Research On The Internal Control Model Of New Rural Cooperative Medical System Based On The COSO Theory

Based on the grasp of the current management and operation situation of China's new rural cooperative medical system, the existing issues have been in-depth analyzed. Resorting to the essence of COSO internal control theory, the internal controlling objectives and controlling elements of China's new rural cooperative medical system have been defined and the controlling model has been built with the help of typical regional case studies. On the basis of theoretical analysis and empirical research, recommendations for improving internal control of new rural cooperative medical system have been proposed.(1) Literature research:collection of information relevant to the study, including literature about rural health care, the new rural cooperative management, internal control theory, and policy documents and supporting documents about new rural cooperative formulated by the national or local administration departments. (2) on-site survey:taking the typical sampling method to select Xi County in Henan, Zengdu distract in Hubei, Shan County in Shandong as the sampling areas; conducting questionnaires survey,in-depth individual interviews and collecting relevant management documents in the local Health department, Office of the new rural cooperative medical management, County and township designated medical institutions in the sampling areas; taking a certain number of prescriptions from all township hospitals in the sampling areas. (3) Qualitative analysis:adopting qualitative research methods to analyze information from interviews and document. (4) Quantitative analysis:adopting statistical analysis methods to analyze the data of the new rural cooperative participation, compensation, fees and others; adopting chi-square test and other non-parametric analysis methods to analyze of prescription medicines in the different township(distract)hospitals.There are three main most important stakeholders relating with NCMS management, which are designated medical institutions, the rural participants and NCMS management institutions. It is necessary to define the internal control objectives of demand, supply, and management respectively to provide evidence for the controlling activities. The internal control objectives of demand side, the rural participants, includes to improve participant awareness, to norm farmers service utilization behavior, to reduce violations of taking the new rural cooperative fund and to promote farmers participating in NCMS management supervision.Internal control objectives of designated medical care institution include four parts with 11 items:to norm health service (strictly enforce the admission standards, norm drug use, norm inspection, norm treatment behavior, norm charges), to improve the health service quality (control costs, improve patient satisfaction), to improve the NCMS management (improve management system, improve managers quality, improve information system, make reasonable compensation for the rural participant).Internal control objectives of NCMS administration agencies include four parts with 11 items:to norm the internal management of administration agencies (improving information sharing and transmitting between different level administration agencies, design reasonable compensation programs, safeguard the fund security, improve management information system, improve financial information reliability, improve the supervision mechanism), to improve the management and services for rural participants (improve funding efficiency, carry out compensation programs strictly, strengthen the publicity of information and advocacy of NCMS, and provide services to farmers timely), to improve the management of the designated medical institutions (set up a reasonable payment system, disburse compensation fund timely, and improve supervision on the designated medical care institutions), and cooperate with medical assistance system effectively (improve participation rate of poor farmers, establish unified service platform of NCMS and medical assistance system).Resorting to COSO internal control theory, the internal control elements of NCMS include the control environment, risk assessment, control activities, information and communication, monitoring and evaluation. The control environment includes appropriate development planning of NCMS, rational management structure, specific responsibility division of each post, good information communication system, sound personnel management mechanism, good cultural atmosphere; The risk assessment consists mainly of the economic risks, system risks, the risks posed by clients, and medical treatment risk; control activities consists of feed forward control, field control and feedback control, with health service institutions and administrative departments as control objects; information and communication consists mainly of defining procedures for information collection, processing, transferring, proclaiming NCMS information, and establishing reporting and complaint system; monitoring and evaluation includes internal and external audits and the supervision.According to the theoretical study and empirical analysis, the establishment of NCMS internal control model consists of four subsystems, the target system of internal control, risk analysis system of internal control, internal control and coordination systems, and diagnostic systems of internal control. According to the internal control model, some policy recommendations were put forward to promote sustainable development of NCMS as follow:(1) Strengthen responsibilities of the government, produce governmental leadership function adequately for establishing and developing the new rural cooperative medical system.(2) Focus on developing the human resources, building up a management team with highly competent and professional specialized.(3) Strengthen risk prevention, complete the risk control mechanism.(4) Enforce the construction of information system, perfect the mechanism of and coordinate and communicate.(5) To promote rational drug use, standardized the services of health care facilities.(6) Strengthen the management of farmer who take part in the NCMS, discipline the behavior of using medical care service.(7) Establish the NCMS laws and regulations; provide legal protection for system operation.