title: New cooperative medical financing policy and hospitalization in rural China: multi-stage cross-sectional surveys.
abstract: BACKGROUND
  In 2003 China began to implement the New-type rural Cooperative Medical System (NCMS). This provided enhanced funding for hospital-based medical services among farmers. We examined self-reported utilization data for evidence of changes following the new policy.
  
  
  METHODS
  We conducted a multistage stratified random cluster sampling method for Jiangxi Province, China. Data were collected via five surveys in 2003-4, 2006, 2008, 2010, and 2012. The study compared the rates of hospitalization, early discharge, and hospital avoidance as descriptive indices after weighting the data. Weighted multiple logistic regression analysis was used. Multi-stage cross-sectional analysis was used to explore the reasons for early discharge and for avoiding the hospital during illness.
  
  
  RESULTS
  We found that the rates of hospitalization, early discharge and hospital avoidance showed upward, downward and downward changes respectively. The logistic regression analysis showed that, controlling for other factors, the financing level significantly affected the changes of the three indexes (p<0.05). The proportion of finance-related early discharge and hospital avoidance dropped significantly (p<0.05).
  
  
  CONCLUSIONS
  NCMS improved the utilization of in-hospital services step by step as time went on, and greatly alleviated cost-related barriers to accessing health services. Even so, because costs continue to restrict access to services we should continue the NCMS policy and improve its guarantee levels.
authors.affiliation: School of Public Health, Nanchang University, Nanchang, P.R. China.
authors.forename: JiaoJiao
authors.initials: J
authors.lastname: Zou
authors.affiliation: School of Public Health, Nanchang University, Nanchang, P.R. China School of Community Health Sciences, University of Nevada, Reno, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: School of Community Health Sciences, University of Nevada, Reno, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Cook
authors.affiliation: School of Public Health, Nanchang University, Nanchang, P.R. China yuanzhaoakng@126.com.
authors.forename: ZhaoKang
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: School of Public Health, Nanchang University, Nanchang, P.R. China.
authors.forename: LianJun
authors.initials: L
authors.lastname: Zhang
authors.affiliation: School of Public Health, Nanchang University, Nanchang, P.R. China.
authors.forename: Xi
authors.initials: X
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: China; Health care finance; Hospital utilization; Mainland China; New-type rural cooperative medical system (NCMS); Rural health services