Study On The Working Mode Of Insurance Against Major Diseases By New Cooperative Medical Scheme In Shandong Province

Background:The New Cooperative Medical Scheme (NCMS) was a vigorous exploration to improve the health and medical insurance of peasants by Chinese government. In recent years, with the aging of the population and the changing of disease spectrum, the major diseases damaged the health and social development seriously, especially in rural areas. But the effect of insurance against catastrophic health expenditure was poor by the NCMS because of its low funding level. From2009, series reforms were implemented by Chinese government in health system, and the governments increased the subsidy for NCMS. With the funding level improved, it was necessary to study the working mode of insurance against major diseases by NCMS, which was beneficial to the peasants, NCMS and health reform.Objectives:This study aimed to establish a working mode of insurance against major diseases by NCMS in Shandong. The goal could be divided into5parts, included to study the conception of the major diseases, to study the related knowledge of insurance, to study the status of the NCMS in China, to analyze the necessity and feasibility for establishing a working mode of insurance against major diseases by NCMS, and to establish a working mode of insurance against major diseases by NCMS in Shandong. Methods:Based on the different objectives and different study contents, different methods were adopted, such as literature review, the Delphi Survey Method, empirical study and descriptive statistical analysis.Main Results:Ⅰ. From2007to2011, the growth rate of hospitalization expenses of the participants of the NCMS in Shandong was33.27%, the growth rate of the per capita costs was30.00%, and the growth rate of the average hospitalization expenses was13.30%.Ⅱ. In2011, the proportion of individual pays for hospitalization was50.98%in Shandong. And the proportion improved with the increasing of the hospitalization expenses. When the expenses were8000yuan or more, the mean proportion was61.92%, and when the individual pays were8000yuan or more, the mean proportion was65.24%.Ⅲ.22experts were selected and2surveys were conducted. The number of the NCMS experts, clinical experts and insurance experts were10,6and6respectively. The experts reached a consensus that the government should purchase insurance to commercial insurance agencies against major diseases in Shandong.Ⅳ. The working mode of insurance against major diseases by NCMS in Shandong was divided into3steps. In2013, the funding level was15yuan per capita, which insuring for20kinds of major diseases, in2014, the funding level was35yuan per capita, which insuring for40kinds of major diseases, and from2015, the funding level was60yuan per capita, which insuring against all the catastrophic health expenditures in participants of the NCMS in Shandong.Ⅴ. As the establishing of the working mode of insurance against major diseases by NCMS in Shandong, the compensation ratio of expenses for hospitalization of major diseases would be85%to90%, and the individual pays would be significantly reduced. Conclusions and Suggestions:Ⅰ.In most areas of China, the effect of insurance against catastrophic health expenditure was poor by the NCMS.Ⅱ.The major diseases’damage was so much and it should be pay more attention to establish a working mode of insurance against major diseases within NCMS. Trying to establish a working mode in Shandong was a good choice.Ⅲ.A working mode of insurance against major diseases within NCMS was established successfully in Shandong, which was divided into3steps.Ⅳ. As the establishing of the working mode of insurance against major diseases by NCMS in Shandong, the individual pays for hospitalization of major diseases would be significantly reduced. At the initial stage, the medical needs would be excited sharply, but the needs would gradually reach the state of saturation, so the future prospects of the working mode of insurance against major diseases would be better and better, and the NCMS would get a better development too.Ⅴ. Suggestions were put forward as follows:i) Select the insured diseases more scientifically and escalate the coverage, ⅱ) Take more measures to guarantee the supply of drugs and consumables for major diseases, ⅲ) Define the pay scope more scientifically, ⅳ) Implement the payment reform vigorously to contain the rise of the health expenditure.