The Influence Of Reform Of New Rural Cooperative Payment Mode On Medical Expenditure

The New Cooperative Medical Scheme (NCMS) was adopted by the Guangling District of Yangzhou Municipality in2004. Its structure and mechanism have been continuously improved since then. Medical services are now more available and affordable to rural households, which helps, to some extent, reduce Illness-induced poverty. However in recent years, the rising healthcare expenditure has drawn wide public attention. Irrational payment system of medical insurance is a major reason. Therefore, advancing the payment reform of NCMS has become a new strategic goal in controlling healthcare expenditure for NCMS. Guangling District of Yangzhou is exploring payment reform, which provides fact basis for the empirical research of this thesis.The thesis first looks at the background and significance of the research. On the basis of collecting and sorting out recent literature on theories, approaches and evaluation metrics of medical insurance payment, it summarizes domestic and foreign researches on medical insurance payment and defines the approach and outline of this thesis.The thesis defines the concept of NCMS, NCMS payment and medical cost control, and explains the theoretical foundation including the stakeholder theory and balance theory.By analyzing the status quo of NCMS payment and healthcare expenditure, the thesis explores reasons for the rapid expenditure rise, pinpointing the irrational payment system of medical insurance as a culprit. It assesses the impact of medical payment reform on medical cost control and establishes a payment model to properly control healthcare cost from theoretical perspective. With sufficient data gained from the on-site investigation of NCMS payment reform in Guangling District, through empirical research and data analysis, it evaluates the effect of the model implementation. It also points out the impact of payment reform in Guangling District on the control of healthcare cost.1. The increase in healthcare cost is effective curbed for enrolled rural residents.2. The composition of healthcare expenditure is streamlined. However, some problems linger.1. The stimulation effect on cost control for medical institutions is limited.2. The control over total expenditure is yet to be improved for medical institutions.3. The disease-specific payment in the reform needs to be enhanced. In its last part, the thesis offers ways to advance the payment reform and put healthcare expenditure under rational control. Specifically a new NCMS payment model needs to be established to effectively control healthcare expenditure. An expenditure supervision mechanism needs to be put in place to standardize NCMS payment reform. Outreach campaigns need to be carried out for the enrolled rural residents. The health-care system reform needs to be promoted, information system of NCMS operating offices improved and effective negotiation and consultation mechanism established.