| Objectives To explore the implementation status of hierarchical medical treatment of NCMS,summary the deficiencies in implementation,and propose policy recommendations by analyzing the allocation efficiency of health resources,implementation status of new rural cooperative medical system(NCMS),and inpatient cases of hierarchical medical treatment in Dingxi City.It was aimed at providing references for allocating medical resources rationally,improving the health service efficiency,and building a sustainable medical service system.Methods The paper used descriptive analysis for comparing changes of health resource allocation and utilization,health service costs and efficiency,the fund raising,compensation and flow of NCMS,the distribution of the hierarchical medical treatment in county and township levels.DEA method was applied to analyzing the efficiency of the resource allocation,principal component analysis was adopted to evaluate the situation of NCMS,single factor analysis was utilized for exploring the relationship between demographic disease characteristics and costs.Results(1)Current status of health resource allocation and utilization efficiency.The total amount of health resources in Dingxi City continued to increase,the number of medical visits continued to increase.The average costs of medical treatment in different levels institutions showed different fluctuation trends.The average of bed utilization showed a trending of go up at first and then down.There were found that the health resource efficiency in Longxi County,Zhang County and Min County were relatively effective,Anding District and Weiyuan County were effective slightly,other countries were ineffective relatively in current scale by compared the efficiency of medical services in horizontally.Health resources were utilized fully in 2009 and 2011,the allocation of health resources did not reach the optimal scale in 2012 and 2016,the allocation of health resources have not been utilized fully in other years by compared the efficiency of medical services in vertically.(2)Implementation status and effects evaluation of NCMS.the participation rates has been rised steadily,the level of funding has been improved continuously,compensation amount,proportion and beneficiary area have been increased continuously from 2013 to 2016.Comprehensive ranking showed that Min County,Anding District,Lintao County,and Longxi County ranked in the top four,indicated that NCMS were more successful,there were many problems about implementation of NCMS in other counties by applying principal component analysis and comprehensive ranking.(3)Analysis on the status of hierarchical medical treatment cases in county and township,the number of hospitalized cases have been increased both in county and township levels.The number of females were higher than males in every year,the number of cases aged 45~54 were the highest,and the largest number of hospitalizations were 6~10 days.The average costs of hospitalization rose steadily,the percentage of drug expenditure declined insignificantly,and the actual compensation ratio of diseases in various systems were risen constantly from 2015 to 2017.The average cost of hospitalization for different years,genders,age groups,disease systems and hospital stays were statistically significant.Conclusions The total health resources have grown steadily in Dingxi City,but they have been allocated unevenly,the structure was irrational,the efficiency of resource utilization was Inefficient and wasteful.The benefits and compensation of NCMS funds has increased,but the proportion of funds flowing out of the county was large relatively,the outcome of the implementation were unbalanced.The number of hierarchical medical treatment of visits have increased significantly,however the growth of average hospitalization expenses rates is too high,and the cost of drugs has remained expensive,there were not significant effects for controlling costs of hierarchical medical treatment. |
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