| The new rural cooperative medical scheme (referred to as"NRCMS") is our country government combined the reality of rural tobuildi a rural basic medical security system with Chinese characteristicsin the new historical conditions. It is evolved from the traditionalcooperative medical system, which is the inheritance and developmentof traditional cooperative medical system. As a developing countrywhich agricultural population dominated, the rural social security systemgoes stand or fall not only relates to the success of the current new ruralconstruction, but also relates to the success of our modernization. In2009，New Medical Reform policy implementation started，which"accelerate the basic medical security system construction" wasclassed as one of the five key reform in2009-2011. In the18th partycongress report in2012, where explicitly proposed "perfect the universalhealth care system and set up the major workplace disease protectionand rescue mechanism", etc. It can be seen that whether the individualout-of-pocket burden of NRCMS members can be truly reduced, thebeneficial level for farmers can be increased has always been the key to build a new socialist countryside. As a big agricultural province, thereare nearly half the population that are NRCMS members in Jilin. It isnecessary to evaluate the operation and results of NRCMS in Jilinprovince synthetically, master the existing overall operation andproblems of NRCMS in Jilin province, put forward somesuggestions to improve NRCMS specifically. It has far-reachingpractical significance for individuals, families and society.【Objective】To investigate the operation of new rural cooperationmedical scheme (NRCMS) in Jilin province during2003-2012inthe New Medical Reform. NRCMS in Jilin province focused onthe vital interests of NRCMS members, evaluate the overall operationand results of NRCMS in Jilin province since the pilot to the fullimplementation objectively, probe into the existing problems andreasons of NRCMS in Jilin province, put forward somesuggestions to improve NRCMS specifically, and provide a referentialmode for the decision department of the government.【Methods】Through a combination of literature and research,funding criteria, enrollment rate, health service utilization, fund raisingand spending and cost compensation were analyzed. Using the2003-2012data from NRCMS of the statistical information system inJilin province to conduct the statistic analysis. The results were inputedand analyzed with SPSS13.0, descriptive analysis of statistics method was adopted in finally result analysis.【Results】About the funding criteria of NRCMS in Jilin province:The funding criteria of NRCMS in Jilin province was increased from30yuan per capita in2003to290yuan per capita on a par with the rest ofthe nation, which contained government subsidies standard of NRCMSwas240yuan per capita(82.8%) and individual pay cost standard ofNRCMS was50per capita (17.2%).About participated of NRCMS in Jilin province: There were6counties (cities, districts) in2003-2004,9counties (cities, districts) in2005,24counties (cities, districts) in2006,67counties (cities, districts)in2007. So far, NRCMS has achieved universal coverage in Jilinprovince.The participation rate was rised constantly, the number ofNRCMS member in Jilin province was increased from1.9million to13.28million, and the participation rate was increased from75%to99.4%in2003-2012.About the health service utilization of NRCMS in Jilin province:The rate of hospital admissionrates in NRCMS in Jilin province wasincreased from2.1%to9.2%in2003-2012. The rate of outpatientdepartment visits of NRCMS in Jilin province was increased from3.9%to43.1%in2003-2012.Both the rates increased annually. Theconstituent ratios of the number of inpatient in medical treatmentinstitution above county level, at county-level，and at township level were30.4%,54.2%, and15.4%in2012. The constituent ratios ofmedical expenditure were56.3%,37.9%, and5.8%in2012. Theconstituent ratios of the number of outpatient department visits inmedical treatment institution above county level, at county-level，and attownship level were31.7%,42.5%, and25.8%in2012. The constituentratios of medical expenditure were39.8%,42.5%, and17.8%in2012.About the uses of NRCMS fund in Jilin province：Both central andlocal governments subsidies increased year by year，meanwhile theindividual pay cost declined year by year in2003-2012. The constituentratios of NRCMS fund included central governments subsidies, localgovernments subsidies and individual pay cost were44%,38.9%, and16.8%in2012. From the trend of fund raising, the total amount of localgovernments raising included the provincial public finance and thecounty public finance mainly were64.1%and32.9%. The expenditureof NRCMS fund in Jilin province was given priority to hospitalizationexpenditure, followed by outpatient expenditure, the physical check-upfees was least in2003-2012. The outpatient, hospital and medicalexpenditure proportion were10.7%,89.3%and0.0%, respectively.About the health care costs reimbursement of NRCMS in Jilinprovince：The hospitalization reimbursement was rised step by step ofNRCMS in Jilin province. The average expense of hospitalization pertime was5408RMB Yuan in2012, up17%from one year ago. The constituent ratios of hospitalization reimbursement in medical treatmentinstitution above county level, at county-level，and at township levelwere46.3%,45.6%, and8.1%in2012. The average hospitalizationreimbursement rates per time were43.2%,63.1%, and73.4%in2012,The average expense of outpatient per time was121RMB Yuan in2012,declined6.9%from one year ago. The rate of outpatient reimbursementwas37%, up43.4%from one year ago. The constituent ratios ofoutpatient reimbursement in medical treatment institution above countylevel, at county-level，and at township level were38.2%,44.7%, and17.1%in2012.About the the beneficial level of farmers of NRCMS in Jilinprovince： The hospitalization reimbursement and outpatientreimbursement people were the major components of NRCMS in Jilinprovince. The benefit rate of hospitalization reimbursement was risedyear by yaer which reached9.2%in2012. he level of reimbursementincreased year by year with the outpatient and hospitalization expenseincreased year by year in2003-2012. The actual outpatient andhospitalization reimbursement rates were increased to37%and52.5%in2012.About the individual out-of-pocket of NRCMS in Jilin province：The average out-of-pocket expense increased year by year in2003-2012,which decreased in2012. The average out-of-pocket expense of hospitalization and outpatient were2568yuan and76yuan respectively.With the annual income of farmers increased year by year, the averageout-of-pocket expense of hospitalization and outpatient per timeaccounted for35.5%and1.1%of their annual income in2012.【Conclusions】The results of NRCMS in Jilin province wasremarkable in2003-2012.To some degree,the individual out-of-pocketburden of NRCMS members reduced, NRCMS members’ enthusiasmwas raised, the medical and health services utilization of NRCMSmembers was promoted, the phenomenon that farmers cannot seekmedical advice due to economic reasons reduced effectively. Thefarmers who benefited from NRCMS increased year by year in Jilinprovince, and the benefits kept rising; the actual compensation ratio andreimbursement were significantly increased, the level of benefit keptrising. At the same time, many problems and challenges also reflected,and need to be addressed, including: NRCMS were shabby comparedwith the farmers’ actual medical demand. We suggest to further perfectthe finance compensation mechanism of NRCMS, improve the proposedraising financing standard to raise the ability and level of NRCMS andperfect the new farming and financing mechanisms for the difference ofmedical care between urban and rural residents. Due to theimplementation of the national system for basic drugs and insufficientcompensation of the grassroots medical institutions, the health services utilization of township hospitals and hospitalized patients decreasedsignificantly. This caused an unreasonable the flow of patients. Mover, itincreased the economic burden of NRCMS members. We suggest toexpand basic drugs range, reduce drug prices from circulation, increasefinancial aid for difficult areas, solve the issues that difficult areas lackof financial aid after the zero rate of sales. Becausethe absence of NRCMS laws, we suggest to improve NRCMS legislation,establish and perfect the law of NRCMS.Innovative points: This research anlayzed and evaluat the overalloperation and results of NRCMS in Jilin province in10years for thefirst time in2003-2012; studied organically and conjunctively NRCMSin Jilin province and medical service utilization and its compensation,stated comprehensively NRCMS running situation and its overall effect;put forward some suggestions to improve NRCMS specifically, andprovided a referential mode for the decision department of thegovernment in the integration of NRCMS for the first time in10yearsworking on the basis of summary and positive statements combined withthe practical situation of Jilin province and its existing problems. |
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