Methods And Applied Research Of Support Decision-making System On New Rural Cooperative Medical Information System

[Background]China New Rural Cooperative Medical Scheme (NCMS) is organized and supported by the government of China; in order to relieve rural residents'burdens of disease. Farmers could participate in NCMS voluntarily. As the insured farmer more and more, covering a wide range, the management of NCMS becomes complex now. Handwork could not meet the demand of NCMS. Thus, with the support of different levels of government, NCMS information system based on computer technology, database, and network build up.Information technology is an effective method to improve working efficiency, ensure the security and realize the scientific management of the NCMS fund. With effort of the central government and the local government in the past few years, the NCMS information system has rapidly developed. However, as technology developed, some issues appeared at the same time, as the allocation of the resources is not balanced; duplication of development exists; the function of support decision-making is not full used; the staff is not professional; the management is not standardized, etc.Previous studies on NCMS information systems were less concerning the system support of decision-making. The research related to the improvement of NCMS information system was less reported. Therefore, in order to improve the NCMS information system, this study choose NCMS piloted counties as objects, tries to design the decision-making support system of NCMS. This study make the financing and payment system of NCMS as an example, design and implement the SimIns software to analysis and revise the financing and payment scheme in Dong'e county. It provides evidence for improving financing and payment in NCMS and promoting the development of NCMS.[Objectives]The aim of this study is to design the NCMS decision-making support system, which may provide evidence for improving the NCMS information system and promoting the development of NCMS. Detailed objectives are as follows.1. Find out problems in NCMS information systems. Propose the decision-making support system which suits to China's actual situation in NCMS. Provide the suggestions to improve the NCMS information system.2. Design and implement the decision-making software SimIns, to support designing and revising the financing and payment scheme in NCMS.3. Explore determinants and influencing factors of NCMS financing and payment scheme. Design a revised financing and payment scheme by using decision-making tool SimIns, and provide political suggestions for NCMS improvement.[Methodology]Data sourcesThere are two parts of data sources in this research, existing data arid survey data. Data collected from survey is mainly used to analysis the status of NCMS information management and simulate the financing and payment scheme of NCMS.Existing data includeâ‘ the operation and policy documents of NCMS office in pilot counties from 2005 to 2008;â‘¡the annual reports of Shandong province in pilot counties from 2004 to 2008;â‘¢the household survey results of EU-funded project "China and Vietnam to establish a fair and sustainable rural health insurance" in 2008;â‘£the literature.Survey data include,â‘ the social, economic and demographic development of research counties from 2005 to 2008;â‘¡the compensation package of NCMS in research counties;â‘¢the interview and survey with the managers of NCMS and governors in research counties;â‘£the management information platform database files in research counties from 2005 to 2008. Data collectionTwo large-scaled field investigations were conducted in 2006 and 2008. Data were collected in four ways as follows.1. Household Survey. According to geographic and economic situation, two provinces Shandong and Ningxia were chosen. Then, three counties were selected from each province in accordance with economic situation. As a result, Zhangqiu, Changle and Dong'e were chosen in Shandong, Qingtongxia, Yongning and Zhongning were chosen in Ningxia. To know about health demand and utilization, NCMS reimbursement and attitude towards NCMS among rural residents, household surveys were conducted in 2006 and 2008, with sample size as 6147 and 3288 households respectively.2 Interview. To know about the implementation, problems in NCMS and stakeholders'attitudes, key-informant interviews and focus-group interviews were conducted.3. Institution investigation. Firstly, learn the administration of NCMS. A questionnaire was designed by researchers and filled out by NCMS officials in NCMS administration to know about the implementation of NCMS. Meanwhile, database related to inpatient reimbursement were provided either. Secondly, learn the situations of healthcare providers. A questionnaire was designed by researchers and filled out by healthcare providers to know about their revenue and expenditure and subsidies from NCMS.Analysis Methods1. Analysis tool. Data from institutions were input and analyzed by Excel 2003. NCMS inpatient reimbursement database were analyzed through SPSS 11.5. Interviews were recorded with informant consent and analyzed by Maxqda2. Data concerning household survey were double input to Epi Data 2.1 and analyzed by SPSS 11.5.2. Premium calculation. Calculate NCMS premium in different benefit packages.3. Logic regression analysis. Calculate the NCMS insurance factors by using logic regression analysis. 4. References reviews. Summarizing second hand materials collected.5. Software development process. The process includes requirement analysis, design, coding, testing and maintenance.6. Calculate financing and payment scheme of NCMS.[Results]Results of this study are as follows.1. The status quo of NCMS information system implementationAccording to the investigation results in 2006 and 2008, the author finds that NCMS information system implemented not balance but smoothly in six sampled counties. Due to the finance reason, the network construction and hardware in Shandong province developed better than in Ningxia province. The Zhangqiu County from Shandong province, as well as the Zhongning County from Ningxia province developed the network version software of NCMS. The Changle County from Shandong province and, Yongning County from Ningxia province used the PC platform for management. Yongning County just realized the Excel software data reporting services. The Qingtongxia City from Ningxia province still managed the NCMS fund by hand.Shandong province, started to build the NCMS information system in 2005, got the financial allocation more adequate than Ningxia province..The department of health in Ningxia province is now planning to establish and integrate all health information platforms, including the NCMS information system and direct reporting network of infectious diseases. There is one or two full time staff responsible for the information management of NCMS in the three sample counties of Shandong province and Zhongning County. However, the qualities of the staff need to be improved.2. The problems of NCMS information system in pilot countiesInformation technology is an effective method to improve working efficiency, however, as more and more systems used, series of issues appeared. Firstly, the development of haredware in different counties is not balance; there is certain of duplication in allocation of resources. Secondly, the data collected from systems do not make full use of analysis, hard to support the decision-making in NCMS. For example, the financing and payment scheme is hard to calculate; the design of system is not flexible enough; lack of participate group analysis; lack of monitoring and evaluation functions; supervision and management level need to be improved. Thirdly, the quality of data from system is not qualified, provincial information platform is not constructed, affecting the data sharing and supervision.3. The analysis and design of NCMS decision-making support systemAccording to the problems and challenges in NCMS information system, the author designs the decision-making support system of NCMS. The NCMS decision-making support system includes data warehouse, data warehouse management module, data mining tool, knowledge and analysis module, human-computer interaction module, the decision support modules. Data warehouse management module need to complete the definition of the data warehouse, data collection, synthesis, extraction and other maintenance operations. The tool of data mining is used to deal with problems by searching, data analysis and mining. Knowledge discovery module is used to control and manage the process of data selection, knowledge discovery engine and found the evaluation process. Decision support modules were designed according to the actual demands of the task. Human-computer interface used the natural language to process module and the semantic query. The author designed six decision support module, including NCMS fund monitoring, calculate and estimate the financing and payment scheme, monitor the distribution of the diseases, participate group analysis, NCMS evaluation.4. The design and implement of the NCMS financing and payment decision-making systemWith the assistance of the World Health Organization, the authors designed and developed the financing and payment decision-making system Simlns according to the demand of China's NCMS. The design process as follows:1) Data collected from the database of NCMS information system, database of HIS, data from health government and general government. Integrate data as the input of SimIns software from different source.2) found the key factors which effect the NCMS utilization and the benefit of farmers.3) Develop the human-computer interface using a variety of methods, including charts and windows interface.4) Design and implement the SimIns software to analysis and revise the financing and payment scheme in Dong'e County. It provides evidence for improve financing and payment in NCMS and promote the development of NCMS.[Conclusion and political recommendation]1. Government at all levels should further support the development of NCMS information system. Government especially the central and provincial government should take the responsibility and subsidize NCMS in time and in full amount.2. Intensifying the capacity building in NCMS administration. Health bureau should take overhead expenditure of NCMS office into consideration; add equipment, network and position in NCMS office to ensure routine work. Meanwhile, NCMS administration officials should have more knowledge on health insurance to be more professional in daily work.3. Paying attention to the NCMS information decision-making support system. Firstly, provide the good data quality by data cleaning, transformation, integration, loading and model establishment. Secondly, in the context of health policy and NCMS management, improve and optimize the data mining tool, knowledge discovery technology and risk management in health area.4. Paying attention to the data quality in NCMS information system. Improve the accuracy, timeliness, completeness, consistency and regularity of the data. Therefore, the managers should standardize the management in every process of NCMS. Providing licensed operating range and authority to ensure that the manual operation could minimize the impact of the data quality.5. Specification the interface design of the NCMS system. The systems under construction should pay attention to interface design, in strict accordance with the government standards for construction. Already completed systems should adjust the system to national standard by integration middleware, conversion technologies.6. Improving the application of NCMS decision-support system. The NCMS managers should develop more decision-support systems, and expand the application of the systems, so that the decision-support systems could play a greater role in NCMS information management.7. Rationally adjusting the financing and payment scheme to improve enrollees' benefits. When adjusting financing scheme, it is suggested that individual contribution to premium should be raised. When adjusting payment scheme, it is supposed to give priority to reimbursement policy in county level hospitals.