Study of negotiation mechanism at designated hospitals at provincial level for catastrophic diseases / 中华医院管理杂志

Stakeholder theory and game theory were applied to analyze the stakeholders,role definition,participation,interest,power,position and the shift of positions under different conditions in the negotiation.Use SPSS 17.0 to analyze the database of NCMS in 2009～2010 in three counties of Hubei province,and then employ Linear programming method to do a case study of price negotiation.It is difficult to meet all stakeholders' expectations under the current condition of catastrophic disease insurance pooled at municipal-level.Medical cost differences in tertiary hospitals at provincial level are small for different regions,which constitute a basis for price negotiation at provincial level.Besides,the negotiation at province level can effectively address the conflicts of interest,and promote the negotiations.Negotiation at provincial level for such diseases,and formulating unified pricing standards for multi-wins.

Study on the status of catastrophic disease medical assistance under NRCMS in A City at Hubei Province and B County at Guizhou Province / 中国卫生政策研究

Objective:This paper designs to analyze the status of catastrophic disease medical assistance in A and B regions, and put forward feasible suggestions to improve the medical assistance level and financial effects. Methods:We selected A city at Hubei province and B county at Guizhou province as sample areas, and obtained 872 copies of questionnaires in the field survey. Then, out-of-pocket health expenditure per year, the incidence, and rel-ative gap of catastrophic health expenditure before and after the financial aid were calculated. Results: Catastrophic disease medical assistance plays a limited role in relieving patients' economic burden. Low financial aid rate, narrow range, high deductibles and low ceiling level are responsible for much lower effective financial aid rate. Conclusion:Raise financial aid rate and widen the scope of medical assistance gradually;Establish effective link-up between cata-strophic disease medical assistance and catastrophic disease insurance / basic medical insurance;Put outpatient OOP into the scope of catastrophic disease medical assistance.

Analyze compensation patterns and compensation effects of catastrophic disease insurance in L City / 中国卫生政策研究

Objective:This paper designs to analyze compensation patterns and compensation effects of cata-strophic disease insurance in L City, and put forward feasible suggestions to improve the compensation patterns of cat-astrophic disease insurance. Methods:We combined the relevant policy documents to analyze compensation patterns, and used benefit rate, OOP and The effective reimbursement rate to analyze compensation effects of catastrophic dis-ease insurance. Results:Catastrophic disease insurance benefit rate in L city in 2013 was 3. 2%; Rates of NCMS fund unilization was 92%, which diversed from county to county. Patients' OOP decreased significantly after reim-bursement of catastrophic disease insurance;Catastrophic disease insurance and NCMS total effective reimbursement rate reached 84.8%;The NCMS compensation rate reached 68. 9%, while fund incurred a financial deficit at the same time. Conclusion:Set deductibles, compensation rate and compensation range scientifically, and cancel ceiling level,improve the program of catastrophic disease insurance. Take measures to reduce the unfair between the districts and counties at city level. Establish effective link-up between catastrophic disease insurance and NCMS.