Study On The Compensation Effect Of Catastrophic Insurance For Inpatients

[Purpose] Based on the comprehensive understanding of the compensation in the survey area,this paper makes use of the medical insurance data in the New Rural Cooperative Medical System,through the use of health service,cost compensation and family sickness ratio,whether there is an unprotected,catastrophic health expenditure and other indicators of the analysis to evaluate the compensation effect of the serious catastrophic insurance of the sample area.[Methods] This paper uses the method of content analysis and bibliometrics to systematically summarize the theory and practice of the related diseases(catastrophic medical expenses)to analyze the theories and methods available for reference in this study,and use the on-site interviews to learn more about the basic situation of the sample area and the compensation of the hospitalized patients that were collected.The database of the New Rural Cooperative Medical System and the database of Commercial insurance company were collected from the sample survey.The SPSS 12.0 was used to analyze the survey data by descriptive analysis.And the variables related to the utilization of health services were used as the interaction variables into the conditional logistic regression model to further evaluate the differences in catastrophic health expenditure among different types of patients.[Results](1)The benefit rate of hospitalized patients was 17.46%,22.91%,23.55% and 11.55% respectively.The incidence of catastrophic illness was 2.54%,3.82%,4.06% and 1.25% respectively.The actual compensation ratios of catastrophic illness insurance were 14.06%,8.58%,9.76% and 11.24% respectively.The cumulative actual compensation ratios were 52.69%,48.73%,50.81% and 52.96% respectively;The burden of family sickness decreased from 0.9954,0.8087,0.7998,0.6785,and the proportion of high burden population decreased year by year.(2)In different types of hospitalized patients with catastrophic illness in the family,the cumulative actual compensation ratio of the patients in wubao households,low-income families and other type of families generally got higher compensation than the general family of farmers.(3)The cumulative actual compensation ratio ot the selected with high cost and high utilizationis is generally higher than that of general disease illness in hospitalized patients;The percentage of the total cost of hospitalized patients with typical diseases was 8.49%,33.61%,31.56% and 25.61% respectively.(4)The unreasonable costs in hospitalized patients accounted for a large proportion of the cost of hospital.Overall,in the same year,the provincial designated hospitals are the highest level of non-compliance costs,followed by other provincial counties,municipal Designated hospitals,other municipal county hospitals,the lowest is the township designated hospitals.(5)The incidence of catastrophic health expenditure: the number of catastrophic health expenditure occurred between 2013 and 2016 is 2537,2610,2028,821,and the ratio of compensated patients accured with catastrophic health expenditure is 59.56%,65.48%,77.81% and 90.01% respectively,the ratio of the patient which should be guaranteed but with no protection was 40.44%,34.52%,22.19%,9.99%.(6)In the study of factors of catastrophic health expenditure effect,age,family population,family category,total hospitalization expenses,hospitalization,unreasonable costs,unreasonable costs accounted for,whether enjoy a serious illness insurance compensation and other variables into the equation,while gender,duration of hospitalization,unreasonable expenses accounted for no such variables into the equation.Among them,the number of family population is the protective factor,the number of hospitalization,the total cost of hospitalization,the total amount of unreasonable expenses,the cost of their own payment is a risk factor for catastrophic health expenditure.[Conclusions] As shown in the research results,after the implementation of the serious illness insurance system in the investigation area,the family burden ratio and the incidence of catastrophic health expenditure in the seriously ill hospitalized patients have improved,the insurance system of Catastrophic Illness has obtained a certain protection effect,but the results of the study showed that some hospitalized patients still faces a heavy economic burden.Here comes the recommendations of this research:(1)Improve the utilization efficiency of the NCMS;(2)Pay more attention to the vulnerable groups and the people who got serious disease;(3)Guide patients to get the reasonable medical treatment,and reduce the occurrence of unreasonable costs;(4)Strengthen the audit of catastrophic illness insurance reimbursement,to ensure that the occurrence of high medical expenses of the insured should be insured.