| [Purpose]The study takes the patients with major diseases in rural areas of China as the research object,analyzes the changes in the utilization of hospitalization services and the economic burden of diseases of the seriously ill patients before and after the implementation of the medical insurance system for the urban and rural residents.On this basis,the paper evaluates the health service accessibility and economic risk protection ability of the New Rural Cooperative Medical Insurance system,and discusses the existing problems in the implementation of the current system,and provides suggestions and references for further policy adjustment and improvement.[Methods]Through the Chinese and English periodical literature databases,such as CNKI,Wan fang and Web of science,we can consult the relevant documents and policies of the major illness insurance,and learn about the current protection system and implementation of the different modes of serious illness in China and abroad.This research studies the literature on the utilization of health services and the economic burden of diseases,and systematically combs the methods and indicators of the research.Through the investigation of the new rural cooperative insurance management organization in the sample area,the database of the hospitalization compensation of the new rural cooperative insurance patients in the sample area in 2013 and 2016 was obtained,and the medical expenses and compensation of the seriously ill patients were analyzed.Then,some of the seriously ill patients were further selected for household investigation to obtain the sociological information of their population,including age,sex,family population,economic income and so on.The methods of descriptive analysis,chi-square test and multi-factor analysis were used.This study analyzes the changes in the utilization of health services,the economic burden of disease and the improvement of equity before and after the implementation of the major illness insurance,and evaluates the insurance system of serious illness from the aspects of fairness and efficiency.Through the in-depth interview with the responsible persons of the new rural cooperative management department and the health administrative department,to understand the current operation of the medical insurance system for serious illness,and to find out the difficulties and main problems existing in the implementation of the system.And to the future system improvement and the development tendency view.[Results](1)By collecting and sorting out the major illness insurance policies that have been issued in various regions of the country,and comparing the policies and programs of the major illness insurance policies in different provinces and cities,it is found that under the guidance of the policy documents issued by the state,According to their own economic and social development,the level of medical expenses,the population structure and the occurrence of major diseases,they have formulated different medical insurance systems with different characteristics for serious illnesses.There is no institutional difference in major illness insurance in various regions,mainly in the financing mechanism.There are differences in the design of the security scheme and the mode of insurance administration.(2)According to the analysis of medical conditions in 2013 and 2016 the new rural cooperative medical database in patients with serious illness,after the implementation of serious illness insurance,illness patient sample area inpatient service utilization increased,annual hospitalization times from 4.23 up to 5.48 times a year,hospitalization days from 48.9 days to 62.7 days,the patients also have a certain direction change to the three grade medical treatment of patients was increased from 66.9% to 76.5%,but outside the county clinic declined,dropped from 33.6% to 25.8%.with local medical expenses and rising levels of serious illness insurance promote the implementation of the health service needs of patients with serious illness were released,the average hospitalization expenses also rose from 59721.3 yuan to 71909.3 yuan.Due to illness of patients can not account for reimbursement of expenses is relatively high(27.2%),so the actual compensation effect of serious illness insurance Co.,improve the actual compensation level only in the new rural cooperative medical system 9.94%,after compensation,the patient's self paid medical expenses reached 32976.9 yuan,slightly higher than in 2013(31065.4 yuan).(3)Through the investigation of the patients with serious illness,it was found that after the implementation of the system,the utilization of hospitalization services was improved,the proportion of patients who should not be hospitalized for economic reasons fell from 75.5% to 55.445%,and the proportion of early discharge fell from 34.5% to 23.445%.As far as fairness in the utilization of hospital services is concerned,after the implementation of the serious illness insurance system,The concentration index of unhospitalized patients decreased from-0.1053 to-0.2017,and that of early discharge changed from-0.1031 to-0.1843.The unsatisfied situation of in-patient service demand appeared more in low-income patients,and the unfairness of health service utilization was aggravated slightly.(4)By comparing the major illness patients surveyed in 2013 and 2016,it was found that after the implementation of the system,the direct disease economic burden of the patients increased,the out-of-pocket cost increased from 32263.3 yuan to 36203.5 yuan,but the incidence of catastrophic health expenditure decreased from 49.8% to 44.3%.The relative difference of catastrophic health expenditure decreased from 32.4% to 19.1%.According to the analysis of compensation benefit attribution,the centralized index of NCMS compensation is 0.1120 in 2013,and the centralized index of NCMS plus medical insurance compensation in 16 years is 0.1626.The compensation cost flows more to high-income patients.The median index was-0.0876,and the central index for catastrophic health expenditure after compensation for serious illness insurance in 2016 was-0.135,which was concentrated on low-income patients because of the unfair benefits of compensation.The multivariate analysis of catastrophic health expenditure shows that income and serious illness insurance system are significant influencing factors of catastrophic health expenditure,and the implementation of serious illness insurance system reduces the probability of catastrophic health expenditure by 0.32 units.[ Conclusions](1)Serious illness insurance system has been relatively complete,but there is still room for improvement.(2)The financing mechanism of medical insurance for serious illness is not perfect,only rely on the new rural cooperative fund as the source of funding,the level of financing is relatively low,resulting in serious fund loss phenomenon.In order to give full play to the protective role of the serious illness insurance to the patient's disease economic risk and to ensure the sustainable development of the system,the medical insurance department should reasonably calculate the financing scale of the medical insurance for the serious illness,widen the financing channels and perfect the financing mechanism.(3)The serious illness insurance can effectively promote the inpatient service utilization,improve the accessibility of the health service utilization,reduce the unsatisfied situation of the patient's health service demand,but also further aggravate the unfair phenomenon of the patient's health service utilization.(4)Serious illness insurance reduces the incidence of catastrophic health expenditure and protects patients from the economic risk of disease.However,due to the increase in medical costs caused by the release of the demand for health services,the cost of reimbursement outside the catalogue is relatively high.After the serious illness insurance compensation,the patient's direct disease economic burden is still heavy.At the same time,because of the unreasonable design of the system,the implementation of the system intensifies the unfair compensation of patients with different income.In order to improve the guarantee effect and fairness of the system,we should set up the starting line of the serious illness insurance reasonably,scientifically define the compensation range,reduce the non-reimbursable expenses,and improve the compensation level of the patients. |
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