Analysis Of Hospital Charges After The Implementation Of New Rural Cooperative Medical System In A Hospital And Deliberation On The Countermeasures Of Cost Control

Objectives To describe the constitution characteristics of farmers’ hospitalization expenses after the implementation of the new rural cooperative medical system(NCMS), analyze variation tendency of hospitalization expenses and its reasons, estimate NCMS effect on reducing the farmers’ medical cost, and explore the countermeasures in order to control medical cost, as well as put forward some suggestions on further improving the operating mechanism of the NCMS.Methods Through a variety of ways to obtain a demographic, economic income, rural cooperative reimbursement data of Shitai County as well as the information of all eligible inpatient hospitalized cost of the People’s Hospital of Shitai County. Excel software was to establish a database; and SPSS15.0was used for statistical analysis. Various average hospitalization expenses indices of each year were calculated. Relative ratio with fixed base and link relative ratio were used to reflecting its development speed, and Pearson correlation was used to analyze the change trends of average hospitalization expenses.Results The per capital income, the per capita medical expenditure and the per capita actual medical expenditure in Shitai County increased year by year during2006-2012. Since the NCMS in the second half of2007, farmers’ participation ratio is maintained at a high level and showed a gradual growth trend. The per capita reimbursement increased over the years; however, the percentage of per capita actual medical expenditure account for per capita percentage did not decline.The number of hospitalized cases of farmer increased year by year in the People’s Hospital of Shitai County. The average hospitalization expense in the first half of2007is less than that of2006. However, since implementation of NCMS from the second half of2007to2010, the average hospitalization expenses has been keeping continuous growth rapidly; which speed-up postpones from2011to the first half of2012. Pearson correlation analysis showed that the average hospitalization expenses from2006to2012was positively related with the year (r=0.954, P=0.000). The fixed base relative of the average hospitalization expenses increased gradually (r=0.939, P=0.002), but no increasing trend was found in the link-relatives(r=0.307, P=0.504). The average daily hospitalization cost kept increasing constantly and fleetly from the implementation of NCMS to2011. Both the average day of hospitalization(r=0.710, P=0.049) and the average expenses of cost per day of the inpatients(r=0.956, P=0.001) are positively correlated with the year. The fixed base relative of the average hospitalization expenses was on the rise with year (r=0.956, P=0.001), but no significant increase was found in the link-relatives.Except general inspection fee and diagnostic fee, all the other kinds of inpatient expenses keep a growth trend after implementation of the NCMS. The sequence from high to low was drug fee, surgical fee, the other cost (including nurse cost, high prices of medical expensive equipment expense, etc), treatment fee, large-scale inspection fee, diagnostic fee sort by the level of increase, of which drug fee, surgical fee, the other cost, large-scale inspection fee increased obviously. After the implementation of NCMS, the average hospitalization expenses rose in varying degrees in different departmen. The sequence was obstetrics and gynecology, pediatrics, internal medicine, other department and surgical department sorted by the level of growth of hospitalization expenses, of which the most obvious was showed in obstetrics and gynecology department.Since the implementation of the NCMS in the second half of2007, farmers’ per capita reimbursement (r=0.962, P=0.002) and the proportion of claims (r=0.936,P=0.006) have been increasing year by year, reflected in obvious increase in2008,2009and2010, and obscure since2011.Conclusions After the implementation of the NCMS, the farmers’participation ratio increased year by year. Farmers’per capita hospitalization expenses generally showed the momentum of short-term rising rapidly, and long-term developing slightly. Although the farmers’per capita reimbursement increased over the years, the NCMS did not play an apparent role in reducing the farmers’actual medical expenses due to the hospitalization expenses rising rapidly.The increase of drug fee, large inspection fee and high prices of medical expensive equipment expense were the main factors leading to the increase of hospitalization expenses, especially in drug fee. Each department per capita hospitalization medical expenses show various degrees of growth, especially in obstetrics and gynecology department. The implementation of the strategies are expected to control the rising medical cost such as separation of drug prescribing and dispensing, the establishment of the system of access and fair use of large medical equipment, popularization of DRGs-based payment system and total prepaid system and so on.