Analysis On The Cost Of Hospitalization For Rural Residents And The Catastrophic Health Care Payment And Its Influence Factors Of Inpatient Families In County Among The Medical Reform Projects In Ningxia

Objective : To study the hospitalization costs and catastrophic health expenditure in project county from‘innovating the paying system,improving the healthy efficiency',to evaluate the effect of the key elements(hospital compensation ratio,deductible,ceiling)of New Rural Cooperative Medical System(NRCMS)compensation policy on hospitalization costs and catastrophic health expenditure,to provide reference for policy makers.Method:Using the baseline year of 2009 and the follow-up survey in the years of 2012 and 2015,selecting the same individual balance panel data in three years,the generalized linear model(GLM)is mainly used to analyze the influencing factors of expenses,the logit model is used to analyze the influencing factors of catastrophic health expenditure.Results:(1)The proportion of hospitalization in township institutions decreased year by year,and the proportion of hospitalization in tertiary institutions outside of the county increased year by year;The number of hospitalized patients in the < 7-day group decreased year by year,while the number of hospitalized patients in the 8-14 day group and the > 14-day group increased year by year.(2)Hospitalization expenses increased year by year before and after compensation,and the proportion of self-payment decreased first and then increase.(3)The results of GLM analysis showed that the hospitalization cost was negatively correlated with the actual compensation ratio and the nominal compensation ratio,and positivelycorrelated with the deductible,self-rated health,length of stay,whether the patient was referred to the hospital or not,and the level of hospitalization institution.(4)Under the threshold of 20% and 30%,the occurrence rate decreases first and then increases before and after compensation.and the incidence rate under 40% threshold decrease year by year.Under the threshold of 50% and 60%,the incidence rate increases year by year before compensation,while after compensation,the incidence rate decreases year by year.The decline rate increases year by year under other thresholds except the threshold value of 20%.(5)The average gap before compensation increases year by year under the 30% threshold,and under the other thresholds,the average gap decreases year by year.The average gap after compensation fell in2015 compared to the year of 2009,the decline rate of the average gap increases under the threshold of 20%,30% and 50%,and decreases under the threshold of 40% and 60%.(6)The positive gap decreases under the threshold of 20%,40%,50% and 60% before the compensation of the NRCMS insurance system,and increases under the threshold of 30%.The change of the positive gap after compensation is same as that before compensation.The decline rate of positive gap increases under the threshold of 20%,30%,40% and 50%,and decreases under the threshold of 60%.(7)According to the analysis results of the logit model,the per capita income level of the family,the actual compensation ratio of patients in hospital,have a negative impact on the incidence of catastrophic health expenditure,while the level of hospitalization institution and the length of stay and the family size have a positive impact on the incidence of catastrophic health expenditure.Conclusion:(1)The adjustment of the NRCMS policy does not make the hospitalized patients go to the basic inpatient institutions.(2)The proportion of inpatients with higher income and long hospitalization days increased year by year.(3)The hospitalization expenses increased year by year,but the out-of-pocket expenses of patients in hospital decreased in2015,compared with that in 2009,and the financial burden of hospitalization was alleviated.(4)Among the key elements of the NRCMS,the increase of the compensation ratio and thedecrease of the payment line have a great influence on the reduction of hospitalization expenses.Meanwhile,higher hospitalization level and more days of hospitalization can increase the hospitalization expenses of patients.(5)The breadth of catastrophic health spending is still large,at a higher level in the country.With the change of NCMS compensation policy,the decline rate of catastrophic health expenditure tends to increase.The NCMS compensation policy has a great significance to alleviate the occurrence of catastrophic health expenditure.(6)The frequency of catastrophic health expenditure in different groups was not balanced,factors such as low per capita family income,high level of hospitalization institution,long hospitalization days and big family size can increase the occurrence of catastrophic health expenditure.