Study On Performance Results Of New Cooperative Medical System In AX County, Fujian

[Objective] To evaluate the running performance of new cooperative medical system (NCMS) for 3 years(2005-2007)in AX county of Fujian, and explore the main influence factors of"high hospitalization fare"and"remedy level for each hospitalization",and analyze the characteristics of"hospitalization out of county at higher levels".[Method] The remedy data for 3 years were collected and analyzed by SPSS package (V.11.5 and 13.0) for evaluating synthetically NCMS running performance in the county. And the main performance indicators of NCMS were evaluated, the influence factors of"high hospitalization fare"and"remedy level for each hospitalization",and the characteristics of"hospitalization out of county at higher levels"were summarized by logistic regression ,ROC curve (receiver operator characteristic curve),Chi-square test and Kappa coefficient.[Results] The indicators of NCMS running performance in AX county were basically good and smooth. The percentage of joining NCMS was closed to 90%. The mean values for 3 years of main remedy indicators were: The mean hospitalization fare was 3621 Yuan (RMB), remedy fare 1212 Yuan for each hospitalization and was basically stable trend; The hospitalization cases (81.2%) and hospitalization fares (61.2%) were at township and county levels. The actual remedy ratio reached to 39.2% and showed a increasing tendency;The drug ratio (47.2%)was stable and in the ranges of MOH regulation;The ratio of physical examination (PE) fare was 9.0% only; The ratio of non-remedy fare was 25.5%;The day interval from leaving hospital to remedy was decreased from 37 days to 7 days, and could get remedy at once recently because of hospital management of NCMS remedy by internet system. The rate of hospitalization number aged 20-34 female was increasing by 23.1% for recent 3 years;The mean percentage of fund expenditure for 3 years reached to 85.0%; The hospitalization fare,drug fare and PE fare shown decreasing trend for recent 3 years, but non-remedy fare increasing trend in the county.The influence factors of"high hospitalization fare"were out of the county for hospitalization at higher levels(OR = 24.6),longer staying at hospital (6 days or more, OR = 13.0, suffering cancers (OR = 4.5) and higher ratio of non-remedy fare(drugs and PE fares, OR = 4.1).The level of remedy fare was mainly influenced by three factors: hospitalization fare (OR≈133);actual remedy ratio (OR≈43);longer staying at hospital(OR≈4.5).The characteristics of"hospitalization at higher hospital levels"were searching additional drugs or PE, resulting in high ratio of non-remedy fare (OR = 3.2); higher the other fare (OR=2.4);higher PE fare (OR=1.8).The existed problems of NCMS in AX county were as follows: one was although the percentage of"hospitalization at higher hospital levels"was only 18.8%, on the other hand, the percentage of total hospitalization fare consisted of 38.8% or more, it follows that the hospitalization conditions for AX county should be improved for attracting sufferers. The another problem was the ratio of non-remedy fare were increasing tendency, indicating that medical facilities inspection should be strengthened by the health administration authority for regulating medical behavior in hospital and to lighten the non-remedy fare.[Conclusion] The NCMS practical performance in AX county is basically good and smooth. The mean hospitalization fare is 3621 Yuan (RMB, lower than per capita net income of rural residence in the county), the actual remedy ratio reaches to 39.2%, remedy fare 1212 Yuan. The mean ratio of fund expenditure for 3 years was 85.0% and welcome by the farmers;The embarrassment of fundraising has been decreased recently. The ratio of joining NCMS of farmers was closed to 90% and the cumulative ratio by household of getting benefit from NCMS reaches to 37%. The successful practice of NCMS can be referenced by the other counties in Fujian and can be creditably named as"National NCMS pioneer County".The key measures for scientific and persistent development of NCMS should be carried out in the future:strengthening inspection and management of related hospitals, reducing the ratio of non-remedy fare and PE fare of patients; normal childbirth cases should be listed as normal remedy policy to improve the equity for female;and increasing governmental subsidy for improving medical service and facilities in the county.