Study On The Effectiveness And Improvement Strategy Of Health Expenditure Financing Model For Tuberculosis In China

[Purpose] Based on the nature of quasi-public goods in the treatment of infectious diseases,analyze the necessity and the urgency of further improve the level of medical expenses of tuberculosis patients;Through the typical regional data,analyze the implementation of the new regional policy,viewing tuberculosis as a special disease and taking the Basic medical insurance as the main financing body to improve medical insurance level;Clarify the government’s responsibility in the treatment of infectious diseases,promote the development of medical insurance financing model fairly,rational and sustainable.[Methods] The UHC theoretical model,descriptive statistical analysis and chi-square test analysis were used to analyze the quantitative data,and the external effect theory,stakeholders theory and was used to analyze government responsibility theory to analyze qualitative information.[Results](1)Medical insurance: under the new policy in the typical area,most tuberculosis patients who join in the basic medical care are included in the new policy.In 2010-2012,the actual compensation ratio for tuberculosis inpatients of the city’s new rural cooperative medical system is 52%,and 23.2% for the outpatient,under the new policy,the average reimbursement rate is 65.7%.Antituberculotic for free: has not changed.Medical assistance: Between 2010 and 2012,only 5.7% of patients in the city were received medical assistance.Under the new policy,the city did not expand the scope of medical assistance.Medical insurance: Under the new policy,the number of services that been included in the coverage of Medicare has increased,but still limited.The scope of assistance has not expanded,under the new policy,the city’s tuberculosis patients had a significant increase in the level of medical assistance,only pay 0-4% of the total cost.(2)Under the new policy,the out-of-pocket inpatient and outpatient costs after confirmed were reduced by 36.7% and 42.5%,while the total cost of per capita medical expense and per capita paid medical expenses before confirmed were 42% higher than two years ago 32.9%;Compared with the basic health care sample group,the direct non-medical expenses of the new policy sample group increased by 30%,and the direct non-medical expenses accounted for 8.31% of the proportion of per capita paid medical expenses.The incidence: the incidence of catastrophic health expenditure fell by 12.07%.under the new policy,the incidence dropped by 27.72%.The total cost per capita has not decreased significantly.The average and relative disparity: Under the basic health insurance policy,the average disparity and relative disparity of catastrophic health expenditure decreased by 15.85% and 14.03% respectively.Under the new policy,it decreased by 31.09% and 7.94% respectively.Concentration index: the concentration index and the average disparity decreased,indicating that the fairness became deviated.Catastrophic health expenditure in different income groups: Under the basic health insurance policy,the disparity of catastrophic health expenditure’ incidence among the poorest and the richest groups narrowed from 47.05% to 6.79%.Under the new policy,the gap increased from 42.85% to 49.86%.Under the new policy,treatment compliance and general satisfaction of patients became better.(3)Health authorities are policy makers,patients are direct stakeholders,medical assistance fund in Civil Administration Department is not affected,the three will have a stronger policy implementation,hope to further improve the level of protection;Due to the increased management costs and the relevant departments income is not much increased,the enthusiasm of fixed-point medical institutions to the policy is in general;The enthusiasm of health insurance sector to the new policy is poor.[conclusion]1.Most of the existing medical insurance,free medicine and medical assistance policy in our country,have reduced the economic burden of patients with the disease to a certain extent,but the protection level is still low,there is the inhibition of patients’ medical needs,the level of protection should further improve.2.The new policy of the typical area mainly expand the patients’ protection project by the financing of medical insurance,improve the proportion of medical expenses reimbursement to a certain extent,improve the level of medical expenses of tuberculosis patients,but the accessibility is not high,the economic burden of patients is still high.The First,the new policy covers the crowd and the protection of the project is still limited,should further expand the protection of people and projects to improve accessibility;The second,the new policy reimbursement level is too high,the lack of targeted policies for tuberculosis treatment resulting in the actual reimbursement ratio.The differences in reimbursement may cause patients with different economic conditions use medical services differently,which affecting health insurance efficiency and social equity;The third,taking the medical insurance sector as financing entity,what contrary to the fairness and stability of the distribution of health care funds,health insurance should not be used as a financing fund alone to improve the proportion of tuberculosis medical expenses reimbursement;Finally,patients with direct non-medical expenses,who were not included in the scope of policy protection,should be assisted by the government fund.3.The stakeholders hold that the medical insurance should not take the main financing responsibility in the new policy;Infectious diseases’ treatment are quasi-public goods,the government should bear the main financing responsibility.