Feasibility Study On The Per Diem Payment Of New Rural Cooperative Medical System In Dafang County

Objective:Through the analysis of capital operative condition and the current status of the paymentreform of New Rural Cooperative Medical System in DaFang county,an city of Bijie inGuizhou Province, mainly around the Per diem payment for research to exploringstandard measure method, implement feasibility and feasible influent factors whichobstacles the implement of Per diem payment payment in Dafang county or in Guizhouprovince. The study aim is to establish a suitable and rational payment method which isadapt to the situation in Guizhou, fully arouse the enthusiasm of many aspects,advantageous to the reasonable control of medical costs, achieves high satisfaction degreeof rural residents, and to ensure the safe and efficient operation of the fund of New RuralCooperative Medical System.Through the research expect to provide theoretical andpractical reference for the reform of New Rural Cooperative Medical System paymentmethod.Methods:Literature study method, quantitative method (mainly field investigation method) andqualitative method (mainly in-depth interview method) were used for study.Using theliterature research, from the perspective of provider and buyer’s, to analysis advantagesand disadvantages of different method of payment. Collect data from the informationsystem of new rural cooperation medical system from2012to2013in Dafang county fordescriptive statistics analysis to statement the situation of the rate of farmer’s participate inNew Rural Cooperative Medical System,fund-raising and the usage of funds.In-depthinterview method was used to the related people from medical institutions,healthadministrative departments and new rural cooperative management department to find theproblems existing in the operation process in new rural cooperative. Cluster sampling method was used to extract hospitalized patients cost lists from Dafangcounty’hospital in March, June, September, December2011and in March,June,2012through the hospital information system.Import excel of hospitalized patients cost lists toSPSS17.0statistical software to analysis. Based on the method of Per diem payment tocollecting data, making a classification of diseases and estimating cost to get the paystandards of Per diem for local hospital in Dafang county.Result:1.The main types of payment method：From the Angle of the service provider, post-pay payment (especially fee-forservices),prepayment system (including DRGS,capitation, Global budget and Per diempayment) and mixed payment system are the main types of pay system (mainly refers toFrom the perspective of the buyer, the main payment include deductible, co-payment andlimits and maximums.2.Operation situation of rural cooperation medical system from2012to2013and the resultof SWOT analysisFrom2012to2013, the farmer participate rate of rural cooperation medical systemabove99%, capital utilization rate were97.16%and95.78%, respectively.The hospitalactual compensation is77.45%and93.47%.The average hospitalization cost was raisedfrom3134.98yuan in2012to3576.02yuan in2013.Compensation funds of New RuralCooperative Medical System to fixed-point medical institutions of county accountfor46.54%and54.84%from2012to2013. Nonfixed-point medical institutions of countyoccupy51.02%and43.28%.SWOT analysis found that the advantage performance is that governmentresponsibility rise, management institutions and medical institutions are actively trying toadapt to the change of environment. Data collection, project establishment and perfectinformation system has accumulated certain experience for the reform of payment.Disadvantage lays in understanding of payment and payment reform are not in place, lackof organization of agency of personnel must have professional skills and literacy, medical institutions’ enthusiasm is not high, regulation is difficult. New rural cooperation medicalsystem and payment reform have a chance in the support and farmers participate rateis high, the New Rural Cooperative Medical System and policy for medical institutionshave certain binding, medical institutions behavior more specification.Threats are mainlyaround the payment standard, new New Rural Cooperative Medical System lack of legalsupport rigidity, medical institutions have some certain resistance.3. Measuring results based on per diem payment in Dafang county3.1Basic situation survey on hospitalized patients1502hospitalized patients of New Rural Cooperative Medical System wereresearched. Based on the first disease classification standard a divided by,there were355pediatric patients, hospital cost between102.70yuan and4718.64yuan, mean702yuan, amedian597yuan, the average hospitalization days5days.The critical patients in hospitalCost is30, the fees from394.45to39678.47, mean1317yuan, median of2251yuan.Theaverage hospitalization days is10days.423patients undergoing elective surgery,hospitalization expenses from114.26yuan to114.26yuan, the mean of3882yuan, amedian of2457yuan, the average hospitalization days, nine days. The694patients,patients hospitalized from63.06yuan to63.06yuan, mean1996yuan, a median of1353yuan, the average hospitalization days7days.Divided by second disease classification standard,355pediatric patients, hospital billsfrom102.70yuan to4718.64yuan, mean702yuan, a median of597yuan, the averagehospitalization days5days; The critical patients of139people, hospitalization expensesfrom394.45to49749.67, mean6849yuan, a median of3137yuan, the averagehospitalization days of12days.314patients undergoing elective surgery, hospitalizationexpenses from114.26yuan to114.26yuan, the mean of2897yuan, a median of1807yuan,the average hospitalization days,8days; The694patients, patients hospitalized from63.06yuan to63.06yuan, mean1996yuan, a median of1353yuan, the average hospitalizationdays7days.3.2Pay standard according to the classification of diseases and per diem paymentAccording to the first disease classification standards, the fee from first hospital day to average day were bellows: pediatric group is from83.45yuan to74.63yuan, the criticalpatient group is from13995.61to13995.61yuan, patients undergoing elective surgerygroup is t from856.97to223.27yuan. The patients in the acute group is from439.41yuanto179.03yuan.Based on the second disease classification standard,the standard payment from firsthospital day to average day Dafang county hospital were bellows: pediatric group isfrom183.45to74.63yuan,critically ill patients group is from1299.05yuan to235.09yuan. Patients undergoing elective surgery group is from681.59to186.71yuan. Nonpatient group patients is from439.41to179.03yuan.3.3Evaluation of per diem payment method according to the disease classificationIn terms of data collection and data quality, need to collect allhospitalized patients with medical institutions listing data a day means bigworkload.Survey in the project name of disease diagnosis is not clear; Hospital billingdate is not real, keep books in a timely manner; Information level is not high and uneven,county health HIS system unable to export all complete information needed. Medicalrecord sample eligibility judge-ment, need a lot of manpower material resources andprofessional medical knowledge support.There are cross on the classification of diseases, such as pediatric patient surgery atthe same time, any class. Course section on disease due to inaccurate accounting time isless than or inaccurate segmentation rate. according to the guizhou province new ruralcooperative medical payment reform implementation scheme provided by the standard,facing many difficulties, the actual operation is difficult, the feasibility is poor.Conclusion:1.New Rural Cooperative Medical System in Dafang County faced some problems.Theoperation of the medical expense growth too fast, the average hospitalization costs risesignificantly; Health insurance funds utilization rate is high, the reasonable capital flow toowe, fund overdraft risk. The inadequate payment and of the essence of the factors affectthe advance of the reform.3. The per diem payment is not suitable for Dafang county and Guizhou province.Such payment has high demand to the quality of measuring data, measuring people. Suchpersonnel, information level at present in guizhou province can not meet therequirements,which means under the present situation,the per diem payment is not suitablefor guizhou province.Payment reform should be implement to exploring other forms ofPayment combined with the situation.