Analysis of the impact of county medical alliance on patient flows under the NRCMS: A case study of Dingyuan county of Anhui Province / 中国卫生政策研究

Objective:This study is conducted to analyze the impact of county medical alliance on patient flows under the NRCMS in Dingyuan county of Anhui province. Methods: data on patient-flow were collected through the NRCMS information platform and related policy documents for 2015-2016, and interviews were conducted to study the main reform practices in the county medical alliance. Results: The patient flow under the NRCMS varied in the way of 1) the total number of inpatients seeking treatment outside of the county decreased by 3.31%;2) the treat-ment volume of county-level hospitals and township health centers were increasing,and the latter one is growing faster than the former,meanwhile,the treatment volume of the village clinics declined,and 3) the hospitalization expenses per inpatient for patients who seek treatment outside the county are much higher than the expenses incurred within the county. Conclusions:the development of county-level medical alliance has influence on patients with common disea-ses who used to seek treatment by helping to reduce the number of inpatients outside the county and reduce the pres-sure of the new rural cooperative fund. However, significant problems still exist such as shortage of talented practi-tioners,and lagging development of information technology system.

Operational Analysis on Critical Illness Medical Insurance for Rural Residents / 中国卫生经济

The premium of Critical Illness Medical Insurance(CIMl) for rural residents were allocated from the funds of New Rural Cooperative Medical Scheme(NCMS).Through analyzing operational condition of CIMI for rural residents,it found that not only did the CIMI effect the insurance level of NCMS,but also it had limited insurance effect,the self-paid economic burden of rural patients with critical illness was still heavy.Therefore,it suggested to define the function allocation of CIMI,set up financing mechanism and management mechanism which would be suitable.Since CIMI was supplemental medical insurance,it needed to set up independed financing mechanism.Since CIMI was basic medical insurance,it needed to set up the integrated management mechanism of basic medical insurance and CIMI.In the integrated process of Urban and Rural Basic Medical Insurance and CIMI,varied financing mechanism could be set up to promote the equity of CIMI.

The analysis of seeking behavior and medical expenses for diabetic outpatients of New Rural Cooperative Medical Scheme in eastern areas of China / 中国卫生政策研究

Objective:To investigate the characteristics of seeking behavior and medical expense of outpatients in the New Rural Cooperative Scheme,and provide suggestions and theoretical basis for the implementation and pro-motion of hierarchical medical policy systems.Methods:In this study,13 counties in the eastern part of China were selected.By using data about diabetes mellitus distribution and medical expense of outpatient service reimbursement database in Beijing New Rural Cooperative Medical Scheme from 2009 to 2013,the diabetes mellitus were divided in-to two groups:with complications and without complications; the number of visits and proportion of the first-class, secondary-and tertiary-level medical institutions and the average annual growth rate of the five-year were calculated and the total expense,the average cost,the individual burden and the annual growth rate of the two types of diabetes mellitus were statistically analyzed.Results:The visits in the tertiary medical institutions of diabetes mellitus without complications decreased from 1895 to 661 and the proportion decreased from 3.05% to 0.6% from 2009 to 2013, while the visits in the tertiary medical institutions of diabetes mellitus with complications increased year by year and the proportion increased from 3.27%~4.24% since 2010.Outpatient medical expenses varied widely between pa-tients with and without complications and the higher the level,the greater the difference between the two.At the first-class,secondary-and tertiary-level institutions,the average expenses per time of diabetes mellitus with complications were 2.50,3.34 and 3.75 times higher than the diabetes mellitus without complications and the average out-of-pock-et expenses per time were 2.62,3.66 and 3.96 times higher than the latter respectively.Conclusions:From 2009 to 2013,the utilization of primary outpatient service in the region achieved some success while there were still some problems including unreasonable outpatient distribution, and more diabetic patients with complications went to the tertiary-level institutions than those without complications.Compared with outpatients without complications,patients with complications face up to a larger direct-economic burden of disease.The construction and the ability to prevent and control diabetes mellitus of basic medical institutions should be further strengthened,and the distribution of pa-tient needs to be reasonably led to enhance the service quality and ability of preventing,treating and controlling dia-betes and complications,and to guide patients with diabetes to seek medical treatment in primary healthcare institu-tions.

Analysis on operational status of the New Rural Cooperative Medical Scheme：Based on the field survey in 14 counties of 6 provinces / 中国卫生政策研究

Objective:To Compare the operational status of the New Rural Cooperative Medical Scheme( NCMS) in 14 Counties of 6 provinces. Methods:Two provinces were selected from eastern, central and western areas respec-tively and then two counties were chosen randomly from each province, but each of Jiangsu and Guangxi Provinces pro-vided 3 to reach the sample number of 14 counties. Excel 2007 was used for descriptive and comparative analysis of fund and in-patient service for NCMS. Results:The average funding standard was about 300 and 350 Yuan for 2012 and 2013. Hospitals outside county were frequently used and the ratio was over 40% in county I. Except Jiangsu and An-hui, the rate of enrollees who get compensation for inpatient service was over 10% and the actual compensation rate more than 50%, Fujian being an exception. Average hospitalization costs per time were different among counties and significantly rose in 2013. The ratio of out of pocket inpatient service expenses to the net rural household income was diverse among counties and it declines in some of them in 2013. The rate of fund for hospitals outside county was high and that of G counties was more than50%. The fund surplus rate was negative in that same year and was accumulatively ranging between 1 and 2%. Conclusions:The NCMS financing level was low and the personal financing responsibility was lighter;the enrollees didn’t contribute enough. In-patient service utilization structure was not rational in different level hospitals. The actual compensation rate for inpatient service didn’t increase a lot and the medical expenses burden didn’t alleviate apparently. The funds supervision was weak and it probably leaded to a high risk fund deficit.

Case study on the payment system reform of New Rural Cooperative Medical Scheme / 中国卫生政策研究

With the full coverage of China 's basic medical insurance, medical costs showed a rapid growth trend. It is becoming more and more important to control the cost of medical treatment. Strengthening the control of medical insurance providers is the experience of international health insurance management and an important direction of China's basic medical insurance system reform. Many areas explore the reform of basic medical insurance payment actively and accumulated a lot of typical experience. When exploring the reform of basic medical insurance payment, the practical experience proposes that we should avoid the shortcomings of the post-payment system and prospective payment system, and push a combination of a variety of payment methods such as the capitation, the Pay per bed day, the DRGs etc. , and the promotion of comprehensive reform of public hospitals to establish a classification diag-nosis and treatment.

Impacts of health care alliance on the visiting rate of NRCMS patients within the county:Case study of Huangzhong county, Qinhai province / 中国卫生政策研究

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.

Study on the ability of New Rural Cooperative Medical Scheme to reduce health risk factors in Anhui province / 中国卫生政策研究

Objective: To describe the degree of poverty caused by diseases among farmers who have joined New Rural Cooperative Medical Scheme( NRCMS) in Anhui province, and analyze the ability of NRCMS to reduce health risk factors in Anhui province, in order to provide suggestions for improving the NRCMS strategy. Methods: This paper randomly selects three counties to conduct comparative analysis on the NRCMS strategic changes from the aspects of registration rates, funding levels and compensation ratios between 2013 and 2014, in order to analyze the ability of NRCMS to reduce health risk factors from the aspects of the rate of poverty caused by diseases, the resolving degree of poverty caused by diseases, the alleviation degree of poverty caused by diseases, etc. Results: The ability of NRCMS to reduce health risk factors in Anhui province has improved between 2013 and 2014 , but the improve-ment is limited. Conclusions:In order to reduce the incidence of poverty caused by diseases among the farmers, gov-ernment should reform the payment methods, control the outflow of patients and improve the multi-level security sys-tem, in order to gradually reduce the poverty caused by diseases among farmers.

The effects of New Rural Cooperative Medical Scheme on catastrophic health expenditure of rural families:A case study of Xiaochang County in Hubei Province / 中国卫生政策研究

Objective: To study the incidence of catastrophic health expenditure of rural families in Xiaochang County of Hubei province, in order to explore the influential factors of catastrophic health expenditure. Methods: By using a multi-stage stratified cluster sampling to conduct a household survey, this paper randomly selects a total of a-bout 1,222 households of 4,673 people from 9 villages of 3 different towns in Xiaochang county of Hubei province, in order to compare the rate and severity of catastrophic health expenditure before and after joining the New Rural Coop-erative Medical Scheme ( NRCMS) , and it uses binary logistic regression model to analyze the influential factors of catastrophic health expenditure. Results: After joining the NRCMS, the rate, average gap and relative gap of cata-strophic health expenditure have all declined within the sampled areas; the influential factors of catastrophic health expenditure are household income, the number of working family members, the number of hospitalizations in family members, and the number of chronic patients among family members. Conclusion: With the increase of household in-come in the rural areas of Xiaochang County, both the rate and severity of catastrophic health expenditure have de-creased. In order to significantly reduce the catastrophic health expenditure in the rural areas of Xiaochang County, the government should perfectly improve the NRCMS's compensation mechanism for chronic outpatients' costs and re-duce the proportion of self-pay patients from low-income families.

Increasing insurance protection efforts and improving the fairness of health care services: A-nalysis on the convergence mechanism between New Rural Cooperative Medical Scheme and Healthcare Financial Assistance Program / 中国卫生政策研究

The goal of China's health care insurance system is to improve the fairness and accessibility of health care services for low-income people. In the past 10 years of practice, the insurance has made remarkable a-chievements and gained popularity among broad masses of people. With the support of World Bank and UK Depart-ment for International Development, China Rural Health Development Project ( hereinafter referred as Health XI Project) have used the advantages of unique funding, management and human resources to launched a series of pro-ject activities, with the main goal of achieving effective convergence between the New Rural Cooperative Medical Scheme (NRCMS) and Healthcare Financial Assistance Program (HCFAP) in order to explore the assistance system of catastrophic diseases. Some areas have achieved seamless convergence between NRCMS and HCFAP to explore the assis-tance program for catastrophic diseases in the context of confirming and optimizing the management of services covered by the project, especially conducting a series of exploration and practice activities in the aspects of increasing new funding channels to establish theCatastrophic Disease Assistance Fund, strengthening the related supporting regulations, etc. The results show that the utilization of services covered by HCFAP in the project has significantly improved, the protection level of health insurance has greatly improved, and the people satisfaction has significantly increased.

Analysis and evaluation of the implementation effect on catastrophic disease insurance of the New Rural Cooperative Medical Scheme in Beijing / 中国卫生政策研究

Objective: To analyze the effects of the catastrophic disease insurance of New Rural Cooperative Med-ical Scheme ( NRCMS) on alleviating the economic burden of patients in Beijing, and evaluate the effect of the policy implementation. Methods: Based on high, middle and low economic development levels and the implementation pro-ceedings of catastrophic disease insurance of NRCMS, this paper selects 3 districts of Beijing, from which it chooses two or three villages and towns with the highest numbers of catastrophic disease patients, in order to understand the opera-tional status quo of the catastrophic disease insurance through in-depth interviews with managers. This paper conducts questionnaire survey among all catastrophic disease patients from the sampled villages and towns, and uses 497 valid questionnaires received to understand patients' subjective feelings and collect relevant data of family income and medical expenditure of catastrophic disease patients in 2013. Then it carries out data docking with the platform of NRCMS man-agement centers and measure the economic burden of catastrophic disease patients. In this paper, quantitative and qualitative data are analyzed using statistical and thematic analyses, respectively. Results: The catastrophic disease in-surance of NRCMS has significantly played an important role in reducing the average medical expenditure of catastroph-ic disease patients and improving the actual compensation ratio in varying degrees. However, the incidence of cata-strophic health expenditures has not significantly improved. Conclusion: This paper suggests to increase deductibles and reimbursement ratios of catastrophic disease insurance in order to broaden reimbursement directory and other initiatives to improve the compensation level and focus on alleviating the economic burden of catastrophic disease patients.

The equality of financing and compensation of New Rural Cooperative Medical Scheme：An empirical analysis in an eastern province in China / 中国卫生政策研究

Objective:To analyse the degree of equality of New Rural Cooperative Medical Scheme (NRCMS) in different economic regions. We provide a reference for equal development of the NRCMS and the reform of the political system and mechanism under the provincial-controlled county fiscal system. Methods:A typical province was chosen with provincial-controlled county fiscal system was fully implemented several years. We collected data on coverage, financing and compensation for the NRCMS from 2005 to 2011. We used the variable coefficient, uniformity coefficient, Theil Index for comprehensive evaluation. Results:Per capita financing has not reached the bottom line. From 2005 to 2011, inter-re-gional and intra-regional variation coefficient, Theil index of service coverage, financing level and hospital actual compen-sation has declined year by year. The degree of inequality in economically developed regions was greater than in less eco-nomically developed regions and economic medium region. Conclusion:The degree of equalization of the NRCMS in the province continuously improved. Innovation of provincial-controlled county fiscal system and mechanism provides a favora-ble environment and forming conditions for equalizing the development of the NRCMS. The paper suggested exploring and building fiscal classification step transfer payment institution and dynamic prediction model of the NRCMS, further optimi-zing financing mechanism, promoting the provincial management system of the NRCMS as soon as possible in order to pro-mote the equalization development.

Catastrophic health expenditure for poor and low-income rural residents under New Rural Co-operative Medical Scheme / 中国卫生政策研究

Objective:To evaluate the catastrophic health expenditure for poor and lower-income rural residents and the ability of New Rural Cooperative Medical Scheme( NRCMS) to alleviate poverty. Methods:We selected Zhe-jiang, Hubei, and Chongqing provinces as sample areas and obtained 1661 questionnaires through a field survey. We calculated the out-of-pocket expenditure per year, incidence, average gap, relative gap, and concentration index of catastrophic health expenditure for participating households. Results:Both before and after compensation, incidence, average gap, and relative gap of catastrophic health payment for poverty group were the highest, followed by low-in-come group. After compensation, the concentration index decreased. This means that catastrophic health expenditure tends to be focused more on families with financial difficulties. Conclusion:To protect poor and low-income rural res-idents from catastrophic health expenditure, we should promote critical illness insurance, improve the medical assis-tance system, implement payment reform, and improve the NRCMS.

Advances in Sichuan grass-root health information construction / 中华医学图书情报杂志

After a description of the basic contents of Sichuan grass-root health information, health information systems at county level or below, and their roles and features, the key points of Sichuan grass-root health informa-tion construction program, progress and problems in Sichuan grass-root health information construction were stressed in discussion , with certain measures put forward for the solution of such problems .

Principals of selecting designated hospitals for inpatients of NRCMS with critical illness / 中华医院管理杂志

Objective To explore how to determine the designated hospitals for critical illness scientifically and reasonably.Methods Analyzing the choice of medical providers by inpatients with critical illness,by means of the database of NRCMS in 2009～2010 in one county,Guangxi province.And analyzing the current policies on the basis of general principals used in health policy analysis.Results The choices of medical providers made by inpatients with critical illness are influenced by various factors.Choice of such hospitals should only be dependent on scientific and reasonable determination of patients' reasonable medical needs,instead of on the medical competency of the hospitals only.Conclusion Maximal cost-effectiveness should prevail,be it the class-1 demand of complete healing which is highly dependent on medical technology,or class-2 demand requiring repeated hospitalizations and not highly dependent on medical technology.Reasonable designation of hospitals for critical illness should be based on reasonable medical needs of patients,instead of medical competency of hospitals only.

Offsite Medical Accounting Information Supervising System for patients of Sichuan new rural cooperative medical scheme / 中华医学图书情报杂志

The Offsite Medical Accounting Information Supervising System was developed for patients of Sichuan new rural cooperative medical scheme (NRCMS) using the C#programming language under .NET development environ-ment based on Microsoft Visual Studio 2010 in order to solve the problems in offsite medical accounting information statistics and supervision for patients of NRCMS.The system is a B/S-based MVP 3-tier structure with VPN hard-ware firewall and VPN client software plus certificate built-in, and can thus be used to supervise the offsite medical accounting for patients of NRCMS, analyze their medical advice seeking indexes at other places, and provide data for the NRCMS fund management .

Current fundraising for NRCMS and sustainable fundraising strategies / 中华医院管理杂志

Dynamic and sustainable fundraising strategies are the prerequisite for the long-term and stable development of the New Rural Cooperative Medical Scheme(NRCMS).The paper analyzed the current situation and problems of NRCMS' fundraising,and proposed the principles for designing a sustainable financing strategy of NRCMS,and then its fundraising strategy.First,clarification of its fundraising sources and rational division of the sharing ratio of the funding bodies (individuals contributions account for 20％of the per capita fundraising) ; second,linking fundraising levels with net per capita net income(5 ％ ～ 6 ％) of peasants; third,expansion of the service scope and level coordinated within NRCM.