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.

Analyzing the Impact of the NRCMS Polices on the Utilization of Outpatient Services in Rural Resident Based on the Balanced Panel Data / 中国卫生统计

Objective To analyze the influence of NRCMS polices evolutionon residents’utilizationof outpatient serv-ices.Methods Based on the same individual balance panel data in two years of three counties in Ji＇nan city,we build panel dat-amodel and conductrandom effects of binary choice panel data model,random effects Poisson regression model,difference in differences(DID)model to analyze the influence.Results Our study shows that the four-week consultation rate in 2011 in-creased by 4. 1% compared to 2008.Age,self-ratedhealthstatus,suffering from chronic diseases or not,the distance to the nearest medical institution have an influence on outpatient service utilization.The new rural cooperative medical outpatient reimburse-ment policy has an effect on thefour-week consultation rate of middle-income residents and high-income residents.The NCMS policy tends to benefit middle and high-income groups.Conclusion we should increase NCMS outpatient compensation level of low-income residents appropriately.

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.

Study on the participating farmers'interest demands for the payment system reform in China's new rural cooperative medical care scheme / 中华医院管理杂志

Objective To study the participating farmers'interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A cross-sectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4.00, 4.00 and 3.63 respectively. Relative to the flat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant ( P ＜0.05 ). Conclusions The diversity of participating farmers'interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds.

Study on the doctor-patient interest demands satisfaction of the payment system reform in China's new rural cooperative medical care scheme / 中华医院管理杂志

Objective To study doctor-patient interest demands satisfaction and its influencing factors of the payment system reform of the new rural cooperative medical care scheme to provide reference for the reform. Methods Cross-sectional survey was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was used in six counties of three provinces in the eastern, middle and western regions of China, and mathematical statistics was applied to analyze the data. Results The doctor-patient overall interest demands satisfaction was high, but the satisfaction was lower both with the income and ability improvement of medical staff and with the benefits of farmers. The influencing factors of the satisfaction of managers in medical institutions included the type of payment, educational level and work unit (P＜0.05). The influencing factors of medical staff's satisfaction included the type of payment, work unit, and working years among others(P＜0.05). The influencing factors of farmers'satisfaction included the type of payment and the average annual income, etc(P＜0.05). Conclusions The core interest demands of both doctors and patients should be valued to enhance their satisfaction. Diseases related groups should be promoted and applied scientifically, and appropriately integrated with other methods of payment. Both doctors and patients'understanding of the payment reform should be improved by propaganda and training, to get their support and cooperation.

Effect Evaluation of Critical Illness Insurance under New Cooperative Medical System: Analysis Based on the Data of China Family Panel Studies / 中国卫生经济

Objective:To evaluate the implementation effects of critical illness insurance of New Cooperative Medical System(NCMS) on the occurrence rate and economic burden of major disease expenditure.Methods:Based on the peasant household data of China Family Panel Studies(CFPS) in 2014.the two-part model was applied to analyze the changes in major disease occurrence and burden after the implement of insurance.Results:NCMS critical illness insurance did not reduce the occurrence of critical disease expenditure,but signally cut down the economic burden of serious illness peasants in central and eastern China.Conclusion:The implementation effect of NCMS critical illness insurance was well in central and eastern China,but was poor in western China;the prevention and health care system of NCMS should be built,while the implementation plans and compensation level of critical illness insurance should be improved in western region.

Empirical analysis for the "Countywide Medical Community" and capitation prepayment / 中华医院管理杂志

Objective To analyze the performance of the combination of "Countywide Medical Community" combine with "Capitation Prepayment". Methods We collected the new rural cooperative medical system ( NRCMS ) data of Funan county ( with "Countywide Medical Community" introduced in 2015, along with Capitation Payment) and Yingshang county (without"Countywide Medical Community"), both in Anhui province, from 2014 -2016. With such data, a longitudinal comparison was made on the performance of Funan "Countywide Medical Community" before and after, and a horizontal comparison on Funan county and Yingshang county regarding the merits and weakness of the Community. Results 2014-2016 witnessed a year-by-year decline of the outside-county proportion of the expenditure, man-time of inpatients, hospitalization expenses and hospitalization reimbursement by NRCMS in Funan county, and an increase of such proportion within the county. Furthermore, these proportions of Funan county were better than those of Yingshang county, proving "Countywide Medical Community" a success. Conclusions The performance of the combination of "Countywide Medical Community" and "Capitation Payment" proved a success.

Analysis on the operation of DRGs pilots in Yulin city of Shaanxi province / 中华医院管理杂志

Objective To analyze the operation of the diagnosis-related groups ( DRGs) pilots for inpatients in the new rural cooperative medical system in Yulin city of Shaanxi province. Methods The medical records of 33306 inpatients discharged from the 3 pilot hospitals between January and July in 2017 were analyzed, aided by expert discussions, on-site assessment and medical records examinations. Results By the end of July 2017, the DRGs grouping tool had been running stably. The DRGs enrollment rates of discharged inpatients were all up to 99% in the 3 pilot hospitals. The coefficient of variation ( CV) was higher than 1 only in a few DRGs. The average length of stay and the average hospitalization expenses growth rate were both found declined. However, there also exist problems in the pilots, namely incomplete regulations for DRGs, low clinical path coverage rate, hysteretic supervision and assessment, uneven quality of medical records management and so on. Conclusions The pilots operated smoothly as evidenced in their initial success. Yet the following recommendations were raised for the improvements: To strengthen the organization and leadership to improve the DRGs related supporting system in pilot hospitals; To strengthen the promotion and application of clinical paths for standardization of the medical service process;To improve the DRGs assessment program and establish DRGs operation monitoring and tracking analysis system; To strengthen the training of medical record coding staff to improve continuously the quality of medical records.

Empirical analysis for the "Countywide Medical Community" and capitation prepayment / 中华医院管理杂志

Objective To analyze the performance of the combination of "Countywide Medical Community" combine with "Capitation Prepayment". Methods We collected the new rural cooperative medical system ( NRCMS ) data of Funan county ( with "Countywide Medical Community" introduced in 2015, along with Capitation Payment) and Yingshang county (without"Countywide Medical Community"), both in Anhui province, from 2014 -2016. With such data, a longitudinal comparison was made on the performance of Funan "Countywide Medical Community" before and after, and a horizontal comparison on Funan county and Yingshang county regarding the merits and weakness of the Community. Results 2014-2016 witnessed a year-by-year decline of the outside-county proportion of the expenditure, man-time of inpatients, hospitalization expenses and hospitalization reimbursement by NRCMS in Funan county, and an increase of such proportion within the county. Furthermore, these proportions of Funan county were better than those of Yingshang county, proving "Countywide Medical Community" a success. Conclusions The performance of the combination of "Countywide Medical Community" and "Capitation Payment" proved a success.

Analysis on the operation of DRGs pilots in Yulin city of Shaanxi province / 中华医院管理杂志

Objective To analyze the operation of the diagnosis-related groups ( DRGs) pilots for inpatients in the new rural cooperative medical system in Yulin city of Shaanxi province. Methods The medical records of 33306 inpatients discharged from the 3 pilot hospitals between January and July in 2017 were analyzed, aided by expert discussions, on-site assessment and medical records examinations. Results By the end of July 2017, the DRGs grouping tool had been running stably. The DRGs enrollment rates of discharged inpatients were all up to 99% in the 3 pilot hospitals. The coefficient of variation ( CV) was higher than 1 only in a few DRGs. The average length of stay and the average hospitalization expenses growth rate were both found declined. However, there also exist problems in the pilots, namely incomplete regulations for DRGs, low clinical path coverage rate, hysteretic supervision and assessment, uneven quality of medical records management and so on. Conclusions The pilots operated smoothly as evidenced in their initial success. Yet the following recommendations were raised for the improvements: To strengthen the organization and leadership to improve the DRGs related supporting system in pilot hospitals; To strengthen the promotion and application of clinical paths for standardization of the medical service process;To improve the DRGs assessment program and establish DRGs operation monitoring and tracking analysis system; To strengthen the training of medical record coding staff to improve continuously the quality of medical records.

Analysis of the impact of the disease-based hierarchical medical system on the inpatients flow covered by the new rural cooperative medical system / 中华医院管理杂志

Objective To understand the influence of the disease-based hierarchical medical system on inpatients flow covered by the new rural cooperative medical system ( NRCMS) , and that on the funding diversion and medical costs so incurred. Methods One county was selected from the eastern, central and western regions of China respectively, where the disease-based hierarchical medical system has been in place. Policy documents of the three counties were reviewed to analyze such changes as NRCMS inpatients flow, inpatients subsidy diversion, NRCMS fund surplus rate of the current year and medical costs per hospitalization before and after the system was in place. Results A comparison with 2014 found a 1. 26%drop of the out-of-county inpatients of county W of the western region, a 2. 00% increase of township hospitals inpatients of county D in the middle region, and the same ratio of out-of-county and in-county inpatients in county F of the eastern region in 2015. Compared with 2014, the fund surplus rate of county W increased 10. 46%, and the inpatient subsidy ratio of county D decreased 2. 51% for those in out-of-county medical institutions in 2015. Thanks for the quota payment of specific diseases under global budget in county W, the inpatient medical costs per hospitalization dropped at both county and township medical institutions. Conclusions The disease-based hierarchical medical system could optimize the NRCMS inpatients distribution among various medical institutions, conducive for establishment and operation of such a system.

Consideration and Countermeasures of Medicine Expense Dishonour in Our Hospital under the Policy of New Rural Cooperative Medical Insurance / 中国药师

Objective:To understand the situation of drug expense dishonour to the patients participated in health insurance new rural cooperative medical system ( NCMS) in our hospital, analyze the dishonour reasons and find countermeasures. Methods:The da-ta of drug expense dishonour to the patients participated in health insurance NCMS were collected in our hospital during October 2014 and October 2015, the reasons for the dishonour were analyzed, and countermeasures were proposed in order to reduce the dishonour under the policy of health insurance NCMS. Results:The most common reason of drug expense dishonour was the violation of restricted medication rules in the policy followed by the irrational use of Chinese medicines and antimicrobial drugs. Hospital should look for countermeasures according to the reasons for the dishonour in order to promote the implementation of the new rural cooperative medical policy and strengthen the rational and regular drug use under the policy of health insurance NCMS. Conclusion: The most important reason for drug expense dishonour was the incompletely implementation of the policy of health insurance NCMS, and the violation of drug use exists in our hospital. Pharmacy department should supervise drug use, focus on promoting the policy of health insurance NC-MS, implement forward position, participate in medication development and promote rational drug use.

The Impact of Global Budget on the Hospitalization Beneficial Degree under New Rural Cooperative Medical System / 中国卫生经济

Objective:To analyze the effect of global budget of New Rural Cooperative Medical System (NCMS) on the per-visit inpatient compensations,inpatient compensation ratios,per-visit inpatient out-of-pocket expenses and inpatient out-of-pocket rates.Methods:The difference in difference method was used to control the non-intervention factors and estimate the net impact of global budget.Results:Global budget of NCMS decreased the per-visit inpatient compensations by 14.37 yuan,but it had no statistical significance.The compensation ratio of hospitalization increased by 5.23％,the average hospitalization self-payment decrease by 141.51 yuan,the self-payment decreased by 5.23％,which all had statistical significance while there were differences on the effects for specific diseases.Conclusion:Global budget of NCMS increased the inpatient benefit,but the effect was varies by conditions.In addition,measurement of global budget's standard still needed to be scientific and reasonable.

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.

Drugs administration and individual affordability under different medical insurance entry price:Example of Anti-tumor Targeted Medicare Drugs / 中国卫生政策研究

Objective: To analyze the New Cooperative Medical System ( NCMS ) funds and Individual afford-ability of anti-tumor targeted drugs under different medical insurance entry price, and to provide the basis for establis-hing the access price for medical insurance. Methods: Choosing Conmana or Kemer ( the lung cancer targeted drug) and Herceptin (breast cancer targeted drug) to analyze the Wuhan NRCMS operating status from 2012 to 2014, use tumor surveillance data from Hubei Province during the period from 2011 to 2015;consult clinical experts to form expert consensus price, refer to the Jiangsu Province Access Price and National Negotiation Price, and explore the fund bal-ance and individual affordability when the afore-mentioned two kinds of drugs can be compensated by medical insurance under different price. Results:The basic account balances of NRCMS in Wuhan from 2016 to 2018 are-11. 948 million Yuan, 2. 513 million Yuan and 82. 955 million Yuan when Kemer can be compensated by medical insurance under Na-tional Negotiation Price. Taking the compensation of Herceptin under National Price after the bargaining, the basic ac-count balances are -26. 901 million Yuan,-35. 962 million Yuan and 17. 542 million Yuan respectively. The rate of poverty caused by illness falls to 33. 40% from 45. 85% when Conmana can be compensated by Medical Insurance un-der National Negotiation Price, while this rate falls to 45. 42% from 46. 00% for Herceptin. Conclusion:The two kinds of drugs can be afforded by the Wuhan NRCMS after the medical insurance access price is negotiated by the govern-ment, but the individual affordability of Herceptin at the National Negotiation Price is worse.

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.

Analysis of characteristic excessive demand for elderly inpatient service and causes covered by NRCMS / 中华医院管理杂志

Objective Understanding the current elderly people’s excessive demand for inpatient services under NRCMS,summarizing characteristics and analyzing causes so to provide inspiration and support for the rational use of health services in rural areas.Methods 1 665 medical records of seniors were randomly selected from medical institutions of county and township levels in 2012.Based on such data,135 household surveys were made,comparing the reasonableness of their hospitalization.Results The unreasonable rate at county level is 14.29%,and 30.10% at township hospitals;The unreasonable rate of internal medicine,surgery and other sections at county level hospital are 1 7.65%、10.38%、9.49%,the unreasonable hospitalization rate of internal medicine,surgery and other sections at township hospitals are 31.98%, 1 9.77%,and 45.83% respectively;The unreasonable hospitalization rate of circulatory system,skeletal muscle type,injury and poison at county level hospital are 20.55%、24.00%、4.76%,the unreasonable rate of the circulatory system,skeletal muscle type,injury and poison at township hospitals are 35.69%,44.74%and 10.91%respectively.Elderly people’s excessive demand for inpatient services varies with their living condition,physical condition,the NCMS compensation policy and other factors.Conclusion To reduce the excessive demand,we put forward effective control measures from the service system,security system and social support,so as to effectively meet reasonable hospitalization demands in rural areas and social problems so incurred.

Health Outcomes Equity among the People Insured in New Rural Cooperative Medical System in Shaanxi / 中国医学伦理学

Objective:To study the health equity and explore the influencing factors of health inequities among those insured in New Rural Cooperative Medical System and to provide theoretical and factual basis for improvement of medical insurance system through .Method:Using concentration index decomposition to explore the sources of inequity in health outcomes and the degree of horizontal inequity in health outcomes .Results:Economical level leads that the concentration indexes of two week prevalence favor the poor , i.e.the worse the health outcome of the rich is.Economical level leads that the concentration indexes of chronic disease prevalence and self -reported health defective rate favor the rich , i.e.the worse the health outcome of the poor is .Conclusion:Economic level is the primary factors affecting two weeks prevalence , age, culture level, the employment situation is the factors al-leviate health outcomes unfair .Increase people′s economic level and cultural level , improve the situation of em-ployment is important to the health equity .

Patients' satisfaction on catastrophic medical insurance of New Rural Cooperative Medical Scheme:Analysis of 484 patients in three districts of B city / 中国卫生政策研究

Objective:To understand the patients'satisfaction on catastrophic medical insurance of New Rural Cooperative Medical Scheme ( NRCMS ) , and provide references for effective management and policy improvement. Methods:According to the principles of representative sampling, a questionnaire survey conducted. 484 patients got compensation for catastrophic insurance in 2013 were surveyed, and information of medical costs was analyzed. Re-sults:The average medical cost accounts for 84. 57% of total household expenditure. Mandatory medical expenditure is still high and economic burden of diseases is heavy. This policy has increased the compensation rate, and the actu-al compensation rate increases 4. 79% in three districts. The average score of patients' attitude toward catastrophic medical insurance is (3.95±1.05) points, 88. 43% of patients continue to participate in medical insurance. Con-clusions and suggestions:Patients' satisfaction on catastrophic medical insurance of NRCMS is high. It is suggested that the existing financing modes should maintain stability in the short term, and the compensatory rate should be im-proved reasonably.