Analysis Of The Effects On Fee-for-Service And DRGs In New Rural Cooperative Medical Scheme

With the New Rural Cooperative Medical Scheme (NCMS) quick spread, how to control medical expenditure in supply-side and how to improve service quality are the important contents being researched. Payment system style is one of them. Currently, there are mainly two types of payments in pilot areas: Fee-for-Service and DRGs. It is necessary to analysis the respective effects on the Fee-for-Service and DRGs in order to continuously reform and improve the payment, and make the NCMS function better. Objective:This paper analyzes the effects on the medical quality and controlling of the medical expenditure between the two types of payment (Fee-for-Service and DRGs) in NCMS. And make a deep analysis on the internal mechanism and external influence among the different effects. To explore the appropriate payment and the conditions which ensure the function effectively, so that the NCMS can effectively play a role in controlling the unreasonable rising of the medical expenditure, improving the quality of medical services and standardizing the medical behaviors. We can ultimately ensure the NCMS operate well and ease the disease burden of farmers, serve the farmers better.Methods:1. Literature study: Refer to a large number of domestic and foreign literatures, mainly about the mechanism and the effect on Fee-for-Service and DRGs.2. Survey method: Make questionnaire survey at the Health Bureau of sample counties, the executive department of NCMS and the medical institutions in county and township. Interview 76 person-times related managers, medical service providers and patients. Sample 418 cases of appendicitis case histories from county hospitals and two township health centers in every inquisitional region, for analysis on the expenditure and quality.3. Analyze and explain the results with the medical insurance theory.4. Statistical Method: descriptive statistics analysis, two-independent samples T-test and the Chi-square test.Results:1. Fee-for-Service motivates medical service providers to provide more services, and brings the fast growth of expenditure at the initial period. But after strengthens supervising and managing implemented by the executive department of NCMS, the speed of rise are controlled at a certain degree.2. There are many quota management patterns in Fee-for-Service areas, such as per-case expense quota, highest expense quota of single case, and so on. The methods limit the average expense, highest expense of single case,so that the provider can not create the profit but can increase the cost after surpassing the quota. Instead,Thus it will suppress the providers'enthusiasm of over-providing services.3. The quota management patterns are implemented unwell in certain Fee-for-Service pilot area.4. DRGs have controlling effect on the appendicitis cases which are defined as the DRGs. Moreover, it urges the stipulated medical institutions to adopt some measures initiatively to change their treatment behaviors, such as dividing total expense to each part, control service cost, strengthening using drug reasonably.5. There are many facts influence the change of medical expenditure and providers'behaviors and payment system is not the only one fact. And there are other facts influence the function of payment.6. Inquisitional region adopt variety of policies to strengthen supervision, such as quota for fee, drug supervision, competitive system, democracy surveillance, auditing strictly, controlling transition, establishing treatment criterion. These measures make up the payment own limitation in a certain extent and make it work better.7. The payment is better in the area which has more management input.Conclusions:1. Choose suitable payment according to the idiographic economic and health condition;2. The mix-payment have better effect on control expense and ensure quality;3. Establish persistent-effect supervising and managing mechanism to make sure the effective implementation to be the key point;4. Ensure the government fund support to the management of NCMS so as to improve the management ability of the NCMS organization;5. Encourage health service institutions to develop the internal management reform.