Abstract
Background: Over the years, China has designed a new rural cooperative medical system for large rural population, which enables them to obtain adequate medical services and prevents poverty caused by medical treatments. However, the rapid economic growth makes the allocation of health resources and the efficient utilization of health services face severe challenges. The study aims to reveal the medical inequality of eight underdeveloped provinces from the perspectives of medical institutions, insurance policies, the government and farmers, in order to puts forward relevant recommendations.Methods: The relevant statistics about assessing the characteristics and equity of demographics, socio-economic and geographical dimensions were from the China Statistical Yearbook and the China Health Statistics Yearbook. A face-to-face sampling survey of farmers in 24 counties of eight less developed provinces (Guizhou, Yunnan, Sichuan, Shanxi, Gansu, Qinghai, Ningxia and Xinjiang) was carried out by multi-stage stratified random sampling. The protection effect of New Rural Cooperative Medical System(NRCMS), satisfaction of medical service and willingness to participate in NRCMS were analyzed.Results: Since the implementation of the new rural cooperative medical system, there has been an inequality in medical service and insurance policy among poor residents in western China. The uneven distribution of medical resources, the inadequacy of local government investment, the complexity of the reimbursement process, and the low amount of compensation resulted in only 26.6% of the population believing that the economic burden of the disease had been reduced, and 57.3% that the relief effect was not obvious. The remaining 16.1% thought the system was ineffective and farmers' satisfaction was not enough. Conclusion: Compared with the eastern and central regions, there was a certain degree of unfairness in government investment in the resources of medical institutions of the western region with new rural cooperative medical care. This study suggested that policy makers can attract high-quality medical staff to the western region by providing economic security and improving policies. In addition, the increase of the government regional health expenditure and supervision propaganda was one of the important ways to improve the farmers' satisfaction with the policy.