Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang 330006, Jiangxi, China.
Department of Public Health Sciences, University of Hawaii at Mānoa, Honolulu, HI 96822, USA.
Int J Environ Res Public Health. 2018 Jun 29;15(7):1368. doi: 10.3390/ijerph15071368.
This survey study was conducted to understand the effect of the New Cooperative Medical Scheme (NCMS) on farmers’ medical expenses through comparing the information from five investigations and to obtain a scientific basis for a more applicable NCMS. The survey was carried out through interviewing farmers in their homes. The multi-phase stratified cluster random sampling was adopted to select 3 counties from all 92 counties of the Jiangxi province, 9 townships from the 3 selected counties, 27 villages from the selected 9 townships, and 60 families from each village between 2006 and 2014, and a longitudinal comparative analysis was conducted. The numbers of households/overall sample for the five years were 1924/8082, 1879/8015, 1885/7506, 1890/7857, and 1896/7811, respectively. We collected family members’ social demographic characteristics, health resources, and peoples’ health and medical expenses and reimbursement of each family member. The adjusted hospitalization expenses per capita of township hospitals and county hospitals were totally on a rising trend. However, the costs of tertiary hospitals were on a decreasing tendency. In addition, the expenses for county hospitalization per admission were on an upward trend in general. Furthermore, the total hospitalization expenses and reimbursement per capita (the insurance paid out for the hospitalization expenses) were also all on an upward trend. The proportion of reimbursement also had a tendency of increasing from 24.41% in 2006 to 41.34% in 2014. The costs paid from farmers’ pockets were fluctuated, but in general all lower than the costs in 2006. Furthermore, the percentage of hospitalization expenses from farmers’ annual incomes gradually decreased each year from 56.38% in 2006 to 26.58% in 2014. NCMS program has had an obvious impact on the hospitalization expenses in the Jiangxi rural area. It reduced the hospitalization expenses of the tertiary hospitals significantly. In addition, the program has also encouraged farmers to get more health care. However, there are still some shortages associated with present construction of the NCMS. Hence, there is a need for local government to continue to take effective countermeasures to control the rising trend of hospitalization expense.
本调查研究旨在通过比较五项调查的信息，了解新型农村合作医疗制度（NCMS）对农民医疗费用的影响，为更适用的 NCMS 提供科学依据。调查通过家访的方式对农民进行访谈。采用多阶段分层聚类随机抽样方法，2006 年至 2014 年，从江西省 92 个县中选取 3 个县、3 个县中选取 9 个乡镇、9 个乡镇中选取 27 个村、每个村选取 60 户家庭，进行纵向对比分析。五年的户数/总样本数分别为 1924/8082、1879/8015、1885/7506、1890/7857、1896/7811。收集了每个家庭/成员的社会人口统计学特征、健康资源、居民健康和医疗费用以及家庭成员的报销情况。乡镇卫生院和县级医院的人均住院费用呈上升趋势，而三级医院的费用呈下降趋势。此外，县住院费用一般呈上升趋势。此外，人均住院总费用和报销费用（用于支付住院费用的保险）也呈上升趋势。报销比例也呈上升趋势，从 2006 年的 24.41%上升到 2014 年的 41.34%。农民自付费用波动较大，但总体低于 2006 年的费用。此外，农民年总收入中住院费用的比例逐年从 2006 年的 56.38%下降到 2014 年的 26.58%。NCMS 项目对江西农村地区的住院费用产生了明显影响，显著降低了三级医院的住院费用。此外，该项目还鼓励农民获得更多的医疗保健。然而，目前的 NCMS 建设还存在一些不足。因此，地方政府需要继续采取有效措施控制住院费用的上升趋势。
