| BackgroundBy the end of September,2008,the new rural cooperative medical system has covered 814 million people in China,accounting for 91.5%of the total rural population. Comparing with the contribution amount of urban health insurance,the financing level of new rural cooperative medical system is much lower.As the utilization of the peasants covered by the system has been raising gradually,how to strengthen the financing management and establish the incentive mechanism for the health care organizations to reduce the economic risk of the rural population when suffering illness and to guarantee the quality of health care provision through improving the health care reimbursement under the limited financing level has been a key issue for ensuring the sustainability of the system.The successful implementation of DRGs in other countries and the progressive achievement of the domestic pilot studies showed that,DRGs could control the health care cost and saved health care resources more comprehensively and effectively.As early as 2003,some areas such as Shanxi,Yunnan,Chongqing and Heilongjiang had started trials of DRGs in new rural cooperative medical system.In the report of latest health care reform,it was suggested that the medical system should explore and further implement DRGs.In April 2007,DRGs reimbursement scheme has been launched for 15 diseases in new rural medial cooperative health system of Minhang district,Shanghai.ObjectivesTo comprehensively summarize the effectiveness of DRGs implemented in Minghang's new rural cooperative medical System from a multi-stakeholders perspective by using health economics methodologies,in order to provide evidences and suggestions for DRGs further improvement and promote the normalization, rationality and sustainability of DRGs development.Contents1.Analysis on basic situation of the DRGs project 2.Effect of DRGs on the health care expenditures and quality3.Patient satisfaction evaluation4.Effect of DRGs on hospitals revenues and internal assessment5.Awareness and acceptability of hospitals & doctorsMethodsSystematic review on International and domestic studies about DRGs and its effectiveness as well as national and local policies about new rural cooperative medical system and DRGs2004-2007 Minhang inpatients medical records and costs statistics,2007 application and reimbursement records of Minhang DRGs projects were collected and analyzed. Satisfaction of DRGs users,hospital directors and doctors were investigated.Key informant interviews were conducted among hospital directors,doctors,officials in management organizations,third-party members.Through pre-after comparison,comprehensive evaluation of DRGs was taken place from a multi-stakeholders perspective based on the investigation data.ResultsDRGs implementation in Minhang's new rural cooperative medical system has got some achievements.Diseases categories choosen are rational.Reimbursement rate for the enrolled peasants has been raised.Peasants'awareness and satisfaction is relatively high.Third party is introduced to be in charge of management.The effectiveness of DRGs's incentive constraint mechanism can be reflected in the following phenomenon:health care organizations make profits and the acceptability remains high after DRGs implementation.The effectiveness of hard constraint includes part of the health care organizations take disagreement on the DRGs utilization to some diseases,standard clinical pathway is more difficult to operate, especially in complex cases.Part of health care behavior appears alienation tendency after DRGs implementation.Suggestions1.Extend the covering range of DRGs.2.Formulate different DRGs reimbursement standards for different levels of health care.Modify the clinical pathway. 3.Build information framework,optimize the operation process and improve the management efficiency.4.Improve the management of insurance payers.5.Strengthen the hospitals'regulation and information publicity.
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