A Study On Financial Mechanism Of New Cooperative Medical System

Medical system reform is very complex in China.It relates to everyone's well-being.With the development of the social economy,the improvement of the rural medical security system becomes one of the great appeals to people.New cooperative medical system(NCMS)is organized,guided,supported by the government,in which farmers enroll voluntarily,aiming at resolving the risk of peasants' serious illness.NCMS is facing a prime problem,which is financing.NCMS claims its ultimate goal is "Almost all the Chinese people are now accessible to basic health care services".But in reality,the accessibility to medical service is low for farmers,with per capita medical expenses continuing to rise,and high co-pay ratio.The mode of payments in arrears reduces the financing equity of farmers.Farmer's medical burden is very heavy,while NCMS has a lot of balances,which indicates there are problems in the financing efficiency and equity.From 2007 to 2011,the mean of financial SBM efficiency based on SBM-Undesirable model is less than 1,which indicates NCMS financing mechanism is inefficient in these five years at least.The Window model also finds financing efficiency is less than 1 in the other years except in 2007 and 2010 with the highest efficiency.The change value of efficiency by Malmquist model is the fastest in the west,most slow in the central region.Various fair concepts(eg.Rawlsianism and utilitarianism)implemented in the system-design have different policy recommendations.In the area of health financing,affordability is the key of fair problem.The simulation based on T-Theil index of affordability medical expenses burden on farmers indicates that compared with other fair view,fair concept based on Rawlsianism characterized as Grassroots-support can improve greater equity of affordability medical expenses burden.So,fair concept based on Rawlsianism is a better fair concept which is more suitable for the existing financing mechanism design.In the current NCMS framework,both the farmers with high risk and ones with low risk must pay the same premium according to the same financing level,while reimbursement of medical expenses is basically the same in similar conditions for the enrollee.Therefore,the existing financing system is a pooling contract.According to the incentive theory,it is not incentive-feasible.It results in the abandonment of the financing system for farmers with heterogeneous preferences and expected health.Only farmers with expected loss of health between two critical values are willing to participate in the NCMS.Therefore,it is necessary to design an incentive feasible separating contract,each of which are responsible for different grades of financing and reimbursement,so as to improve efficiency and equity.The simulation indicates that in NCMS the separating contract can improve coverage and financing equity by transformation from pooling contract,in the rational design of the control handle.In the context of NCMS,whether the efficiency and equity are consistent and Synchronized?Granger causality test enlighten that between financial efficiency and medical care per capita ratio exist the Granger causality relationship under 10%of the significance level.VAR model demonstrates the existence of consistency among the financial efficiency and equity.The consistency suggests the synchronic improvement between them is possible.But the financial mechanism is the obstacle of synchronic improvement between efficiency and equity.So the transformation of contract form of the NCMS financial mechanism is necessary,so as to obtain synchronic improvement financing efficiency and consistency of equity improvement between efficiency and equity,which differs from Okun's bucket principle which declares that it is impossible to obtain the efficiency and equity at the same time.Based on the demonstration about efficiency,equity and the structure of contract,this dissertation envisages and discusses a mixed financing contract for the existing NCMS,which has both the basic account which is pooling-contract-type and compulsory,and demand account which is separating-contract-type and voluntary.The contract system compassing both the basic account and demand account is a new hybrid contract system.This dissertation answers the feasibility of the hybrid contract system through mathematical model,and the welfare effect through simulation.Therefore,the new hybrid contract can ensure the consistency of improvement of efficiency and equity.