According to the plan of the Ministry of Finance, the coverage of the new rural cooperative medical system should reach 80 percent this year, and full coverage should be realized next year. Therefore, it is undoubtedly of great practical significance to conduct an empirical study on the operation of the new rural cooperative medical system as well as its advantages and disadvantages.
Analysis of the pros and cons of the new rural cooperative medical system
The agricultural population of Liaoyang City, Liaoning Province, is 1,029,100, accounting for 56.5% of the city's total population. Since July 2005, a new rural cooperative medical system combining social coordination and individual accounts has been implemented. According to data from the Liaoyang City Bureau of Statistics, by the end of May 2006, 797,700 farmers had participated in this system in ***, with a participation rate of 77.51%. The survey used a random sampling method, with questionnaires (sample size of 200, recovery rate of 95%) and unstructured interviews (sample size of 50) in five townships in Liaoyang City. The questionnaire data were statistically analyzed by professional statistical software and the results of unstructured interviews, which allowed us to have a general understanding of the operation of the new rural cooperative medical care system as well as its strengths and weaknesses.
(I) Benefits of the New Rural Cooperative Medical Care System
China's new rural cooperative medical care system is a rational institutional arrangement that conforms to the situation and suits the national conditions and the state of economic development, and it has played a certain role in providing rural residents with a moderate level of medical care and health care protection. From the situation in Liaoyang City, the main performance:
1. The new rural cooperative medical care is the basis of medical protection for farmers. In rural China, with the gradual withdrawal of the old rural cooperative medical system, it has caused the real problems of expensive and difficult medical treatment for the rural population, and even some farmers have become poor and returned to poverty as a result. This greatly affects the quality of life of farmers and seriously restricts the economic development of rural areas. Therefore, farmers are in urgent need of a new type of medical insurance system that can meet the needs of medical and health care. According to the questionnaire survey in Liaoyang, 94.79% of the farmers said they needed medical protection; 93.75% of the farmers were willing to participate in the new rural cooperative medical system; and 78.23% of the farmers thought that the new cooperative medical system had many benefits, such as timely access to the doctor and reimbursement of some medical expenses. The new rural cooperative medical care system has arisen in response to the urgent need of farmers for medical protection, and has provided farmers with a certain degree of institutional protection for their health. This system implements a combination of social coordination and individual account mode, the major diseases to achieve coordination, individual accounts can be accumulated and transferred to solve the problem of farmers' medical security, enhance the farmers' self-care and protection awareness, greatly mobilized the enthusiasm of farmers to participate in the insurance, so that the vast majority of farmers are willing to take out an insurance policy for their own health.
2, the new cooperative medical care for the major medical care to provide protection. The new rural cooperative medical system provides a mechanism for the coordination of major illnesses, insured farmers to pay 10 yuan per person per year per household insurance premiums deposited in the personal account, you can get the national, provincial, municipal and county financial **** 40 yuan subsidies to form a social fund, the participants of the major illnesses incurred in the treatment of the costs can be compensated for in accordance with the prescribed standards. This mechanism has effectively solved the problem of treating farmers' serious illnesses and reduced their financial burden. The results of this survey show that: 67.71% of the farmers believe that the new cooperative medical care has solved the problem of seeing a doctor to a certain extent; 71.88% of the farmers believe that this system provides some protection against serious illnesses; and 78.13% of the farmers believe that participating in this system can reimburse some medical expenses and reduce their financial burden. According to a participant suffering from appendicitis in Xima Township, Dengta City, Liaoyang, he spent 1,100 yuan on hospitalization treatment*** and was compensated 400 yuan through the social co-ordination, with a compensation ratio of 36.4%, which solved more than one-third of his medical expenses.
3. A new cooperative medical management and service system is taking shape. Compared with the old cooperative medical system, China's new rural cooperative medical system has a high level of coordination, a sound management system, financial subsidies in place at all levels, and has gradually formed an integrated management and service system. In Liaoyang City, for example, the new cooperative medical care system takes the county as the unit of coordination, with contributions from all villages being handed over to the county office for unified management, and a county coordination committee, county office and supervisory body have been set up in accordance with a unified model that implements the integration of contributions, fund-raising, accounting, management and services. The integrated management and services have realized the scientific and standardized operation of the new rural cooperative medical care system, effectively avoiding the problem of moral risk in the operation of the system, and improving the safety and efficiency of the system. According to an unstructured interview survey in three townships in Liaoyang City, the vast majority of farmers are relatively satisfied with the management and service system of the new cooperative medical system, and only a few of them think that the service needs to be improved.
(II) Inadequacies of the New Rural Cooperative Medical Care System
China's new rural cooperative medical care system has been in operation for less than four years since the pilot program began in 2003, and there are still some obvious flaws and inadequacies in the system from its design to its operation. Mainly in:
1, the system to promote and publicize not in place to affect the farmers to participate in the insurance. The promotion of China's new rural cooperative medical system is characterized by inadequate publicity and administrative mandatory amortization. The former leads to farmers' lack of understanding of this new system and their unwillingness to participate in it, while the latter reflects the local government's crude compulsion of farmers to participate in it in order to obtain financial subsidies from the higher levels and to achieve political results, both of which affect farmers' correct understanding of the new cooperative medical care system. According to the questionnaire survey in Liaoyang City, more than one-third of the 6.25% of farmers who are unwilling to participate in the new cooperative medical care system do so because they do not understand the system. On the one hand, this is due to the low literacy level of the farmers, with an average of only 7.6 years of education among all the respondents, who do not understand the terminology of the new cooperative medical system, and some of them cannot even read the publicity materials of the new cooperative medical system. On the other hand, it is because the publicity content is not detailed enough, and there are problems such as the scope of medicines, the scope of diagnostic and treatment programs, and the unclear procedures for handling the system. In the survey, it was found that 35.42% of the farmers did not understand the scope of medicines and the scope of diagnostic and treatment programs, and 40.63% did not know the compensation standards for hospitalization for serious illnesses. In addition, some farmers were not compensated when they could have been, but were not, because they did not fulfill their obligation to inform the public in a timely manner or because they exceeded the deadline for compensation or did not go through the procedure of transferring to another hospital, causing dissatisfaction among farmers with the system. These problems are caused by the lack of management, service and publicity, which directly affects the farmers' motivation to participate in the insurance system, and even some farmers who have already participated in the insurance system are less credible and intend to withdraw from the system.
2. The narrowness of the beneficiaries leads to a lack of credibility. China's new rural cooperative medical system is a combination of social coordination and individual accounts, but only for major illnesses, the system model. Individual accounts are funded by individual contributions for outpatient care and medicines; social coordination is funded by finances at all levels and is used to coordinate treatment for major illnesses. In the case of Liaoyang city, participants in the new cooperative medical care system receive only about a 20 per cent reduction in medical fees for outpatient visits to designated medical institutions at the township and county levels, in accordance with the policy, and no compensation is paid for outpatient visits to designated medical institutions at the county level or above. It is clear from this that the beneficiaries of the new cooperative medical system are mainly those who are hospitalized for serious illnesses. In the field survey, it was found that only 13.54% of the households surveyed had members who were in poor health and had suffered or were suffering from major illnesses in the recent past. In other words, the probability of the rural population having a major illness is not very high, and most farmers get minor illnesses on a daily basis, usually treated on an outpatient basis, spending the premiums they have paid, and basically not benefiting from state subsidies. Even if they are hospitalized for serious illnesses, the number of beneficiaries is very limited due to the limitations of designated medical institutions and starting payment lines. In addition, the scope of medicines and diagnostic and therapeutic programs of the new cooperative medical care is relatively small, which also has a certain impact on the benefit area. In the questionnaire survey, 45.83% of the farmers think that the scope of medicines is relatively small, and 48.25% think that the scope of diagnosis and treatment programs is relatively small. It can be seen that the narrow beneficiary surface of the new cooperative medical care system leads to the lack of credibility of the system. This is well illustrated by the fact that 66.67% of the 6.25% of families who are unwilling to participate in this survey think that the system is useless. Regarding which model of cooperative medical care farmers are willing to participate in, more than 75% of farmers answered that they would like to participate in a system that insures both outpatient and inpatient care.
3. It is difficult for farmers to cover their daily medical expenses with their small contributions. Individual contributions to the new rural cooperative medical system vary according to the economic situation of each region, but the contribution standard in most regions is 10 yuan per person per year. In Liaoyang City, for example, each person, on a household basis, contributes 10 yuan per year and deposits it in an individual account for medicines and outpatient visits. Judging from the level of contributions, even for a family of five, the total amount in the individual account is only 50 yuan, which is far from enough to pay for medicines and outpatient visits for the whole family for a year. The results of the questionnaire survey show that 67.71% of the families believe that the new cooperative medical care has solved the problem of access to medical care to a certain extent, while 19.79% believe that it has not solved the problem at all; 64.59% of the families believe that the money in their individual accounts is not enough to pay for medical care, while 27.08% believe that it is barely enough to pay for medical care. It can be seen that farmers' low contributions have led to insufficient funds in their individual accounts to meet their basic medical needs. Therefore, a considerable number of participants believe that they have not benefited from this system or have not seen the role of medical protection of this system.
4. The government's low investment has led to a low level of protection. In the new rural cooperative medical system, in addition to the farmers to individual account contributions, all levels of financial subsidies to the participants 40 yuan per person per year, into the social coordination for compensation for serious illnesses. However, judging from the operation of the system, insufficient government subsidies have resulted in a very low level of coverage. Survey results show that 92.71% of farmers believe that government subsidies are insufficient, and 64.44% believe that the proportion of compensation standards for major diseases is relatively low. Taking Liaoyang Dengta City as an example, the number of hospitalizations from April to December 2006 was 5,913, with a total per capita sub-average cost of about 17.81 million yuan, and the amount of compensation from the Social Coordination Fund was about 4.27 million yuan. The average per capita sub-average cost was calculated to be RMB 3,011.66, and the average per capita medical fee compensation was calculated to be RMB 721.53 according to the hospitalization compensation standard, which gives a compensation ratio of about 24%. In other words, if the starting line is not taken into account, 76% of the cost of hospitalization or treatment for serious illnesses has to be borne by the farmers themselves. If we add to this the daily costs of medicines and outpatient care for the sick, the financial burden of medical treatment and health care for farmers is still very heavy. At the same time, due to the poor medical conditions, aging equipment, and low technical level of medical staff at county and township designated medical institutions, some patients with serious illnesses do not dare to go to these medical institutions, and can only go to the city or provincial designated medical institutions for consultation and treatment. This is because the compensation for major diseases under this system is not based on the type of disease, but rather on the level of the medical institution, and there is a starting line and a lower ceiling, meaning that medical expenses above the starting line will be compensated, and medical expenses beyond the ceiling will not be compensated. Therefore, the higher the level of the medical institution, the lower the reimbursement; and the cost of medicines that are not covered by the insurance is also deducted, so that farmers receive little compensation for serious illnesses or hospitalization. For some diseases (such as epilepsy), the designated medical institutions do not have corresponding treatment departments or are not even covered by the insurance, so they can only go to non-designated specialized medical institutions for treatment, and in this way they are not compensated for, and the farmers have to bear all the medical expenses themselves. From this, it is easy to see that due to the government's investment leads to a narrow beneficiary surface and low level of protection, so that the role of the new rural cooperative medical system to play quite limited.