Study Of Major Illness Insurance Compensation Of The New Rural Cooperative Medical Service

Objective:We performed a preliminary summary on the situation of medical insurance of the patients from insured residents in the sample country——Xiangshui,Jiangsu province.On the basis of this,we analyzed the factors that affect the level of medical insurance of patients with major illness,and provided some suggestions to the major illness insurance policies of New Rural Cooperative Medical Insurance,so that we can promote the major illness insurance to run faultlessly.Methods:Using cross-sectional methodology,we made a description and analysis on the data of the medical insurance level of major illness patients in the sample country from 2012-2015,and input the corresponding data through EXCEL software,and used the inferential statistics on the data through SPSS.The comparison of the two groups of sample data were performed through Mann-Whitney U test,the comparison of several groups of data were examined through Kruskal-Wallis H test,with statistical significance of difference in P<0.05.Results:From 2012-2015,the actual compensation rate of high-costs inpatients is all under the average of those of country inpatients;as the boundary of initiating the major illness insurance in 2013,the compensation rate is higher in 2013 than other years;self medical costs per time of high-costs patients in 2013-2015 is higher than in 2012.With the increasing of the period of expenses,the major illness insurance level of high-costs inpatients has increased as well,while the self medical expenses also increased several times over;the compensation rate of different cost periods of patients in every year has decreased gradually,self medical costs has increased year by year.The actual compensation rate of high-cost patients outside the country is obviously lower than those inside the country during 2013-2015,and the self medical cost per time outside the country is far higher than that inside the country.What's more,the actual compensation rate of high-cost patients outside the country has decreased gradually during 2013-2015,self medical cost increased gradually;the actual compensation rate and self medical expenses of local patients decreased gradually.The amount of major illness between 2013 and 2015 take a percentage of 5.9 of the total amount in the country;the actual compensation of major illness is high and the self medical expenses is low;the first six disease entities are named cerebral infarction,end-stage renal disease,breast cancer,lung cancer,esophagus cancer,gastric carcinoma(replaced by carcinoma of the rectum in 2015),which take a proportion of 90.67%,some of the diseases is very little,and ever some entities have no records of reimbursement.Conclusion:Currently the actual insurance level of high-costs inpatients is low,and the more medical service costs,the lower level of the actual compensation,self-medical costs have been increased which further increased the burden of the patients.Major illness insurance patients' actual level of compensation is higher,but takes a small proportion.Under the restriction of disease entities and designated medical agencies,high-cost patients cannot be insured by major illness insurance,the economic burden of diseases is heavy.The article comes up with some related policies in the aspects of government compensation,management of medical agencies,revolution of payment methods,and integrated promotion of health insurance of urban and rural residents,to complete the scheme of medical compensation of major illness patients,promote the connection between major illness insurance and the new rural cooperative medical insurance,and ease the burden of famers' medical expenses.