| Objective Analysis of Hunan Province, the new rural cooperative medical system (hereinafter referred to as the "new rural cooperative") to run the status quo, Hunan Province in2003-2009the new rural cooperative development trend of the longitudinal study, a comprehensive survey to acquire the relevant information, the Participatingthe fund raising, fund expenditures, the compensation of the five aspects and the operational benefits of the Fund in-depth analysis. An objective assessment of the new rural cooperative from the pilot application to the implementation process since the full implementation of the operational benefits of the Fund, the farmers really get the benefit, analyze and forecast the future trend of development of the new rural cooperative to explore problems in the new rural cooperative work method for the reasonable compensation scheme established by the regulatory regime for the rational allocation of health resources in Hunan Province, to promote the development of new rural cooperative medical health and to provide a basis.Hunan Province2006-2010participating elderly hospitalization data from the disease constitute the distribution of statistical analysis to understand the onset of disease prevalence and distribution characteristics, a clear onset of disease prevention and control work priorities, to provide for future population health interventionbasis.Method The survey was conducted under the jurisdiction of13cities in Hunan Province, an autonomous prefectures and122counties (cities, districts) of all levels of the new rural cooperative agencies, designated medical institutions and the new rural cooperative Participating Farmers. The survey sampling, Hunan Province,2009the province of all counties (districts) and the new rural cooperative data, data analysis methods, using statistical analysis software-related data collection, collation and analysis. As follows:1) general statistical analysis of the status quo analysis of Hunan Province, the new rural cooperative of14cities and prefectures (Changsha City, Zhuzhou, Xiangtan, Hengyang, Shaoyang City, Yueyang, Changde City, Zhangjiajie, Yiyang City, Chenzhou City, Yongzhou, Huaihua City, Loudi City, Xiangxi state), the new rural cooperative medical information to cities and prefectures as a unit for statistical analysis. Statistical analysis software SPSS13.0, Excel, etc.;2) the years of2003-2009, the new rural cooperative development trends in the use of vertical contrast, the univariate analysis, trend prediction using residual gray forecasting model to predict;3) hospitalized elderly spectrum of disease distribution using the international classification of Diseases codes (ICD-10),2006to2010, before the new rural cooperative elderly hospitalized50patients for statistical analysis.Result50,479,300of the agricultural population, the new rural cooperative medical care system has been fully covered in Hunan Province in2009.I The Hunan NRCMS Analysis:a. Participating:In2009, Hunan Province, the average participation rate to reach91.49%, which parameters together rate the highest for the Changsha City up to95.03%, minimum Loudi City,86.33%, Shaoyang City, Yongzhou, Changde City, Xiangxi state, Zhangjiajie CityHuaihua City, Loudi City half of the City, state Senate combined rate below the provincial average.b. Fund-raising:In2009, the funding criteria of Hunan Province is100yuan/person. Individual farmers pay20yuan, the central financial subsidy of40yuan, the provincial government subsidy of24yuan, cities, counties two fiscal subsidies, government subsidies accounted for80%of the total amount of the new rural cooperative fund.Hunan Province, the new rural cooperative fund raising from three sources:First, governments at all levels of financial subsidies for individual farmers to pay funds, social contributions. In2009, Hunan Province, the new rural cooperative plan to raise4,644,405,500yuan, the actual funding of4,784,828,200yuan, of which1.84billion yuan from the central budget funds, local property grant funds of1.86billion yuan (provincial finance1,177,573,400yuan, Municipal Finance336661600yuan, county finance352,431,100yuan), the urban and rural self-pay924million yuan of funds. Financial assistance is basically on time in full and in place to protect the new rural cooperative medical system to the smooth implementation.c. Fund expenditure:2009, Hunan Province medical fund expenditures amounted to4740996000yuan, the co-ordinated fund expenditure4583221500yuan, accounting for96.67%of the total fund expenditure. The actual expenditures accounted for annual fund raising a total ratio of99.08%, of which Xiangtan city104.11%, Shaoyang100.20%, Changde105.81%, Yongzhou100.22%and Loudi103.56%, more than100%. In2009Hunan Province medical fund expenditure to hospitalization subsidy as the main form, including hospitalization subsidy fund expenditures accounted for87.20%, ambulatory grant expenditures accounted for3.92%, fixed hospital maternity benefits fund expenditures accounted for2.88%, serious special outpatient grant expenditures accounted for2.61%, subsidy fund expenditures accounted for0.26%.4. Hospital compensation1) hospitalization rates:in2009Hunan Province farmers in times reached38128400people, hospitalization rate8.26%. The provincial hospital hospitalization rate was0.56%, the rate of hospitalization for0.70%municipal hospital, county hospital hospitalization rate was2.66%, the rate of hospitalization for4.34%Township hospitals. From the inpatient rate distribution, the farmer sees a doctor the inpatient mainly concentrated in the county and township level two hospital.2) hospital costs:2009, Hunan hospital for a total cost of9600715500yuan, the average hospitalization expenses for2518yuan. Which Loudi City, Changsha City, Xiangtan City, Shaoyang City, Hengyang city of5ground city, the average hospitalization expenses in provincial above average level, is the highest in Changsha for3183.40yuan; the average hospitalization expenses were lower than average level of the province are Yongzhou City, Zhuzhou City, Chenzhou City, Yueyang City, Yiyang City, Changde City, Zhangjiajie, Huaihua and Xiangxi, Xiangxi is the lowest is1780.03yuan.Medical institutions of different levels in different levels of hospital costs,2009Hunan Province, city, county, township medical institutions at all levels of the average hospitalization expenses were9946.31yuan, 5583.41yuan,2689.71yuan and958.51yuan. Changde City, Shaoyang City, Yiyang City, Chenzhou City, provincial, municipal, township average costs are higher than the provincial average.3) can be reported to cost:2009, Hunan province hospitalization expenses for a total cost of8075559300yuan, accounting for the total hospitalization expenses of84.11%times can be reported, the cost is2117.99yuan. May report the highest proportion of Changde city is87.41%, is the lowest in Changsha City for79.62%. Can report proportion is higher than the provincial average with the exception of Changde in Huaihua City, Yiyang City, and Chenzhou City, Xiangxi, Loudi City, Shaoyang City, Yueyang City, Hengyang city; below the provincial average also has the city of Yongzhou, Xiangtan City, Zhuzhou City, Zhangjiajie city.2009Hunan Province, city, county, township medical institutions at all levels of hospital times can be reported fees were7327.65yuan,4478.41yuan,2378.86yuan and904.09yuan. Hengyang City, Yueyang City, Yongzhou Province, city, county, countryside four class are costs are lower than the average level of the province.d. the hospital compensation:in2009Hunan province subsidy amount is3996798500yuan, province, city, county, township medical institutions at all levels of hospitalization reimbursement amount total hospitalization subsidy ratio was17.22%,14.54%,38.96%,29.18%.2009Hunan province average average hospitalization subsidy costs1048.25yuan, province, city, county, township medical institutions at all levels of hospital are the amount of compensation in the order of2682.65yuan,1788.58yuan,1268.96yuan and582.38yuan, the proportion of subsidy is respectively26.97%,32.03%,47.18%,60.76%. Changsha City, Zhangjiajie city and Yiyang city of province, city, county, countryside four class are hospitalization subsidy ratio were lower than the provincial average; Yueyang City, Changde City, Yongzhou city and Xiangxi Province, city, county, countryside four class are hospitalization subsidy ratio were higher than the provincial average.e. outpatient compensation:2009, Hunan started out-patient co-ordinate the pilot, farmers per person per year of average outpatient service fund compensation standards for the10-15yuan, special chronic out-patient co-ordinate the fund compensation standards for the5-10of average per capita per month. Start the out-patient co-ordinate the pilot county (city, area) for a total of58, of which11counties of Yongzhou city all start, Changsha City, Xiangtan city and Chenzhou city did not begin out-patient co-ordinate the pilot job. Out-patient co-ordinate trips8891560times total subsidy, subsidy179439600yuan.f. Benefit of fund:In2009Hunan province average hospitalization benefit degree is41.63%, each city state hospitalization subsidy benefit is not balanced,14cities in7cities in the province the proportion of subsidy is above average, Changsha City, Shaoyang City, Yueyang city and other places City hospitalization subsidy level is relatively low. Although the regional funding levels are similar, but the compensation levels differ greatly, which grants the highest proportion of Changde city of46.22%, was the lowest in Changsha City is only36.46%, the lowest percentage in compensation and compensation with the highest proportion of area difference of nearly10percentage points.g. Benefit from the surface of fund:In2009, the fund as a whole the average hospitalization benefits coverage is32.85%, each city state hospitalization subsidy benefit is not balanced, the highest for the city of Yiyang in83.60%, the lowest in Loudi city for12.12%, only Yiyang City, Yueyang City, Changde City, Zhangjiajie, Xiangtan, Huaihua6city in the province of above average yield surface.Ⅱ.2003-2009in Hunan province new rural cooperative medical system development trend analysisa. Participation:Hunan province the first batch of pilot work of new rural cooperative medical system from2003July officially began, so usually we will in2003July to2004December to the first operating year. The first operation year in new rural cooperative medical system covering only the agricultural population of3420000people, along with the new rural cooperative medical system is ceaseless and perfect, the coverage is expanding year by year. In2005the new Liling9pilot counties (city, area), covering the agricultural population of9120000people.2006pilot counties to count to43, covering the agricultural population of24635000people. In2007the new County Urban reached99, covering the agricultural population of47969000people. The implementation of complete2008province county urban reached122, implementation of the new rural cooperative medical system comprehensive coverage, to complete2009province participation rate is91.22%. From2003to2009, the Hunan medical participation rate has been on the rise, but still slightly lower than the average level of central area, and the national average level still has certain difference, a difference of2.97%.b. Fund raising situationStarting from2003-2009pilot to carry out in the round, Hunan NCMS financing level gradually upgrade:in2003the NCMS financing standard is30yuan/person, including the fiscal subsidy of20yuan, farmer burden10yuan;2006farmer individual pay is changeless, raise standards for50yuan/person; in2008the total funding standard was raised to80yuan/person, individual farmers to pay the amount still is10yuan of;2009funding standard continued to improve until100yuan/person, including financial subsidy standard is80yuan/person, individual payment standard also increased to20yuan/person; to complete2010province the NCMS financing standard is raised to140yuan per person per year, of which all levels of financial subsidies standards to120yuan per person per year. Provincial and municipal, county urban district each year to ensure that the financial subsidies in place in full and on time, financial subsidy funds have accounted for more than80%of the total amount of NCMS fund of central finance allowance, which accounts for about40%of main fund source.c. fund expenditure2003-2009years complete province overall fund utilization rate shows ascendant trend, followed by70%,80.94%,80.60%,88.82%,90.20%,103.62%, the province plans as a whole the average fund usage rate of94.43%. As of2009December, Hunan Province, the total subsidy number33219328person-time, pooling fund expenses for102252614000yuan. Fund expenditure is mainly used for hospitalization subsidy subsidize hospitalized childbirth, illness, quota special outpatient subsidies, subsidy, which cumulative hospitalization subsidy accounting for cumulative overall fund89.95%, fixed hospital maternity benefits accumulated fund expenditure accounted for2.45%, serious special outpatient subsidies or accumulated fund expenditure of2.71%, accumulative total subsidy fund expenditure accounted for0.76%.Ⅲ Hospital compensationa. the average hospitalization expenses:From2003to2009, the Hunan province overall hospitalization expenses level was slow ascendant trend, in2008reached2621.52yuan/passengers, a9.71%increase over2003-2009growth under control, cost relatively dropped somewhat2008less103.52yuan, down0.04%.b. Average hospitalization subsidies:From2003to2009, Hunan’s average hospitalization subsidy costs increase year by year, hospitalization subsidy level is rising, especially with the2008and2009to raise standards, the growth rate is also higher cost subsidy. In2003the hospital costs are subsidy amount is only639.18yuan, accounting for26.75%of the total cost, average hospitalization expenses in2009increased to1048.24yuan, the proportion of subsidy was elevated to41.63%.c. Self cost:From2003to2009, although the farmer hospitalization expenses increased year by year, but the average cost of subsidies has been greater than the growth rate of inpatient cost growth, so the farmer pays part of the cost has been reduced, by2003,1750.28yuan to1469.75yuan reduction, at their own expense subsidy ratio decreased from73.25%to58.37%.d. inpatient hospital level distribution:The province’s hospitalization subsidy trips distribution in township health centers in most medical institutions at county level, the structure of medical assistance at the county level or above, is the least number of less, provincial medical organizations. From the beginning of2008in the provincial medical institution of agricultural patients is increasing, visiting rate increased from5.69%to6.77%. In2009the municipal medical treatment rate is reduced, the other three level medical treatment rates have improved, the patient began to have from the municipal medical institutions to the ends of diversion trends, namely to the provincial medical organizations, downward County, countryside two class medical institutions.f. capital flows:Grant passengers flow and grant funding disproportionately, county subsidy proportion is the largest, the smallest proportion of municipal subsidies. New rural cooperative medical fund is mainly used for farmers in County, countryside two class medical institutions hospitalization subsidy costs, the amount of compensation for the overall amount of about70%. Capital flows from the point of view, the Hunan new policy changes gently, province, city and county level three the proportion of subsidy increases year by year, and the proportion of subsidy in cut each year.g. hospitalization rate:2009peasants inpatients number to be amounted to3812840times, in7years the rate increased from4.57%to8.26%, growth range is biggerh. the hospital compensation policy:On14city state of compensation policy information complete71counties (city, area) agricultural compensation policy were analyzed, and the71sample counties from2007to2009of the original statistical data:deductible level and average hospitalization expenses (r=0.8067, p=1) and time (compensation costs r=0.6211, p=1) or there is a positive correlation between the top line, the level of the average hospitalization expenses (r=0.0483,p=1) there is no correlation, and compensation are cost (r=0.1986, p=1) there is a positive correlation between. i. pooling fund benefit:Although the whole fund subsidy benefit in2007years has declined, but the fund benefits the overall upward trend, benefit to promote in year after year. The initial2003year whole fund subsidy benefit and hospitalization subsidy benefit surface are respectively4.57and2.80%, and2009has been increased to32.65and8.26%.j. pooling fund earning degrees:2003to2009, Hunan hospitalization subsidy benefit degree shows ascendant trend, especially in2008,2009in two years, the growth rate of a noticeably increases.2003fund subsidy benefit of26.75%, to2009already increased to41.63%, compared to2003increased55.63percentage points.IV Investigation on disease spectrum of elderly hospitalized farmers a. the participation rate:2006-2010in Hunan province in the elderly aged65and above in the new rural cooperative medical system number increased from664934to2611754, from75.39%to95.37%participating.b. hospitalization rate:2006-2010in Hunan province in the elderly aged65and above by63254person-time inpatients to increase514170person-time, hospitalization rate from9.51%to19.69%.c. disease:Disease system respectively to the respiratory system up to2010, data of the top ten diseases, respiratory system50.34%. According to the classification of diseases,2010in the top ten diseases were pulmonary infection, chronic bronchitis, coronary heart disease, hypertension, coronary heart disease angina, acute exacerbations of chronic bronchitis, cerebral infarction, pulmonary heart disease, cerebral infarction, pneumonia.5years before the10inpatients with slight variations, in the first row is always a lung infection, the rest has been among the top ten of angina pectoris of coronary heart disease, hypertension, chronic bronchitis, pneumonia, cerebral infarction.ConclusionⅠ. The Hunan province new rural cooperative medical system running smoothly.The new rural cooperative medical system comprehensive coverage since, farmer participation rate rises steadily, financial subsidy increases considerably, funds raised in new rural cooperative medical system in full, the overall operation efficiency rise, the participants’benefit degree increase year by year, effectively alleviates the peasants’economic burden of disease.Ⅱ. The new rural cooperative medical system has promoted the implementation of the development of rural health service.The new rural cooperative medical system the cost of compensating regulation, reasonable guiding farmers cooperative medical system and medical treatment, the development of rural health service has formed a complementary, mutually reinforcing relationship. Patient flow changes conducive to promoting health and reasonable utilization of resources, enhance health services accessibility, from a certain extent changed the status quo of rural health. Ⅲ. The main factors influencing fund operating efficiency.Compensation ratio, deductible level is the main factor influencing hospitalization subsidy benefit. Subsidy level is not certain and economic situation is proportional, and fund spending plan, compensation ratio. Proportion of compensation for new rural cooperative medical system benefit level and farmers’ choice of medical treatment orientation has great influence. Deductible on hospitalization subsidy benefit affecting the general was negatively related to pay lines, high benefit face more narrow, less deductible will benefit the wider. Compensation line cap affects new rural cooperative medical system to alleviate farmers’poverty caused by diseases, to play the role of.5, out-patient co-ordinate the fund can effectively expand the medical benefit, to relieve the pressure of outpatient medical costs, improve and consolidate the majority of farmers ’ enthusiasm, has the very vital significance.Ⅳ. The main problem.A new type of rural cooperative medical system in the implementation of a certain extent of excitation of the farmer’s medical needs, but the rate of hospitalization, hospitalization costs have fast growth trend, already exceeded due to the new rural cooperative medical system itself inspired the medical needs of the growing category, the presence of excessive medical risk.Ⅳ Hunan Province, farmers’main diseases.This study showed that pulmonary infection, chronic bronchitis, coronary heart disease, hypertension, coronary heart disease angina, acute exacerbations of chronic bronchitis, cerebral infarction, pulmonary heart disease, cerebral infarction, pneumonia and other diseases that predispose the elderly to common diseases on the health of the elderly, great harm. The new rural cooperative medical system is a farmer to participate in voluntary mutual aid system, not the true sense of the social security system, it is characterized by low level, wide coverage, so the security level and the security level is limited. With the city’s basic medical insurance, new rural cooperative medical security strength is lesser, regulations to be sound,Ⅵ. New rural cooperative medical system is still a low level security system.management needs to be further standardized, efforts need to be further more. Can say, the new rural cooperative medical system is the rural medical security system in the primary stage, is a low level of rural basic medical security system. In this sense, the new cooperative medical system is in a transition period from junior to senior development, need various government support and attention, governments at all levels will also be in the implementation of the new rural cooperative medical processes play a more important role. |
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