| Objective:To investigate and analysis the operational status of NCMS outpatient prepaid capitation in Haiyuan county, combined with the experience of outpatient theoretical analysis and innovative prepaid payment system, research and study the effect of outpatient primary health care institutions to implement prepaid capitation in Ningxia rural, to provide the basis for improving NCMS payment system reform and promoting the new rural cooperative clinic prepaid capitation system with sustainable development.Methods:To checking the operation of NCMS clinic funds in Haiyuan county by statistical yearbook data and medicare billing data, and learning the clinic prepaid capitation system operation in Haiyuan county by satisfaction survey of project-related personnel, it is a typical case studies about NCMS outpatient its prepaid capitation system implementation effect.This study use the evaluation of the NCMS to capitation outpatient prospective payment after the implementation as the main line, to vertical comparison with baseline survey before the implementation of the project, comparative and analysis the distribution, usage, outpatient benefit coverage, outpatient benefit degrees, both times outpatient expenses of funds before and after outpatient prepaid capitation funds implementation in Haiyuan county, to do a horizontal comparison about the difference in the township project coordination and control of township clinics payment methods.SPSS 11.5 software and EXCEL were used for statistical analysis, two weeks attendance rate and the flow of outpatient medical institutions were analyzed by c2 text.Results:1.The new rural cooperative participation rates were 95.37%, 95.88%, 96.51%, 97.90%, 94.24%, and the participation of 100% coverage from 2009 to 2013 in Haiyuan county. 2.NCMS funding levels increased year by year, and the total financing of 37.9508 million yuan increasing to 160,397,000 yuan from 2009 to 2013 in Haiyuan county. 3.The outpatient medical institutions of Haiyuan county mainly in township hospitals in 2009 year, and their outpatient attendances reached 281,442, accounting for 71.72%. The distribution of outpatient attendances of Haiyuan county, mainly in village clinics and township hospitals from 2010 to 2013. 4.The both outpatient cost levels of county medical institutions are higher than the village levels outpatient medical institutions, the overall level is below 30 yuan. 5.After the implementation of the total outpatient prepaid in Haiyuan county 2010, the number of outpatient visits has increased, the actual compensation ratio increased year by year, and declined in 2013. 6.The two weeks attendance rates of Haiyuan county in 2009,2011 and 2012 year were increased, the difference was statistically significant(c2=24.089,P=0.000). 7.To investigating the flow of outpatient institutions of residents in three years about Haiyuan county, difference was statistically significant(c2=163.759,P=0.000), the baseline survey about outpatient medical institutions in 2009, the first is county-level hospitals(representing 30.38%), the village health clinic is the first 2011 and 2012 outpatient medical institutions ranked, they were 43.42% and 45.54%. 8.The outpatient benefit coverage were a substantial increase from 2009 to 2013, from 105.98% in 2009 to 274.50% in 2013. 9.The outpatient benefit of the Haiyuan county increased steadily year by year, from 2009 to 2011, they are 36.22%, 49.46%, 61.11%, 2012 to 2013 declined slightly, it’s 60.14% and 55.11%. 10.Overall fund cost overruns in the case of outpatient does not exist in Haiyuan county, but the balance varies widely, to coordinate fund outpatient utilization was 30.25% minimum in 2010, up to 64.47% in 2013. 11.The president and medical personnel of township hospitals, village doctors and staff of the social security agencies are satisfied with the overall effect about the NCMS outpatient prepaid capitation implementation of the program accounted for 88.9%, 56.2%, 72.6%, 66.6% in Haiyuan County.Conclusion:1.Since the NCMS outpatient prepaid capitation system implement in Haiyuan county, the township hospitals and village health clinic visits, outpatient compensation, reimbursement have some growth.2.NCMS outpatient prepaid capitation system lead to the rural primary health care institutions in the two health resources are fully utilized, service behavior of medical institutions to standardize, and guided rural residents to rural two grassroots medical institution, hierarchical diagnosis and medical pattern has been initial formed.3.Releasing participating health needs of farmers, improving the outpatient health care utilization, reducing both times outpatient expenses, expanding the participation of farmers and improving the participation of farmers benefit rate after NCMS outpatient prepaid capitation system implementation in Haiyuan county, to ensure the safety and stable operation of the new rural cooperative funds.4.The implementation of the NCMS outpatient prepaid capitation to mobilize the enthusiasm of the grassroots medical staff.Township and village levels about balance of the retention policy has played a positive incentive effect, encourage medical personnel to improve their ability, active service of the patient.5.The implementation of Haiyuan County outpatient prepaid system, basically reached the goal of national health reform, the people get benefits, the medical staff is encouraged, to security the funds safe and sustainable, in the scheme to further improve the basis can be popularized in the whole region. |
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