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Developing a Basic Medical Insurance Statement in Chinese Underdeveloped Areas

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Iran J Public Health, Vol. 47, No.4, Apr 2018, pp.489-498 Original Article Developing a Basic Medical Insurance Statement in Chinese Underdeveloped Areas Hongpu HU 1, *Yanli XU 2, Qingkun CHEN 1, Juan LI 1, Chenliu YANG 1, Yanli WAN 1 1. Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing, China 2. Medical College of Hebei Engineering University, Handan, Hebei, China *Corresponding Author: Email: [email protected] (Received 12 May 2017; accepted 11 Oct 2017) Abstract Background: We presented the running state of rural basic medical insurance system in Henan and discussed the enforcements and development experiences of underdeveloped areas. We provided data evidence to sup- port the improvement and development of a basic rural medical insurance system. Methods: We selected Henan Province, China as a sample, using the method of cluster sampling, from policy documents published in the national and provincial level of the new rural cooperative medical policy and work documents, data from 2004 to 2014, the National Health Statistical Yearbook of health statistics yearbook of Henan Province and relevant statistical data of the province. Results: The new rural cooperative policy has covered the whole population in Henan Province. The number of individual received benefits is increasing. In 2013, the number of persons counted has reached to 270 million, funds raised and expenditures reached 38.5 billion and 26 billion, respectively. The operational task force has been developed rapidly. In 2013, on average each staff managed the cases for 16.4 thousand rural residents. Conclusion: The major implementation and development experience from the new rural cooperative policy of Henan province include: education of related knowledge, optimization of compensation plan, development of operational system and framework, improvement of management rules, reinforcement of information system development and financial supervision and increment of investment in rural medical healthcare. Keywords: Underdeveloped areas, Rural basic medical insurance system, Development experiences Introduction As an economically unbalanced agricultural coun- farmers and reducing economic pressures of farm- try, China still has realistic problems that limit the ers are important to narrow the urban-rural gap, developments to become a well-off society and build new socialistic villages and maintain social towards modernization, such as excess rural popu- stability. The rural cooperative medical care system lation and the following three rural issues includ- in China has been developed for more than 60 ing agriculture, rural areas and farmers (1). There- years, and it makes it effective to provide appro- fore the physical and mental health of farmers and priate medical health services to farmers with only their satisfaction of rural medical services are es- a small amount of healthcare co-pays from farm- pecially important to the future of medical devel- ers at low income level. To keep up with the mod- opments. In the meantime, establishing a high ernization of the society and resolve the problems quality rural basic medical insurance system, for rural residents to seek medical advice, the Cen- providing superior medical health services to tral Committee of the Communist Party of China 489 Available at: http://ijph.tums.ac.ir Hu et al.: Developing a Basic Medical Insurance Statement in Chinese … (CPC) and the State Council promulgated “the NCMS, development of NCMS Agencies, de- Decision on Rural Health Works Enhancement” fined as: in October 2002, and it indicated the purpose of The participation of farmers = the number of the new rural cooperative medical system participating farmers in the province / the total (NCMS). In the second half year of 2003, the im- number of farmers in the province×100%; plementation of NCMS officially started. In ten The benefit of participating farmers = the number years, the government has improved rural basic of compensation farmers in the province / the medical treatment, established a medical system, number of participating farmers in the province and solved the difficulty and high cost for farmers ×100%. to receive quality medical treatment, and NCMS Henan Province is located in the middle of China, has achieved major success. near the middle and lower segment of the Yellow Currently, the economic development of China is River, southwest of Huang-Huai Plain, next to 6 imbalanced, the eastern region of China experi- provinces including Shandong, Anhui, Shanxi, Hu- ences rapid development while the middle and bei, Shanxi and Hebei. Henan has 18 prefecture-level western regions are being developed sluggishly. A cities: Zhengzhou, Kaifeng, Luoyang, Pingdingshan, good economy should guarantee the enforcement Anyang, Hebi, Xinxiang, Jiaozuo, Puyang, Xuchang, of rural medical insurance system, however the Luohe, Sanmenxia, Nanyang, Shangqiu, Zhoukou, low economy status of underdeveloped areas lim- Zhumadian, Xinyang, Jiyuan, abuts 5 cities: Gongyi its the coverage and compensation of rural medi- city, Xiangcheng city, Yongcheng city, Gushi city, cal insurance system (2). Meanwhile, the large Dengzhou city, and a total of 103 counties. Henan rural population and the increasing medical ser- has a large total population and a large agricultural vice need swill also propel rural medical insur- population; in 2010, the population in Henan took ance system to become a significant basic policy 7.01% of the total population of China. While Chi- including active exploration and constant im- na’s rural population was 8.57% of the total rural provement. This study applied cluster sampling population of China, Henan’s rural population method to data from Henan province which has (57,540 thousand) was 61.2% of the total population an under-developed economic status to present (94,050 thousand) of Henan Province (2). Compar- the current state of rural basic medical insurance ing to other provinces in China, Henan is at a lower system, and discuss the experiences about how economic development stage and has a larger popu- underdeveloped areas establish rural basic medi- lation, lower cultural education level, less cultural cal insurance system. Finally, we provided scien- quality, serious outflow of higher educated residents, tific evidence regarding rural basic medical insur- unsubstantial economic foundation, insufficient ance system improvement and enforcement. long-term investment and higher proportion of pov- erty counties, which all limit the developmental Methods speed of Henan. In this study, the SPSS software (Chicago, IL, This study selected Henan Province as a sample, USA) was used to make a descriptive statistical using the method of cluster sampling, from poli- analysis of the above indexes by using the average cy documents published in the national and pro- number, median, rate and so on. vincial level of the new rural cooperative medical policy and work documents, data from 2004 to Results 2014, the National Health Statistical Yearbook of health statistics yearbook of Henan province and Development History of Henan Rural Basic relevant statistical data of Henan Province. The Medical Insurance System main indicators of policy effectiveness evaluation Henan is a large agricultural province. The total include farmers’ participation Status, benefit situ- rural cooperative population of farmers is ation of NCMS Farmers, financing situation of 81,190,000. Properly solving most rural civilians’ Available at: http://ijph.tums.ac.ir 490 Iran J Public Health, Vol. 47, No.4, Apr 2018, pp. 489-498 medical insurance problems is the most key pri- Province responded to the call of CPC central ority to people in the province. After the found- committee to start NCMS implementation. ing of the People’s Republic of China, Henan NCMS has innovation and development on rural basic medical insurance system experienced planning government responsibilities and insur- multiple stages from sprout, initiation, develop- ance contents. NCMS is farmers’ medical treat- ment, climax, recession, recover rebuilding, sec- ment mutual assistance system which has organi- ond time cooperative medical treatment to the zation, guidance and support from government, NCMS phase, and it went with constant explora- voluntary participation of farmers, financing tion (3). from individual participants, collectivity and gov- The initial stage of country establishment (1949- ernment. Meanwhile, it mainly includes severe 1965) is the sprout of Henan rural basic medical disease plan. NCMS usually sets county as the insurance system. In 1955, Henan health depart- unit of plan as a whole, and it is mainly used as ment announced “Joint Medical Institutions subsidy of large medical treatment fees or hospi- Regulation”, it was the policy basis of the prov- tal medical treatment fees. NCMS, mainly includ- ince’s cooperative medical treatment. During the ing severe diseases plan as a whole, is a health period of 1965 to 1980, Henan rural cooperative service institution which match with the require- medical treatment started to reach a new level. ments of socialist market economic system and Henan took a series of actions to focus on village the situation of rural social and economic devel- works, including training medical health teams, opment. In 2008, Henan achieved the complete organizing urban medical health workers to go to coverage of NCMS, there were a total of villages, transferring medicine, medical and in- 72,490,000 farmers joined NCMS, and the partic-
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