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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.
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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.
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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.
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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.