Designing Study On The Hospitalization Expenses Reimbursement Plan Of The New Rural Cooperative Medical System In Nanjing City

Objective This study focuses on the movement situation of the new rural cooperative medical system (NRCMS) in the suburb areas and counties in Nanjing city by survey, analyzing the distribution situation of the farmers' taking part in NRCMS hospitalization expenses and health services utilization, discovering the problem of the current reimbursement plan in the suburb areas and counties, designing the reimbursement plan by the actual situation of NRCMS in the Suburb areas and counties, exploring the possibility of the relative unification reimbursement plan, and putting forward the policy suggestion of improving NRCMS management and normalizing health services providing and health utilization behavior and enhancing efficiency of the fund usage.Methodologies The literature study and quantitative methods were adopted. The survey were carried out in the collecting three years material of NRCMS and farmers' taking part in NRCMS hospitalization expenses in the four suburb areas and a county in 2004 year. It's request that the population in the every sample is more thirty-three percent. The study design reimbursement proportion with the method of "the graduation, partition and accumulation reimbursement."Results The results of the investigation show that NRCMS covers the rural population to increase continuously and the financing level raises year by year. It has realized severe illnesses orchestration is more than other illnesses as principle of the policy, but the funds surplus rate is more higher. The hospitalization person distribution is unbalance in the different rank hospital. Hospitalization utilization in the suburb areas and counties contains a certain difference, every time hospitalization expenses present up the general regulation in the whole that hospital rank is more high and every time hospital expenses is more bigger, but we can think it have no difference in the same rank hospital by analysis of variance, PSS_{in group}＞0.05. The actual reimbursement proportion in the hospitalization expenses is low. The hospitalized funds usage distribution is unbalance and the characteristic is more high rank hospital to be bigger proportion. The design of reimbursement plan can influence the farmer taking part in NRCMS to select hospital.Policy Recommendations NRCMS in the whole city can build up relative unification hospitalization expenses reimbursement plan: deductible is zero, reimbursement proportion is designed according to actual measurement in the suburb areas and the county, which is properly chose between 30% and 70%. The ceiling and reimbursement scope can be unified. It could normalize the service behavior of the contract medical treatment organization. Medical practice in hospital should be pursued class by class. Township health center built up should be strengthen. It is active that investigating be carried out in the reimbursement method and expenses to pay a way. NRCMS management information system should be built up and improved.