Research On Anhui New Rural Cooperative Medical System Reimbursement Pattern To Compensate Farmers For Medical Charges

The new rural cooperative medical care system is designed to tackle medical security for nearly two thirds of rural population. Since the pilot project was launched in2003, the ratio of participating in the new rural cooperative medial care system increases year by year by the end of2009, the number of participants increased to833million, and the participation ratio went up to94.19%. The new system has been advocated by the vast majority of farmers. In2009,760million farmers benefited from the compensation expense, and to a certain extent, has alleviated the problem of farmers returning to poverty due to illnesses in the meantime, the medical burden that rural residents are confronted has been reduced, the utilization of health services has been improved and the supporting capability of the new system has been enhanced. The compensation program with uniformly-raised funds constitutes the foundation as well as the core of the new system. To select a pattern for the funds to be uniformly raised is a preliminary work in formulating the compensation program. Considerations have been given to the “compensation for serious illnesses and to the compensation for minor ailments” so as to chart the fund utilization in the new system. At present stage, the reimbursement patterns with uniformly-raised funds in the new system across the country implement the guiding principle of “raising funds for serious illnesses” at a varying degree. Specifically, there exist such patterns as “inpatient fund-raising plus outpatient fund-raising”,“inpatient fund-raising plus an outpatient household account plus outpatient fund-raising”,“fund-raising for serious illnesses”, and “fund-raising for serious illnesses plus an outpatient household account”. Both advantages and disadvantages can be found in these reimbursement patterns designed to compensate farmers for medical expenses. This paper, by studying basic information statistic statements and relevant materials of the new rural cooperative medical care system in Anhui Province, conducts an analytic comparison on reimbursement compensation in last three years. In methodology, the author of this paper takes into consideration of maneuverability, sensitiveness and representation of the indexes, and carries out descriptive analysis after employing Excel database for data entry. Results indicate that the new system in Anhui Province is in a stable operation, and four major goals, namely,“secured hospitalization, compensated outpatient, less expenditures in illness treatment, and convenient reimbursement”, have been preliminarily realized, satisfaction degree among the participating farmers is on a continual rise, and operational quality and various key tasks take the lead at a national level. As the financing level goes up, the benefit rate and actual compensation ratio of inpatient and outpatient charges are improved. But the research finds that the new system in Anhui is also confronted with deep-seated problems and conflicts: the fund use appears too conservative, and there is a need to further improve fund utilization ratio, so as to keep the balance of uniformly-raised funds less than15%of the total funds raised at the year too many hospitalized patients are concentrated in medical institutions at a county level and above, and farmers do not trust health clinics in towns which need to be developed the bottom line of reimbursement at a township level is very low and a large number of outpatients choose to be transferred to be hospitalized, leading to a sharp increase in hospitalized patents, and if necessary, adjustment should be made to the program so as to curb the abnormal upward trend in inpatient ratio the phenomenon of "uneven benefits” has been found in different areas in Anhui, and benefit fairness is to be improved besides, there is an inadequate supervision on the funds, and fund misuse occurs occasionally financial accounting is not up to standard, and the system of internal control remain inadequate. Thus, this paper suggests that Anhui continue exploring a sounder compensation program, and on the basis of consolidating the coverage and with the help of actuarial system for health insurance, scientifically determine the supports for the new system, formulate a scientific and rational compensation program, improve financing standard, advance the uniformly-raised funds for outpatient charges, and improve the benefiting scale for participating farmers the gap between counties and districts in the province is to be further narrowed, and nearly the same medical security among the farmers in the province is to be actively sought for furthermore, the compensation pattern is to be reformed, benefiting condition of participating farmers be improved, and farmers are to be guided for a rational divergence fund management system is to be improved, and the internal control system for the funds be formulated, so as to establish a long-term, effective regulatory mechanism in the meantime, financial accounting is to be standardized, and financial internal control system be improved in the course of formulating and adjusting the compensation program with uniformly-raised funds, farmer’s participation in the new system is to be improved, too.