| [Purpose]To understand the operation and management status of New Rural Cooperate Medical Scheme(NRCMS) funds in pilot countries under county level public hospitals reform in Hubei; to analyze the factors affecting the fund's endurance and the mechanisms; to explore the impact of reform policies on the fund's endurance; to identify problems and risks in the process of running NRCMS fund, analyze the reasons,and propose appropriate solutions and suggestions, to provide references for effective operation of NRCMS and perfection of the reform system.[Methods]On the basis of literature research, through field investigations and letter investigations, to get the specific programs of the reform, operation and management rules of NRCMS and the basic operation data of NRCMS fund in every pilot country from 2011 to 2013.Then, by using statistical analysis, stakeholder analysis, AHP,comparative analysis and macro policy specification analysis to analyze the data and information collected.[Results]1. The development of NRCMS in pilot areas before and after the reformFrom 2011 to 2013, some developments and changes appeared, not only in NRCMS of the first batch of pilot areas which had experienced the reform,but also in NRCMS of the second batch of pilot areas which which had not experienced the reform,as following:In participating, the participation number of the first batch of pilot areas increased by 2.26%, and that of the second batch of pilot areas decreased by 1.41%,but the rates of increase and decrease were not significant.In financing, using and compensation, the annual total financing, expenditure,utilization rates of NRCMS funds, number of visits and the actual compensation ratioof hospitalized patients both showed a certain growth, and the growth rates of the first batch of pilot areas were both higher than those of the second batch of pilot areas. The growth rates of the first batch of pilot areas were 56.51%, 91.38%, 16.94 percentage points, 43.30% and 6.29 percentage points in proper order, and those of the second batch of pilot areas were 51.35%, 84.29%, 15.15 percentage points, 39.49% and 4.22 percentage points successively.In balance, the annual balance rates of the two batches of pilot areas both showed a downward trend, but there was no significant difference in the reductions, and they were 18.53 percentage points and 18.25 percentage points respectively. And the annual balance rate of the second batch of pilot areas has already dropped to-2.11%,the fund showed an overdraft.2. Factors of NRCMS fund's enduranceThe endurance of NRCMS fund is mainly affected by the NRCMS agencies,medical institutions, patients and government; involving financing, compensation, and management of the fund. The main factors affecting the financing are the number of participation, payment standards and government's spending on NRCMS; factors affecting the compensation are the price of medical services, usage of medical services, compensation policies, disease spectrum, medical technology and the education degree of patients; and factors affecting the management are payment methods, supervision and audit. The standard partial regression coefficients between total financing and the number of participation,government's spending on NRCMS,per capita net income of farmers are 0.821, 0.172 and 0.070. And the coefficients between total annual expenditures and the number of discharged patients,number of outpatients, actual compensation ratio of hospitalized patients are 0.122,0.247 and 0.626,and correlations with out-patient average-time costs and per capita hospital costs have no statistical significance.3. Impact of the reform policies on NRCMS funds endurance(1)Overall: the endurance of NRCMS funds can be expressed by the annual balance rate,and the impact of the reform policies on the endurance of NRCMS fundwas realized mainly through the effects on the Fund's income and expenditure. The annual balance rates of NRCMS funds in two batches of pilot areas showed declining trends,the figure of the first batch of pilot areas fell to 0.09% from 18.63%, and the second batch of pilot areas fell to-2.11% from 16.14%.(2)Status of factors:In the aspect of government's spending on NRCMS,two batches of pilot areas both showed a increasing trend, and the growth rate of the first batch of pilot areas(57.56%)was higher than that of the second batch of pilot areas(46.54%).As for the price of medical services, the out-patient average-time costs of two batches of pilot areas were both on the rise, and the growth rate of the first batch of pilot areas(6.48%) was significantly lower than that of the second batch of pilot areas(37.35%); the per capita hospital costs of the two batches of pilot areas were also on the rise, but the growth rate of the first batch of pilot areas(15.74%) is slightly higher than that of the second batch of pilot areas(11.70%).In terms of the usage of medical services, the numbers of outpatients of the two batches of pilot areas both showed growth trends, the growth rate were between 20%-30%, and the growth rate of the first batch of pilot areas(25.72%) is slightly higher than that of the second batch of pilot areas(22.33%); the numbers of discharged patients were also on the rise, and the growth rate of the first batch of pilot areas(25.86%) was significantly lower than that of the second batch of pilot areas(36.82%).On the side of actual compensation ratio of hospitalized patients, the two batches of pilot areas both showed growth trends, and the growth rate of the first batch of pilot areas(6.29 percentage points) is slightly higher than that of the second batch of pilot areas(4.22 percentage points).[Conclusions]1. From 2011 to 2013, the participating of the two batches of pilot areas remained stable; the financing, expenditure, range and level of compensation both improved significantly, and the growth rates of the first batch of pilot areas were bothhigher than those of the second batch of pilot areas; the balance of two batches of pilot areas both showed significant decreases, and the second batch of pilot areas has already overdrawn NRCMS fund.2. The endurance of NRCMS fund is mainly affected by financing, compensation and management. The main factors affecting the financing are the number of participation, payment standards and government's spending on NRCMS, and the impact of the number of participation is particularly significant; factors affecting the compensation are the price of medical services, usage of medical services,compensation policies, disease spectrum, medical technology and the education degree of patients, and the impact of usage of medical services is particularly significant; and factors affecting the management are payment methods, supervision and audit.3. Overall, the impact of the reform policies on NRCMS funds endurance is not significant.Specifically, in funding, as a result of the reform policies, NRCMS funds bear the increase of the cost of treatment, and the burden on the operation of the fund increased, which prompted the government to increase the spending on NRCMS. As a result, the reform policies were conducive to promote the total funding of NRCMS funds increase.In spending, as for medical expenses, the effect of reform policies on controlling outpatient treatment expenses in pilot areas was significant, but the effect on controlling inpatient treatment expenses was not ideal; in terms of the number of visits, the effect of reform policies on promoting more outpatients to choose medical institutions in the country and primary medical institutions was obvious, but the effect on promoting inpatients to choose primary medical institutions was not ideal; in the aspect of compensation ratio, reform policies not only help to improve the actual compensation ratio, but also help narrow the gap between the compensation ratio within the scope of the policy and the actual compensation ratio. And the hospitalization reimbursement was the main part of the reimbursement of NRCMS,therefore, as a result of comprehensive effect on the fund spending, the reform policies brought a significant growth in fund expenditures.All in all, the reform policies not only promoted the increase in the funding of NRCMS funds, but also brought a significant growth in expenditure, and therefore the impact on the fund's balance rate was not significant. |
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