Study On Status And Influencing Factors Of High-cost Inpatients Security Level Of New Cooperative Medical Scheme

Objective:Based on the preliminary summary on current situation of high-cost inpatientssecurity level of New Cooperative Medical Scheme(NCMS)，the dissertation analyzeinfluencing factors of high-cost inpatients security level of NCMS and essentialcauses of low security level，also discuss focused on some important influencingfactors，provide policy suggestions for improving high-cost inpatients security level ofNCMS and reducing farmers out-of-pocket expenses effectively.Methods:Through agency survey, to get the basic operation data of H, L counties inGuangxi from2009to2011and the data of NCMS inpatient cost of H County in2011,L County from2009to2011. On this basis, use statistical analysis, counterfactualanalysis, sensitivity analysis and the health system diagnostic tree research to analyzethe relevant data and information.Results：1.The average actual compensation ratio of high-cost inpatients are41.62%,36.09%,33.68%and38.05%in H County in2011and in L County from2009to2011(All data are lower than county average, and the differences are statisticallysignificant). Out-of-pocket expenses of high-cost inpatients are4.14,2.63,2.76and3.09times as respectively counties’per capita net income of farmers. the average ratioof compensation scope expenses to total hospitalization expenses are respectively73.97%,90.48%,90.14%and89.47%(All data were lower than the county average,and the differences are statistically significant). The average compensation ratio ofuremia is maximum during high-cost inpatients from different diseases（51.25%）,which is10percentage higher than the remaining four diseases (the differencesarestatistically significant).(Do not contain a secondary compensation)2. The implementation of secondary compensation policies during two counties in2011significantly improve the actual average compensation ratio of high-costinpatients. The average actual compensation ratio in H, L counties are increased by8.00%and14.21%. Simultaneously the average out-of-pocket expenses of high-costinpatients in H, L counties are reduced by13.71%and22.93%(the differences werestatistically significant).3. Nominal compensation ratio，the ratio of compensation scope expenses to totalhospitalization expenses，hospital level，diseases subject，total hospital expenses，hospital stay and top line are influencing factors of high-cost inpatients security level，and nominal compensation ratio，the ratio of compensation scope expenses to totalhospitalization expenses，hospital level are key influencing factors.4. To simulate that average nominal compensation ratio （analog1）and actualcompensation ratio （analog2）of part costs more than high-cost standard which thissubject define of high-cost inpatients security of sample counties increased to70%，out-of-pocket expenses of compensation scope of high-cost inpatients whichout-of-pocket expenses exceeded rural per capita net income last year reduced50%（analog3），average out-of-pocket expenses of high-cost inpatients reduced to ruralper capita net income（analog4），The required new funds in H County accounted for2.17%,8.00%,7.80%and29.91%of total funding, L County accounted for5.32%,8.06%,12.39%and26.94%of total funding.On the whole, analog1and analog3arefeasibility, analog2and analog4are not feasibility.5.From the five aspect including NCMS financing, payment, organization,regulation and behavior，the ultimate effect of low security lever of high-costinpatients of NCMS can be summarized as a Lack of government investment，limitedpersonal financing，NCMS managers are lack of capacity，limited regulatory capacityand inadequate measures of NCMS，payment reform lags behind and so on.Conclusion：1. Actual compensation ratio of high-cost inpatients is low，disease economicrisk is high，security level should be improved urgently.2. secondary compensation policy of NCMS can raise security level of high-cost inpatients effectively, but equity of policy implementation is poor，urban and ruralresidents critical illness insurance should be set up as soon as possible, and transitfrom existing secondary compensation policy to normative critical illness insurance.3.Sample counties should improve nominal compensation ratio of hospitalizationabove the county level，and gave priority to give higher compensation ratio andimplement special compensation measure aim at some high cost-effective seriousdiseases and inpatients over higher fee；perfected double action transfer treatmentsystem，design of transfer treatment system should especially focus on down transferwhile regulating up transfer；focused on strengthening development of some highercost and mature clinical treatment in county-level medical institutions；enhancedregulations of medical institutions services，gave priority to add high cost-effective，mature clinical treatment program and drugs which didn’t belong to reimbursementlist to the compensation scope.4. For the sake of insure steady promotion of high-cost inpatients security level，On economic level sample counties should continue to greatly improve funding ofNCMS. Meanwhile，payment system reform, such as single-disease payment, shouldbe carried forward actively to control the increasing medical fee of high costinpatients. For instance, a fixed payment is supposed to be implemented to seriousdiseases which are costly and stable.5.It varies among different regions when it comes to the security level of highcost inpatients. Measures should be adjusted to different local conditions.