The merger of urban and rural basic medical insurance on health-seeking behaviors of the elderly in Guangyuan city, Sichuan province

Abstract

Due to the inequalities between the systems of basic medical insurance, the Chinese government decided to merge urban residents basic medical insurance with the new rural cooperative medical scheme into a new form in 2016. Guangyuan city is a pilot city for medical insurance reform in Sichuan province; therefore, it is significant to study the impact of the merger of basic medical insurance on the health-seeking behaviors of the elderly in Guangyuan city. The research objectives were (1) to know the health-seeking behaviors of the elderly under the merger policy, (2) to point out impacts of the merger policy on the health-seeking medical behaviors of the elderly, and (3) to seek recommendations for improvement of existing medical insurance policies. This research employed observation and in-depth interviews. Two Grade-A hospitals in urban and a township health center in rural areas were selected for data collection with one-week observation followed by an in-depth interview. The observation focused on the medical environment and the whole treatment process of the elderly, while the in-depth interviews were conducted with 7 elderly living in the urban area and 8 elderly living in the rural area above 60 years old. The contents of the interviews included their background, living habits, medical habits and behaviors, thinking of medical insurance, and healthcare reform. It was found that health-seeking behaviors of the elderly were: (1) the elderly's health-seeking behaviors were more inclined to quality and medical results; (2) the elderly tended to avoid facing their health problems directly; (3) the elderly would prefer western medicine first and then traditional Chinese medicine; and (4) their children had absolute power to decide their parents' health-seeking behaviors. For the impacts of the merger policy, it was found that (1) the transportation development had greatly promoted elderly's use of health resources and medical insurance; (2) the merger policy could effectively stimulate and improve elderly's health-seeking behaviors, but the effect of this stimulation was limited; and (3) the merger was not effectively improved elderly's mindset of seeking health with attachment to the traditional passive behaviors. IMPLICATION OF THE THESIS: The findings of this study can reflect the impacts and changes of health seeking behaviors of elderly in Guangyuan city under the medical insurance reform. It can also reflect the specific implementation of medical insurance policy reform to a certain extent, and provide direction and ideas for relevant government departments to further implement health security policy reform.