Resistencia de Compresión Diagonal de muretes

The RCMS ID booklet is a record of the financial balance of payments and expenses under the new Scheme and participants must show it when they go to see a doctor.

They are issued the booklet upon payment of the Scheme’s premium. The Miao people paid a premium to join the new RCMS and the premium became a deposit in the new RCMS ID booklet. The new RCMS ID booklet is part of the personal health

Older Miao People and Rural Health Policy in China Lin Yuan, University of Sydney, 2012

savings account. However, when a booklet is lost there is considerable delay in delivering a new one. The annual renewal of the booklet always takes more than six months. During this period, the villagers cannot use it. Worse still, the village doctors prefer charging local patients cash and seldom tell them that they can use any remaining money in their contribution account that is indicated in the booklet. This is because the village doctors don’t want to be bothered to apply to get the money back from the township centre hospitals – a process which often takes at least a month.

Furthermore, because of the lack of communication between children and parents, most elderly Miao do not know they have paid their contributions to the new RCMS and do not know where the booklet is located in the house. Although some of the younger participants understood that they can use the money in their booklet, they would forget to take it with them when visiting the doctor in the village clinic. For example:

We know that we can use the money on our new RCMS booklet account. However, my husband is very ill and we went to the village clinic in a hurry and forgot to take the new RCMS booklet. We just owed the doctor and planned to pay him back later.

[Participant M23]

Reimbursement

Many older people commented that there are numerous restrictions on reimbursement under the RCMS. They cannot apply for reimbursement if they go to private clinics.

They cannot apply for reimbursement for medicines for chronic illnesses. They cannot apply for reimbursement if they go to see a doctor in the designated public hospital as an outpatient or if the doctor treats them in their own home.

Older Miao People and Rural Health Policy in China Lin Yuan, University of Sydney, 2012

After the new RCMS was piloted in these villages, any villager could give the local doctor a call if somebody at home was ill. Particularly older Miao people who are too weak to walk or take a motorcycle ride need doctors to visit them at home. After the doctor gets a call, he will walk or ride a motorcycle to the patient’s home and give them treatment. However, the older Miao participants reported that this costs more than if they go to see a doctor in the clinic and they cannot apply for any reimbursement for a home visit.

In the rural township hospital, inpatients can apply for over 50 per cent reimbursement, but it is costly for the local rural people to go there and it would take at least two hours. There is no fund pooling arrangement for outpatient care and so members are encouraged to use inpatient services whenever possible.

It is quite far for us older Miao to see a doctor in the local township or county hospitals. However, we can only apply for reimbursement if we are admitted in the township or county hospitals. This is inconvenient to us older Miao people.

[Participant M4]

Many older Miao participants also complained that the RCMS reimbursement procedures were too complex for them and made them run ‘here and there’. It is particularly complex for the illiterate older Miao. Without the help of younger children, some older Miao people would not know how to cope with the complex procedures (including how to find a photocopy machine to copy the new RCMS ID booklet, to collect the doctors’ prescriptions, and to collect all the related receipts

Older Miao People and Rural Health Policy in China Lin Yuan, University of Sydney, 2012

from the hospitals, etc.). They thought it was a nuisance to apply for RCMS reimbursement:

To apply for reimbursement, we older people need to go to “Huanhuan” township to do photocopies and pay people to type the documents into the computer. We cannot read because we never went to school. It is hard for us to find a place. [Participant M2]

Conclusion

Older Miao participants experienced poor living circumstances, poor health, high mortality of their children and very limited access to adequate health care under the new RCMS. Though the elderly Miao had very limited awareness of the Scheme and how it worked, they still believed that it had made health care more readily available.

Nonetheless they identified major restrictions on their access to its benefits. The main issues related to: accessibility, including financial constraints; insufficient medical resources; attitudes of hospital doctors and local officials; limited awareness and understanding of the Scheme; complexity of the procedures involved in obtaining reimbursement; inadequate reimbursement coverage; communication difficulties; and transport barriers.

Many of these concerns were echoed by local health professionals and managers, whose experiences and perceptions of the RCMS are described in the following chapter.

Older Miao People and Rural Health Policy in China Lin Yuan, University of Sydney, 2012

CHAPTER 6