Study On Payment Of Interest Equilibrium In The New Rural Cooperative Medical Scheme

OBJECT:The object of this paper is to research the academic model and the practical model ofthe payment in the New Rural Cooperative Medical Scheme, based on the interestequilibrium theory.DATA:The data of this paper include literature data and investigation data.literature datainclude research papers and monograghs on interest equilibrium and payment.Investigation data include the documents of the payment reform, the interview of theinterrelated people, the related statistic yearbook, the data of the New RuralCooperative Medical Scheme and the data of the medical institutions in Zhenan Xianof Shan Xi Province and Qianjiang area of Chong Qing Province.METHOD:The research methods of this paper include document surveys, stakeholder's analysis,game theory, principal-agent model in theory research part, and investigation,interview, incomplete information static game model, fix effect model and ordinaryliner square regression in empirical and practical model research part. CONTENT:The total research frame is to design the academic model of the interest equilibrium payment, prove it through empirical research, and then found the practical model with the guidance of the the conclutions of the the academic model and the empirical research, based on the research pattern of "from the theory to the practice, and then from the practice to the theory".This paper analysis the interest equilibrium is the reason why the market, the system and the public policy will be stable situation, by several related concepts and theory analysis in economic, New Institutional Economics and Public Choice Theory. And then the paper remain that the agency, medical institutions and rural are the main stakeholders, and have different interests, through the interest equilibrium analysis of the New Rural Cooperative Medical Scheme. The agency is representative of the interests of the rural and the government. Under certain conditions, the maximum of the agency' interest should be the core value and ultimate goals of the New Rural Cooperative Medical Scheme, based on which the interest equilibrium can promote sustainable development of the New Rural Cooperative Medical Scheme. And the suitable payment is the exactly way to the interest equilibrium situation. Payment is the valve and channel of benefit allocation in the New Rural Cooperative Medical Scheme and different payments will lead different benefit allocations. This study proposes the mixes payment of quota for single disease payment, limiting expenses payment of a single disease and total budget payment is the appropriate interest-equilibrium payment, through the analysis of the payments' merits and demerits, and the benefit allocation influence. To demonstrate the proposition, this paper uses dynamic game of incomplete information, construct game tree, and principal-agent model to prove that the mixed payment of prospective payment and post payment is the interest-equilibrium payment firstly, and that the mixed payment of quota for single disease payment, limiting expenses of a single disease and total budget payment is the interest-equilibrium payment.Based on the first part' theoretical model, the second part research the empirical data of the Zhenan Xian in Shan Xi Province and Qianjiang area in Chong Qing Province, to further improve the theoretical model.The empirical study results show that the mixed payment of quota for single disease payment and limiting expenses of a single disease in Zhenan has good effect on expense control and no bad effect on the balance of payments surplus of the medical institutions, the revenue of the medical staffs and the medical quality, but the deficiencies are that supervisory measures are not enough, and the total expenses control is inadequate. The empirical study results also indicates that the mixed payment of limiting expenses of a single disease and total budget payment in Qianjiang area has less expense control effect, but more reasonable expense structure. These results show the rationality of limiting expenses payment of a single disease, the importance of expenses supervisory measures and that the supervisory measures should be implemented with the system mechanism reforms of the medical institutions.The third part researches the practical model of the interest-equilibrium payment, including four main contents: (1) the formulation methods and programs of the expenses standards of quota for single disease payment, limiting expenses payment of a single disease and total budget payment.(2) the single disease choice methods of quota for single disease payment.(3) the expenses supervisory mechanism construction of the interest-equilibrium payment. There are three ways to build the supervisory mechanism by the supervisory game model: one is to build strict punishments system, second is to organize the supervisory committee to reduce the supervisory cost and lead the good competition between medical institution for Xian level, third is to enlarge supervisory power of the government and peasants.(4) implementation with the system mechanism reforms of medical institutions, including the capability construction of township clinics, the management system reform of medical institutions for Xian level and township clinics, constructing the financialinstitution of cost accounting, wage and income distribution system reform.CONCLUSION:The research conclusions of this paper are: (1) The main stakeholders of the NewRural Cooperative Medical Scheme are the medical institutions, the peasants and the agency.The benefit of the medical institutions is to make both ends meet, the benefit of the peasants is to reduce the economic burden of diseases, and the benefit of the agency is the security and the validity of the money's use. (2) It is the necessary condition of the sustainability for the New Rural Cooperative Medical Scheme that the interest equilibrium with the interest of the agency is the core value. (3) The interest-equilibrium payment is the way to realize the interest equilibrium, the content is that quota for single disease payment is major, with limiting expenses payment of a single disease and total budget payment. (4) The practical model of the interest-equilibrium payment consists of three parts: the formulation methods and programs of the expenses standards, the single disease choice methods and the supervisory mechanism. The interest-equilibrium payment and the practical model form the interest-equilibrium payment system. (5) The interest-equilibrium payment system should be implemented with the system mechanism reforms of the medical institutions, including the capability construction of township clinics, the management system reform of medical institutions for Xian level and township clinics, constructing the financial institution of cost accounting, wage and income distribution system reform.