Analysis On The Operation Of New Rural Co-operative Medical System In Gansu Province During 2008-2016

Objective: Through quantitative research on the operation of the new rural cooperative medical system(NCMS)from 2008 to 2016,and the operation effect of NCMS for 14 cities(prefectures)of Gansu province in 2016,through qualitative research of farmers satisfaction,summarizes the achievements of NCMS in Gansu province.And analyze the main factors affecting of improving farmers’ satisfaction,an objective analysis of existing problems and their reasons,and put forward corresponding countermeasures and suggestions.To provide certain reference for the government to further improve the medical security system for urban and rural residents.Methods: Using literature analysis to know more about the research progress and current situation of the NCMS and its effects both at domestic and abroad;Collect the data on national economic development and NCMS operation from 2008 to 2016 in Gansu province,and on the basis of the extensive data to do an analysis of participation,fund raising and using,participants’ benefits and economic burden of disease by using descriptive statistical analysis method;Using weighted TOPSIS and RSR to compare the effect of NCMS in 14 cities(prefectures)in 2016;Using interview and questionnaire method to investigate the NCMS stakeholders,and using single-factor analysis to study on the farmers’ satisfaction of the NCMS.Results:1.Analysis of the implementation plan: The implementation plan of NCMS in 2016 mainly includes three parts that are fund collection and use,outpatient and inpatient compensation policies,and overall fund payment methods.The NCMS fund is composed of state financial subsidies,local financial subsidies,and individual farmers’ payments.The NCMS fund is mainly divided into four types: inpatient compensation fund,outpatient compensation fund,new rural cooperative risk fund and major illness insurance fund.The outpatient department is grouped into general outpatient and outpatient special disease compensation policies,and the inpatient is mainly divided into three categories which are generally hospitalization,compensation for hierarchical medical,and compensation for major diseases,according to the different levels of medical institutions,the deductible,reimbursement ratio,and ceiling line are different.In 2016,the reform of payment method is seen as the focus of the NCMS,and the overall payment method is mainly based on total prospective payment of total amount money system.2.Operation Status: From 2008 to 2016,the NCMS participation number and rate increased year by year,the province’s participation rate is 98.53% in 2016,participation rate the highest is 99.20% of Wu wei and the lowest is 98.05% of Lanzhou in 2016;The financing and expenditure level increased year by year,the total financing increased from 1.684 billions yuan to 10.213 billions yuan,the main source of funding is government and farmers;The total expenditure grow from 1.256 billions yuan to 9.348 billions yuan,mainly to hospitalization expenditure;The level of farmers’ medical service utilization increased year by year,hospitalization visits by 1.124 millions to 2.635 millions,out-patient visits by 106.243 thousands to 43.774 millions,the main flow of hospitalization visits is to county-level medical institutions,clinics people is to rural medical institutions;The benefit level of NCMS augment year by year,the real proportion of interregional compensation increased from 52.15% to 66.70%,the outpatient reimbursement increased from 29.19% to 72.75%;The farmers economic burden of medical decreased year by year,the economic burden of hospitalization decreased from 41.73% to 20.41%,and the outpatients decreased from 1.00% to 0.14%.3.Effect comparison: Five cities that Jiayuguan,Wuwei,Zhangye,Tianshui City and Baiyin ranked among the top 5 in terms of operational effectiveness;Others that are Dingxi,Longnan,Qingyang,Jinchang and Gannan Prefecture ranked among the after 5 in terms of operational effectiveness;Three cities operation effect is good,two cities is poor,and the remaining nine cities in the middle level.On the whole,it has a distribution situation of “less on the two sides and more in the middle”.4.Survey of farmers’ satisfaction and influencing factors analysis: Participants are generally more satisfied with the NCMS.Age,physical condition,family income,the proportion of medical expenditure to the total expenditure of the family,understanding of NCMS,awareness of the scope of reimbursement and the reimbursement ratio,service quality and attitude of different level medical institutions,security ability of designated medical institutions,the levels of personal payment,the reimbursement ratio and simplicity of reimbursement procedures are having a significant effect on the satisfaction of NCMS.Conclusion: From 2008 to 2016,the new rural cooperative medical system in Gansu Province has achieved certain results.The specific performance is as follows: The overall operation in 2008-2016 was good,giving full play to the guarantee;The operation effect of each city(state)in 2016 was stable;The personal factors of farmers and the acknowledge of new rural cooperative,fixed medical institution factors,and new rural cooperative medical program factors have an im-pact on the satisfaction of the new rural cooperative medical system.At the same time,there are also problems such as the heavy personal payment burden and the unreasonable flow of patients for medical treatment.In the future,the legislative process of medical insurance in urban and rural areas should be accelerated,the financing mechanism should be improved,the rural medical service system should be strengthened,and the supporting policies should be further improved.