The Study On Medical Expenses Controlling And Operational Status Of New Rural Cooperative Medical Scheme In China

BackgroundIn January 2003, China launched the pilot project of New Rural Cooperative Medical Scheme(NCMS). At present NCMS have been fully established in China's rural areas, Institutional framework and operational mechanism of NCMS have been basically shaped, disease burden of farmers coverd in NCMS has reduced to a certain extent. However, as China's NCMS become more sophisticated, the medical expenses of NCMS has unreasonably increased a lot, the per capita hospital costs has increased to 2712.0 yuan from 1901.1 yuan between 2003 and 2008, and unreasonable growth of medical expenses of NCMS may caused many problems, such as benefit level of people covered in NCMS decrease, reimbursement ratio decrease and fund overdraft emerge in some pilot regions. All above problem could hinder the sustainable development of NCMS. Therefore, how the system is designed to control medical expenses of NCMS effectively has become a major policy issue which need to be solved urgently.Objectives1. To collect related evidence on three policy options(payment on diseases categories, two-way referral and information system), establish database respectively and conduct systematic review(SR);2. To select related literatures based on relevant standards and principles of systematic review, then synthesize evidence and systematically analyse the benefit and weakness of each policy option;3. To make a policy brief on the medical expenses controlling of NCMS based on the results of this study and context factors of our nation, and provide it to relevant administrative organization through Shandong EVIPNet;4. To analyse the operational status of the NCMS in Shandong province, point out the problems and propose corresponding policy suggestions.Methods1. The first part of this study, we utilize the research idea of policy brief which is initiated by EVIPNet-Asia. Firstly, we analyse the necessity of medical expenses controlling of the NCMS and we also analyse influencing factors of medical expence controlling of the NCMS in the perspective of stakeholders. So we can fully describe the policy issue—medical expenses controlling of NCMS. Secondly, we propose three policy options aiming at stakeholders(manager, supplier and demander) of NCMS to solve this policy issue based on above description of the policy issue and a full discussion between the researchers and policy-makers of Shandong EVIPNet. Thirdly, we collect related evidence on three policy options(payment on diseases categories, two-way referral and information system), establish database respectively, conduct SR and systematically analyse the benefit and weakness of each policy option. Finally, we propose corresponding policy suggestions.2. The second part of this study, we utilize the NCMS's working reports of Shandong province in the year of 2007,2008 and 2009. We use EXCEL database to input data, then use SPSS 13.0 to conduct statistic analysis. Finally, we conduct a comprehensive descriptive study on operational status of NCMS in Shandong province.Results1. In the first part of the study, we firstly analyse the necessity of medical expenses controlling of NCMS, and point out that medical expenses controlling of NCMS is helpful to maintain fund balance and enhance benefit level, thereby ensure the NCMS get sustainable development. This study also analyse influencing factors of medical expenses controlling of NCMS in the perspective of stakeholders, and the stakeholders of NCMS include manager and demander as well as supplier. Finally we include 33 related literatures about payment on diseases categories of NCMS and 25 related literatures about two-way referral as well as 23 related literatures about information system, then we analyse the benefits and weakness of each policy option respectively.2. In the second part of the study, we analyze what progress NCMS in Shandong province have make in six aspects including participation, fund rasing, fund distribution, fund reimbursement, medical expenses controlling and administrative organization of NCMS. We also found three problems involving fund overdraft, medical expenses controlling and working expenses of administrative organization.Conclusions and Suggestions1. In the first part of the study, we finally propose three policy suggestions to improve the payment on diseases categories of NCMS, involving improving disease classification, dynamic adjustment of payment standard and supporting quality control measures; we propose four policy suggestions to improve the two-way referral system of NCMS, involving improving service ability of community health organizations, strengthening standardized management of two-way referral, designing appropriate incentive systems and formating a regional health care consortium; we propose four policy suggestions to improve the information system of NCMS, involving increasing information management personnel, improving the function of county-level information system, improving coding rules of drugs and clinic project classification and strengthening supporting decision-making function of information system.2. In the second part of the study, we propose four policy suggestions to improve operational status of NCMS in Shandong province, involving adjusting reimbursement program, reforming payment method, enhancing funding criteria and providing enough working expenses to administrative organization.