New cooperative medical financing policy and hospitalization in rural China: multi-stage cross-sectional surveys.

ABSTRACT

BACKGROUND: In 2003 China began to implement the New-type rural Cooperative Medical System (NCMS). This provided enhanced funding for hospital-based medical services among farmers. We examined self-reported utilization data for evidence of changes following the new policy. METHODS: We conducted a multistage stratified random cluster sampling method for Jiangxi Province, China. Data were collected via five surveys in 2003-4, 2006, 2008, 2010, and 2012. The study compared the rates of hospitalization, early discharge, and hospital avoidance as descriptive indices after weighting the data. Weighted multiple logistic regression analysis was used. Multi-stage cross-sectional analysis was used to explore the reasons for early discharge and for avoiding the hospital during illness. RESULTS: We found that the rates of hospitalization, early discharge and hospital avoidance showed upward, downward and downward changes respectively. The logistic regression analysis showed that, controlling for other factors, the financing level significantly affected the changes of the three indexes (p<0.05). The proportion of finance-related early discharge and hospital avoidance dropped significantly (p<0.05). CONCLUSIONS: NCMS improved the utilization of in-hospital services step by step as time went on, and greatly alleviated cost-related barriers to accessing health services. Even so, because costs continue to restrict access to services we should continue the NCMS policy and improve its guarantee levels.