Factors associated with health service utilization under the New Rural Cooperative Medical System (NRCMS) in Hainan, China: preliminary evidence from a household survey

Abstract

In 2003, the Chinese rural health care system underwent substantial reform with the introduction of the New Rural Cooperative Medical System (NRCMS). In order to identify factors associated with health services utilization among rural residents enrolled in NRCMS in Hainan Province, China, we conducted a cross-sectional household survey in rural villages from six randomly selected Han and ethnic minority cities or counties in Hainan in 2009 to identify factors associated with health service utilization among rural residents enrolled in the NRCMS in Hainan Province, China. Logistic regressions were used to identify factors associated with utilization of outpatient visits and inpatient visits. Among the total 871 subjects of observations, about 45% had at least one outpatient visit in the 12 months prior to the survey and 13% had at least one inpatient visit during that period. Outpatient visits were directly associated with location of residence (Han-concentrated region vs. ethnic minority-concentrated region), education level, presence of chronic disease, health insurance plan and satisfaction with quality of care in NRCMS network providers. Similarly, inpatient visitation was significantly associated with education level, presence of chronic disease and satisfaction with quality of care in NRCMS network providers. The use of both outpatient and inpatient services was significantly associated with location of residence, education level, presence of chronic disease, health insurance plan and satisfaction with quality of care in NRCMS network providers. Evidence suggests that NRCMS was significantly associated with access to care in rural areas, especially in ethnic minority regions in Hainan, but there still exist challenges in assessing the degree of unnecessary utilization of inpatient services.