Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices

BMC Public Health

Research Article

Nicola Cherry¹  Jie Tao²  Ming Zhao²  Zhen Jiang²  Chunsun Ling²  Qicheng Jiang² 

[1] Community and Occupational Medicine Program Faculty of Medicine, University of Alberta 5-30 University Terrace Edmonton, T6G 1K4, Alberta, Canada;School of Health Administration Anhui Medical University, Meishanlu 81, Hefei, Anhui, China;

关键词: Intervention Site;    Systemic Steroid;    Comparison Site;    Prescription Cost;    Township Hospital;   

DOI  :  10.1186/1471-2458-11-50

 received in 2010-04-29, accepted in 2011-01-24,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIn 2003 the Chinese government introduced voluntary cooperative medical schemes (CMS), soon to be in place throughout rural China. Families who chose to enroll do so as a single unit and nothing is known about any differential effect of these new schemes on family members. This study evaluates the impact of one pilot CMS in Anhui Province on health care use by girls aged less than 5 years and women 65 years or older, and on the pattern and cost of prescriptions.MethodsHealth care records were extracted covering a 10 year period, before, during and after the pilot CMS in 4 townships, one with the intervention and 3 comparison townships without. The impact of the intervention on the age and gender distribution of patients presenting for health care and on the prescription of certain drugs was assessed by logistic regression. The cost of prescriptions before, during and after the intervention period was also assessed.Results203,058 registration and 643,588 prescription records were identified. During the intervention there was a reduced likelihood overall that a patient was female (OR = 0.92: 95%CI 0.87 - 0.97) at the intervention site. Girls aged < 5 years had an increased likelihood of health care (OR = 1.41: 95%CI 1.23 - 1.59) during the CMS, but women ≥ 65 years were relatively disadvantaged (OR = 0.84: 95%CI 0.75 - 0.95). The use of antibiotics and systemic steroids increased disproportionately at the intervention site for patients ≥ 5 years. Prescription costs at the township hospital also increased at the intervention site, particularly for older men.ConclusionsThis evaluation suggests that all family members did not benefit equally from the pilot CMS and that women ≥ 65 years may be disadvantaged by the newly available reimbursements of health care costs through the CMS. It points to the need, in future evaluations, to use individuals rather than families as the unit of analysis, in order to determine whether such health care inequalities are wide-spread and persistent or are reduced in the longer term. The results also support earlier concerns about the influence of new funding resources on prescription practices and the need for regulation of for-profit prescribing.

【 授权许可】

Unknown   
© Jiang et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.