A Case Study Of Commercial Insurance Compa-Nies Prticipating In The Operation Of New Rural Cooperative Medical Scheme Business

With the collapse of the economic system reform, rural cooperative system and the old cooperative medical system gradually disintegrate, a new type of rural cooperative medical system established in China since2003,referred to as the New Rural Cooperative Medical System(NCMS).After the development of ten years, NCMS has become the most important form.It played an important role of protecion rural residents to alleviate the poverty caused by the diseases and returning to poverty due to illenss. The development of NCMS is facing a series of problems, such as,staff numbers are inadequate, the high management costs, lack of technical expertise, weak regulatory capacity, the government constantly improve the new rural cooperative medical policy to solve the above problem, some local governments actively explore new approaches to manage NCMS business.in practice,Commercial Insurance Companies (CIC) has participated in the operation of NCMS business.The pilot of CIC to participate in the NCMS business had expanded in many parts of China.this is a new phenomenon in China’s health reform.the government should actively and steadily to explore, but obviously domestic academic research is insufficient, a systematic study is of great significance to avoid the loss of social welfare by the public policy mistakes.Main Objective:Total purpose of this study is to analyze the NCMS business management status in different areas and elaborate functions that CIC has played in the management of NCMS business from the perspective of job duties, staff,motivation. cost, operation mechanism, performance indicators,meanwhile,make comparison with areas that only government manage NCMS business, and put forward policy recommendations based on the research results.Methods:This study used a case study approach, to extract5counties that CIC participate in the local NCMS management from Zhejiang Province (Zhejiang is National key contact areas of CIC participate in the local NCMS) and Qingdao Chengyang District,7other counties of Qingdao to be contrast that only the government management NCMS.This study had interviewed62people from commercial insurance companies,govemment and hospital in sample county.Mainly used focus interviews and group discussions, at end of the investigation, the qualitative interview data should be sorting and summary,and then conduct theme inductive analysis according to the study outline;Predesigned quantitative questionnaires were sent to related personnel to fill,and ues excel table to type-in, spss13.0for statistical analysis, data analysis by calculating the mean and the proportion of value.The main results:1) The audit and reimbursement of NCMS is the main mission for CIC,meanwhile,some CIC is also responsible for oversight and audit hospital prescriptions, CIC do not participate in the fund raising of NCMS.The fund closed operation and management fee can not be extracted, the government annual pay the commission fee to CIC from financial budget.2) Incentives for CIC participating in operation of NCMS business include keeping cooperation with government, pressure of market competition and strategic need for business development. Reasons for government consignating NCMS business to CIC include insufficient staff and budget, inexpert in health insurance management.3) After the CIC participating in the operation of NCMS, complaint channels had increased.But,the CIC only recorded the patient’s problems and timely feedback to the government, government agencies come forward to solve the problems.4)The government grasp the rights to dispose hospitals if illegal actions occurred.During the CIC participating in the operation of NCMS, some CIC assist government to supervise the diagnosis and treatment behavior of hospital,others commissioned by the government to supervise the diagnosis and treatment behavior of hospital, meanwhile.the behavior of CIC under government supervision.5) The circulation of NCMS funds:the hospital instead of government to pay the patients for the reimbursement of expenses,after the CIC and government checked the reimbursement claims,the compensation funds will How from government to CIC and then to hospital.Compared with the areas that only government manage the NCMS, CIC participate in the NCMS increases anther funds transfer link.6) The counties of CIC-run mode have less government staff compared with the government-run mode But if the CIC stalls are taken into account, the CIC-run mode has obviously more staffs,42.0%higher than the government-run mode.7) The average operational cost for NCMS office is2.49Yuan in government-run mode and3.26-3.51Yuan in CIC-run mode; and when we take the CC into account, the average cost for CIC-run mode is5.25Yuan per insured,110.36%higher than that in government-run mode.Conclusion:1)Mandatory administration mode is the main form of the CIC participate in the NCMS. CIC is responsible for audit and not responsible for profit and loss of the fouds, CIC do not participate in the fund raising of NCMS. The main difference of such cooperation in difterent areas is that the degree of cooperation is differ.2) After the CIC participate in the NCMS, the changed functions to a certain extent.3) Flexible employment mechanism of CIC effectively solve the government’s shortage problem of staff in NCMS management,meanwhile, its professional claims experience has improved the quality of NCMS management service.4) After the CIC participate in the NCMS, NCMS management total social costs have been significantly reduced, but from the government’s point of view government administration costs decreased.5)After the NCMS information systems had been improved. Most of reimbursement and settlement business had achieved real-time settlement, the workload of CIC had reduced significantly, the necessity for CIC participate in the NCMS need to be consider in further study.Policy Suggestion:1) The cost of institutional change cannot be ignored during change of government’s functions.2) Improving the system to prevent the government to shirk its responsibility by the outsourcing of public services, the government should clearly define their responsibilities, to strengthen the supervision system.3) The government need to consider the overall situation when developing the framework for cooperation, CIC may suddenly withdrew from the cooperation.4) Government and commercial insurance companies should actively explore the method to preserve and increase NCMS funds, the mixed operation of CIC offers a path.5)The supplementary effect should be expressed, CIC need to explore the suit insurance plan for rural areas actively.