Study On Performance Of New Cooperative Medical System In Fujian (2004-2009)

Objectives: To analyze and evaluate comprehensively the performance of new cooperative medical system (NCMS)between 2004 and 2009, analyze the influence factors and the problems and put forward some suggestions for running NCMS in Fujian.Methods: The compensation database of farmer's hospitalization cases and related NCMS report forms were collected and analyzed by SPSS package (V11.5). The new rapid method of comprehensive evaluation of NCMS with 9 indicators was adapted and revised from Ministry of Health in 2009. And a questionnaire survey and related literatures were used for collecting required information for this study.Results: The results are mainly as follows:Firstly, good progres and performance from pilot conties to full cover in Fujian could be summarized for 2004-2009. They were as follows: the NCMS joing rate of farmer(from 68.5% to 95.3%), the level of raising money per capita (from 30 to 100 Yuan)and actural compensation ratio of hospitalization patients shown increasing tendency(to 36.2% in 2009). And hospitalization burden or the adjustment value of hospitalization fee (hospitalization fee / income per yaer per capita) shown decreasing trend(0.87～0.92 in first two years,only 0.61 in 2009). The constructions of databae system for NCMS in 8 cities were achieved basically and geting compensation because of disease for farmers gradually in time. The poverty by diseases in farmers was released by NCMS and the system was warmly gratulated by farmers in Fujian for recent 6 years.Secondly, to carry out NCMS comprehensive evaluation, find main influence factors on the performance. The method of NCMS evaluation was adapted from MOH and revised, and shown basically agreetment with the actural situation in Fujian. The performance scores of NCMS comprehensive evaluation were affected by many factors. The main influence factors were found in this study by using logistic regression analysis, for example, hospitalization benifet rate(OR=20.355), actural compensation ratio (OR=1.508～1.776)and expenditure ratio of the fund (OR=1.149)and so on.Thirdly, the main problems of running NCMS in Fujian were as follows: the model and levels of raising money from each family are not so flexible or various and coordinative with local madical charge. More fund and instruments are needed for a lot of township health centers. The increasing medical costs in all kinds of hospitals need urgently more effective control and supervision. The decreasing of hospitalization self-payments is not so significant for recent years. The manpower, skills and fund in administration centers of NCMS should be trained and strengthen. Generally speaking untill now, the date intervel of geting compensation from hosptals after recovering should be shorten and so on.By the way, five suggestions are listed in this study. They are establishing scientific and reasonable financing mechanism, calculating scientific compensation program, specifying behaviors of designated medical institutions, promoting NCMS into legalization and controlling medical costs.Conclusions: The conclusions are mainly as follows:1. Good progres and performance of NCMS in Fujian were achived in 2004-2009. The joing rate of farmer, the level of raising money and actural compensation ratio of hospitalization cases showed increasing tendency. And hospitalization burden shown decreasing trend. The NCMS information systems with internet in 8 cities were basically set up. The poverty with diseases in farmers was gradually released by NCMS.2. NCMS comprehensive evaluation is worthy of implementing and studing. Afer being improved, revised and localized, the new rapid method of comprehensive evaluation of NCMS with 9 indicators is practical in Fujian.3. The main problems of running NCMS in Fujian: Not so flexible or various for the model and levels of raising money from each family, the lack of medical techenicians and financial supports for township health center, local hospitals and administration centers of NCMS, no effective methods to be used for the control of medical charges and so on.