A research of effect of New Rural Cooperative Medical System to peasant's medical service requirement and utilization in China

Background: More than 57% of Chinese populations are resided in rural areas. From 2003, Chinese government began to carry out New Rural Cooperative Medical System (NRCMS) in rural areas. It is a new health insurance system and it covers all of Chinese rural areas. It is organized, guided and sponsored by government. Peasants join it voluntarily. The fund is raised from individual, collective and government. But the effect of NRCMS to peasants' medical service requirement and utilization is unclear. Methods: A multi-phase stratified random sampling has been adopted to select 3 sample counties (Wuyuan, Luxi, Xiushui), 9 towns, 27 administrative villages in Jiangxi province in China. 70 families from each sample village were selected randomly as the objective of study. A baseline (2003, 2004) and 4 follow-up (2006, 2007, 2008, 2010) household surveys were carried out. The questionnaire recommended by the Ministry of Health, adjusted according to the actual situation by School of Public Health, Nanchang University. Results: A total of 9390 households and 38,863 respondents participated in the surveys. From 2003 to 2010 Two-week prevalence rate changed from 105.11 ‰ to 71.24 ‰,the rate of peasants seeing doctor in two weeks changed from 84.32 ‰ to 47.58 ‰, the hospitalization rate per year increased from 46.71‰ to 77.88‰, The rate that patients should be in-hospital but they have not been decreased from 32.9% to 9.48%,The proportion of peasants who not going to hospital by financial difficulties decreased from 36.00% to 15.17%, the rate of patients leaving hospitals ahead of time decreased from 11.73% to 5.92, the main reason of patients leaving hospitals ahead of time changed from financial difficulty (65.91% ,2006) to patients thinking themselves recovered (26.92%,2010), The proportion of patients chose village clinics as their outpatient service place changed from 70.61% to 74.57% and the proportion of patients chose county hospitals as their in-hospital service place changed from 50.27% to 55.91%. All changes above are significantly. Conclusions: Peasants' out-patient service requirement and utilization in Jiangxi Province were lower than that of national average. NRCMS has low influence to peasant's outpatient service requirement and utilization. Its main role for out patient service was to expand its benefits area and it also can affect peasants' choice about seeing doctors place. It has a big influence to peasant's in-hospital service requirement and utilization and reduced economic barriers of peasant's in-hospital service effectively.