| Objective: by comparing the practice of total prepaid system which depends on the newrural cooperative patient co-ordination mode and effective regulatory measures at the pilotregions of Ningxia. Evaluate the effect of total prepaid system at pilot areas. Explore thecalculation mode and method of outpatient co-ordinate fund compensation standard. Study theregulatory measures which depends the total prepaid system. To provide a reference for thereform of the new rural cooperative medical.Methods: Using a combination of qualitative and quantitative methods. To understandthe operation from the annual report data of the new rural cooperative medical. Through thehousehold survey, the outpatient prescription survey, outpatient and hospital employeesatisfaction surveys, interviews of relevant personnel to understand the operation of totalprepaid system. The main analysis indicators are rural residents’ health services utilization,average cost of outpatient prescription, practices of outpatient prescribing, outpatientsatisfaction, hospital workers satisfaction and other contents. Using Epidata3.02to entry thedata, and using SPSS18.0statistical analysis software to analysis of the data. The test ofsamples average using t-test and covariance analysis, the test of samples rate using χ2test.Results:1、The participation rate of the total Prepaid pilot counties rose from96.25%and95.37%in2009to97.39%and96.51%in2011, the participation rate of control counties below the pilot counties;2、The utilization of patient co-ordinate fund is low, the utilization rate of Yanchi in last threeyears are8.32%、21.62%、30.56%, the rate of Haiyuan are11.87%、28.91%、50.3%, the rate ofTongxin are2.88%、15.24%、33.67%,the rate of Xiji in2009and2010are28.53%、59.89%, the rate of Pengyang in2009and2010are34.53%、42.46%;3、Farmers’ yield significantly increased inoutpatient co-ordinate of pilot counties, compared with2009, farmers’ yield increased by110.53%、128.31%in2010and2011in Yanchi county, farmers’ yield increased by68.84%、128.01%in2010and2011in Haiyuan county, farmers’ yield increased less in out-patient co-ordinate of control counties,compared with2009, farmers’ yield increased by18.64%、29.68%in2010and2011in Tongxin county,12.58%increased in Pengyang county and59.55%increased in Xiji county;4、after two years ofimplementation in the outpatient total prepaid system, the surplus of Huamachi hospital whichlocated in Yanchi county is115thousand yuan in2011, Gaoshawo hospital is35thousandyuan, Fengjigou hospital is31thousand yuan, a loss of16.7million yuan in Dashuikenghospital, the surplus of Shidian hospital which located in Haiyuan county is7thousand yuan,Xian hospital is93thousand yuan, Gaoai hospital is93thousand yuan, Guanqiao hospital is36thousand yuan, Luoshan hospital is28thousand yuan, Jiatang hospital is97thousand yuan,loss of52thousand yuan in Gancheng hospital, the number is48thousand yuan inGuanzhuang hospital, and31thousand yuan in Hongyang hospital;5、The prevalence of pilotcounties’ farmers compared with baseline:Yanchi county decreased by16.2%to12.1%,Haiyuan county decreased by17.1%to11.8%, the hospitalization rate of Yanchi countyincreased from10.3%to11.1%, Haiyuan county increased from8.4%to9.4%; Theprevalence of control counties’ farmers compared with baseline: Xiji county increased from12.3%to14.2%, Pengyang county increased from14.3%to14.9%, but Tongxin countydecreased by19.1%to13.3%, the hospitalization rate of Yanchi county increased from8.8%to13.0%, Pengyang county increased from9.1%to10.5%, Tongxin county increased from10.0%to10.4%;6、the proportion that farmers of pilot counties choose in rural medicalinstitutions for treatment increase yearly, the last three years’ proportion of Yanchi county are51.0%、58.0%、62.5%, the numbers of Haiyuan county are44.6%、66.9%、67.6%; theproportion of Pengyan county which is control county is46.5%、56.4%、53.5%, the proportionof Tongxin another control county is42.4%、46.5%、67.9%, Xinji county’ proportion is 56.0%、66.8%、61.0%;7、The doctors’ behavior of prescription improved significantly, in thecase of major disease spectrum similar, the pilot township hospitals of Yanchi, the averagenumber of prescriptions dropped from3.47in2009to1.92in2011(t=20.145，p=0.000), theaverage cost of prescription dropped from41.87to19.12(t=16.903，p=0.000); the pilottownship hospitals of Haiyuan, the average number of prescriptions dropped from2.94in2009to2.37in2011(t=11.129，p=0.000), the average cost of prescription dropped from25.37to19.67(t=16.903，p=0.000);8、The farmers of pilot counties on the overall satisfaction of newrural cooperation medical policy are higher(χ2=9.818，p=0.002), the medical staff on theoverall satisfaction of total prepaid system is ordinary, Yanchi was57.6%and Haiyuan is68.3%, the difference was not statistically significant(χ2=3.475，p=0.062).Conclusion:1、the system of total prepaid to ensure the safe operation of the outpatientco-ordination fund;2、total prepaid system to have more scientific and rational calculationmethod to ensure the fund safe and efficient operation;3、total prepaid system setted up aneffective regulatory measures;4、 total prepaid system changed the behavior of primaryhealth care sector service;5、total prepaid system effectively reduce the out-patient medicalexpenses of the primary health care sector;6、total prepaid system needs to have a goodinformation system.Recommendations:1、to establish a more comprehensive estimated program ofoutpatient, to ensure the efficient and safe use of the rural cooperative funds;2、perfectinformation system, to ensure the utilization of information more fully, and to facilitate themonitoring and management;3、further strengthen the regulatory measures of patientco-ordination, to ensure the quality of outpatient prescription; strengthen the supervision ofthe funds to ensure that funding is in place in full and ensure the primary health care tooperate normally;4、to strengthen collaboration between the various units to ensure the totalof prepaid system to run smoothly;5、further strengthen the project training for doctors, toregulate their medical practices. |
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