| BackgroundNew Cooperation Medical System in rural areas (NCMS) is a basic health insurance instistution in rural China. It has filled the grey area of rural health insurance in China. From 2003, the interested groups has brought creative ideas in these areas of work, and explored actively to improve and regulate the operation procedure of NCMS and to ensure its stability. In China, NCMS makes up participant medical fee accord to certain ratios. This model has held the participants of NCMS partially responsible for their medical cost and in consequence lessened the financial burden of governments. The key of this model is to confirm a certain ratio of reimbursement. If the ratio is too low, NCMS will lose its function of controlling risk; if the ratio is too high, NCMS will face the challenge of moral hazard. In the prospect of controlling risk, medical expenditure on inpatients'is the major part, which represents 70% of overall cost of makeup fund of NCMS.ObjectivesThis research analyzes the operation of NCMS and inpatients'situation in different areas of Hubei. Factors influencing NCMS and inner relation of these factors are also analyzed. At last, proposal on benefit participants of NCMS is made.MethodsThis research studied the pilot cities or districts of NCMS which had carried out one year by typical investigation and analyzing data from Hubei NCMS. Economic status, participants, fund raising, allocation of fund, and reimbursement of outpatients are also analyzed. In the process of analyzing, the method of cluster analysis, insurance actuarial, and econometrics are employed. We divide participant into 3 parts accord to income and population distribution. Multiple regression model based on cross sectional analysis of influencing factors is use.ResultsFund raising represents a rising trend, of which the proportion of local fund increases while fund from centre government and private spenditure decrease. Fund expenditure occupied 74.57% of raised fund, of which 82.75% of pooled fund has been spent. The fund expenditure of inpatients varies in different levels of health facilities. 16.25% of 80 investigated cities or district post Deficit of 1.06%, the balance of NCMS is 21.99% with the highest ratio of 51.69% and lowest of 0.67%(include risk fund). NCMS pilot cities or districts'inpatients rate rise from 4.47 in 2006 to 4.65 in 2007. Income per capita, participation rate, balance of NCMS fund, inpatient ratio are influencing factors of reimbursement for rural residents. Income level and balance of NCMS fund show negative relation to inpatients reimbursement (relation coefficient rate is -1.328, -5.4). inpatients ratio and participation rate show active relation to inpatients reimbursement (relation coefficient rate is 1.032, 0.131).SuggestionsIn order to pursuit sustainable development of NCMS, ensuring the rational use and stability of fund, different areas should allocate fund and reimbursement rate according to economical development and inpatient situation. In this way, fund could be used more prudently, fund balance and overuse would be control, cautions on fund expenditure and risk control would be improved. Therefore, reinforce and better NCMS management and medical service surveillance, restrict induced cost by health provider and excessive use of health resource, and optimize medical resource allocation are necessary... |
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