The Study On How The Mechanism Of New Rural Cooperative Medical Scheme Affects Its Ex-tensional Function

New Rural Cooperative Medical Scheme (NRCMS) is one of the most important medical security system in rural areas. The NRCMS was defined as a mutual aid system in the Decisions of the CPC Central Committee and the State Council on Further Strengthening Rural Health to solve the problem of poverty due to illness in rural areas. The NRCMS was organized, guided and supported by government. Rural residents may take part in NRCMS voluntarily, and the funding comes from residents, cooperators and governments by level; In2003, Opinions On the Establishment of New Rural Cooperative Medical Care Scheme was jointly issued by Ministry of Health, Ministry of Finance and Ministry of Agriculture., the NRCMS begun to try out in some areas in our country. There were more specific goals in every phase in No.1Central Document. According to this document, experiments of New Rural Cooperative Medical Scheme need to be developed; In2009, the NRCMS was regarded as a social medical insurance system in Social Insurance Law of the People’s Republic of China which was examined and adopted by the Seventeenth Meeting of the Standing Committee of the11thNational People’s Congress,marking the change from mutual aid system to medical insurance system. Since2003, the attend rate, the funding level and the compensation standard have been growing. The number of people who took part in the NRCMS increased from68.99million in2004to835million in2009, the attend rate increased from7.26%in2004to95%in2009.The total funding from11billion in2006increased to more than120billion in2010.The compensation standard from30RMB per person per year in2003increased to200RMB per person per year in2010. As a medical insurance scheme, the main function of the NRCMS is to scatter rural residents’disease risk and compensate their economic burden results from disease. The NRCMS played a good role in decreasing rural residents’economic burden of disease and preventing poverty caused by illness. Many domestic scholars’ studies about the function of NRCMS were evaluation study concentrated in the function of decreasing the economic burden of diseases, rarely in the extension function of the NRCMS. In this thesis, we shall study the extension function of the NRCMS based on the analysis of the mechanism of NRCMS. Evaluate the extension function of the NRCMS and analyze its effect and shortages, and find out the right advices for completing the extension function.The specificcontents are as following:(1) Analyze the mechanism of NRCMS theoretically, and clear the formation mechanism of the extension function of the NRCMS.(2) Study the extension function of NRCMS by literature study and empirical research.(3) Evaluate the effects and shortages of the extension function of the NRCMS, and propose the reasonable advices for completing it.Literature study and empirical research were both used in this paper. Literatures came from Shandong university library, including the reform of the NRCMS, reimbursement of the NRCMS, data from National Health Services Survey and other related health statistics. Survey data is from two parts. One part is the baseline survey of2007which was granted by Luxembourg and the technically supported by WHO named Luxembourg-WHO-Shandong Province Rural Health Personnel Training and Chronic Disease Control and other relevant documents collected by final evaluation in2010.These data include some policies about physical examination and health records, and the data of health education and training to medical staffs relying on New Rural Cooperative Medical Scheme. The other part of the data is from a field survey of two counties called Yiyuan and Juxian in August2010.1278electronic prescriptions from Juxian township hospitals and other institutions about New Rural Cooperative Medical Scheme was elected and some policies and operation indicators about the NRCMS was collected at that time.. The major finding of the study are as following:(1) The NRCMS impacted the diversion of patient flow obviously. Rural residents were inclined to township hospitals for outpatient, while county hospitals for inpatient. The NRCMS funding compensated hospitals by level was inclined to county hospital too.(2) There were positive aspects and negative aspects impact on medical behavior under NRCMS. Especially the irrational prescription behaviors and the cost of prescription were still not controlled effectively.(3) The establishment of physical examination and health records relying on NRCMS promoted the health interventions and management to high-risk groups. But the reimbursement of NRCMS for prevention was inadequate so that the NRCMS played an limited role in guiding Rural residents to develop prevention activities and mastering health knowledge and changing bad habits.(4) The promotion to the use of basic medicine was as following. Put basic drugs in the scope of reimbursement and raised the reimbursement ratio, which promoted the use of basic drugs. While the unreasonable drug use was still relatively common.The main conclusions of the study are as following:The NRCMS has played a positive role in patient flow, medical behavior, disease prevention and the use of basic drugs. But there were many defects, we should take some measures, perfect deductible,take co-payment and payment method, improve supervision mechanism and disease prevention, strengthen the ability of basic-level medical institutions to promote the extension function of the NRCMS.