| The New Rural Cooperative Medical System (NCMS) is a new medical insurance in it's primary stage for rural people since its implementation in 2003. So far, it is implemented steadily and the disease burden and other related problems have been greatly lighted. However, by the origin of NCMS, too much of this designing are originated from the traditional cooperative medical system, its primary designing is to decrease the economic risk by cooperative group pool in avoiding risk from catastrophic disease. From the allocation of NCMS fund and its compensation system, the NCMS fund has the characteristics of medical insurance and exit third service fee, so the "moral hazard" is unavoidable. Most of the "moral hazard" is happened in the consigned healthcare facility due to smaller financing and lower compensation ratio relatively. The NCMS emphasize volunteer in its participating, Therefore, effective strategy and measures be taken in keeping the sustainable development of NCMS.ObjectiveFirstly, find out the knot, character and regulation of nonstandard behavior in leading unnecessary cost; secondly, analyze and find out the direct and indirect factors in affecting the nonstandard behavior, and lastly make up the model of unnecessary cost control in macro and micro level, and at the same time for a general analysis of its available mechanism.MethodsIn this study, direct judgment and indirect judgment methods are taken in measuring the unnecessary cost. For this aspect, peer review is used in the former for judging whether the nonstandard behavior is existing or not, its seriousness and specific knot happened. The latter are used in the analysis of the change of income in the different NCMS County and in its different period so as to judge the nonstandard behavior. In order to maintain the model of cost control and its relative mechanism, this study adopted normal statistic description and multi-regression analysis for defining the direct and indirect affecting factors.In this study, according to the actual designing, 6 NCMS counties with matched samples are chosen, and then two samples (county and town) are chosen respectively. During the study, six normal representative diseases as simple appendicitis, pneumonia are chosen, and divided participant with non-participant by same criteria and number.Findings and resultsBy this study, we got following finds:1. out-patients of NCMS county are far increased compared with non NCMS county from 2003-2005, and the county facilities are far increased than town hospital.2. Income of out-patient of NCMS county doubled than non NCMS from 2003-2005 and drug income is increased than the total income, it's a little slow in the town hospital.3. No any significant difference in the per-visit and per-day cost from 2003-2005.4. Compared with non NCMS county, unnecessary cost is serious, hidden and spread, not like non NCMS county in the drug and medical check; compare participants with non-participants, the consigned facility mostly increased the income by longed the out-patient and there still has cost transfer.5. Direct factors affecting unnecessary cost of county facilities are: the number of doctors, ratio of high professionals, NCMS or not, average age of doctor, average facility cost per-doctor, total working staff, and the actual opening bed. Negative factors are the ratio of high professionals and average age of doctor and others are positive and in different directions.6. Direct factors affecting unnecessary cost of township facilities are: the number of doctors, ratio of lower professionals, NCMS or not, average age of doctor, total working staff, and the actual opening bed. Positive factors are NCMS or not, average age of doctor, total working staff, others are negative and in different directions.7. Indirect factors affecting unnecessary cost of county level facility, are: internet management, ratio of ideal with actual staff in management department, average NCMS management cost, pure income of per-rural person, consigned county facilities, total county health finance, GDP etc. and ratio of ideal with actual staff in management department, average NCMS management cost, pure income of per-rural person, financing income, consigned facilities, GDP are positive affecting factors and others are negative, still the ratio of ideal with actual staff in management department and internet management are factors in different directions.8. Indirect factors affecting unnecessary of town level facility, are :internet management , ratio of ideal with actual staff in management department, average NCMS management cost, pure income of per-rural person, financing income, consigned facilities etc. most of them are negative factors besides ratio of ideal with actual staff in management department and consigned facilities.ConclusionsFrom the above analysis, we draw following conclusions:1. There exits "moral hazards" in the implementing of NCMS, which strengthen the nonstandard behavior and increase the unnecessary cost.2. New nonstandard behavior is appeared, more hidden and difficult to discover.3.Doctors' technology and professional regulation are greatly affecting the unnecessary cost. Therefore, many different ways (degree education, professional training program etc.) should be taken to improve the technology of consigned facilities, versatile flexible way also used in the professional education and more promotions (system, strategy opportunity etc.) should be made during the implementation.4. To make enough NCMS management staff, prioritized different means in the period of monitoring and computerized the management pathway. It's also very important in making the county-town computer contact.5. Make a closed management in different level of macro and micro strategy and regulation so that get coordinated effectiveness.Policy suggestionTo attain the objective of cost control, unnecessary cost control and available mechanism should be taken from different level, and different strategy, policy and different means should be connected, coordinated and closed management.1. Model of cost control in micro levelThis model aims to solve the problems of direct affecting factors that oriented in the present problems. It focused on the immediate direct measures to attain the anticipated results, it mainly stay in the surface level.2. Model of cost control in macro levelThis designing aims to solve the problem of indirect affecting factors. Compared with the micro level, it focused on the short period and direct uncontrolled problems, it is occupied in the inner level.
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