The Mechanism Study On Anti-unity Institutions’Outpatient Fee Included In New Type Of Rural Cooperative Medical Care System Compensation

Tuberculosis(TB) is one of chronic infections disease caused by tubercle bacillus, among them phthisis is most common, according to the world health organization(WHO) reports that nearly a third of the global population had affected tuberculosis bacterium, the number of new cases of TB patients each year is8.7million, each year about2million tuberculosis patients die. China is one of the world’s22tuberculosis high burden country, the number of patients with tuberculosis is second of the world; At present our country500million people get tuberculosis bacterium, more than6million people suffered tuberculosis, including2million patients is infectious, every year25million people death from the disease, is more than two times of the total death of other kinds of infectious diseases.The fourth national tuberculosis epidemiology sampling survey results show that80%of TB patients are in the countryside, three-quarters of patients are young with production capacity. Free policy of the patients with tuberculosis Started in2004, but free policy only include five A line tuberculosis medicaments and part of inspection items (including four sputum smear and a chest radiograph check), for a total of about250yuan. Patients in the actual treatment process also need to accept liver function and other aspects of the check and auxiliary treatment, the treatment cost far more than cost cuts, most TB patients can’t afford the treatment burden, economic obstacle directly affect the poor tuberculosis patients seek medical attention.The new type of rural cooperative medical care system (NCMS) is the basic medical insurance system of our country’s rural residents, since the pilot in2003run well. Many scholars has been study the use of medical security reduce the economic burden of TB patients, many districts also started on this to try. At present about the outpatient service included into the NCMS compensation are mostly about TB control management, less study about the compensation policy and the supervision after incorporate.Study ObjectiveAnalyse the present NCMS capital operation and compensation policy of TB in project county; behavior of supply and requisitioning parties, patients’medical cost and economic burden; influence study of NCMS capital operation after anti-unity institutions’outpatient fee included in NCMS compensation; design of TB patients compensation service pack, clear compensation kinds of tuberculosis drugs and check, reimbursement ratio, compensation methods.Study MethodologyAccording to purpose sampling principle, weather the anti-unity institutions’ outpatient fee included in NCMS compensation,and compensation policy chose Zhejiang and Sichuan province. According to the formula of sample size estimated in group design two sample mean differences, local tuberculosis epidemic, patients representativeness factors select4projects county each province, each county survey patients50. The principles for selecting patients:from January1,2009to31December2009and so far in the agency registration and cured or finish treatment before field survey, patients should be all in NCMS, less than65years old of local residents, the without serious illness, severe complications or complications and the MDR-TB patients (serious complications including Ⅱ type serious liver, renal insufficiency, serious heart disease, spirit disease, cancer, etc.). Finally Changxing, Anji, tonglu, xinchang of zhejiang province, JianYang, Yanjiang, Renshou,Dongpo of sichuan province are selected for project county,392patients were surveyed and collected these patients medical report in anti-unity institutions. This study also interviewed principal of health bureau NCMS office, controler and doctor of anti-unity institutions,a total of24. In addition the research also collect2005-2009 five years document of compensation policy, NCMS capital operation, social economic and tuberculosis epidemic use NCMS and anti-unity institutions’structured questionnaire.This study use descriptive analysis, chi-square test, rank and inspection, many factors analysis method to analyze the patients’medical expenses, disease burden, behavior of supply and requisitioning parties, influenced factors of CDC cost.Study Results1. NCMS compensation policy of project countiesEach project county of Zhejiang province NCMS compensation mode are outpatient co-ordinated+hospital co-ordinated, outpatient service fees compensate by proportion, hospital are segmentation proportional compensation, reimbursement ratio changes with the medical institution level. Each project county in Sichuan province compensation mode are family account+hospital co-ordinated,30yuan per person per year into family outpatient service account for outpatient service medical treatment cost reimbursement, hospital expense are compensated in proportion According to the local NCMS fund operation and financial regulations make policy of the special diseases outpatient service, secondary compensation. According to diagnosis and treatment catalog of NCMS, the commonly used check of tuberculosis diagnosis and treatment (X-ray, blood, urine, liver meritorious, kidney work) and A line of tuberculosis medicaments are on its expense range, and second line medicine, protect liver medicine, immune agents,auxiliary drug is not submit.2. NCMS fund operation of project countyQuestionnaires shows since the implementation of NCMS, financing standard and total fund are raising; deductible lower, reimbursement ratio and ceiling line are improving; fund operation smoothly, and did not appear risk. But there are still outpatient service compensation expenses proportion low, and high rate balance.3. NCMS compensation policy of TB in project countyIn addition to countries’tuberculosis free policy, Anji and Tonglu county of Zhejiang province, Jianyang and Yanjiang country of Sichuan province, implement further compensation policy, but the compensation policies of TB patients treated in other institutions rather than anti-unity institutions common to other disease. The others project counties’outpatient fee of anti-unity institutions can’t get to submit.4. disease burden of TB patientsZhejiang into groups of patients, medical expenses is4660yuan, accounting for43%total income family, Catastrophic spending to28%; Zhejiang group of patients did not include the medical cost is5895yuan, accounting for29%total income family, catastrophic spending to44%; Sichuan province into groups of patients, medical expenses is4161yuan, accounting for55%total income family, catastrophic spending to49%; Sichuan province group of patients did not include the medical expenses for3879yuan, accounting for70%total income family, to41%;Medical reimbursement in some extent could reduce the economic burden of patients, the total reimbursement ratio is10%, and total medical expense account of family income10%lower than before submit, catastrophic spending5%lower after submit an.5. patients medical examination process analysisResearch found the vast majority of patients are through other institutions referral to the anti-unity institutions, only about10%of patients are directly to the anti-unity institutions. Patients major referral to anti-unity institutions by county and township medical organizations, no one because submit ratio high, all patients number of medical institutions are more than two, ChangXing patients’number of medical institutions even more than three.6. impact to NCMS fund when improve NCMS compensation proportion ofanti-unity outpatient Based on the collected data of new cases number,the average cost, outpatient compensation spending of NCMS to calculate the proportion of TB compensation expenses in outpatient compensation spending of NCMS. The analysis found that with the increase of outpatient service compensation expenses, TB compensation proportion will be reduced. Even if the outpatient fee reimbursement ratio increased to100%, compensation expenses to TB is less than five hundred thousand, proportion in outpatient spending is far less than1%, improve the submit of anti-unity institutions outpatient compensation ratio have little influence to NCMS funds.Interview found that opinion to improve ratio of tuberculosis reimbursement are different, the controller and doctor of anti-unity institutions contact directly with patients, know the patient’s burden well, all think should improve reimbursement ratio, they also pointed out that this need related department cooperate and government support. NCMS officials don’t support improve tuberculosis reimbursement ratio, for the limited funds should use by serious illness such as cancer, organ transplant.Suggestions1. Strengthen TB related knowledge propaganda, improve the rural residents’ understanding of tuberculosis symptoms, the designated treatment unit, free treatment policy;2. Improve the social’s attention of tuberculosis, make people realize the tuberculosis is a social problem, related to people’s life, health and social development, need more attention;3. Need to put the anti-unity outpatient expends into NCMS submit range, in order to reduce the burden of patients, improve patients focal treatment, management and compliance;4. Proportion submit is feasible, need to expand NCMS drug reimbursement directory, improve the reimbursement program, convenient for people to submit; tuberculosis can also through special disease for compensation;5. tuberculosis compensation can through fixed subsidies, at the same time, need to increase subsidies and cancel the deductible;6. while improve tuberculosis patients compensation the supervision needs to strengthen, control the induced demand of supplier and the moral damage of acquirer, and strengthen TB focal treatment.