Study On Performance Evaluation System Of The New Rural Cooperative Medical System

New rural cooperative medical system (hereinafter referred to as NCMS) is a medical insurance system which covering the largest population in the world.NCMS provides basic medical insurance for 700 million farmers in China, in order to help farmers reduce the medical burden and lower the economic risk caused by serious illness. In view of the importance of this livelihood project,party and state leaders have taken a clear-cut stand of that "The pilot project of NCMS must succeed,not to fail". At the same time,government financial investment at all levels are increasing year by year. In 13 years from 2003 to 2015, the financial investment of government has increased from 20 yuan per person at the beginning of the pilot project to around 380 yuan per person, which has increased by 19 times. Hundreds of billions of RMB in financial investment can not change the awkward situation of "poverty caused by illness" among the rural residents completely, according to the book building and tent card data of the State Council Poverty Alleviation Office, at present 42% of the poor people in the rural area of our country are impoverished-caused by illness, the rate in some places even as high as 50%, in all the causes of poverty, poverty caused by illness in any region is ranked in the first. These data show that the NCMS is still in the initial stage of the development of the medical security system, there are still many problems need to be faced and solved.At present, China’s medical security system is in the integrated development period, at such a critical time node,scientific and rational evaluation of the new rural cooperative system performance,is not only a correct understanding of the effectiveness of the new rural cooperative construction of the necessary prerequisite,but also can improve the integration of urban and rural medical insurance.The construction of the new rural cooperative performance evaluation system is the most effective means to quantify the development level of the new rural cooperative medical system. It is helpful to summarize the achievements and problems of the implementation of the system, and avoid the dilemma of "the old worry unsolved, the new worries appear" .Therefore,it is of academic and practical significance to study the performance evaluation system of NCMS.In view of this, this paper synthesized performance evaluation and policy improvement theories, in accordance with the modern economics and management science research paradigm of "literature review - historical evolution of the system -construction of performance evaluation system of institution operation - empirical test-system improvement", and combined with the field research data to construct the performance evaluation system of NCMS from fairness, efficiency, quality and sustainable development these four dimensions, At the same time, this paper also uses the comprehensive index method to optimize the evaluate method to solve the existing problems,making the evaluation system in line with "easy to use, easy to read, easy to understand" principle.Jiangxi Province is the old revolutionary base area where the agricultural population accounts for three-quarters of the total population. Jiangxi Province is also the one of the first batch of NCMS pilot provinces, its unique level of economic and social development making the evaluation of the performance of NCMS in Jiangxi Province to be more typical and representative. Under the guidance of NCMS performance evaluation system and comprehensive index scoring model, this paper evaluates the performance of NCMS in Jiangxi province.The total score ofperformance of NCMS in Jiangxi Province is 76.98 points, and the evaluation results are consistent with the general cognition.On the basis of these indexes, the paper analyzes the existing problems in the process of NCMS operation in Jiangxi Province,and puts forward corresponding policy recommendations for these problems, and provides the policy reference of the upcoming medical insurance institution for the urban and rural residents in Jiangxi Province.Overall, the research contents of this paper are divided into five parts, and the specific structures are as follows:The first chapter, introduction.This chapter is the master plan of this paper. This part describes the background and theoretical and practical significance of this study,and analyzes the research status at home and abroad, and overviews the theoretical basis of the paper, as well as introduces the research ideas and research methods, also points out the innovation points and deficiencies.The second chapter, the operation of the new rural cooperative medical system and its existing evaluation system.This chapter first analyzes the supply and demand equilibrium of the new rural cooperative medical system from the aspects of institutional demand factors, institutional supply factors and institutional environment factors.Then, this chapter makes a preliminary analysis on the operation effect of NCMS, and compares the results of NCMS operation in the east, middle and west of China with the first-hand data collected from field survey and interview in Jiangxi province,Shanghai city and Yunnan province.After more than ten years of development, NCMS basically achieved full coverage and wide benefit to support the umbrella to health of farmers. However, due to the big differences in the regions of our country, the operation mechanism environment of NCMS exists the tremendous heterogeneity, which has resulted some differences in financing,benefit rate,compensation rate and the process of urban-rural integration of NCMS between less developed areas and economical developed areas in our country. It is necessary to evaluate the performance of NRCMS timely and accurately because NRCMS is still a social security system in the process of growth.Therefore, this chapter reviews and analyzes 20 performance evaluation systems, analyzes their contributions and shortcomings, summarizes the existing problems of performance evaluation system,and provides research basis for the follow study .The third chapter, the construction of new rural cooperative performance evaluation index system,which is the core content of this paper.In this chapter, we selected 23 primary indexes from 702 existing indexes by consulting literature,querying policy documents, field investigation and experts’ interviews, etc., in order to ensure the evaluation index is scientific,reasonable,comparable and available.On the basis of this, we combined the subjective evaluation (Delphi method) and the objective evaluation (the threshold method) to further select the performance evaluation index,and finally construct the new rural cooperative performance evaluation index system,including four dimensions of fairness,efficiency, quality and sustainable development, and 9 secondary indexes and 22 thirdly indexes. In the reliability test, the overall Cronbach’s a coefficient is 0.797, the reliability of this study can be considered very good; in the validity test,the index system after two rounds of expert review,so the content validity can be considered high efficiency.At the same time,this chapter also uses the comprehensive index method to optimize the index scoring method,and sets the scoring reference value for the 22 third-level indexes in the performance evaluation system.Through the comprehensive evaluation of the reference value, the evaluation results can not only show the results, but also can carry on the longitudinal and the horizontal comparative analysis.The fourth chapter, the application of new rural cooperative operation performance evaluation system: a case study of Jiangxi province.In this chapter, the new rural cooperative operation performance evaluation index system is used to evaluate the operational performance of the new rural cooperative medical system in Jiangxi Province, and to test the operability and accuracy of the evaluation system.Through the analysis, the new rural cooperative performance evaluation index is 76.98, the evaluation grade is moderate,the evaluation result is consistent with the general cognition.Restricting factors of innovation and development of NCMS in Jiangxi Province can be summarized into two aspects, on one hand it is the internal institutional factors of NCMS, on the other hand it is the external conditional factors of NCMS. The internal institutional factors restricting the innovation and development of NCMS in Jiangxi Province are from six aspects: Firstly, the cooperative funding level of NCMS in Jiangxi Province is low, which has limited the protection function of NCMS; secondly, there is no legal basis and institutional guarantee for the stability of the government subsidy funds; thirdly, the management efficiency of NCMS is low;fourthly, there is more different between NCMS in Jiangxi Province and NCMS in other areas,which is not conducive to the operation and implementation of the long-distance transaction of NCMS; fifthly, the referral system design is not reasonable;sixth, the actual hospital compensation is relatively low, which has limited the protection level of participating farmers, and then affects the sustainable development of NCMS. The external condition factors restricting the innovation and development of NCMS in Jiangxi Province are from three aspects: Firstly, the medical concept of"Heavy treatment, light prevention" is deep-rooted; secondly, the development of rural primary medical and health cause is laggard; thirdly, the price of medical and healthservices has risen too fast.The fifth chapter, research conclusion and prospect, which is the summary of the paper. First,the main conclusions of this paper are summarized. Second,around how to solve the farmers’ three core problems of that "enjoying participation","truly satisfied" and "urban-rural integration", puts forward policy recommendations to the health insurance system for urban and rural residents that will be implemented soon.Finally, future research prospects are proposed and provide some reference for the future research.The main contributions of this paper are as follows:1.Based on the evaluation of the contributions and shortcomings of the new rural cooperative performance evaluation system, the "4E" multidimensional performance theory is introduced into the research field of NCMS performance evaluation.This paper constructs a new performance evaluation system of NCMS, which includes four dimensions: fairness, efficiency, quality and sustainable development. It provides a scientific basis for evaluating the performance of NCMS.2.The method of indexing was optimized by using comprehensive index method.In this paper, the scoring reference values are set for the 22 third-level indicators in the performance evaluation system,and this research method is the first time in the existing literature in the performance evaluation of NCMS.3.This paper uses the new rural cooperative performance evaluation system and comprehensive index scoring model, combined with field survey data, to evaluate the performance of new rural cooperative medical system in Jiangxi Province.Based on the evaluation results, the author points out the problems existing in the process of NCMS operation in Jiangxi Province and puts forward the corresponding policy recommendations, which provides policy reference for the imminent implementation of the urban and rural residents medical insurance system.