The Impact Factor Analysis Of The Single-disease Quota Execution Of New Rural Co-operative Medical System

Objective:To explore the reason of finnaly no single-disease quota execution case of new rural co-operative medical system which theoretically meet the requirements of the local new rural cooperative single disease policy in a third class hospital in anhui province among five years.Methods:To understand all relvant policies with regard to single-disease quota from local new rural cooperative medical system,and to obtain 22092 cases which satisfied to the requirements of new rural cooperative single disease policy from the medical record information system,HIS system of the studied hospital among the year 2014 to2019,including basic patient information,disease information,diagnosis and treatment information,total cost,self-paying amount and the amount of compensation.The resulting data is imported to create an SQL database for matching consolidation and export to Excel.Then the Excel data is imported into the SPSS17.0 software.First,The chi-square was used to analyze the distribution of different socio-demographic characteritics cases of new rural cooperative single disease quota payment.Then we use single-factor logistic regression to explore the relationship between their variables and whether to implement the new rural cooperative single disease quota payment,with P<0.2 as the inclusion criterion.Finally,the related variables which were selected in signal factor analysis were put into the multivariate logistic regression model.To further determine the relevant factors affecting the implementation of the quota payment for new rural cooperative single disease quota execution.Test level a=0.05.Results:A total of 22,092 cases were studied.There were 9703 cases（43.92%）discharge from hospital which were accounted according to the single-disease quota execution.The Chi-square results show: Compared with the year between August2016 year and July 2018 year,the execution rate of single-disease quota were more lower from August 2014 year to July 2016 year and August 2018 year to July 2019year.There were statistically significant difference among goups（χ2 value=4482.696,P<0.001）.Compared with patients who were middle aged elderly over 45 years or children under 15 years,the execution rate of single-disease quota were more lower among patients aged from 15 years to 45 years（χ2 value=190.283,P<0.001）.The single-disease quota execution rate of female participants were lower than that of male participants.The single-disease quota execution rate of migrant participants were lower than participants who were in rural or have no jobs（χ2 value=119.32,P<0.001）,there were statistically significant difference.Single factor analysis on the implementation of quota payment for single disease in new rural cooperative medical system show that many factors affect the implementation of the new rural cooperative single disease quota payment,such as hospital stay times,admission route,outcome,major diagnostic and therapeutic techniques,hospital profit and loss,whether to join the clinical pathway,surgical procedure number,number of discharge diagnoses and surgical grade.Multiple logistic regression analysis on the related factors influencing the implementation of fixed payment for single disease in new rural cooperative medical system show that the contributing factor of the new rural cooperative single disease quota payment were as follows: male,farming in the countryside,the execution year of single disease was in the third and fourth years（take the August one 2014 year to July thirty-one 2015 year as the first year and so on）,non-emergency adminssion,join the clinical pathway,the main diagnostic and therapeutic technique was surgical operation,the profit and loss amount of the hospital was large（the deficit was negative）.However,the hinder factor of the new rural cooperative single disease quota payment were as follows:the young and middle-aged between 15 year and 45 year,long time of hospitalization,discharge to non-healing status,many operations during hospitalization and fourth level surgery.Conclusion:There were some obstacles in the implementation of the new rural cooperative single disease quota payment.The number of discharge diagnosis was no related to the new rural cooperative single disease quota payment.There were many factors hinder the implementation of single disease quota payment such as female,young and middle-aged,migrant worker,long time of hospitalization,poor prognosis,no participate in clinical pathway,high operation level,more number of surgical procedure,the main diagnostic and therapeutic technique was internal medicine and the little amount of hospital profit and loss.Further improve the awareness of participants,strengthen the implementation of clinical pathay,adjust quota standard in time,strictly exmine and verify the withdrawal cases can promote the implementation of single disease quota payment.