aged less than 5 years and women 65 years or older, and on the pattern and cost of prescriptions.
Health care records were extracted covering a 10 year period, before, during and after the pilot CMS in 4 townships, one with the intervention and 3 comparison townships without. The impact of the intervention on the age and gender distribution of patients presenting for health care and on the prescription of certain drugs was assessed by logistic regression. The cost of prescriptions before, during and after the intervention period was also assessed.
203,058 registration and 643,588 prescription records were identified. During the intervention there was a reduced likelihood overall that a patient was female (OR = 0.92: 95%CI 0.87-0.97) at the intervention site. Girls aged < 5 years had an increased likelihood of health care (OR = 1.41: 95%CI 1.23-1.59) during the CMS, but women ≥ 65 years were relatively disadvantaged (OR = 0.84: 95%CI 0.75-0.95). The use of antibiotics and systemic steroids increased disproportionately at the intervention site for patients ≥ 5 years. Prescription costs at the township hospital also increased at the intervention site, particularly for older men.
This evaluation suggests that all family members did not benefit equally from the pilot CMS and that women ≥ 65 years may be disadvantaged by the newly available reimbursements of health care costs through the CMS. It points to the need, in future evaluations, to use individuals rather than families as the unit of analysis, in order to determine whether such health care inequalities are wide-spread and persistent or are reduced in the longer term. The results also support earlier concerns about the influence of new funding resources on prescription practices and the need for regulation of for-profit prescribing.
2003 年，中国政府引入了自愿合作医疗计划（CMS），很快将在全国农村地区实施。选择参加的家庭作为一个单一单位参加，目前尚不清楚这些新计划对家庭成员有何不同影响。本研究评估了安徽省一个试点 CMS 对 5 岁以下女孩和 65 岁及以上妇女的医疗保健使用、处方模式和费用的影响。
提取了覆盖试点 CMS 前、中、后 10 年的健康记录，在 4 个乡镇进行，1 个干预乡镇，3 个对照乡镇。通过逻辑回归评估干预对就诊患者年龄和性别分布以及某些药物处方的影响。还评估了干预前后的处方费用。
共确定了 203058 条登记记录和 643588 条处方记录。在干预期间，干预点的女性就诊患者总体上不太可能（OR=0.92：95%CI 0.87-0.97）。<5 岁的女孩在 CMS 期间更有可能接受医疗保健（OR=1.41：95%CI 1.23-1.59），但≥65 岁的妇女相对处于劣势（OR=0.84：95%CI 0.75-0.95）。≥5 岁的患者在干预点使用抗生素和全身类固醇的比例不成比例地增加。干预点乡镇医院的处方费用也有所增加，尤其是老年男性。
本评估表明，并非所有家庭成员都能平等受益于试点 CMS，≥65 岁的妇女可能因 CMS 新提供的医疗费用报销而处于不利地位。它指出，在未来的评估中，需要以个人而不是家庭为分析单位，以确定这种医疗保健不平等是否广泛存在且持久，或者是否在长期内减少。研究结果还支持了人们对新资金来源对处方行为的影响以及对营利性处方监管的早期关注。
