Research On Payment Reform Of The New Cooperative Medical System In Longhai City

The New Cooperative Medical System(NCMS)is a mutual support system aiming at rural residents,the focus of which is Comprehensive Arrangement for Serious Disease(CASD).Since 2003 the government implemented,piloted,and gradually developed the NCMS,most of rural population have been insured.The NCMS is playing an important role in meeting basic needs of the rural residents and easing their problems of “poverty due to illness” and “illness back to poverty”.Nevertheless,as the development of the NCMS,the expenditure is surging as well.For a long time,the NCMS has been applying “Post-pay System”,that the major payment is Fee for Service(FFS).This traditional payment tend to cause supplier-induced demand,excessive medical service,and supervision difficulties,which further increase unreasonable medical expenditure and burden of the patients.In the overall context of comprehensively deepening reform,a payment reform to “Pre-pay System”,is the way to curb the excessive growth of medical expenditure and ease burden on rural residents.Longhai City is a comprehensive reform pilot area of county-level public hospitals and one of 15 reform areas of Diseases Related to Groups(DRGS).Since 2011,the county has been actively exploring ways to reform payment.The government grouped different diseases,mapped out clinical pathways according to the groups,and let the hospital in charge of the medical fund paid to them based on clinical pathways.This method is relatively mature after years of experience.This essay starts out from the context of surging NCMS expenditures and leads to NCMS payment reform.Making Longhai City as the example,this essay analyzes the exploration,design,achievements of NCMS payment reform,uses “4E”theory to assess feasibility of payment reform,makes suggestions on improving the payment reform and introduces the experience of NCMS payment reform for references of others.