The Evaluation Of Implementary Schemes Of New Rural Cooperative Medical System In Yunnan Province

Objective To evaluate the implementary schemes of New Rural Cooperative MedicalSystem(abbr. NCMS) in Yunnan Province, in order to find out proper schemes of NCMS.Meanwhile, the research results as a theory, can be used to guide NCMS practice, and canprovide scientific basis for solving problems in the implementation of NCMS and establishingsustainable NCMS patterns in other various counties of Ynnnan and other western provinces.Methods The study course included two phases. In 2005, the NCMS data werecollected from 4 sample counties by filling out annual report forms and questionnaires. Theyincluded the documents of implementary schemes, the proportion of participants of NCMS,financing funds, the derated fee of out-patients, the reduction of hospitalization charges, etc.Meanwhile, medical staff and participants of NCMS who selected through stratified clustersampling and simple random sampling in 4 sample counties, were interviewed for theircomments and attitude toward NCMS by using a questionnaire. Some important persons, suchas the vice governor who was in charge of NCMS, director of County Health Bureau, directorof NCMS administrated office, deans of township health centers, were interviewed. In 2007,the data of NCMS funds and implementation of 52 pilot counties in 2006 as well as the data ofproportion of participants involved in NCMS of all Yunnan's 129 counties in 2007 werecollected and analyzed.Results In 2003 and 2004 annum, the NCMS implementary schemes in Xundian andMengzi adopted family account in out-patients and reducing proportion of medical expenditureof hospitalization. Longling County took family account also and derating different proportionfor different level of hospitalization fee. And Lufeng County took reducing proportion of medical fee for both out-patients and in-patients. The maximum money that participants canget from NCMS fund for their hospitalization was not much (less than 3600) in all 4 samplecounties in 2003 annum. In 2004,, the implementary schemes were adjusted in minimum rate,maximum rate and reducing proportion of hospitalization in 4 counties.From 1 August 2003 to 31 December 2004, the proportion of participants who get moneyfrom NCMS fund in out-patients were 250.04% in Lufeng, 124.02% in Longling, 60.68% inXundian and 8.05% in Mengzi. And the proportion of participants who get money from NCMSfor hospitalization were 6.01% in Lufeng, 4.91% in Mengzi, 4.55% in Xundian and 3.67% inLongling. The proportion of money payed for out-patient in total NCMS funds were 36.49% inLongling, 35.49% in Lufeng, 13.57% in Xundian and 6.36% in Mengzi. The proportion ofmoney payed for hospitalization in total NCMS funds were 71.41% in Lufeng, 70.16% inXundian, 60.88% in Mengzi and 57.41% in Longling. Therefore, the surplus rate of NCMSfunds were 32.76% in Mengzi, 16.27% in Xundian, 6.10% in Longling and -6.9% in Lufeng(overdraft).From 1 January 2005 to 31 May 2005, the proportion of participants who get money fromNCMS fund in out-patients were 101.13% in Lufeng, 12.26% in Longling, 5.34% in Xundianand 2.39% in Mengzi. And the proportion of participants who get money from NCMS forhospitalization were 2.62% in Lufeng, 2.31% in Mengzi, 2.30% in Xtmdian and 1.64% inLongling. The proportion of money payed for out-patient in total NCMS funds were 16.30% inLufeng, 4.97% in Longling, 3.74% in Xundian and 3.47% in Mengzi. The proportion of moneypayed for hospitalization in total NCMS funds were 55.31% in Xundian, 47.19% in Lufeng,39.15% in Longling and 38.89% in Mengzi. Therefore, the surplus rate of NCMS funds were57.64% in Mengzi, 55.88% in Longling, 40.95% in Xundian and 36.51% in Lufeng.Most of respondents (64.3%～85.8%) were commonly satisfied with the local NCMSimplementary scheme except Mengzi (41.2%). Respondents from Mengzi suggested that 9yuan go to family account and only 1 yuan go to the funds. More participants of NCMS weresatisfaied with local NCMS scheme than medical staff in Lufeng, Longling and Mengzi (P＜0.05). The participants in the poor townships were more likely to be satisfied with NCMS thanothers in Xundian and Lufeng(P＜0.01). The participants of NCMS among differenteconomical townships were same satisfied with NCMS in Longling and Mengzi (P＞0.05). The respondents considered that there were different advantages and disadvantages indifferent NCMS implementary schemes. For compensation of out-patients, the advantages offamily account scheme were in fairness to every participants, easy to operate when participantneed to see the doctor, easy to see the benefit of NCMS, and fixed total fund for out-patient sothat overdraft of fund can not appear. The disadvantages included that participants wererestricted to see doctor because of limited sum of money in family account and low beneficialproportion of participants. The reduction proportion of out-patient fee resulted in high visitingsof out-patient in villages and township hospitals and high beneficial proportion of participantsfor out-patients. But, it was difficulte to manage, can augment the workload of administratedpersonnel, and also increased the risk of overdraft of the NCMS fund. For compensation ofhospitalization, reducing proportion of hospitalization fee was easy to understand and operatedby the personnel. But it was unfaired because reducing proportion was same for minor andsevere disease. It can incease fairness to reduce different proportion for differenthospitalization fee, that was greater proportion reduction for greater amount of hospitalizationfee. But it difficult to calculate the proportion of reduction. And it also increase the risk ofgreater hospitalization fee.The 4 discrimination equations for categorizing types of implementary scheme og NCMSwere created by using multi-factors discrimination analysis. The correction rate was 80% whenapplied them to practice.In 2006, NCMS were expanded into 52 counties. There were mainly three models inreduction of out-patient fee, including family account, family account plus proportionalreduction and proportionak reduction for all participants. All of the 52 counties tookproportional reduction for hospitalization fee. In 2006 annum, the proportion of money pay forparticipants in total NCMS fund in 52 pilot counties was 67.34%. The beneficial rate incounties which using family account for out-patient fee were from 29.61% to 63.13% and theNCMS fund were from 55.47% to 61.63%, which lower than in the counties usingproportional reduction in out-patients which with 142.05% in beneficial rate of out-patient and73.83% of proportion of money pay for participants in total NCMS funds. In 2007, all the 129counties in Yunnan carded out NCMS, and with participating of 86.12%.In the period of 2004 to 2006, the beneficial paticipants of hospitalization in fisrt 20 counties were increased year by year and was 4.76% in 2006 which greater than that of second32 pilot counties with the rate of 3.91%. The beneficial rate of hospitalization in Yunnan wasless than 4.72% each year.Conclusions The NCMS implementary scheme in each pilot countiy was acceptable,and had high satisfaction among participants. Each NCMS scheme has its own advantages anddisadvantages. Further study was needed to find the befitting scheme. The family account hashorizontal fairness for out-patient, easy to administrate, and reducing risk of overdraft of theNCMS funds. But the beneficial participants were few. Reduction proportion of out-patient feehas vertical fairness for out-patient, it can result high visiting in out-patient of villages andtownship heanth centers. The beneficial participants were more. It was benefit for participantsto see doctor as soon as unwell. But it was difficulte to administrate for personnel and mayincrease the risk of overdraft of NCMS funds. Reduction the same proportion of hospitalizationfee was unfair for participants. But it was easy to caiculate the proportion of reduction.Reduction different proportion for different hospitalization fee can increase fairness. But it wasdifficulte to calculate the proportion of reduction, and may increase the risk of large amount ofhospitalization fee. Therefore, it was suggested that each pilot county can make suitableadjusted of implementary scheme of NCMS depending on own situation, balancing theadvantages and disadvantages of each scheme, and combining with discrimination equations,in order to increase the rational use of NCMS funds and benefit of participants.