Rural Cooperative Medical Care Research Articles

Investigation on medical security and quality of life of migrant workers with pneumoconiosis

Objective: To investigate and understand the medical security and quality of life of migrant workers with pneumoconiosis, so as to provide scientific basis for the prevention and control countermeasures of migrant workers with pneumoconiosis and targeted poverty alleviation. Methods: Using a stratified random sampling method, 200 migrant workers diagnosed with pneumoconiosis at the Shandong Academy of Occupational Health and Occupational Medicine from January 2016 to December 2021 were selected as the observation group, while 200 non migrant workers diagnosed with pneumoconiosis were selected as the control group. St. George's Respiratory Questionnaire (SGRQ) and Pneumoconiosis Questionnaire were used to collect and compare information on the age, working age of dust exposure, economic sources, employment status, income, medical security and quality of life of two groups of patients. Results: The age of migrant worker pneumoconiosis patients in the observation group was (58.1±8.1) years old, and the working age of dust exposure was (19.3±10.1) years. The main source of income was children support (85.5%, 171/200), employment status was mainly wait for employment or unemployed (69.0%, 138/200), personal monthly income was mainly non income (90.0%, 180/200), and family annual income was mainly less than 10000 yuan (48.0%, 96/200). The average personal annual medical expenditure of 5000-<10000 yuan accounted for 42.0% (84/200). The age of pneumoconiosis patients in the control group was (59.2±8.9) years old, and the working age of dust exposure was (20.2±10.5) years. The main source of income was retirement pension or salary (99.0%, 198/200), with retirement as the main employment status (66.0%, 132/200), the main personal monthly income was 2000-<4000 yuan (61.5%, 123/200), the main family annual income was 20000-<40000 yuan (44.0%, 88/200), and the average personal annual medical expenditure was mostly non-expenditure (92.0%, 184/200). There were statistically significant differences in the distribution of economic sources, employment status, personal monthly income, family annual income and average personal annual medical expenditure between the two groups (P<0.001). The main type of insurance for the observation group was rural cooperative medical care (68.5%, 137/200), and 87.0% (174/200) had no medical reimbursement and a proportion less than 50%. There were statistically significant differences in insurance type and medical reimbursement proportion between the two groups (P<0.001). The respiratory symptoms, activity ability, daily life influence and total quality of life scores of pneumoconiosis patients in the observation group were significantly higher than those in the control group, the differences were statistically significant (P<0.001) . Conclusion: Migrant workers with pneumoconiosis have low income, high medical expenditure, low medical reimbursement proportion and poor quality of life. Therefore, it is necessary to draw high attention from relevant departments and provide timely attention and assistance to improve the quality of life of migrant workers with pneumoconiosis.

Current health resources required for the management of ankylosing spondylitis in developing areas of China.

Current health resources required for the management of ankylosing spondylitis in developing areas of China.

Developing a Rural Healthcare System

Background: Healthcare related welfare is a matter of resource allocation. In modern market economies, redistribution in Western societies is accomplished through state welfare systems to balance the inequality of market resource allocation. However, resource allocation in socialist countries has its own peculiarities. And the relationship between market transformation (social transformation) and resource allocation methods in post-socialist countries is an important academic topic. This paper examines the changes in the rural cooperative medical system（RCMS）in China in order to explore the changes in rural cooperative healthcare governance mechanisms during recent social transformation. Objectives: The main purpose of this paper is to place the rural cooperative health care system（RCMS）in a macroeconomic-political context and to compare the changes in cooperative health care resource allocation mechanisms across time. Methods: The article undertakes a narrative literature review approach and method. The review used the following sources: Web of Science and PubMed. The search used the keywords" rural cooperative medical care system", "community benefits", " public service-based welfare" and "governance",and limited to articles published between January 2019 and June 2022. The selection of articles was based on the inclusion/exclusion criteria (keywords defined and time span of publication). Results: From collectivized cooperative medical care System（RCMS） to today's New Rural Cooperative Medical System（NRCMS), its governance mechanism has changed and the nature of welfare has changed with it. It has also changed from community welfare, where organized grassroots communities supply medical services, to government-led public service-based welfare. Main Contribution to Evidence-Based Practice: The paper shows the process of change in China's rural cooperative healthcarel system（RCMS), mainly analyzing the change of healthcare welfare governance mechanism. Thus ,it provides a reference for governmental health policies development and for international researchers.

Comparison of hospitalization cause and risk factors between patients undergoing hemodialysis and peritoneal dialysis

This retrospective study was designed to compare the cause of hospitalization and influencing factors between patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Baseline data and laboratory parameters of 192 dialysis patients (92 HD patients and 100 PD patients) were compared. Quantitative parameters with normal distribution were assessed using independent t-test or analysis of variance (ANOVA). Quantitative parameters with non-normal distribution were assessed by non-parametric test. Qualitative data were statistically compared using χ2 test. The number of patients with urban employee medical insurance (88 HD patients and 60 PD patients) and rural cooperative medical care (12 HD patients and 40 PD patients) significantly differed (P < .01). The hospitalization rate of PD patients was significantly higher than that of HD counterparts. The average length of hospital stay of PD patients was 10 days, remarkably longer than 8 days of HD patients (P < .01). The primary cause of hospitalization for HD patients was infection-related complications, followed by cardiovascular, cerebrovascular complications and dialysis access disorders. The primary cause of hospitalization for PD patients was infection-related complications, followed by dialysis access disorders, cardiovascular, and gastrointestinal complications. Compared with the HD group, the levels of hemoglobin, serum albumin, alkaline phosphatase, intact parathyroid hormone were significantly decreased, whereas serum urea nitrogen, serum creatinine, phosphorus levels and cardiothoracic ratio were remarkably increased in the PD group (all P < .01). The hospitalization rate of PD patients is relatively higher, and the length of hospital stay is longer. Extensive attention and efforts should be delivered to enhance the understanding of disease and lower the risk of complications for patients.

Cost-effectiveness of medical migration for chronic kidney disease: a national cross-sectional study in China

BackgroundThe phenomenon of medical migration is common in China. Due to the limited capacity and substantial geographical variation in medical practice, patients with chronic kidney disease (CKD) travel more frequently to seek medical care. We aimed to assess the cost-effectiveness of medical migration for CKD patients in China and provide real-world evidence for the allocation of CKD resources.MethodsRecords of patients with CKD between January 2014 and December 2018 were extracted from a large national database. A patient is defined as a medical migrant if she travelled across the provincial border to a non-residential province to be admitted for inpatient care. The propensity score matching method is used to estimate the effect of medical migration on medical expenditure, length of hospital stay, and in-hospital mortality. The cost-effectiveness is evaluated by comparing the estimated cost per life saved with contemporaneous estimates of the value of a statistical life.ResultsAmong 4,392,650 hospitalizations with CKD, medical migrants accounted for 4.9% in 2018. Migrant patients were estimated to incur a 26.35% increase in total medical expenditure, experience a 0.24-percentage-points reduction in in-hospital mortality rates, and a 0.49-days reduction in length of hospital stay compared to non-migrant patients. Overall, medical migration among CKD patients incurred an average of 1 million yuan per life saved, which accounted for 20–40% of contemporaneous estimates of the value of a statistical life. Compared with migrant patients with self-payment and commercial insurance, migrant patients with public health insurance (urban basic medical insurance and new rural co-operative medical care) incurred lower cost per life saved. Cost per life saved for CKD patients was similar between female and male, lower among older population, and varied substantially across regions.ConclusionsThe medical care seeking behaviors of CKD patients was prominent and medical resources of kidney care were unevenly allocated across regions. Medical migration led to a reduction in mortality, but was associated with higher medical expenditure. It is imperative to reduce the regional disparity of medical resources and improve the clinical capacity. Our study shows that it is imperative to prioritize resource allocation toward improving kidney health and regional health care planning.

Study on the hospitalization cost and its influencing factors of imported malaria patients in Guangxi Zhuang Autonomous Region and Yunnan Province

To analyze the hospitalization cost and its influencing factors of imported malaria patients in Guangxi Zhuang Autonomous Region and Yunnan Province, so as to provide insights into the evaluation of the economic burden due to imported malaria, and the guiding of malaria control and the rational allocation of medical resources. The data pertaining to the hospitalization costs of imported malaria patients admitted to Shanglin County People's Hospital in Guangxi Zhuang Autonomous Region during the period from January 1 through December 31, 2019, and Tengchong Municipal People's Hospital in Yunnan Province from January 1, 2015 to December 31, 2019, were collected, and the epidemiological data of these imported malaria patients were extracted from the Information Management System for Parasitic Diseases Control and Prevention, China. The composition of the hospitalization expenses was analyzed using a descriptive method. In addition, the factors affecting the hospitalization expenses of imported malaria patients were identified using a univariate analysis and a recursive system model. A total of 206 imported malaria patients were included in this study, including 194 men (94.17%) and 12 women (5.83%). The mean length of hospital stay was 5.00 days per patient and the median hospitalization expenses were 2 813.07 Yuan per time, in which the expenses for laboratory examinations were the highest (45.31%, 1 274.62/2 813.07). Univariate analysis showed that hospital (z = 5.43, P < 0.01), type of malaria (χ2 = 34.86, P < 0.01) and type of payment (χ2 = 7.72, P < 0.05) were factors affecting the hospitalization expenses of imported malaria patients. Recursion system modeling revealed that the total effects on hospitalization expenses of imported malaria patients included length of hospital stay (0.78), selection of hospital (0.34), basic medical insurance for urban and rural residents (0.19), new rural cooperative medical care (0.17), Plasmodium falciparum malaria (0.15), gender (0.11) and P. vivax malaria (0.09). The hospitalization expenses of imported malaria patients are affected by multiple factors in Guangxi Zhuang Autonomous Region and Yunnan Province, in which the length of hospital stay is the most predominant influencing factor. A reduction in the length of hospital stay is effective to decrease the hospitalization expenses of imported malaria patients.

Optimization Research and Exploration of New Rural Cooperative Medical Information System

&lt;span style="line-height: 114%; letter-spacing: 0.1pt; font-family: 'Times','serif'; font-size: 10pt; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 宋体; mso-bidi-font-family: 'Times New Roman'; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;" lang="EN-US"&gt;The New Rural Cooperative Medical Care Information System (NRCMS) used a single relational database to store most of the data in the early days. The scheme is difficult to expand and has little concurrent ability, so it is not suitable to deal with semi-structured, Unstructured data. Then along came distributed technologies such as Hadoop, which had the advantage of using inexpensive machines to store and process data. But HADOOP was designed to distribute data equally among the nodes in the cluster for storage and processing, ignoring the differences in the storage and computing capabilities of the cluster nodes themselves, and the performance of individual nodes even affects the performance of the collation system, and it is master-slave node processing data, there are data can tamper, system terminal is too single and so on. The contribution of this paper lies in the overall structure and technical route of the new rural cooperative medical system, and the optimization method of data flow of heterogeneous nodes, which can effectively save the scale and cost of the cluster, with the help of blockchain technology to ensure the security and credibility of data, optimize the front-end cluster service architecture, support multi-channel and high-concurrent key information push mode, has a very good promotion.&lt;/span&gt;

Challenges Faced by Multidrug-Resistant Tuberculosis Patients in Three Financially Affluent Chinese Cities.

PurposeThe aim of this study was to analyze socioeconomic burdens and other difficulties that multidrug-resistant tuberculosis (MDR-TB) patients in cities are facing, to identify major obstacles and which groups of patients are most affected.MethodsFace-to-face and phone-call interviews were conducted in early 2018 to follow-up with patients newly diagnosed with MDR-TB in 2017 in three tuberculosis hospitals in three financially affluent Chinese cities. Demographic data and information on their medical care, insurance coverage, and medical expenses were collected and analyzed.ResultsA total of 144 newly diagnosed MDR-TB cases were reviewed during the study period, excluding 38 who were lost to follow-up and 29 patients who refused to participate, 77 patients were enrolled in this study. A total of 61 (79%) of these patients were hospitalized after MDR-TB diagnosis with an average hospital stay of 14 days, of them 57 (74%) were sputum positive on diagnosis. The proportion of patients who failed community care were 48% married, 56% in white collar employment and 43% in temp jobs/unemployed. In terms of insurance coverage, the proportion of patients who failed community care were 23% with no insurance and/or New Rural Co-operative Medical Care Scheme (NRCMS) and 45% with Urban Employee Basic Medical Insurance (UEBMI)/Urban Residents Basic Medical Insurance (URBMI) and commercial insurance. Difficulties patients encountered were, financial pressure (33%), psychological stress (26%), adverse drug reactions (23%), repulsive reaction to injections (17%). Fourty-eight percent of the patients spent over ¥2000 (USD300) per month on TB treatment.ConclusionDespite insurance coverage, financial hardship remains the number one difficulty MDR-TB patients encountered in relatively financially affluent cities. Among them, the married working class were found to be the most financially sensitive group and have the highest tendency to fail community care. It is of utmost urgency to enhance the current medical policy to improve treatment adherence.

Population's acceptance and attitude toward a novel fecal immunochemical test for colorectal cancer screening: a multi-center survey in China

Objective: To investigate the acceptance and attitude toward a novel fecal immunochemical test (FIT) in colorectal cancer screening among populations in China. Methods: From May 2018 to May 2019, 2 474 people aged 50-74 years were recruited from five provinces of China (Zhejiang, Anhui, Jiangsu, Hunan and Yunnan). The general demographic characteristics, acceptance of the new FIT technology and operational difficulties through the whole screening process were obtained through questionnaire survey. Multivariate logistic regression model was used to analyze the factors related to difficulties encountered in sampling stool, reading and uploading results. Results: The subjects were (60.0±6.4) years old, and female, high school of above educated, unemployed/retired/other, married and with medical insurance status of "new rural cooperative medical care (NRCMC)" accounted for 61.7% (1 526), 29.0%(718), 34.3% (849), 92.7% (2 293) and 31.3%(775), respectively. The population's acceptance of the FIT technology was 94.8%. In the process of FIT screening, the percentage of occurred difficulties in sampling stool, reading and uploading results were 33.1% (819), 46.4% (1 147) and 62.9% (1 557), respectively. The main difficulties were the uncertainty about whether the sampling operation was standard (28.0%), the inability to accurately judge the result displayed (32.5%) and the need for help without using a smartphone (44.2%). The results of multivariate logistic regression model analysis showed that people aged 65-74 years old and with medical insurance status of "NRCMC" were more likely to encounter difficulties in sampling, and those who were unemployed/retired/other and living with 3 or more family members were less likely to encounter difficulties in sampling. Those aged 65-74 years old, farmers or migrant workers, and those with "NRCMC" were more likely to encounter difficulties in readingresults, and those with 3 or more family members were less likely to encounter difficulties in reading result. Those with "NRCMC" were more likely to encounter difficulties in uploading results, and those with education level of high school or above, living with more than 3 family members were less likely to encounter difficulties in uploading results. Conclusion: The acceptance of the new FIT technology is relatively high among the subjects. Age, education level, occupation, number of family members living together and medical insurance status might be related to difficulties encountered in sampling stool, reading and uploading results, and it can be further strengthened in terms of the technology and characteristics of sub-populations.

Influencing factors of health seeking behavior among rural residents of Yanchuan County in Yan'an City

Objective To understand the health seeking behavior among rural residents of Yanchuan County in Yan'an City and to analyze its influencing factors. Methods From July 2017 to August 2017, we selected 552 rural permanent residents of Yanchuan County in Yan'an City by convenience sampling. All of them were investigated with the self-designed health seeking behavior questionnaire for rural residents. The binary Logistic regression was used to analyze the influencing factors of health seeking behavior among rural residents. Results When rural residents were ill, 224 (40.58%) rural residents bought medicines for treatment, 216 (39.13%) knew disease related knowledge and 352 (53.01%) rural residents attended rural cooperative medical care. Binary Logistic regression showed that the influencing factors of health seeking behavior of rural residents included ages, monthly income, attending insurance or new rural cooperative medical care, knowing disease related knowledge, diet rules and the proportion of vegetables and meats each meal. Conclusions Health conscious of rural residents is weak; the health seeking behavior is traditional, backward and negative; they lack knowledge on health, medical treatment, health care and emergency treatment and their medical insurance participation is inactive. Government sector should pay attention to health seeking behavior of rural residents, strengthen the development of rural doctor team and clinics in villages and towns, improve medical care system and rural cooperative medical care so as to solve the problems high cost and difficulty of getting medical service among rural residents. Key words: Cross-sectional studies; Health seeking behavior; Rural residents; Influencing factors

Does health insurance promote people's consumption? New evidence from China

In order to change the situation that reimbursement rate of the new rural cooperative medical care system (NCMS) was too low to alleviate farmers medical burden, in August 2012, China began to expand the coverage of the NCMS to include the treatment of critical illnesses. Could more effective health insurance promote the consumption of rural residents? We studied the impact of the critical illness insurance (CII) on rural household consumption, and find that the CII increases per capita household daily consumption by >15%. But healthcare and medical expenditures have not been affected. Our comparison of outcomes for households with different levels of consumption and income shows the CII mainly promote the consumption of rural affluent family, but no incentive for poor family, resulting in deterioration of consumption inequality of rural households. The finding is robust to various alternative hypotheses and specifications.

Study on the participating farmers′ interest demands for the payment system reform in China′s new rural cooperative medical care scheme

Objective To study the participating farmers′ interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A cross-sectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4.00, 4.00 and 3.63 respectively. Relative to the flat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant(P<0.05). Conclusions The diversity of participating farmers′ interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds. Key words: Health services administration; New rural cooperative medical care scheme; Payment system reform; Participating farmers; Interest demands

Study on the doctor-patient interest demands satisfaction of the payment system reform in China′s new rural cooperative medical care scheme

Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctor-patient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit(P<0.05). The influencing factors of medical staff′s satisfaction included the type of payment, work unit, and working years among others(P<0.05). The influencing factors of farmers′ satisfaction included the type of payment and the average annual income, etc(P<0.05). Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients′ understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation. Key words: Health services administration; New rural cooperative medical care scheme; Payment system reform; Interest demands; Satisfaction

Investigation and Analysis on the Current Situation of New Rural Cooperative Medical Care in Hebi City

Objective: summed up the implementation of successful practices and its major achievements in the New Rural Cooperative Medical Care through research and analysis in Hebi six counties (districts). For other regions to continue to improve and further promote NRCMC to provide some reference and sustainable development. Method: combination of qualitative and quantitative methods, including literature, questionnaires, interviews and so on. Results: the NRCMC fund in Hebi has been raised and the expenditure has increased year by year through several years of development. Farmers participate in the NRCMC continues to improve, the rate showed a rapid upward trend, increasing the intensity of compensation, farmers benefit increased. Conclusion: the NRCMC system and institutional framework has been basically formed, combined with the actual optimization of compensation programs to reduce the precipitation fund, increase system security efforts to improve the status of primary health care institutions to accelerate the comprehensive development of health in Hebi.

Barefoot Doctors and the “Health Care Revolution” in Rural China: A Study Centered on Shandong Province

Barefoot doctors were rural medical personnel trained en masse, whose emergence and development had a particular political, economic, social, and cultural background. Like the rural cooperative medical care system, the barefoot doctor was a well-known phenomenon in the Cultural Revolution. Complicated regional differences and a lack of reliable sources create much difficulty for the study of barefoot doctors and result in differing opinions of their status and importance. Some scholars greatly admire barefoot doctors, whereas others harshly criticize them. This paper explores the rise and development of barefoot doctors based on a case study of Shandong province. I argue that the promotion of barefoot doctors was a consequence of the medical education revolution and an implementation of the Cultural Revolution in rural public health care, which significantly influenced medical services and development in rural areas. First, barefoot doctors played a significant role in accomplishing the first rural health care revolution by providing primary health care to peasants and eliminating endemic and infectious illnesses. Second, barefoot doctors were the agents who integrated Western and Chinese medicines under the direction of the state. As an essential part of the rural cooperative medical system, barefoot doctor personnel grew in number with the system's implementation. After the Cultural Revolution ended, the cooperative medical system began to disintegrate-a process that accelerated in the 1980s until the system's collapse in the wake of the de-collectivization. As a result, the number of barefoot doctors also ran down steadily. In 1985, "barefoot doctor" as a job title was officially removed from Chinese medical profession, demonstrating that its practice was non-universal and unsustainable.

Analysis of characteristics of medical assistance to advanced schistosomiasis patients in Hunan Province, 2015

To understand the current distribution and characteristics of advanced schistosomiasis patients who accepted medical assistance in Hunan Province in 2015, so as to provide the evidence for perfecting the policy and measures of the medical assistance to advanced schistosomiasis patients. The patients who had been diagnosed as advanced schistosomiasis were verified and confirmed according to the standard of the medical assistance to advanced schistosomiasis patients in Hunan Province in 2015. The epidemiological survey was conducted to investigate the demographic characteristics, history of diagnosis and treatment, and medical assistance to these persons. There were 3 850 advanced schistosomiasis patients who accepted the medical assistance in Hunan Province in 2015, and among them, 2 664 patients were male (69.19%), and 1 186 were female (30.81%). Most of them (92.82%) came from the main schistosomiasis endemic areas, such as Yueyang, Changde and Yiyang. There were 2 369 cases of ascites (61.53%), 1 466 cases of splenomegaly (38.08%), 15 cases of colon proliferation and dwarf (0.39%). The mean age of advanced schistosomiasis patients who accepted the medical assistance was (62.94 ± 11.67) years old, with 64.31% of them being more than 60 years old. The age of initial diagnosis of advanced schistosomiasis was (53.85 ± 21.32) years old, and it was concentrated in 40-60 years old (68.57%). The mean duration of advanced schistosomiasis was (9.58 ± 10.06) years, and it was mainly distributed in 10 years (75.95%). The mean duration from initial diagnosis of schistosomiasis to advanced schistosomiasis was (22.33 ± 14.20) years. The priority of the medical assistance to advanced schistosomiasis patients was given to the county hospitals (76.57%); and the effective rate of assistance was 94.46%. Totally 86.57% of the patients with advanced schistosomiasis got the medical insurance (rural cooperative medical care, urban medical care, etc.). The burden of the medical assistance to advanced schistosomiasis patients is still heavy because of many patients and low cure rate in Hunan Province. The ascites patients and high age patients should be the important objects of the medical assistance.

Analysis of the impact of the disease-based hierarchical medical system on the inpatients flow covered by the new rural cooperative medical system

Objective To understand the influence of the disease-based hierarchical medical system on inpatients flow covered by the new rural cooperative medical system (NRCMS), and that on the funding diversion and medical costs so incurred. Methods One county was selected from the eastern, central and western regions of China respectively, where the disease-based hierarchical medical system has been in place. Policy documents of the three counties were reviewed to analyze such changes as NRCMS inpatients flow, inpatients subsidy diversion, NRCMS fund surplus rate of the current year and medical costs per hospitalization before and after the system was in place. Results A comparison with 2014 found a 1.26% drop of the out-of-county inpatients of county W of the western region, a 2.00% increase of township hospitals inpatients of county D in the middle region, and the same ratio of out-of-county and in-county inpatients in county F of the eastern region in 2015. Compared with 2014, the fund surplus rate of county W increased 10.46%, and the inpatient subsidy ratio of county D decreased 2.51% for those in out-of-county medical institutions in 2015. Thanks for the quota payment of specific diseases under global budget in county W, the inpatient medical costs per hospitalization dropped at both county and township medical institutions. Conclusions The disease-based hierarchical medical system could optimize the NRCMS inpatients distribution among various medical institutions, conducive for establishment and operation of such a system. Key words: New rural cooperative medical care; Hierarchical medical system; Diseases; Inpatients flow; Fund diversion

Pediatric Medical Care System in China Has Significantly Reduced Abandonment of Acute Lymphoblastic Leukemia Treatment.

In this study, we have analyzed both administrative and clinical data from our hospital during 2002 to 2012 to evaluate the influence of government medical policies on reducing abandonment treatment in pediatric patients with acute lymphoblastic leukemia. Two policies funding for the catastrophic diseases and the new rural cooperative medical care system (NRCMS) were initiated in 2005 and 2011, respectively. About 1151 children diagnosed with acute lymphoblastic leukemia were enrolled in our study during this period and 316 cases abandoned treatment. Statistical differences in sex, age, number of children in the family, and family financial status were observed. Of most importance, the medical insurance coverage was critical for reducing abandonment treatment. However, 92 cases abandoning treatment after relapse did not show significant difference either in medical insurance coverage or in duration from first complete remission. In conclusion, financial crisis was the main reason for abandoning treatment. Government-funded health care expenditure programs reduced families’ economic burden and thereby reduced the abandonment rate with resultant increased overall survival.

What limits the utilization of health services among the rural population in the Dabie Mountains- evidence from Hubei province, China?

BackgroundIndividuals living in rural mountain areas tend to use health services less to manage discomfort or illness. This study aims to identify the variables that best explain the health service utilization of a sample of the rural population in the Dabie Mountains in China.MethodsTo obtain information about health service utilization, a cross-sectional household survey was conducted using face-to-face interviews among the residents of a poor town in the Dabie Mountains. A total of 1,003 residents aged 15 or more, who had felt unwell in the last two weeks before the survey, were included in the analysis. The χ2 test and binary logistic regression were used to analyze the factors influencing health service utilization.ResultsA total of 51.2% of those surveyed had not used health services when they felt unwell, higher than the data reported in the 4th National Health Services Survey of China. Enabling variables played an important role in predicting the utilization of health services. Factors associated with increased health service utilization included being younger, travelling longer to the nearest clinic, and higher household net income.ConclusionTo reduce disparities in health service utilization, (1) some effort should be made to change the perceptions and attitudes of older people; (2) reimbursement levels of the New Rural Cooperative Medical Care System should be improved to reduce economic barriers to health service utilization.

The Study of Cloud Computing Data Interaction Platform on the New Type of Rural Cooperative Medical Care System

Cloud computing is mainly studied and applied in data-intensive industries. It is rarely seen in the medical industry, though it is the most representative one of data-intensive industries and closely related to people's lives. There is no medical data interaction platform of cloud computing. This paper introduces the framework of cloud computing data interaction platform for the new rural cooperative medical care system (NCSM), which will allow for NCMS data interaction on this interactive platform.