Xiao XUE, Qiaojing ZHENG

School of Public Administration, Chongqing Technology and Business University, Chongqing 400067, China

Abstract [Objectives] The paper was to understand the health of rural poor population in Chongqing, and to put forward countermeasures for health poverty alleviation. [Methods] The 439 people living in poverty in Qianjiang District and Pengshui County, Chongqing, were investigated on the spot to deeply understand and analyze the health status, current medical insurance status and accuracy of medical system of rural poor population in Chongqing. [Results] The vast majority of poor households had been lifted out of poverty after targeted poverty alleviation. Poverty due to illness was the main cause of family poverty. The prevalence of chronic diseases in poor households was high, and the overall health level showed a downward trend. The countermeasures and suggestions for strengthening the construction of medical insurance system, exploring and perfecting rural medical assistance system, enhancing the service capacity of primary medical and health institutions, and strengthening health education and health management were put forward. [Conclusions] The study provides an empirical evidence for improving the health level of poor rural residents and promoting targeted health poverty alleviation policies.

Key words Chongqing, Poor population, Health status, Targeted health poverty alleviation

1 Introduction

China has achieved remarkable results in poverty alleviation in recent years, with 740 million people lifted out of poverty by the end of 2017. Of the 30.46 million people living in poverty, 42.3% were poor due to illness, and poor living conditions make it difficult to get out of poverty. Health poverty alleviation is an important part of winning the battle against poverty and lifting the rural poor people out of poverty, and also an inevitable requirement for realizing the healthy China strategy and building a moderately prosperous society in all respects[1]. At present, health poverty alleviation in China has such problems as imprecise targets, ineffective effects and insufficient sustainable motivation, which are the main factors restricting rural poor people from getting rid of poverty and improving their health level. Therefore, it is of great significance to carry out practical research on health poverty alleviation policies[2]. Taking Qianjiang District and Pengshui County of Chongqing as examples, this paper analyzes the health status of poor population, in order to provide an empirical evidence for improving the health level of poor rural residents and promoting targeted health poverty alleviation policies.

2 Policy practice of health poverty alleviation

Health poverty alleviation refers to that the poor people are guaranteed access to basic medical and health services and health security, and are prevented from falling into poverty due to illness or falling back into poverty due to illness by taking the measures such as increasing investment in health resources, establishing medical security mechanism, carrying out health science popularization and health promotion, and establishing disease prevention and control mechanism[3]. The year 2020 is the final year for securing a decisive victory in building a moderately prosperous society in all respects and in the battle against poverty, and health poverty alleviation is a hard task that must be accomplished. The whole country should adhere to the "dual focus" of epidemic prevention and control and health poverty alleviation, and firmly win the battle of health poverty alleviation centering on the goal of ensuring basic medical care for the poor[4]. According to the decisions and arrangements of the CPC Central Committee and the State Council on poverty alleviation and the requirements of healthy poverty alleviation work, Chongqing had thoroughly implemented theKeyPointsofHealthyPovertyAlleviationWorkin2020: (i) comprehensively addressed the prominent problem of ensuring basic medical care, and promoted the capacity building of county-level hospitals with high quality, the mechanism construction of integrating county and township services with rural services, the standardization of rural medical and health institutions, the training of county and rural medical and health professionals, and the 5G+ special campaign for poverty alleviation through health care; (ii) comprehensively investigated and rectified all kinds of problems, focused on the rectification of feedback problems, carried out solid investigations and rectification of health poverty alleviation issues, and conscientiously conducted general surveys on poverty alleviation; (iii) effectively prevented people from returning to poverty due to illness, improved the institutionalized classified treatment mechanism and the medical security mechanism for the poor population, and strictly implemented the "four not take off"; (iv) established a long-term mechanism for healthy poverty alleviation, which organically linked with the rural revitalization strategy, integrated with comprehensive medical reform at the county level, and integrated with the healthy China construction; (v) did a good job in the summary and publicity of health poverty alleviation, established a library of health poverty alleviation publicity materials, and comprehensively and systematically carried out the summary and publicity work[5]. Although Chongqing has made remarkable achievements in the health poverty alleviation, there are still some problems, such as inadequate responsibility transmission of the subject of inspection and rectification, inadequate diagnosis and treatment service capacity, and need to be strengthened in the consolidation and improvement of poverty alleviation[6].

3 Data sources and research methods

3.1 Data sourcesPengshui County, a national poverty-stricken county in Chongqing, and Qianjiang District, a city-level poverty-stricken county in Chongqing, were selected as the investigation areas. In December 2019, a questionnaire survey was conducted among 184 poor households and 439 poor households in 10 villages and 5 towns in Qianjiang District and Pengjiang County of Chongqing through research interviews, interviews and questionnaires. Personal information (basic information, source of income, medical behavior, medical services, social security, health status,etc.), family situation and reproductive capacity (family members, income and expenditure, human capital, material capital,etc.) were investigated. A total of 420 valid questionnaires were recovered, with an effective rate of 95.7%. Chongqing Municipal Health Commission, health poverty alleviation departments of the two districts and counties, as well as medical institutions such as county people’s hospitals, township health centers and village clinics, were interviewed, to learn about the progress and implementation results of health poverty-relief work.

3.2 Research methodsData were summarized by Excel software, and the effective experience and problems of health poverty alleviation in Chongqing were deeply analyzed. A self-evaluation system for the health status of the poor population was constructed using 15 indicators from 5 dimensions (Table 1). A score of 91-100 was rated as healthy, 71-90 as general, and 0-70 as unhealthy.

Table 1 Health self assessment system for poor people

4 Research results

4.1 General situation of survey areaQianjiang District is a city-level poverty-stricken county in Chongqing (take off the hat of poor counties in 2016), while Pengshui County is a key county in the national poverty alleviation work (out of the list of poor counties in 2020). The economic development level of the two districts and counties is relatively backward in Chongqing, with a large number of poor people, and the task of health poverty alleviation is arduous. Qianjiang District and Pengshui County had adopted safeguard measures and support mechanisms for the health improvement of poor people, reform measures of "medical alliance construction" to promote the service capacity development of primary medical and health institutions, reform of medical insurance system in line with graded diagnosis and treatment and, a series of health poverty alleviation measures including the signing up of family doctors, and had made significant progress and remarkable achievements. After the implementation of targeted poverty alleviation, the vast majority of poor households had been lifted out of poverty (Table 2). There was a large gap in income: 53.1% of the families had an annual income of 20 000-80 000 yuan, and 17.7% had an annual income of less than 10 000 yuan (Table 3).

Table 2 Changes in the number of people returning to poverty due to illness in Qianjiang District and Pengshui County from 2018 to 2019

Table 3 Average annual household income level of 181 poor households

4.2 Health status of poor rural residents in Chongqing

4.2.1The trend of family miniaturization is obvious, and poverty due to illness is the main cause of family poverty. The survey data show that most of the sample families had 4-6 people, with an average registered population of 4.38, and the average permanent population was 2.60. The size of rural families was small, and 14.9% of the families were both poor households and households enjoying the minimum living guarantee, so it was difficult to guarantee their basic life. The results of the survey on "the main causes of household poverty" showed that 52.5% of households were poor as a result of incapacity for work due to illness, and 45.3% were poor as a result of high medical expenses for treatment of illness (Table 4).

Table 4 Survey results of 181 households on main causes of household poverty

4.2.2The prevalence of chronic diseases in poor households is high, and the overall health level shows a downward trend. A further survey of the poverty-stricken population caused by illness showed that 35.0% of the population suffered from chronic diseases, of which 68.7% suffered from hypertension and 31.3% from diabetes, chronic obstructive emphysema or other diseases; 27.4% of the poor had difficulty in moving around, 2.9% were unable to take care of themselves, 4.0% were unable to carry out daily activities, 55.7% had extreme or moderate pain or discomfort, and 19.5% had moderate or extreme anxiety or depression. The results of the self-rated health status scoring showed that the average score of the self-rated health status of the respondents in 2018 and 2019 was 72.63 and 72.57 points, respectively, among which 16.9% of the poor believed that their health status had improved, 19.8% that their health status had deteriorated, and 63.3% that their health status remained unchanged (Table 5). The data showed that the health of the poor population in the survey area was at a moderate level and showed a downward trend.

4.3 Current situation of medical security

4.3.1The level of basic medical insurance compensation and medical care for urban and rural residents needs to be further improved. According to the survey data, 97.9% of the poor people had purchased basic medical insurance, which to some extent alleviated the medical cost burden of residents. Further analysis demonstrated that the diseases covered by basic medical insurance were limited and can not meet the actual needs of the rural poor. In addition, the overall medical level of rural areas in China was low, and poor peasant households with serious diseases needed to go to provincial and municipal hospitals for treatment, and the proportion of self-expenses increased significantly, so the medical treatment of poor people due to disease could not be fundamentally improved[7].

4.3.2Health poverty alleviation policies need to be further improved. This study investigated the medical treatment behavior of the poor population in the recent 2 weeks and 1 year, and the results showed that township hospitals and county-level hospitals were the main medical institutions for the poor (Table 6). Further investigation and analysis suggested that the vast majority of poor people had the habit of long-term medication, while the health poverty alleviation policy favored the poor people who were hospitalized, and the poor people who did not suffer from major diseases and needed long-term medication did not have effective medical security.

Table 5 Self assessment of health change of 420 respondents

Table 6 Medical behaviors of sick poor people

In conclusion, by the end of 2019, the majority of poor households in the surveyed region had been lifted out of poverty, the problem of poverty caused by illness had been alleviated, and the health of the poor population was at a moderate level and on a downward trend. Although basic medical insurance alleviated the medical burden of the poor due to illness to a certain extent, due to the small amount of reimbursement and the limited types of reimbursed diseases, it had not substantially solved the problems of the poor due to illness and difficulty in seeing a doctor.

5 Measures and suggestions

5.1 Strengthening the construction of medical insurance systemThe construction of "seven guarantee lines" should continue to be strengthened, and medical subsidies for poor people must be strengthened through basic medical insurance for urban and rural residents, critical illness insurance, medical assistance, medical fund for poverty alleviation, health medical fund for poverty alleviation, disease emergency assistance, commercial supplementary insurance and other measures[8]. Information comparison must be further strengthened, and the policy of subsidizing health insurance for poor people should be thoroughly implemented; the triple security system for poor people must cover and link up well, so as to ensure that 100% of all people are covered by insurance. The reimbursement rate of inpatient medical insurance for poor people in district and county-level hospitals will be raised by 10% and the threshold for reimbursement will be cut by 50%.

5.2 Exploring and improving the rural medical assistance systemThe existing post-medical assistance methods are improved, and the channels for reporting and reimbursement of emergency medical assistance funds are smoothed and optimized to realize one-stop services. A mechanism for tracing medical treatment to the source of poverty is established, and the policy flexibility is increased. The medical expenses incurred by poor families who become poor due to illness are included in the coverage of medical insurance.

5.3 Improving the service capacity of community medical institutionsThe long-term mechanism of medical service pairing support is improved, and the limited resources are tilted to rural areas with weak foundation and remote mountainous areas[9]. The health service capacity at the grass-roots level is enhanced, and the construction of medical treatment alliance is improved. Tertiary hospitals, district and county hospitals, township hospitals and village clinics are closely linked, and leading hospitals send professionals to grass-roots hospitals to ensure that the goal of "slight illness do not need to go out of the village, common diseases do not need to go out of the township, serious diseases do not need to go out of the county" can be realized[7].

5.4 Strengthening health education and health managementIn the process of health services, poor people should be actively guided to prevent and care for common diseases[9]. On the one hand, the popularization of health knowledge should be strengthened, such as broadcasting health education videos, distributing health education brochures and holding health knowledge lectures. On the other hand, early prevention, intervention and treatment of diseases can be achieved through the management of chronic diseases and screening of major diseases, so as to avoid the deterioration of rural residents’ conditions and enable them to receive effective treatment when their conditions are relatively mild, especially focusing on the health status of vulnerable groups[10].