Analysis On The Cost Of Hospitalizationthe For Residents And The Fairness Of The Benefit In County Among The Medical Reform Projects In Ningxia

Objective:Through appraising the change in the cost of hospitalization between the period of the adjustment of The New Rural Cooperative Medical System?NCMS?in project county from“innovating the paying system,improving the healthy efficiency”,evaluating the Increasing reimbursement rate,the capping line and the setting deductibles in the compensation policy of NCMS,it is analysied the contribution that the change of the healthy insurance policy for the amelioration of beneficial degree's fairness in residents from the county of the project.Meanwhile it can provide the micro data's support for the further adjustment of policy.Method:Using the data in the baseline?year of 2009?and the follow-up survey in the years of 2011 to 2015,it is analysied that the expenses related factors by GLM.Then it is compared that the fairness of the beneficial degree during the four years by the method of concentrated curve.And it is used to analyze the contribution of each factor for the fairness of the beneficial degree by the decomposition of the concentration index?CI?and the method of the oxaca decomposition.Result:?1?comparing with the baseline survey,it is rising in the hospitalization costs between the pre and after compensation in follow-up years?H=471.13H=227.31,p<0.05?,but it is a declining trend in the proportion of self payment year by year?H=171.543,P<0.05?.?2?The results of the GLM model show the actual reimbursement rate is inversely proportional to inpatient out of pocket expense and is proportional to the deductible,the days of hospitalization,the level of the inpatient institution and the economic status in family.?3?There is a upward tendency for the beneficial rate of the NCMC year by year(?²_trendtest=359.950,p<0.05).There is a upward tendency for the inpatient beneficial degree?H=498.373,P<0.05?.There is a difference between the actual reimbursement rate in the four years?H=169.904,P<0.05?,with increasing in proportion.?4?The results of the GLM model show that the reimbursement for the expenses is positive proportional to the actual reimbursement rate,the deductible,the capping line,the days of hospitalization,the level of the inpatient institution and the economic status in family.?5?The CI of the beneficial degree is 0.0659 in the year of the baseline survey,and the CI are-0.0210,0.0399 and 0.0348 in follow-up years.The CI is positive,except for the year of2012.That means there is a the pro-rich's inequality to the beneficial degree,but the absolute value is declining with a constant improvement in fairness.Decomposing the fairness of the beneficial degree,in 2009,the contribution rate of the family economic situation is 57.58%,and the contribution is positive.The contribution rate of the deductible is 18.80%,and the contribution is positive.The contribution rate of the actual reimbursement rate is 12.75%,and the contribution is negative.In 2011,the contribution rate of the family economic situation is114.72%,and the contribution is negative.The contribution rate of the actual reimbursement rate is 25.93%,and the contribution is positive.The contribution rate of the deductible is18.07%,and the contribution is positive.In 2012,the contribution rate of the family economic situation is 89.96%,and the contribution is positive.The contribution rate of the deductible is48.34%,and the contribution is positive.In 2015,the contribution rate of the family economic situation is 118.96%,and the contribution is positive.The contribution rate of the deductible is19.09%,and the contribution is positive.?6?The change of CI in the beneficial degree is-0.031from 2009 to 2015.The oxaca decomposition results display display that the contribution of the family economy to changes in fairness is 11.04%.And the contribution is mainly caused by the change of two years'CI.The direction is opposite to the change of CI,which exacerbates the unfairness.it is beneficial for adjusting the fairness of the beneficial degree above NCMC by increasing the actual reimbursement rate and setting the deductible.And the contribution rates are 27.41%,17.16%.The contribution is mainly caused by the changes of two years CI,which the direction is consistent with the change in CI.Conclusion:?1?Compared with the baseline survey,the hospitalization cost has been increasing for the follow-up year,but the proportion of hospitalization self-payment has decreased year by year,and the burden of medical care for residents has been eased.?2?Increasing the actual reimbursement rate is conducive to the decline in the cost of self-hospitalization,and increasing the deductible will augment the burden on the residents of self-hospitalization.It will be resulted for an increase in hospital out-of-pocket expenses by unreasonable increasing the days of hospitalization and blind selecting the high-level medical units.In addition,the better the family economic conditions,the higher the out-of-pocket expenses.?3?The benefit population of the NCMC are continuously expanding,and both the breadth and depth of benefits have been significantly improved.But the actual reimbursement rate still has a large room for growth,and there is a problem of unfavorable depth of benefits.?4?First,the overall beneficial degree presents inequality for the pro-rich in the four years,but fairness is improved year by year.Second,the actual reimbursement rate has a greater contribution to reducing the unfairness of the pro-rich person,and the capping line has a negative effect.At the same time,reasonably controlling the days and the levels of hospitalization becomes an important factor in promoting fairness.Finally,a relatively balanced family economic situation can effectively alleviate the unfairness of compensation benefits.?5?During the implementation of the policy adjustment from 2009 to 2015,it is played a positive role in the change of fairness by the actual reimbursement rate and the deductible,which contribution is mainly caused by the change of CI.It is obvious to promoting the fairness by controlling of patients with general diseases in the primary medical institutions and reasonably guiding the flow of the medical treatment.Other than during the implementation of the policy,there are still Unfavourable factors of fairness,such as unjustified days of hospitalization and economic constraints.