| ObjectivesZ and S counties in Henan Province were chosen as the study fields, and the comparison of the New Rural Cooperative Medical Systems(NRCMS) between health department host mode and commercial company fund-principal mode was carried out to explore the possible managemental model and the operational mechanism of NRCMS. This project will be ver useful for searching for the effective measures and methods for decreasing the operating cost and the managemental cost in the process of NRCMS, and promoting the sustainable development of NRCMS in China.MethodsQualitative method was used in combination of the quantitative method. Z and S counties in Henan Province were chosen as the study fields. The study methods included the literature review, field questionnaire survey and group interview. The study contents included the background, operating situation, cost, effectiveness and the satisfaction of NRCMS. Comparison between the state-run mode and the insurance company-host mode was carried out to explore the feasible managemental mode and the operating mechanism of NRCMS.ResultsThe specific business of NRCMS in Z County was host by a joint management committee, and in S County it was host by China Life Insurance Company. Both counties had the similar geographical status, but the economic level in S county was higher than in Z county. The health resources every 1000 population in S country were higher than in Z County too.The specific function of the hosting agencies in these two counties were similar, being responsible for the specific business of NRCMS. The main difference between them was that the specific business of NRCMS in Z County was host by an internal agency in health department managed by the health administrative department, but in S county by a commercial insurance company supervised by the health department. The activity of the hosting agencies in both Z and S Countes was supervised by the different agencies. In Z county, it was supervised by a joint management committee administrating the hosting agency as well. However, in S county, an administrative department supervised the hosting activity and the previous joint management committee was changed to the regulatory office mainly responsible for the supervision management.The staffs of hosting agency in S county were less than in Z county, having the higher educational level, working for a shorter period and Sounger than in Z county. The initiation cost of the hosting agency in S county was lower. After the adjustment of the population, the initiation cost per capita in Z county was 0.18 yuan higher than in S county. The operating cost in Z county was 0.65 yuan, and 0.22 Suan in S county which was 0.43 yuan less. The fee which the hosting agency in S county consumed during the operating process including various office supplies and related costs was less than in Z county, which means its capability of controlling the governmental expenditure was stronger than it host by the health department. The efficiency of staffs in S county was higher than in Z county.For the flow of the hospital fund in Z county, there was no significant difference among them to the township, county, municipal, provincial level and above, which was more than 20%. On the contrast, the flow of hospital fund was more concentrated in S county which were mostly to the municipal medical agencies (more than 40%). For the distribution of the fund compensation, the main fund flowed to the hospitalization (large), followed by the out-patient (small), physical examination and normal delivery, and finally the out-patient (chronic diseases). From the use of the fund in these two counties in 2008, we can see the use of the fund began to be reasonable. However, from the whole, the proportion of hospitalization was larger and the outpatient (chronic diseases) was less.Answers to the satisfaction of NRCMS in Z county focused on "very satisfied", while the answers in S county preferred to "basically satisfied." The multivariate logistic regression analysis showed that the factors associated with the satisfaction in S county were family income, financial methods, subyidy approaches, the service attitude and quality of medical agencies, and whether participated in the commercial insurance except NRCMS. The multivariate analysis in Z county showed that the main factors associated with the satisfaction were subyidy approaches, drug prices, the service attitude of medical agencies and the convenience of the reimbursement.Z county and S county took the same mode in controlling the medical cost. Commercial insurance companies own the rich experience in controlling insurance costs which made them have the advantages in controlling the medical costs.Conclusions1.1. Z County and S County have the similar level of social economics. Both Z and X Counties are located in the flatland of Henan Province. Although S county has a little higher economic level and GDP and financial income per capita are higher than that in Z county, both of these two counties belong to agricultural counties and are almost same in the social economic level, particularly the health resources.1.2. The mode with the separation of the administration from the host by commercial insurance in S County is good for the realization of the operation and supervision. The specific business of NRCMS in S County was host by commercial insurance company and supervised by the health administrative departments. This separation of the administration from the host is good for the security of the fund. On the contrary, in Z county, health administrative departments are not only responsible for the operation of the specific business but also responsible for the supervision of the NRCMS. Comparing these two hosting administration modes,the mode with the separation of the administration from the host is better for the government to carry out the policy designation and supervision. Meanwhile, it is also better for supervising the fund and securing the safety of the fund. Moreover, It is also better for the utility of the social resources and playing the function of the commercial insurance in the social administration, which realizes the effective use of the social resources.1.3 The mode hosted by the commercial company fund in S County does not only save the cost but also increase the running efficiency. Comparing the running cost hosted by the commercial company fund in S County and by the health departments, both the initiation cost and running cost were less and decreased the expenditure, which is the advantage of the commercial agencies in the operation and saved the input of the social resources. Meanwhile, in the running efficiency, the mode hosted by the commercial company fund in S County had the higher working efficiency than that hosted by the health departments. 1.4 The use of the fund was similar in these two host modes. In the use of the fund, both counties had the similar condition. Both of them had the hospitalization compensation accounting for a larger proportion. More attention should be paid for the compensation of the out-patient chronic diseases.1.5 Both counties had the similar satisfaction on NRCMS. In the analysis of the satisfaction on NRCMS, Z County had more answers "very satisfied" than S County, including the drug price, medical service etc, which were different from other surveys. However, when the answers "very satisfied" and "satisfied" were combined, both counties had no significant difference in the satisfaction on NCRMS. More farmers were "satisfied" with NRCMS and few were "unsatisfied". Therefore, considering the social economic level, the application condition of NCRMS and the results of this questionnaire survey, the people in both counties had the similar satisfaction on NCRMS.1.6 Both counties took the similar mode in controlling the medical expenses. But the commercial insurance companies had the lower running risk in controlling the medical expenses than the health departments because they had the plenty of experience in controlling the insurance fees.1.7 In summary, both counties had the similar social economic level, the fund use of NCRMS, the mode of controlling the medical cost and the satisfaction on NCRMS. The mode hosted by the commercial insurance fund in S County saved the cost and increased the running efficiency in comparison with the mode hosted by the health departments.
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