| Since be experimented in 2003, the New Rural Cooperative Medical System (NCMS) has been achieved remarkable effects. The NCMS standardized management and operational mechanisms have been cultivated.The fund operated safely. The utilization of the medical service has been significantly inproved. The burden of medical expenses got reduced. More and more peasants begin to realize the benefit from the NCMS , which contribute to the rise of the participation rate. The NCMS was promoted in an all-round way in the country in 2008. However, so far the compensation scheme in different places differs widely. Evaluation and measurement on the scheme were done by many scholars. The NCMS compensation scheme is being explorated and adjusted constantly.At the beginning of carrying out the NCMS, most experimental county in Jiangxi Province made the compensation scheme which contained mainly inpatient and family account. Three different patterns of the inpatient expenses compensation have been taken in different counties since 2003. These are compensation according to the cost, the medical institution rank and both the cost and the rank.The pattern according to the cost takes high compensation ratio at high cost and tends to give more compensation to the serious patient. The pattern according to the rank takes high compensation ratio in low-rank medical institution and tends to guide peasants to go to the low-rank medical institution. While the pattern according to both the cost and the rank think about the two sides. Different compensation pattern will result in different consequence. Which pattern can reach the better effect? Which pattern can be operated conveniently, understood and accepted easily by the masses? It is the problem that the NCMS managers must consider. After making the compensation pattern, measurement for the compensation cost should be done to assure the security of the NCMS fund. Since a few years, many scholars have done the measurement studies. But it is necessary to improve the formula when measuring.Objective:1,Analysising the compensation effect of different compensation patterns in experimental counties in Jiangxi Province, comprehensively evaluate various of compensation patterns to provide a basis for the government decisions.2,According to original measuring formula, combining to the actual situation of Jiangxi Province, establish the measurement model of inpatient expenses compensation to make a reference for the measurement of medical cost, the adjustment and improvement of the compensation pattern.Methods:The data is coming from the reporting data about every NCMS experimental county in Jiangxi Province. The data of all the experimental counties was used when evaluating compensation patterns, as to 9 sample counties data was used when building the measurement model. The concrete methods are followed:1,Taking the measures combined to the qualitative research and the quantitative research, choosing three indicators that utilization rate of inpatient fund,the benefit coverage and degree of the inpatient, according to the general description and the dymamic sample clustering analysis, to compare the average of the indicators in different compensation scheme so as to evaluate the compensation scheme.2,Choosing three participating counties each year among 2003, 2005 and 2006, observing the inpatient expenses per time,the benefit coverage and the annual inpatient expenses per capita, to find the law of the indicators changing. According to original measuring formula, build new measurement models and test them.Results:1,In the counties which compensate according to the cost, the average of the benefit coverage are less than 3%; the average of the benefit degree are about 25%; and the average of the utilization rate of inpatient fund is up to 86.14%. In the counties which compensate according to the rank, the average of the benefit coverage are above 4%, the highest 5.06%; the average of the benefit degree are rising year by year, the highest 34.43%; and the average of the utilization rate of inpatient fund is a rising trend and up to 87.58%; In the counties which compensate according to both the cost and the rank, the average of the benefit coverage are also above 4%, the highest 5.91%; the average of the benefit degree is up to 29.16%; and the average of the utilization rate of inpatient fund is up to 80.51%. The result of the dynamic sample clustering analysis show that among the 4 counties that compensate according to the cost, 1 county has the general effect and 3 counties less effect; among the 11 counties that compensate according to the cost and the rank, 6 counties achieve good effect and 5 counties have the general effect; among the 3 counties that compensate according to the rank, 2 counties achieve good effect and 1 county has the less effect. By comparison, the pattern of compensation according to the rank can achieve a favourable effect and be practiced easily. It can be spreaded in Jiangxi Province.2,According to the actual situation of Jiangxi Province, modify the original measurement and build a new formula:the annual inpatient compensation expenses per capita=(inpatient expenses per time in medical institution of different rank×ratio of be compensated expenses-the threshold)×compensation proportion×benefit coverage×changing coefficientAccording to the law of the annual inpatient expenses per capita changing, in the case of whether the compensation scheme adjusted and different length of participating the NCMS, the changing coefficient of medical institution in different rank were figured out in four cases. The results are as follows:①When the compensation scheme is not adjusted and the first year after participating, they are 1.33 above the county-rank; 1.46 in the county-rank; 1.03 with town hospital.②When the compensation scheme is not adjusted and more than two years after participating, they are 1.25 above the county-rank; 1.03 in the county-rank; 1.00 with town hospital.③When the compensation scheme is adjusted and in three years after participating, they are 1.50 above the county-rank; 1.74 in the county-rank; 1.94 with town hospital.④When the compensation scheme is adjusted and more than four years after participating, make reference to the second case.Add the different coefficient to the formula above, and then get three measurement models. The testing result shows that model 1and 3 reach the better effect, but the model 2 has less effect.Multiple linear regression analysis shows that the annual medical expenses per capita and the compensation proportion in town hospital,the length of participating have great influence on the annual medical compensation expenses per capita. Thus, when adjusting medical compensation expenses per capita the adjustment to compensation proportion in town hospital should be seriously considered and the control to the medical expenses in town should be strengthed. At the same time the role of the compensation proportion in county-rank hospital shoule be paid attention to.Conclusion:1,The pattern of compensation according to the rank can achieve a better effect and be practiced easily. It can be spreaded in Jiangxi Province.2,The new measurement model has a favourable effect on the whole. It has practical significance to the measurement of medical expenses and the adjustment of the compensation pattern.3,the annual medical expenses per capita and the compensation proportion in town hospital,the length of participating have great influence on the annual medical compensation expenses per capita. When adjusting medical compensation expenses per capita the adjustment to compensation proportion in town hospital should be seriously considered... |
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