An Empirical Research On Jiangxi New Cooperative Medical Expense Control

The new rural cooperative medical care system of Jiangxi province has beencarried out for10years from local pilot to full operation. This system is a basic medicalinsurance system for rural areas. Through the establishment of risk-sharing and diseasesafeguard mechanism, this system effectively improve farmers’ ability to pay for healthservices and the ability to resist disease risk, to some extent alleviate the problems ofpoverty caused by illness. However, in recent years, the rapid growth of the new ruralcooperative medical expenses, not only brought huge economic burden to nationalfinance and farmer who participated, but also restricted the improvement of the standardof medical care. Controlling the excessive growth of medical costs and making thelimited funds maximize the social and economic benefits have an important significantto solve the problem of seeing a doctor. These measures definitely can maintain thesustained and healthy development of the new type of rural cooperative medical caresystem.Based on this, the paper start form the explanation of the new type of ruralcooperative medical care costs especially about inpatient’s hospitalization costs andfocus on the cost control problem. This thesis is divided into six chapters.The first chapter is the introduction part. It concludes the research background,literature review, research framework, research content and research methods.The second chapter discusses some concepts and basic theories related to themedical costs and cost control. And then make a theoretical analysis on factors whichmake the cost of a new type of rural cooperative medical care increase.The third chapter is about the empirical study on the new rural cooperative medicalexpenses controlling in Jiangxi province. From analyzing the data of the ruralcooperative medical expenses, we can get the following conclusions: the new ruralcooperative medical system runs well in Jiangxi province; the actual medicalcompensation ratio is growing, but the average cost of hospitalization and the averagehospitalization compensation costs is growing more faster than the actual medicalcompensation ratio. In different hospitals, The average hospitalization costs in themedical institutions above the county level is more than the average hospitalizationcosts in the county medical institutions, and the average hospitalization costs in thecounty medical institutions is higher than the average hospitalization costs in thecommunity medical institutions.The number of patients and the amount of fund flowing into the county hospital is increasing. Thus, the government has implemented a numberof medical cost controlling measures, such as propelling the medical fee payment,strengthening the supervision of the designated medical institutions, controlling theaverage hospitalization cost controlling, complying the essential drug system and so on.The forth chapter is about the case study of the new rural cooperative medicalexpenses controlling in taihe county. From analyzing the data of the rural cooperativemedical expenses, we found that: the new rural cooperative medical system runs well intaihe county; but the average hospitalization costs is growing very fast. In different kindof hospitals, it is the county hospital whose average hospitalization costs grow fastestthan any other hospitals. The number of patients and the amount of fund flowing intothe county hospital is increasing. In order to control the medical expenses, taihe hasimplemented a series of medical cost controlling measures, such as controlling thenumber of hospitalization patients in the community hospital; limiting the cost of drug;implementing the fee-for-service payment mode.The fifth chapter is about the experience of the medical cost controlling both athome and abroad, including the experience of the medical cost controlling in Germany,American, England and Singapore. As for the experience of the new rural cooperativemedical expenses controlling, we learn from other province advanced experience.Chapter six make policy recommendations to the cost control about the new typeof rural cooperative medical care system. Firstly, reform and improve the payment ofmedical expenses; change the single payment according to service items; implement themixed payment system giving priority to prospective payment system. Secondly,establish and improve the dual referral system of three-level medical institutions andproperly bypass patients. Thirdly, establish the sound supervision and restraintmechanisms, and strictly standardize medical service behaviors.