| Objective: The performance of the provider payment reform implemented during Health XI Project was evaluated through analysing the impact of provider payment reform on inpatient service and cost containment in new rural cooperative medical system(NCMS) in Huining, so as to provide scientific basis for further provider payment reform of NCMS.Methods: Mixed methods including quantitative and qualitative research methods were adopted in this study. The annual reports of Gansu province and Huining county from 2009 to 2014 were collected for descriptive statistical analysis by using Excel2010 including inpatient expenditure, hospitalization rate, inpatient expenses outside the county, and payment out of pocket. The inpatient compensation data of inpatient cases of NCMS from 2010 to 2013 was collected for time series analysis by using Stata13.0 including average hopitalization expenses, average length of stays and proportion of hospitalization admission from inside and outside the county. Qualitative interview was used in relevant managers and medical workers working in Health Bureau, cooperative management office, county hospitals and township hospitals.Results:1) Inpatient situation outside Huining county:The trend of inpatient ratio outide the county firstly increased and then decreased from 2009 to 2014, especially in 2011(6.24% rised); The inpatient expenditure outside the county increased from 2009(48.56%) to 2013(67.64%) and dcreased in 2014(5.53%), higher than provincial mean level; The average hospitalization expenses went up from 2009(9635) to 2014(12299); The ratio between payment out of pocket and per capita net income firstly increased and then decreased to the peak in 2011(193.91%), and droped in 2012(112.86%), recovered in 2014(126.47%). 2) After provider payment reform: The trend of average hospitalization expenses outside the county counstantly rised while that inside the county slowly declined; The trend of average length of stays outside and inside medical institutions both reduced; The trend of inpatient number proportion outside the county declined expecially in city hospital, the trend inside the county went up especially in town hospital;98.55% inpatients outside the county had no refferal applicaton. 3) Before and after the provider payment reform: Compared with the trend before reform, the average hospitalization expenses trend inside the county decreased especially in county hospitals; The average length of stays trend inside the county declined expecially in town hospitals; More and more inpatients chose medical institution inside the county. 4) The change of inpatient disease spectrum: the rank outside the county was not obviously changed, the rank inside the county changed obviously. Compared with before reform, the rank of dorsoathies, hypertensive disesaes and chronic lower respiratory diseases dramatically worked upward; The rank of influenza and pneumonia, upper respiratory infections, diseases of apendix, symptoms and signs involving the digestive system and abdomen went down.Conclusions: 1) After the provider payment reform in 2012, the trend of inpatient ratio outide the county changes from rising to falling; Average hospitalization expenses constantly climbs; The inpatient expenditure outside the county firstly increases and then decreases; Payment out of pocket firstly decreases and then increases. 2) The impact of provider payment reform in Huining is obvious, the average hospitalization cost containment has achieved initial success especially in county hospitals; The average length of stays of inside and outside county has both shortened; The trend of inpatient proportion outside the county declines; The trend of inpatient proportion inside the county increases; The provider payment reform only covers medical institution inside the county, the expenses control impact of medical institution outside the county is lacked. 3) The inpatient disease spectrum has changed inside the county after provider payment reform. |
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