Study On The Discernible Standards Of Excessive Demand For Inpatient Service Of New Rural Cooperative Medical Scheme

ObjectiveWith the development of New Rural Cooperative Medical Scheme (NRCMS), how tocontrol the moral risk of suppliers’ and demanders’ to reduce unreasonable health servicesupply and utilization have becoming an important issue which needs urgent studies ofrelevant theories and methods as a guide to effectively improve the efficiency of limitedfunds of NRCMS and to reduce the burden of the society’s and the peasants’ whoparticipate in the NRCMS. This study is to establish an explicit Non-diagnostic criterion ofexcessive demand for inpatient services in Chinese rural areas, based on meeting healthservice needs reasonably. The standard includes the situations of the patients before andafter admission within a certain time, mainly used for administrators to examine theadmission appropriateness, instead of serving as the only admission standard for doctors.This standard provides theory basis and methods for co-routine audit and supervision inhospitalization services of New Rural Cooperative Medical Scheme, in the hope ofstrengthening regulatory measures of NRCMS from aspects of induced demand andunnecessary health services, thereby enhancing the regulatory capacity of ralative agencies,improving the management system of NRCMS, and promoting a long-term and sounddevelopment of NRCMS.Methods(1) Literature analysis: preliminarily establish the explicit Non-diagnostic criterion ofexcessive demand for inpatient service through literature analysis.(2) Field survey: Taketypical sampling way to select a better county of NRCMS as a sample and use randomsampling approach to extract a total of300copies of the2011hospitalized cases of the newrural cooperative non-delivery.(3) In-depth interview: Further acquire with completesuggestions and advices about the discernible standards of excessive demand for inpatientservices based on in-depth interview or other sociological investigation methods to insiders.(4) Delphi Method: The explicit Non-diagnostic criterion was demonstrated with Delphimethod. In accordance with the design of subject,10-15clinical experts with over10yearsof clinical working experience were respectively selected from each sections includinginternal medicine, surgery, gynecological, pediatric to form a consultation group. Two rounds of expert consultation were conducted to evaluate every specific index filtered in thestudy. At last, the preliminary standard for the admission of Chinese rural areas wasdesigned.(5) Statistic analysis: Expert consultation results were analyzed by statisticalmethod.(6) Implicit criteria: Firstly, identified the reasonableness of the sampling medicalrecords of hospitalization using implicit criteria. Then found out the difference and itscauses based on the excessive demand recognition of the sample records using the explicitNon-diagnostic criteria and implicit criteria. At last, proposed amendments to the―explicitNon-diagnostic criteria‖so as to fix the criterion.Results(1) This study established the discernible standards of excessive demand for inpatientservice of NRCMS.After two rounds of expert consultation, it preliminarily established the discerniblestandards of excessive demand for inpatient service of NRCMS. It mainly includedintensity of service and severity of illness two primary indicators, severe electrolyte orblood gas abnormality, abnormal blood pressure, sudden onset of unconsciousness and soon29secondary indictors. Variation coefficient of the primary indicators and secondaryindictors were less than0.5, coefficient of the every one of indictors have significantdifferences (P<0.05), it was explained that experts evaluation of all secondary indictor’sdiscrete degree are small and coordination’s well. The results are reliable and credible.(2) Tested the reliability and validity of the―explicit Non-diagnostic criteria‖usingimplicit criteria.First, the study collected300Non-Childbirth medical records of4township hospitalsin2011, Dangyang, Hubei Province. Then the inpatient admission appropriateness wasidentified by means of―explicit Non-diagnostic criteria‖and―the implicit criteria‖. Bycomparing the two results, we found out that the hospitalized reasonable consistent rate ofthe "explicit Non-diagnostic criteria" and―the implicit criteria‖reached83.08%, whichillustrated the degree of fitting of the two methods of evaluation results was ideal and"explicit Non-diagnostic criteria‖carries a high reliability and validity.Conclusions(1) According to the policy and management goals of the NRCMS, based on absorbingclinical criteria of foreign and the experience of management of NRCMS, through literatureanalysis and Delphi method, the study explored to establish a discernible standard of excessive demand for inpatient service of New Rural Cooperative Medical System which isobjective, reasonable, concise, and convenient, including intensity of service and severity ofillness with29indicators among which21indicators can be used in township hospital.(2) Based on the analysis of the300medical record of4township hospital inDangyang city, Hubei province by using the discernible standards of excessive demand forinpatient service of NRCMS, the result shows that the indicator system can distinguish thecase of inappropriate in hospital fairly and objectively which provide beneficial try forjudging the rationality of in-patient service. The evaluation indexes system possesses thefunction of management, providing theoretical basis and methods for daily audit andsupervision of NRCMS designed by this study.(3) The discernible standards of excessive demand for inpatient service of NRCMS issuitable for designated medical institutions of diffident level and different type in China’svast rural areas. There is no need to separate the evaluation on the rationality of in-patientservice of designated hospitals in diffident level.