Methods And Simulation Study On Adjusting Hospitalization Reimbursement Scheme Based On The NCMS Information System

Background and ObjectivesAs we all know,the new rural cooperative medical system (NCMS) is animportant part of rural health work in the new period,which can promote ruraleconomic and develop the harmonious of society.At the same time,the improvementof hospitalization reimbursement Scheme is very important for NCMS.At present,the financial departments have increased the subsidy year by year,from 2003 to grant 20 Yuan per person per year by 2010 will increase to 120 Yuan.Hospitalization reimbursement scheme also continuously adjusted.In practice,manyplaces confused by the lack of scientific measurement methods to guide theadjustment of scheme,which become a the impact for NCMS,it is also out of linewith the policy objectives such as risk-sharing,to solve poverty caused by diseases,balance of payments.So it is important to study on adjusting hospitalizationreimbursement Scheme based on the NCMS information system.This study focused on adjusting hospitalization reimbursement Scheme based onthe NCMS information system by integrating the key technologies of solving povertycaused by diseases.To answer the questions by establishing the dynamic relationshipbetween medical risks-poverty caused by diseases-the amount of funding per capita-the ratio of reimbursement-the effect of reimbursement.Materials and MethodIn this study,"policy-making scientific process"research methods as a guide,follow the"data mining"concept,the use of inductive analysis of the literature andthe"demonstration of multiple qualitative and quantitative"analysis of the newcompensation package for farmers in the co-patient problems.For the main problem,methods of use of logic to adjust the compensation package calculations hospitalizedideas;measured in the formation of ideas,based on the analysis of the use ofmathematical models,tend to score matching methods,such as adjustment of thecompensation package for residential development of the concrete steps and calculation methods;the final use of data simulated proof method to verify thescientific nature of the whole technology,feasibility and fit with reality.The main data collection methods include document collection,sample survey ofregional institutions and the basic intention of investigating officers,such assecondary data extraction.This study chose Jiangsu,Shanghai,Jilin,and Shandong Province as sample ofsurvey,including the 16 counties.Investigation include:the operation situation ofNCMS,the situation of management institutions,the NCMS information systemdatabase.At the same time,we carried out the intention investigate on the officials,mainly related to the actual implementation of hospitalization reimbursement scheme,as well as the need for technical support and so on.Main Results1.Analysis on necessity for adjusting hospitalization reimbursement Scheme of theNCMSThis part is to answer the reason for the adjustment of hospitalizationreimbursement Scheme.We summarized NCMS-related policies and relevantliterature,and investigated the sample area.We cleared the problems of adjustinghospitalization reimbursement Scheme of the NCMS,and analysis on necessity foradjusting hospitalization reimbursement Scheme of the NCMS.(1) Analysis on NCMS-related policiesThe core objectives of the NCMS relevant documents is promoting coverage ofNCMS system,content about scheme adjustment are limited.With the developmentof NCMS system,content about scheme adjustment become important step by step,and put forward the deductible,compensating proportion and ceiling design standards.At the macro policy level,it can be seen that scientifically and rationally adjustinghospitalization reimbursement Scheme of the NCMS is the health administrationdepartments at all levels must be addressed,which is stabilized NCMS system and anessential requirement for mature.(2)Analysis on NCMS-related literatureNCMS research has been vigorous development by analysis on NCMS-relatedliterature;and research focus shows a certain brand,from the initial pilot survey,tothe comprehensive evaluation in recent years,concern about the level of funding andcompensation significantly increased.Analysis on the specific literature of Financingand reimbursement,we found that most of the literature from the perspective of the researchers carried out analysis of the current situation and found that levels ofprogram design problems,such as compensating proportion lower,Deductible higherlow ceiling.But the literature deals with adjusting hospitalization reimbursementScheme is very small,which can not effectively answer the policy-makers,the actualoperation of the adjustment in the program all the confusion there.(3)Analysis on the investigation of sample areas100% of the sample cities and counties under the policy called for the adoption ofdeductible,compensating proportion,ceiling adjusted by means of hospitalizationreimbursement Scheme,and adjustment of hospitalization reimbursement Scheme isvery normal.At the same time,the results of investigate show that,NCMS managersgenerally agreed that the relevant aspects of program design is difficult to implementNCMS.Above 70% administrator related that"the measurement of risk for medicaltreatment","poverty caused by diseases of the measurement","address specific riskestimates of funding requirements","how to solve the problem at the same time toensure balance"system is the key technical problems,which will inevitably affect thepolicy objectives such as risk-sharing,to solve poverty caused by diseases,balance ofpayments.2.Measurement ideas of NCMS adjusting hospitalization reimbursement SchemeAccording to the result of analysis on necessity for adjusting hospitalizationreimbursement Scheme of the NCMS,we develop the Measurement ideas of NCMSadjusting hospitalization reimbursement Scheme base on NCMS information systemaround the policy objectives such as risk-sharing,to solve poverty caused by diseases,balance of payments.3.Steps and methods of NCMS adjusting hospitalization reimbursement SchemeWe clarified the purposes,the key task,measured steps,and examples of specificdata of each specific measurement based on the measurement ideas.In this part,weuse some database of the NCMS information system,including applicant familydatabase,applicant individual database hospital medical compensation database.(1) Calculation on disease economic risk before and after reimbursementIn order to clear disease economic risk of rural residents before and afterreimbursement,we should clarify the probability of disease economic risk in all kindsof people,and quantitative disease economic risk of all kinds of people,and clear the proportion reduce of disease economic risk before and after reimbursement,and thenwe can develop the linkage model between Scheme adjustment and the reduce degreeof disease economic risk.(2) Measurement on poverty caused by diseases before and after reimbursementIn order to clear the reduce degree of poverty caused by diseases,we shouldclarify the standard of poverty caused by diseases by the method of disease economicrisk Calculation,and quantitative the risk degree of poverty caused by diseases,andclear the reduce degree of poverty caused by diseases before and afterreimbursement,and then we can develop the linkage model between Schemeadjustment and poverty caused by diseases.(3) Calculation on the amount of per capita fundingIn order to clear specific financing level corresponding to the level ofreimbursement and the distribution of reimbursement,at the same time,specific levelof reimbursement and distribution of reimbursement corresponding to the level offinancing,we should clarify actual medical expenses in different crowd,and considerall kind of factors which could influence the amount of per capita funding and adjustthe medical expenses and get the amount of per capita funding.And then,we cancalculate the amount of per capita funding under the premise of the specific scope ofclaims and reimbursement ratio base on reimbursement Scheme.(4) Develop linkage model between scheme adjustment and balance of paymentsThe aim of analysis the relation between scheme adjustment and balance ofpayments is to calculate the amount of per capita funding we need afterreimbursement scheme adjustment。In order to realize this aim,we should find keyfactor which impact the risk of applicant to be hospitalized and key factor whichimpact the treatment behavior of in-patient;and the change of treatment behavior ofin-patient Scheme adjustment after reimbursement;and then clear the relationbetween scheme adjustment and the amount of per capita funding.(5) Analysis on the suitability of scheme adjustmentIn order to clear the suitability of scheme adjustment,we should analysis thechanges of policy effect by hospitalization reimbursement Scheme adjustment and thechange of financing level,which can provide a basis for decision-making.4.Simulation study on adjusting hospitalization reimbursement SchemeAccording to Steps and methods of NCMS adjusting hospitalizationreimbursement Scheme,we simulate the reimbursement Scheme base on one samplecounty's NCMS information system database. (1) Sample county's basic situation of NCMSThe amount of per capita funding is 45 Yuan in 2006 and 50 Yuan in 2007.Sample County's Scheme has not been set the deductible.Ceiling of town hospitaland county hospital increased from 20 thousand Yuan in 2006 to 30 thousand Yuan in2007.As the aspect of reimbursement,The proportion of reimbursement increased10 percent from 2006 to 2007.The in-patient's disease economic risk reduced 29.9% in 2007 and 22.7% in 2006.The ratio poverty caused by diseases decreased 18.4 % after reimbursement in 2006,and the phenomenon of poverty caused by diseases relieved 22.5 percent.The ratiopoverty caused by diseases decreased 39% after reimbursement in 2007,and thephenomenon of poverty caused by diseases relieved 28.4 percent.This illustrated thatthe new Scheme is better than 2006's on the solution of poverty caused by diseases.(2)Analysis on the behavior of treatment between two years in Sample CountyBy the use of previous method,we matched the two years following the analysisof Scheme adjustment,the patient population in the choice of hospital-leveldifferences found in the county hospital by calculating the crowd to a higher-levelhospitals exist flow,changes in coefficient A equal to 1.14.At the same time,there isthe cost of growth trends,analysis shows that the county Scheme adjustment in thesecond year after the average cost rose 7.8%,of which the annual deduction formedical expenses out of proportion to normal growth,where the use of surveys,thecounty area GDP The average annual growth rate of 6.4% on behalf of,you can getthe county to adjust the second year of the Scheme,the average daily cost of inpatientpopulation growth factor B at 1.4%.(3) Measurement on hospitalization reimbursement Scheme adjustmentWe followed the steps and methods of measurement,analysis of the wholedistribution of medical risk,based on the medical risks,financing,Scheme adjustment,linked with analysis of the effects of policies.Based on the results,we chose theadjustment which is to increase the proportion of reimbursement 5% or 10% and raisecap line 5000 or 10000 yuan.(4)Analysis on the suitability of scheme adjustmentAccording to the macro-analysis methods,we got the proportion of 0.6 percent inabout a combination of the current reimbursement level of the Scheme are below thelower limit in the appropriate range,increase the reimbursement level prompted therise of the larger space. At the same time,based on cost and effectiveness of the ratio of reimbursementwas found to increase the ratio of 10%,capped at 5,000 lines increase,brought aboutby poverty caused by diseases to resolve the extent and degree of mitigation relativeto maximize cost-effectiveness ratio.Innovation and application1.By using the method of systems analysis and logical interpretation to solve theproblem of NCMS and developing measurement ideas of NCMS adjustinghospitalization reimbursement Scheme.2.Under the guidance of the existing methods,we clear the purpose of each step,develop the key tasks and key indicators related to the formula and method ofcalculation.The program resulted in the specific measured steps to enhance thepatient to adjust the compensation package can be measured interoperabilitytechnology.3.Setting up the relationship between the probability of medical treatment,medical costs,medical economic risks,poverty caused by diseases,the scope ofclaims,the proportion of pay and per capita amount of funding.4.Following the concept of data mining,we full use of the information systemdata based on data modeling.To analysis the medical costs due to the release ofdemand by the method of PSM.5.By using the idea of cost effectiveness analysis to resolve the choice forhospitalization reimbursement Scheme adjustment.