Study On Hospital Expenses And Compensation Of Insured Peasants Taking Part In The New Rural Cooperative Medical System (NCMS) In Jiangshan

ObjectiveThrough analysis of the hospital expenses and compensation of insured peasants taking part in the new rural cooperative medical system (NCMS) in Jiangshan, we discussed the influence of the NCMS policy, the hospital levels, payment methods, diseases categories and basic characteristics of individuals to the hospitalization costs and compensation of insured peasents. The future trend of cooperative medical costs and compensation were predicted based on several years of costs data in Jiangshan. Also the integrated, comprehensive evaluation was carried out combined with health service demand and utilization of insured peasents. It provided scientific basis for promoting the NCMS policies, improving rural health service utilization and using of cooperative medical care funds rationally.MethodsThe qualitative and quantitative methods were used in this study. Data to analysis of hospitalization costs and compensation were from information database of NCMS management office and 64,263 messages of the effective hospital costs from the period of January 2005 to August 2008. The costs and compensation from 2010 to 2011 were predicted by the monthly expenses and compensation from January 2005 to March 2010. Meanwhile 177 insured peasents were sampled using questionnaire on health service demand and utilization and in-depth interviews to make a comprehensive assessment of future trends about the NCMS hospitalization expenses and compensation. The Statistical softwares of ACCESS2000,SAS8.0,SPSS13.0 were used to analysis the results. The statistical methods included general description, non-parametric test, multiple linear regression, multiple classification and orderly variable Logistic regression, time series ARIMA model.Results1.The proportion of drug costs is the highest in hospitalization costs, accounting for 43%,while the service fees of medical professionals is only 4%. The structure of hospitalization costs is unreasonable.2.Although first-level hospital's reimbursement is higher than that of second-level hospital's, most insured peasents still chose second-level hospital to be in hospital, accounting for 60.9% of the total number of hospitalization.2.Although first-level hospital's reimbursement is higher than that of second-level hospital's, most insured peasents still chose second-level hospital to be in hospital, accounting for 60.9% of the total number of hospitalization.3.Six kinds of diseases which have the largest number of hospitalized patients and the most hospitalization costs and compensation are:①Pregnancy, Childbirth and Puerperal Complications;②Tumors;③Injury and Poisoning;④Disease of digestive system;⑤Disease of circulation system;⑥Disease of respiratory system.4.Although the number of patients hospitalized who can pay more than 10,000 yuan only accounts for 8.25%, their costs of hospitalization occupied 40.11%, hospital compensations occupied 50.46%. When we will make an adjustment of NCMS, we should pay close attention to them.5.There are two main reasons that affect insured peasents'choosing of hospital:①high technical level or good effect;②close distance or easy to go.6.According to the trend of costs and compensation:by 2010, NCMS fund of Jiangshan will achieve its goal of"Balance of Payments, a slight surplus", but financing standard must add to 226 yuan per peasent and per year, NCMS fund of 2011 will not appear the deficit. If it is 250 yuan per peasent and per year, NCMS fund of 2011 will complete"Balance of Payments, a slight surplus".ConclusionThe implementation of the NCMS in Jiangshan played a positive role in meeting the demands for health services and lightening the financial burden of local peasents. Nearly 61% of the insured peasents tended to treatment in the municipal hospitals, at present the compensation policy of NCMS did little effect in attracting cooperative medical compensation fund sinking. Pregnancy, Childbirth and Puerperal Complications",Tumors","Injury and Poisoning","Diseases of digestive system","Diseases of circulatory system","Diseases of respiratory system"are the six kind of diseases which need the most hospital fees and compensations, so we should focus on prevention, care and treatment for these types of disease. In the implementation of the NCMS for more than five years, there was great increase in medical costs of insured peasents. We estimated that in 2011 the cooperative medical financing standard will be raised to 226 yuan per peasent and per year, if not more, there will be a deficit risk of cooperative medical fund, so it will be required to use the accumulation fund of NCMS to maintain the balance.