| BackgroundLacks the medical marketability reform which controls to create the medical expense excessively quickly rise, for did not have the basic safeguard farmer to create the pressure which generally was unable to withstand the load. In 2003 our country reconstructed the New Rural Cooperative Medical System (hereafter refers to as NCMS) , proposed to the fund division by the big sickness overall plan goal primarily, received decides, the balanced revenues and expenditures essential requirements, public, fair, fair assignment principle, as well as division scope and so on proper attention to both physical examination limits. The NCMS gathers the fund the movement process to divide into the fund raising, the division, to compensate and to supervise four stages. The fund division is approximately this system from the fund raising the middle link which can move smoothly to the compensation. At the same time, because the fund total amount which collects is getting bigger and bigger, the cake did Has been big, but the fair division cake's mechanism and the rule have not established. After causing old was unfair breaks, to appear newly is unfair, causes the minority groups to hasten the attenuation.In Shandong Province's practical work, the most various counties every year must according to the fund raising, 'the compensation and the surplus situation analyzes the reckoning same year' s fund to divide whether reasonably, how to make the adjustment and the improvement next year, but because some county' s administrative peoples changed frequently, sometimes will present some not to have the NCMS to gather experience' s leadership to be responsible for the decision-making, or original administrative peoples to new policy and new situation negligence, also will create some fund division and the use aspect question unavoidably.Once the movement plan after the examination public announcement,within one year could not make the big revision in principle, then easy to cause the question the further accumulation aggravation.Therefore, establishes the science, reasonable, to adapt the Shandong Province actual fund division and the use mechanism, regarding promotes the entire province regional NCMS to gather system's unceasing consummation, the enhancement management quality and the effectiveness, has the great importance the theory significance and the practical significance.But after retrieval literature, I discovered that domestic does not have the system to study the NCMS to gather the fund division theory and the model report, is the minority empirical study mainly about the compensation pattern classification, how the influencing factor and big sickness slight illness limits and so on question limited research, theoretically has the classified confusion and many flaws. Therefore needs to gather according to the NCMS the experiment site, the advancement and the popularization law of development, carries on a time thorough system' s NCMS to gather the fund division theory the research, arranges by the time blurs the place, to raise the senior staff to gather the farmer well to profit the level to serve.GoalsThe general goals are gather the fund division from the theory and the real diagnosis aspect to Shandong Province' s NCMS to carry on the: scientific approach, and carries on the real diagnosis using the design model, found the science in order to the division method, will consummate the NCMS for the present to gather the system to provide profits from and refers to.Theoretical side: take the welfare economics theory, the social security theory, most superior economics and the sociological aspect' s and so on resources deployment theory, decision theory as a foundation, unifies our country and Shandong Province' s NCMS gathers the formulation the general and specific policies, to discuss to establish the NCMS to gather the fund division the theory, and is clear about its connotation, extension, the establishment principle and so on.Real diagnosis aspect: taking a Shandong Province 2003-2009 year data as the standard, separately to all levels of aspects and so on outpatient service and in hospital disbursement, physical examination, in hospital childbirth, big sickness overall plan, two compensations, venture capital and fund surplus makes the analysis proof, auxiliary and attains the data by thorough investigation's experience, through vertically and horizontally compares, reveals present Shandong Province NCMS gathers the question which, the origin the fund division aspect exists and so on.Model aspect: Using the Delphi method primarily, gathers the technical guidance expert storehouse take the Shar dong Province NCMS the expert advice as the datum, establishes one to have the serviceability and the feasibility Shandong Province NCMS gathers the fund division standard, so that each overall plan unit may quite be according to the above convenient adjusts every year's fund allocation quickly, the solution blind decision-making brings the excessive surplus with exceeds expenditures excessively influence fund use efficiency questions. And may use this model, to confirm passing each overall plan unit fund division efficiency.Finally, propose the policy suggestion that completes the fund division.Data and techniqueThe material mainly comes from three aspects: first, reference; second, scene investigation and study material; third, the material of the expert consulted.According to the different research goal, has adopted the different research technique. Gathered the fund division fundamental research to the NCMS to use the literature review law, deductive line or method of reasoning and so on. Gathered the fund division model study to the NCMS, has used the improvement Delphi law. Gathered the fund division empirical study to the NCMS, used has determined the nature of with the quota unifies the method which, the spot investigation and the literature material unified. Regarding the numerical variable material, use the standard deviation of mean value, missed, targets extremely and coefficient of variation. Regarding the classified variable, with rate, the constitution compared, targets and so on. In addition, also has utilized methods such as comparison analytic method, lamination sampling method, statistical modeling.FindingsIn the fundamental research aspect, through and has profited from the domestic and foreign partial economics, the sociological theories to formerly the policy research, in domestic proposed for the first time the NCMS gathers the fund division the theory, the connotation and the extension and so on, and had determined guarantees the basic principle, the availability and the time-limited principle, the balanced principle, fairness principle, the efficient principle, has unified planning the principle basic principle. Proposed to rejects the physical examination fund, in hospital childbirth fund establishment in the existing fund division, transfers undertakes by the public health special fund. Proposed the method, removed two compensation funds into the disposable adjustment compensation .In the model study aspect, has established expert' s fund division"the golden standard" , inferred the digitized NCMS to gather the funddivision model. We may see through the model, the year fund raising andthe graduation medical establishment's compensation compared to having the related relations, in the partial values may estimate or under the fait accomplice premise, can carry on the calculation to other values, or carries on the trimming through the adjustment proportion or the amount, thus enables the policy maker to be possible to act according to the localactual situation to decide how to design the overall concept. This model, may prevent to pat the head decision-making effectively the malpractice. In the compensation compares the hypothesis under the premise, may also calculate approximately in the future needs to finance the total, will serve for the future fund collecting. May also compile the expert the opinion the proportion value direct substitution model, adjusts some item of expense the fund disbursement. At the same time, for model feasibility, also inferred the model five limiting condition according to the policy.In the empirical study aspect, had devised "Big" , "Middle" , "Small" three patterns, from the angle of entire province, the angle of different income type county and the angle of small sample county gathered 2003-2009 year fund division to the Shandong Province NCMS the historical situation to conduct the empirical study. "Big" the pattern demonstrated that at present the entire province venture capital withdraws excessively much, the fund accumulation surplus is oversized. When compensation should raise the compensation proportion which the village-level outpatient service, outside the township level outpatient service, the county level in hospital and the county are hospitalized, the maintenance township level in hospital proportion, reduces county level and outside the county the level outpatient service compensation proportion. "Middle" the pattern demonstrated that in the fund using, presents the income to be lower basically, fund utilization ratio also lower situation. In the overall plan fund' s disbursement, presents the low income county < income county < high income county obviously the situation, explained that the high income county the senate gathers the farmer to be bigger to the fund use proportion. The low income county withdrew most venture capitals, the deviation which has been conservative. The low income county outside the township level outpatient service, the county outside the outpatient service and the county is hospitalized the division fund to be higher than other counties, the income county in the village-level outpatient service, the county level outpatient service division fund are most, the high income county divides the fund in the township level in hospital and the county level in hospital to be most. Three counties are most by the county level in hospital division fund, all has surpassed 30%. The high income county stress in hospital compensation, the mid and low earning county outpatient service uses much, but because hospital treatment ability is bad, chooses the outside areas the proportion to be high. Their outpatient service overall use assumes the declining trend basically, in hospital use assumes the obvious trend of escalation, but the speed excessively quickly initiation overdraws. The low income county in the village-level outpatient service, the county level in hospital' s compensation close expert standard, the income county outside the county in the outpatient service and in hospital compensation close expert standard, the high income county in the township level outpatient service, in the township level in hospital and the county leveloutpatient service' s compensation conforms to the expert standard. Three county' s outpatient service overall plan comparison meet standards, the family account entered the withering away stage gradually, the physical examination fund was under the active control, and the special sickness planted the compensation to improve. The deficiency is mainly overdraws seriously, in hospital overall plan overuse. The high income county also has the massive two compensations. The hypothesized county overwhelming majority data and entire province data characteristic' s conjunction explanation hypothesized county may study originally as the entire province detail drawing. "Small" pattern to demonstrate, during 2003-2004 year period, because the primary experiment site, the fund division does not have basically, only then outpatient service fund and in hospital fund mix disbursement. 2005-0006 period fund use change is fierce, the benefit factor is low. Three sample county in hospital compensation's situation overall is friends with in the outpatient service compensation, but creates surplus are excessively many and overdraws also frequently also exists. In each kind of fund venture capital's division is good, the physical examination and two compensations are quite chaotic. The family account creates the outpatient service compensation seriously passive, did must be reformed already.Suggestions1st, enhance the understanding of the fund division important to the NCMS. Completes fund division which the NCMS gathers, blocked the NCMS to gathering the fund raising, the assignment, the compensation and the supervision in four stages the pharynx and larynx, to prevented the fund oversized surplus and overdraws excessively has the very vital role.2nd, adjusts the bad procedure of the NCMS to gather in the fund division. Originally in the fund division' s physical examination fund and in hospital childbirth' fund, should unify by the public health fund undertakes, removes two compensation fund item. Reduced creates surplus the fund in the past the proportion, enlarged in the controllable scope to the accumulation surplus fund use.3rd, enhance overall plan level and the fund raising levels, enhance the total quantity of the fund that may divided. Must enlarge the central committee and the provincial level finance to the place support dynamics, increases farmer' s per capital national income by to raise the overall fund raising level as soon as possible earnestly. In the foundation of experiment site municipal overall plan, gradually transits to provincial level overall plan.4th, coordinate medicine redoes the expense control work, after reducing the fund division waste. Enlarges reforms by the finance to the public Medical establishment' s compensation dynamics reduces them, to raise medical by the medicine the impulsion, carries out basic drug system, speeds up the prepay system, limit the price and so on . Carries out clinical way, the graduation medical service and active control medicine expense coordinated reforms.5th, straighten out Medical establishment' s system to reduces the conflicts of interest which the fund division brings. Speeds up the straightening out system, the villages and towns hospital realizes delimits the county level management, the village-level fixed point Medical establishment implements the thorough integration, simultaneously strengthens the province, the municipal large-scale Medical establishment to the work of "Strong Base" .6th, strengthens the fund supervision necessary work and displays the fund division fully the superiority. Strengthens to the fund verification supervision, achieves earmarks a fund for a specific purpose, transparent expenditure. In addition, must complete the foundational necessary project of basic unit NCMS to gather the fund management talented person' s raise work, farmer's health education work, the perfect public health system work, to strengthen the basic unit health services structure construction work and so on.InnovationSought the NCMS to gather the fund division theory for the first time, elaborates its thought rested on, the principle, the connotation, the extension and so on sisterly. Established the Shandong Province NCMS to gather the fund division model for the first time, and unified the policy of medicine reform and the reality experience proposed the idealized model on fund division.. In the empirical study established the concept "hypothesized county" for the first time.
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