Evaluation On Hierarchical Diagnosis And Treatment Policy Under New Rural Cooperative Medical Scheme In Huining County And Jingning County, Gansu Province

Objective:To investigate the effect of Hierarchical Diagnosis and Treatment policy(HDTP)under New Rural Cooperative Medical Treatment(NCMS)in Huining County and Jingning County,respectively.And to propose suggestion for future policy improvement..Methods: Before and after control study design was employed.Inpatient reimbursement data sets and NCMS annual reports were collected span the time duration of 2012 to 2016 from Huining and Jingning NCMS management office.Descriptive data analysis,generalized linear model and multiple logistic regression models were conducted using Excel2007 and STATA12.0 to measure the effect of the policy in terms of inpatient flow,medical expense,as well as length of stays.Results:(1)The implementation status of NCMS: The participation rate of NCMS in Huining County was above 98% from 2012-2016,funding pool and number of inpatient compensation were increasing year by year.Inpatient compensation benefit rate also increased from 6.76% in 2012 to 12.34% in 2016.In the mean time,NCMS participation rate in Jingning County remained at a relatively high level from 2011-2016,the total amount of financing increasing year by year,the hospitalization compensation rate has been rising year by year,and it has increased by 6.8% in 2016 compared with 2011.(2)Patient flow analysis showed that,the implementation of the policy increased within-county-inpatient percentage and decreased out-county seeking medical services proportion.The proportion of inpatient within county roses by 3.81% in 2014-2016 in Jinning,in contrary to the corresponding proportion of inpatient medical services outside of the county.(3)As regarding to hospitalization expenditure,both hospitalization expenses and out-of-pocket expenses increased Huining County.The actual compensation in the county increased,while the actual compensation out-of-county inpatients decreased.The Hospitalization expenses in Jingning County was reduced,but for out-of-county inpatient increased.The self-paying expenses of inpatients in the county decreased,while for patient hospitalized outside the county increased.the actual compensation for inpatients within and outside the Jingning County all increased.(4)Medical service efficiency: After the implementation of Hierarchical Diagnosis and Treatment policy,the number of length of stays within and outside the County of Huining County was reduced,the length of stays of hospitalization in the county of Jingning County decreased,as well as length of stays of hospitalization outside the county was slightly increased.Conclusions:(1)In 2012-2016,the NRCMS in Huining County were operating at a good condition,and the level of beneficiaries of farmers continued to increase.However,the excessive growth of the cost of hospitalization medical care have an negative influence on the NCMS’ effectiveness.In 2011-2016,the new rural cooperative system in Jingning County performed well overall.The hospitalized medical care needs of patients were further released and the NCMS’ development was futher promoted.(2)Hierarchical Diagnosis and Treatment policy led to reasonable inpatient flow in Huining County,there was no significant effect on the control of the patient’s secondary hospitalization cost,and the patient’s internal and external self-paying was not effectively reduced.The actual compensation fees of patients within and outside the Huining County all go up.The length of stays of hospitalization for patients within and outside the county has been shortened,and the efficiency of medical services has been improved,which has,to a certain extent,reduced the patient’s burden of medical treatment.(3)The implementation of the Hierarchical Diagnosis and Treatment policy in Jingning County has effectively promoted the shunting of patients,changed the pattern of medical care for inpatients in the new rural cooperative medical system.The total cost of hospitalization for patients in the county and personal self-paid expenses were reduced.The burden of medical treatment for patients in the county was reduced,and the control effect of inpatient expenses outside the county was insignificant.However,the actual compensation fees within and outside the county all increased,which was conducive to alleviating the pressure on farmers to seek medical treatment.