Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Hong Wang


In 2002, the Chinese government renewed commitment to rural health. One experimental insurance program, Rural Mutual Health Care (RMHC), provides affordable coverage for rural residents where a previous insurance system, Cooperative Medical System (CMS), was poorly functioning. This study examined how RMHC affected physician prescribing in Fengshan Township, Guizhou Province, China. Six village doctors were chosen for study based on prior reviews showing high, average, or low rates of prescribing errors. 858 prescriptions with the single diagnosis of common cold were systematic sampled from insured and uninsured patient visits in March-May 2003 (under CMS) and 2004 (under RMHC). Peer physicians reviewed prescriptions for inappropriate prescribing. X2, Fishers exact, and two-tailed t-tests were used to explore demographic and prescription characteristics. Multiple linear and logistic regressions were used to model outcomes of: number of medications, cost, injection use, and inappropriate prescribing with covariates of: patient age and gender, prescribing doctor, year, insurance, and year-insurance interaction. Results show mean cost decreased from 13.09 yuan in 2003 to 7.22 yuan in 2004 (p<0.001). Cost increased from 7.12 yuan for the uninsured to 11.19 yuan for the insured (p<0.001). After adjusting for other covariates, RMHC had lower drug costs and fewer medications as compared to CMS (respectively, p=0.025 and p=0.001), but RMHC had no significant effect on injection use or inappropriate prescribing (respectively, p=0.641 and p=0.912). In conclusion, this study shows RMHC successfully controls medication costs, but likely has little effect on quality of care. A larger, more rigorous study is needed to assess RMHCs impact on quality of care.


This is an Open Access Thesis.

Open Access

This Article is Open Access