Study On The Effective Factors And Mechanisms Of Rural Cooperation Medical System In Chongqing, China

The new rural co-operative medical system (NCMS) was introduced into Chongqing in 2003 as a sub-type of medical insurance system. There has been a rapid development of NCMS since 2003 and the system has already covered all rural counties of Chongqing by 2007. The city of Chongqing is taking the lead exploring the integration of medical ensuring design between the citizens of city and farmers of countryside and great progress had been made. All farmers of Chongqing became eligible for the coverage of NCMS, effective from 2009.Increased financial support from the government enables more and more farmers enjoy the NCMS in Chongqing. Mean while, various moral and ethical misconducts also come into play, e.g., unnecessary needs or over-service from hospitals, conspiracy between hospitals and patients, which become serious issues affecting the implementation and development of NCMS. It would be impossible to move the NCMS forward if these behaviors are not under control. Therefore, it is urgent for the administrators of NCMS to investigate the effectiveness of operation, existing problems, and functioning mechanisms so that NCMS can be improved systematically.The objective of this dissertation is to study the principle theories of medical insurance, compare the classic models of medical insurance in the world, analyze the historical changes of NCMS in China, investigate the operational effect and existing problems of NCMS in Chongqing, examine the reasons and influence as well as functioning mechanisms of the NCMS and provide suggestions for further improvement of the NCMS. The following eight chapters are presented to address these issues.Chapter 1 includes the objective, significance, main contents, study designs, and general methods of the program.Chapter 2 discusses the rural medical insurance models of foreign countries and a comparative study was designed to analyze the features, pros and cons of five classic international models of health care system including free health care, social medical insurance, medical insurance of business, community health care and medical insurance savings-account.Chapter 3 analyzes the changes of the new rural cooperative medical system in China. Since there are close relationship between system design and system circumstance, it is wise to design NCMS with historical laws.Chapter 4 examines the effects and problems of NCMS in Chongqing via a survey in 1268 rural families. The results show that the progress has been made on alleviating the rural medical burden and improve the accessibility of medical service, while various problems still remain to be resolved.Chapter 5 analyzes the standards, models, methods, principles of raising money and the payment models, and ends with a number of constructive suggests. It is necessary to make different level on fund raising, and make the compensation package with different combination, and adjust the mode of payment.Chapter 6 analyzes the influence and functioning mechanism of medical supply on cooperative medical system. Through agency investigations and data of annals, the author explored the fairness and efficiency of medical supply in Chongqing, examined the reasons of increase in medical cost, and concludes that over-service is the main reason that influences the benefits and willingness of the participants.Chapter 7 analyzes how the family income, gender, and age affect the willingness of the participants, benefit from the NCMS and evaluation on NCMS. It would be better to attract farmers by meeting needs than just low participant fees.Chapter 8 brings forward the optimization method of NCMS in Chongqing.Conclusions:1.To create a unique rural medical insurance system suitable for Chinese, four aspects must be emphasized. First, the government is expected to be responsible for medical insurance of the citizens; second, the mechanisms for the management of medical cost need to be formulated; third, medical ensuring law system needs to be made to regulate the behaviors of benefiters; fourth, the coordinated reforms must be in step.2.The hospitalization costs would decrease 46% and the outpatient costs would decrease 25% if the over-service were controlled effectively. The actual medical cost of Chongqing would decrease 42.1% in general and the reimbursement would increase 36% in 2009.3.The average medical cost and reimbursement of low-income participants are higher than that of the others; therefore, the "converse subsidy" phenomenon does not exist in this research, which is a concern of many researchers in medical insurance.4.The current NCMS can be improved via the following:1) multi-level of medical insurance system must be built to meet different farmers' different needs.2) Encourage farmers save money for their future medical service.3) Rational and realistic reimbursement mechanism must be made.4) Supporting reforms must be built to improve the NCMS.Directed by pertinent theories, this dissertation gives an in-depth analysis to efficacy, problems, influencing factors and degrees of NCMS in Chongqing by using the multiple research methods, and provides constructive suggests for optimizing the NCMS. There may some innovations on research methods and conclusions:Two unique research methods are used in this study:epidemiological investigation is used to improve the representation of sample, among which stratified random sampling is combined, and mathematical models established by the author is applied to deduce how medical supply affect the NCMS.This study point out that the NCMS should play the role of basic medical supplier, and the system design and institutional reform of NCMS should be followed according to this the basic orientation.