Feasibility Research On The Reimbursement Scheme Of Outpatient Pooled Funds Based On Ensuring The Income Of Rural Practitioners

BackgroundIn implementing process of the New Rural Cooperative Medical System (NCMS), reimbursement scheme of family account confronted serious problems. A new model, the outpatient pooled financing model, is preferred as it could bring more benefit to the members of NCMS, increase the usage of funds, and boost utilization ratio of outpatient service. The new model is still in trial and the research on it is still lacking. Rural practitioners should be taken into account in this new model, as they are the main rural health services provider. It's significant to ensure the smooth development of the outpatient pooled financing model.ObjectiveBased on guaranteeing the income of rural practitioners, the research utilized data of Wuhan NCMS to verify the new model in the field in reimbursement, risk control and organization management. Also, the collaborating system was discussed. MethodTypical sampling was used in this research to investigate a Street. Three well-operating rural health rooms and the township hospital were surveyed. Observation, questionnaire, and interviewing methods were used to investigate the sampling organizations, rural practitioners, and stuff in management institutions.Result and Discuss1. The implementation of family account model is unsatisfactory. Although average out-patient compensation fee was high, only few farmers had benefited. It's indicated that members of NCMS might spend all their funds in one time or skip to a higher grades hospital. Simultaneously, the utilization ratio of health service is low and the part of the NCMS fund was left unspent.2. Three methods were introduced to reckon the doctors'revenue. The result indicated that the average income of rural practitioner was 2800 per month, which make them mid-high income population. Income from service increased unreasonably, which caused by income from drugs declined.3. Feasibility analysis of the implementation program(1) The health facility in the Street is in good condition, the setting of rural practitioners there are comparatively reasonable, and much work has done to better management.(2) Excluding the increasing number of outpatients, the pooled fund is secured and will leave 30% unspent. However, the increase caused by pooled outpatient model is significant, which makes the pooled fund at risk. The risk exposure could be up to 50 thousand yuan. However, the fund gap was only a drop in the bucket relative to the total NCMS fund and even fund balance for in-patient. So it's feasible to fill the out-patient fund gap by the in-patient balance. Also the out-patient fund would be abundant if the allocation for out-patient was up to whole fund's 20% or 40%.(3) In risk prevention, the pilot areas have taken several measures such as setting quota for outpatient compensation every time and per annum, risk-sharing for overdraft, and limiting doctors'prescription. There was much higher risk consciousness, which would help to prevent the risk of fund running.(4) The implementation of new model would significantly decrease income of rural practitioners up to 1000 yuan per month. If the disparity was offset by government finance, there was at least 20 thousand yuan to plough into this model to ensure equivalent revenue.Presently rural health rooms didn't assume the basic function for public health work. It's proposed per capita outlay for public health service not less than 15 yuan in 2009. After returning rural practitioners to the basic public health function, this income disparity would be covered.(5) It's necessary to establish the computer information management system, which is the important condition to strengthen monitoring and timely feedback. In accordance with actual situation, the proportion of out-patient fund should be adjusted. 4. There are other problems facing outpatient model, such as higher operating risk of pooled fund, difficulties to supervise appointed health facilities, moral risks, excessive supply of health service, and adverse selection. ConclusionsBy analyzing the operation of the fund, risk control, organization management, and income of rural practitioners, we find outpatient pooled funds model feasible, with several problems in operation process needs to be addressed. Policy suggestionTo adjust proportion of pooled outpatient fund on the base of actual need; to strength surveillance of supplier and users of health service and management institutions; to increase the reasonable income of rural practitioners in order to sustain them as an indispensable part of rural health and regulate their behavior.