The Research Of Hospitalization Paymentsystem In New Rural Cooperative Medical Scheme In The City Of Gaoyou

Objectives: To understand how New Rural Cooperative Medical Scheme (NRCMS)fund is conducted and how hospitalization cost is controlled in Gaoyou, and givesuggestions about the factors which are involved. The payment mode reform servesas an important means to control the NRCMS spending. Through a field survey andevaluation of the payment reform in county-level designated medical institutions inGaoyou, the paper aims to dig out the problems in the reforming process and theneeded accessory support. Based on that finding, the new hospitalization paymentmode is designed in reference to foreign and domestic experiences.Methods: Summarize the successful exerise of payment system based on theliterature reviewand.Collect the data of the operation of NRCMS during the yaer of2008to2011,plus the inpatient data in county-level hospital of2011. Excel and SASstatistical software was used to process and analyze the data. Field investigation wasused to object administrators of NRCMS in Gaoyou and experts who engaged in theresearch of this program.Results:○1The overall operation of NRCMS in Gaoyou is in good conditon.Problems also emerge with growing cost, increasing expenditure of medcine andmaterial outside the reimbursementdirectory，and a loss of equilibrium betweenfunding and compensation；○2The effect of the current hospitalization paymentsystem’s cost control is not obvious. Problems are as follows: less cases of a singledisease, narrow coverage, lack of information and clinical support, and improperpaying standard.○3Reform policies are brought forward depending onsingle-disease, DRGs and day-by-day paying system. Diseases are classified into50 types,48of which make up76.08%of the whole inpatients; a paying standard isformulated according to varying diseases; in addition, an evaluation system is set upwith cost and quality being the leading indexes.Policy recommendations:○1In Gaoyou, there is a need to improve the NRCMS payingmode reform, enhance the supervision of medical sectors, and better the funding andcompensation mechanism to meet the increasing medical treatment spending.○2The reform calls for the adjustment of macro policy, such as the unified medicalcode, the establishment of cost accounting and invoice systems, the buildup ofdiagnose-transfer system.○3Clinical-based regulation should be introduced into thereform in Gaoyou. Cost and quality assessing system should be adopted to carry onperformance paying. Information system should be completed and more transparent,and medical staff’s motive should be stimulated.