Chronic Diseases In Rural Areas Research Articles

Do the New Rural Pension Scheme promote the health status of chronic patients in old age? —Evidence from CHARLS 2018 in China

BackgroundMany researchers have examined the impact of social insurance on health in elderly. However, in most cases, they have only demonstrated correlational results and have not been able to determine causal effects, possibly because confounding biases have not been fully addressed. In this study, we investigated the health effects of the New Rural Pension Scheme (NRPS) on the elderly (age≥60 years old) with chronic diseases in rural areas, and to explore the causal relationship and effects of NRPS and health status.MethodsThis paper used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and applied Bayesian networks and fuzzy regression discontinuity design to conduct causal analysis. Bayesian networks were used to explore the causal directed acyclic graphs of factors related to NRPS and health status. Based on the results of Bayesian network, a fuzzy regression discontinuity design was employed to estimate the causal effect of NRPS on health status.ResultsAmong rural elderly with chronic diseases, Bayesian network mapping of causal relationships among NRPS, health status and covariates showed that age was a common cause of NRPS receipt and satisfaction with health. The results of the fuzzy regression discontinuity analysis showed that the effect of receiving NRPS on the health status was positive, but there was no statistically significant difference concerning the interval estimates. The results of the subgroup analysis with chronic obstructive pulmonary disease (COPD) and asthma indicated that the effect of NRPS receipt on the health status of elderly people with COPD was positive. There was a statistically significant effect of receiving NRPS on self-rated health description (β1=3.653,P=0.032\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\beta }_{1}=3.653,P=0.032$$\\end{document}) and health satisfaction (β1=4.204,P=0.033\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\beta }_{1}=4.204,P=0.033$$\\end{document}) in COPD population and a statistically significant effect of receiving NRPS on health satisfaction in asthma population (β1=9.844,P=0.008\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\beta }_{1}=9.844,P=0.008$$\\end{document}).ConclusionThis paper has confirmed the contribution and positive causal effect of NRPS on health status in a subgroup of older adults with COPD and asthma, using the CHARLS database as evidence. Thus, Chinese government should increase the take-up rate of the NRPS to enhance their positive impact on health status of elderly people with chronic diseases in rural areas.

Enhancing Income as a Starting Point for Designing Sustainable Health Product-Service Systems for Chronically Ill Elderly in Rural Areas

Insufficient income, inadequate healthcare resources, and insufficient chronic disease management awareness pose a fundamental obstacle to the sustained health maintenance of elderly individuals with chronic diseases in rural areas. In response to these challenges, this study adopted a research-through-design approach and introduced system design thinking by incorporating new stakeholders, experiential insights, and services. Initially, during the background research stage, a semi-structured interview was conducted to gain an understanding of the pains, needs, and potential opportunities of the target users. Subsequently, in the design model construction stage, desk research was carried out to refine and integrate the common components identified in various design models. In a focus group, these components were then incorporated into the development of a Sustainable Health Product-Service System Design Model tailored for rural elderly with chronic diseases after refining the pains, needs, and potential opportunities defined in the first stage. This design model encompassed elements including a background layer, a stakeholder layer, a funding layer, a product layer, a service layer, and an information layer. In the system design and design model validation stage, a design project aimed at health maintenance was launched within Liyang Town, with the design thinking method following a process of empathizing, defining, ideating, prototyping, and testing. Throughout the project, the established model guided the design process and facilitated the conceptualization and implementation of a Product-Service system. In conclusion, an investigation encompassing 15 elderly individuals was undertaken to analyze their income balance, health condition, health awareness, and their satisfaction with the health system. This analysis spanned the period both before and after their involvement in the project. The outcomes of this examination revealed notable enhancements across all three dimensions evaluated, highlighting the positive impact of the project on the elderly participants. Furthermore, the project’s social benefits were also comprehensively established.

Association between chronic disease and substance use among older adults in Tennessee.

Substance use and misuse have a negative impact on health care outcomes, specifically in the older adult population. Older adults are at risk due to several factors occurring toward the end of life such as changing family dynamics, loss of friends and loved ones, and chronic diseases. Substance use in older adults with chronic diseases in rural areas remains poorly studied. This study examines older adults greater than 55 of age in the state of Tennessee, U.S.A. Data was extracted from the 2019 National Behavioral Risk Factor Surveillance System (BRFSS) with a subsample for the State of Tennessee (N = 6242) and individuals over age 55 (N = 3389). At least 33.7% (N = 1143) of older adults have a chronic disease, and 24.4% (N = 828) have at least two or more chronic diseases. Alcohol use in the past month was reported in 29.4% of older adults; however, chronic disease status was not associated with alcohol use. Marijuana use and smoking in the past month were significant for older adults with two or more chronic diseases. Low income and less high school education were associated with chronic disease and smoking. Marijuana use and smoking were found to be significant in older adults with chronic disease, but not with alcohol use. Preventative measures such as screening tools, education, and providing resources to patients should be targeted to populations at risk to promote overall health outcomes.

Environment and chronic disease in rural areas of Heilongjiang, China (ECDRAHC)

PurposeEnvironmental factors such as long-term exposure to cold can increase the risk of chronic diseases. However, few studies have focused on the impact of environmental factors and lifestyle changes on...

Choix thérapeutiques des hypertendus et diabétiques en milieu rural : Une étude mixte dans deux zones de santé de l'Est de la République Démocratique du Congo

Therapeutic choices of hypertensive and diabetics in rural areas: A mixed study in two health zones in the East of the Democratic Republic of Congo.BackgroundOne third of patients in the Democratic Republic of Congo (DRC) do not use the formal health system to access healthcare.AimIn this manuscript we analyse the therapeutic decisions of hypertensive and diabetic patients in rural eastern DRC and the reasons for these decisions.SettingThe study was conduct in two health zones (HZ) in South Kivu (Bagira and Walungu), DRC.MethodsA mixed-methods convergent study was conducted from November 2018 to December 2018. Quantitative data were collected using a questionnaire and qualitative data were collected using focus groups. The quantitative data were analysed using descriptive statistics and a Fischer exact test, while the qualitative data were analysed using thematic analysis.ResultsOut of 382 subjects declaring a chronic pathology, hypertensives and diabetics represented 21.5% and 7.9%, respectively. Health facilities were the first therapeutic choice of the chronically affected persons. The alternative therapeutic choices found were the use of prayer rooms, consultation with traditional healers and self-medication. Poverty, ignorance, the pharmaceutical business, and the socio-cultural dimension of the disease are the main causes of alternative therapeutic choices for hypertensives and diabetics.ConclusionTo ensure appropriate care for patients with chronic diseases in rural areas, it is important to establish a bridge of regulated collaboration between the formal and informal health sector.

Biopsy Proven Kidney Disease From A Rural Tertiary Care Centre — A Social And Epidemiological Perspective

Abstract The prevalence of chronic kidney disease (CKD) is rising in rural areas. Screening of high risk cases, early detection and referral by the physicians reduces the prevalence of kidney disease in the population. Hereditary disorders, Glomerular diseases, Obstructive nephropathies are common causes in CKD in rural areas. Kidney biopsy is an essential diagnostic tool in to diagnose glomerular diseases. This prospective study done at tertiary care teaching hospital between 2017 and 2020 to understand the profile of glomerular diseases in rural area. Forty patients were included in the Study. Primary glomerular disease (PGD) was present in 26 patients and Secondary glomerular disease (SGD) in 10 and primary tubulointerstitial pathology in 4 patients. The most common Secondary glomerular disease was lupus. Glomerular diseases are amenable to immunomodulatory therapy leading to change in clinical outcome of the disease. However, Kidney biopsy is underutilized particularly in elderly patients, hypertensive nephropathy patients, suspected non diabetic kidney disease and lupus patients. Financial and social issues play dominant role in the treatment plan of chronic diseases in rural areas. Regional registry of kidney biopsy of urban and rural areas separately helps in paving a way of understanding the profile of glomerular diseases and its prevention.

Rural chronic disease research patterns in the United Kingdom, United States, Canada, Australia and New Zealand: a systematic integrative review

BackgroundPeople living in rural and remote communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. The aim of this paper was to describe the characteristics and outcomes of studies investigating innovative models of care for people living with chronic disease in rural areas of developed countries where a metropolitan comparator was included.MethodsAn integrative systematic review was undertaken. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to understand the empirical and theoretical data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom.ResultsLiterature searching revealed 620 articles published in English between 1st January 2000 and 31st March 2019. One hundred sixty were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations.ConclusionsThis integrated review reveals that the published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.

Prediction of hypertension, hyperglycemia and dyslipidemia from retinal fundus photographs via deep learning: A cross-sectional study of chronic diseases in central China

Retinal fundus photography provides a non-invasive approach for identifying early microcirculatory alterations of chronic diseases prior to the onset of overt clinical complications. Here, we developed neural network models to predict hypertension, hyperglycemia, dyslipidemia, and a range of risk factors from retinal fundus images obtained from a cross-sectional study of chronic diseases in rural areas of Xinxiang County, Henan, in central China. 1222 high-quality retinal images and over 50 measurements of anthropometry and biochemical parameters were generated from 625 subjects. The models in this study achieved an area under the ROC curve (AUC) of 0.880 in predicting hyperglycemia, of 0.766 in predicting hypertension, and of 0.703 in predicting dyslipidemia. In addition, these models can predict with AUC>0.7 several blood test erythrocyte parameters, including hematocrit (HCT), mean corpuscular hemoglobin concentration (MCHC), and a cluster of cardiovascular disease (CVD) risk factors. Taken together, deep learning approaches are feasible for predicting hypertension, dyslipidemia, diabetes, and risks of other chronic diseases.

Chronic ill health in a regional Victoria setting: A 13-year comparison.

High-quality data regarding the prevalence of chronic disease in rural areas are essential in understanding the challenges faced by rural populations and for informing strategies to address health care needs. This study compared the prevalence of a range of self-reported chronic conditions and utilisation of GP services and emergency department in a regional Victorian setting between two studies conducted in the same region in 2001-2003 and 2014. Repeat cross-sectional studies conducted over a decade apart. The projects were conducted in the Goulburn Valley in regional Victoria. The earlier study randomly selected households from local government lists. The later study randomly selected householders from the telephone directory. Participants were asked whether they had been diagnosed with a range of chronic health conditions and how often they had visited a general practitioner or emergency department in the past 12months. The age-standardised prevalence of depression was higher in the 2014 study than the 2001-2003 study in men (increased by 8.0% (95% CI 4.5, 11.5%)) and women (increased by 13.7% (95% CI 8.4, 19.0%)). Similarly, the prevalence of age-standardised diabetes and hypertension was higher in 2014 than 2001-2003 (men increased by 3.6% (95% CI 0.7, 6.5% (diabetes)) and 13.6% (95% CI 8.6, 18.6% (hypertension)), women increased by 3.1% (95% CI 0.3, 6.5% (diabetes)) and 8.4% (95% CI 2.3, 14.5% (hypertension))). The results of this study indicate that the prevalence of self-reported depression, diabetes and hypertension has increased in this regional Victorian area over the past 13years. The reasons for these observed increases and the subsequent impact on the health care needs of regional communities warrants further investigation.

Why Patients with Chronic Disease Keep Silent? Analysis of Item Nonresponse in Rural China

This study aimed to identify the characteristics of item nonresponse and examine the factors affecting the refusal or failure to respond of patients with chronic disease in rural China. A cross-sectional survey data from patients with chronic disease from rural China were analyzed. A total of 1,099 patients were enrolled. Chi-square test and cumulative logistic regression determined the predictors of having item nonresponse. The respondents in central provinces (OR = 2.311, 95%CI = 0.532∼1.144, P < 0.001) with over eight household members (OR = 0.067, 95%CI = -1.632∼-0.349, P = 0.002), multiple chronic diseases (OR = 0.301, 95%CI = -1.673∼-0.727, P < 0.001), and low health knowledge level (OR = 2.112, 95%CI = 0.405∼1.090, P < 0.001) had more item nonresponse numbers. Compared with the participants with high school education level and above, the item nonresponse number seemed to increase when the participants were illiterate (OR = 2.159, 95%CI = 0.254∼1.285, P = 0.003), had primary school education (OR = 2.161, 95%CI = 0.249∼1.294, P = 0.004) and junior school education (OR = 2.070, 95%CI = 0.160∼1.296, P = 0.012). This study indicates the influencing factors of the item nonresponse in survey of patients with chronic disease in rural China. This study contributes to investigation practice and highlights that health institutions should improve the quality of follow-up services. Moreover, the government should pay more attention to the care of vulnerable groups, especially patients with chronic disease in rural areas.

Assessing the effects of the percentage of chronic disease in households on health payment-induced poverty in Shaanxi Province, China

BackgroundChronic disease has become one of the leading causes of poverty in China, which posed heavy economic burden on individuals, households and society, and accounts for an estimated 80% of deaths and 70% of disability-adjusted life-years lost now in China. This study aims to assess the effect of chronic diseases on health payment-induced poverty in Shaanxi Province, China.MethodsThe data was from the 5th National Health Survey of Shaanxi Province, which was part of China’s National Health Service Survey (NHSS) conducted in 2013. Totally, 20,700 households were selected for analysis. We used poverty headcount, poverty gap and mean positive poverty gap to assess the incidence, depth and intensity of poverty before and after health payment, respectively. Logistic regression models were further undertaken to evaluate the influence of percentage of chronic patients in households on the health payment-induced poverty with the control of other covariates.ResultsIn rural areas, the incidence of poverty increased 31.90% before and after health payment in the household group when the percentage of chronic patients in the households was 0, and the poverty gap rose from 932.77 CNY to 1253.85 CNY (50.56% increased). In the group when the percentage of chronic patients in the households was 1–40% and 41–50%, the poverty gap increased 76.78 and 89.29%, respectively. In the group when the percentage of chronic patients in the households was 51~ 100%, the increase of poverty headcount and poverty gap was 49.89 and 46.24%. In the logistic model, we found that the proportion of chronic patients in the households was closely related with the health payment-induced poverty. The percentage of chronic disease in the households increased by 1 %, the incidence of poverty increased by 1.01 times. On the other hand, the male household head and the household’s head with higher educational lever were seen as protective factors for impoverishment.ConclusionsWith the percentage of chronic patients in the households growing, the health payment-induced poverty increases sharply. Furthermore, the households members with more chronic diseases in rural areas were more likely to suffer poverty than those in urban areas. Our analysis emphasizes the need to protect households from the impoverishment of chronic diseases, and our findings will provide suggestions for further healthcare reforms in China and guidance for vulnerable groups.

EASE OF USE AND USEFULNESS OF A MOBILE MEDICATION APP IN AGING ADULTS

Older adults account for approximately one-third of all prescribed and over-the-counter medication use. Self-management of medication schedules may become increasingly difficult. Mobile technology is a possible intervention for self-management of health and chronic disease in rural areas where aging adults experience health disparities. The purpose of this study is to explore the usefulness and ease of use of a mobile medication reminder app for self-management of medications among rural aging adults. Adults’ ≥ 55 years of age were recruited from two Midwestern rural communities. Participants (N=15) downloaded MediSafe® on their mobile device and used the app over two weeks. Subjective and objective data was collected on 13 participants at 2 weeks and included: perceived usefulness, problems, task time, and errors. Univariate descriptive statistics were performed on the data. Most participants did not have difficulty downloading the app; 9 uploaded medication information correctly and 3 needed assistance uploading medication information. Six participants forgot to log medication use. Ten participants perceived the app as useful and 8 believed it helped improve self-management of medications. The most useful app features were medication reminders and medication tracking. Eight participants recommended medication apps should include real-time alerts for harmful medications or potential drug interactions. Mobile medication apps are perceived as useful to help with self-management, and with initial assistance, are fairly easy to use. Aging adults in rural areas may benefit from different app features that are not currently available. Mobile apps and technology may benefit from transgenerational and transcultural design.

Drone-Aided Healthcare Services for Patients with Chronic Diseases in Rural Areas

This paper addresses the drone-aided delivery and pickup planning of medication and test kits for patients with chronic diseases who are required to visit clinics for routine health examinations and/or refill medicine in rural areas. For routine healthcare services, the work proposes two models: the first model is to find the optimal number of drone center locations using the set covering approach, and the second model is the multi-depot vehicle routing problem with pickup and delivery requests minimizing the operating cost of drones in which drones deliver medicine to patients and pick up exam kits on the way back such as blood and urine samples. In order to improve computational performance of the proposed models, a preprocessing algorithm, a Partition method, and a Lagrangian Relaxation (LR) method are developed as solution approaches. A cost-benefit analysis method is developed as a tool to analyze the benefits of drone-aided healthcare service. The work is tested on a numerical example to show its applicability.

Realities of ambulatory multi-drug treatment of chronic diseases in rural areas of Lublin Province, eastern Poland - comparison of situations in 2010 and 2013.

The economic stratification observed for many years among the population in Poland, increasing poverty rates, especially those being effects of the current economic crisis in the country, and the rising prices of medicines, are potential risk factors for medication non-adherence among patients in the poorest class of the Polish population. Materials an method. The subjects were 2 groups of inhabitants of rural areas of Lublin Province in eastern Poland. The first consisted of 209 people aged 52-80 years who were surveyed in 2010, the second - 210 people aged 51-88 years, surveyed in 2013. All patients were outpatients who attended the Endocrine Clinic in Poniatowa. The studies were conducted with the use of the standardized survey questionnaire. The problem of medication non-adherence among the surveyed was evident and has risen from 43.1% in 2010 to 54.8% in 2013. Both in 2010 and in 2013, the main reasons for this state of affairs were the financial problems of the surveyed people. During the period 2010-2013, both expenditure on medicine as well as the ratio "patients' expenditure on medicine/expenditure on food" had increased. In 2010, 25 respondents per 209 (12%) expressed the opinion that they had always had sufficient means to buy necessary medications, in 2013 - only 3 per 210 (1.5%). In 2013, most of surveyed patients (54.8%) did not follow prescribed treatment plans (in 2010-43.1%). In most cases, medication non-adherence were the result of financial problems. Current regulations governing refunding of the costs of medicines may make effective ambulatory treatment of chronic diseases impossible.

What Contributes to the Activeness of Ethnic Minority Patients with Chronic Illnesses Seeking Allied Health Services? A Cross-Sectional Study in Rural Western China.

Actively seeking health services lies at the core of effective models of chronic disease self-management and contributes to promoting the utilization of allied health services (AHS). However, the use of AHS by ethnic minority Chinese, especially the elderly living in rural areas, has not received much attention. This study, therefore, aims to explore the association between personal characteristics and the activeness of ethnic minority patients with chronic diseases in rural areas of western China seeking AHS. A cross-sectional study was conducted to collect data on the socio-demographic and economic characteristics, health knowledge level and health communication channels of the sampled patients. A logistic regression model was used to examine the association of these predictors with the activeness of the surveyed patients in seeking AHS. A total of 1078 ethnic minorities over 45 years old who had chronic conditions were randomly selected from three western provinces in China and were interviewed in 2014. It is found that the New Cooperative Medical Scheme (NCMS) is the most salient predictor affecting the activeness of Chinese ethnic minorities in seeking AHS. The probability is 8.51 times greater for those insured with NCMS to actively seek AHS than those without (95% Confidence Interval (CI) 4.76–15.21; p < 0.001). Moreover, participants between 60 and 70 years old and those who have five to six household members are more likely to seek AHS compared with other social groups (Odds Ratio (OR) = 1.64, 95% CI 1.28–2.97, p = 0.007; OR = 1.95, 95% CI 1.15–2.36, p = 0.002). However, the activeness of patients seeking AHS is lower for those who have better household economic conditions. Besides socio-demographic predictors, the Chinese ethnic minorities’ activeness in seeking AHS is clearly associated with the communication channels used for receiving health information, which include direct communication with doctors (OR = 5.18, 95% CI 3.58–7.50, p < 0.001) and dissemination of elementary public health knowledge posted on bulletin boards (OR = 2.30, 95% CI 1.61–3.27, p < 0.001) and traditional mass media (OR = 1.74, 95% CI 1.22–2.48, p = 0.002). First, the government should further improve the coverage of NCMS to households suffering from chronic diseases and satisfy the requirements of social groups at different income levels and various ages in their health care to improve their activeness in AHS utilization. Second, doctors’ advice, bulletin boards and traditional media are common health communication channels for those seeking AHS and thus should be continuously employed in rural western China. Third, specified healthcare services should be designed to meet the needs of different patient segmentations.

Rural-urban differences in the prevalence of chronic disease in northeast China.

Rural-urban differences in the prevalence of chronic diseases in the adult population of northeast China are examined. The Jilin Provincial Chronic Disease Survey used personal interviews and physical measures to research the presence of a range of chronic diseases among a large sample of rural and urban provincial residents aged 18 to 79 years (N = 21 435). Logistic regression analyses were used. After adjusting for age and gender, rural residents had higher prevalence of hypertension, chronic ischemic heart disease, cerebrovascular disease, chronic low back pain, arthritis, chronic gastroenteritis/peptic ulcer, chronic cholecystitis/gallstones, and chronic lower respiratory disease. Low education, low income, and smoking increased the risk of chronic diseases in rural areas. Reducing rural-urban differences in chronic disease presents a formidable public health challenge for China. The solution requires focusing attention on issues endemic to rural areas such as poverty, lack of chronic disease knowledge, and the inequality in access to primary care.

Financial protection effects of modification of China's New Cooperative Medical Scheme on rural households with chronic diseases.

BackgroundSeveral years have passed since the rural New Cooperative Medical Scheme (NCMS) in China was established and policies kept continuous improvement. Its policies on chronic diseases vary by county but have certain shared characteristics. Following this modification of medical insurance policy, this study reassesses the provision of insurance against expenditure on chronic diseases in rural areas, and analyzes its effect on impoverishment.MethodsWe conducted an empirical study using multi-stage stratified random sampling. We surveyed 1,661 rural households in three provinces and analyzed the responses from 1,525 households that participated in NCMS, using descriptive and logistic regression analysis.ResultsThe NCMS has reduced the prevalence of poverty and catastrophic health expenditure (CHE), as measured by out-of-pocket (OOP) payments exceeding 40% of total household expenditure, by decreasing medical expenditure. It provides obvious protection to households which include someone with chronic diseases. However, these households continue to face a higher financial risk than those without anyone suffering from chronic diseases. Variables about health service utilization and OOP payment differed significantly between households with or without people suffering from chronic disease. And CHE risk is commonly associated with household income, the number of family members with chronic diseases, OOP payment of outpatient and inpatient service in all three provinces.ConclusionTo reduce CHE risk for these households, it is critical to decrease OOP payments for health services by enhancing the effective reimbursement level of NCMS and strictly regulating the providers’ behaviors. We recommend that a combinatory changes should be made to the rural health insurance scheme in China to improve its effect. These include improving the NCMS benefit package by broadening the catalogue of drugs and treatments covered, decreasing or abolishing deductible and increasing the reimbursement ratio of outpatient services for people with chronic diseases, together with expansion of insurance fund, and modifying health providers’ behaviors by payment reform.