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Research on Out-patient Global Budget of New Rural Coorperative Medical Scheme

Author: DuLiXia
Tutor: ChengXiaoMing
School: Fudan University
Course: Social Medicine and Health Management
Keywords: The new type of rural cooperative medical care Outpatient Total prepaid Payment
CLC: R197.1
Type: Master's thesis
Year: 2011
Downloads: 379
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Abstract

Serious co-ordination in the beginning of the implementation of the new rural cooperative medical research background (hereinafter referred to as the \In 2008, the State Council held a national new rural cooperative medical work conference to make policy-oriented implementation of patient co-ordination. The end of 2009, the national implementation of the outpatient service areas had reached one-third. According to the data of the Ministry of Health, Health Statistics Yearbook, 2009 compared to the average annual growth rate of total health expenditure per capita in 2003 was 16.09%, 19.49% average annual growth rate of per capita health care costs. From the composition of total medical costs nationwide outpatient costs usually account for more than 65% of total health care costs, and the proportion of a growing trend. The high-speed growth of health care costs has become a grim situation facing Medicare and challenges, the new IICA outpatient no exception. With the increasing patient co-ordination with regard to medical costs and compensation levels to improve in some areas of outpatient fund cost overruns risk, especially after the implementation of the outpatient service medical needs huge release to the new rural cooperative patient co-ordinate the smooth development brought tremendous challenges and tests. A certain level of funding, the appropriate payment is to control health care costs, an important means to maintain the fund balance, therefore the urgent need to expand outpatient payment system from the angle control health care costs and the new rural cooperative fund balance. Current Payment control fee effect best total prepaid, many regions have started to adopt this payment method, the relevant departments are also actively advocate. The Ministry of Health is in \Prepaid has a very important practical significance from the point of view of cost control and policy research to study outpatient total. The total prepaid research involving new rural cooperative the outpatient Total prepaid research is limited and not enough depth from the theoretical aspect also has a very important significance. Combined with the actual survey results of the study, to explore existing funding levels, how to carry out the new rural cooperative medical outpatient total prepaid, prepaid implementation of the new rural cooperative medical outpatient total provide a reference. Research purposes by research on the the current outpatient co-ordination Payment Status purpose and content (a), the combined total prepaid theoretical analysis and practical experience, research and investigate the implementation of the rural grassroots medical institutions outpatient total prepaid estimates approach, the implementation of the conditions and regulatory mechanisms provide for to perfect NRCMS outpatient payment system to promote the sustainable development of the new rural cooperative basis. (B) research content analysis of a sample region NCMS implementation, focusing summarize its outpatient payment system status and problems of 2 analysis of new the farmers together the total outpatient existing prepaid estimates, the implementation of the condition and its operating mechanism, the calculation method and the operating mechanism to adapt to the status quo of China's new rural cooperative. Nanling County, Anhui Province typical case analysis, according to the calculation method of this study, the the outpatient Prepaid total estimates, and analyze the effect of the implementation of one year after implementation, summarize the problems and proposed countermeasures. 4 according to the current situation of research and a typical case study results and analysis, asked the the outpatient total prepaid for the new rural cooperative calculation method and conditions for implementation of the recommendations. Research methods (a) Source selection of sample areas according to the level of economic development, taking into account the geographical distribution of select outpatient service has been implemented for more than 1 year (it is best to have implemented outpatient total prepaid) counties (cities, districts) as a research object, the selected sample of 10 regions in Zhangjiagang City, Jiangsu Province, Jurong City, Anhui Province Feixi County and South Lingxian Lintong District, Shaanxi Province, and Xunyi, Xundian County, Yunnan Chengjiang County, Shanghai Nanhui District Qianjiang District of Chongqing Municipality. The data collection method in this study in the second half of 2009 to conduct a site survey, Nanling County, Anhui Province, in 2010 the new rural cooperative medical clinic in early 2011 to collect basic data for analysis. Specific data collection questionnaires, secondary data collection, key informant interviews. Literature induction, medical insurance premiums were roughly Law, PETS feasibility analysis, and a typical case study method; (b) of the analytical method in this study used analysis methods used analysis tools have Excel2007 SPSS11.5. 1 sample region outpatient the Manpower status quo (1) of the main conclusions of the four studies (a) sample areas the new IICA overall situation and problems 10 the sample NRCMS overall in a good stage of development, mainly reflected in the following five aspects. Stable new rural cooperative fund balance overall participation rate of increase year by year; second is the level of funding the annual growth rate of about 25%, the majority of the sample region personal financing accounted for between 0.01% to 0.02% of the year per capita net income of farmers; ; Fourth hospitalization benefit the surface gradually expanded year by year to strengthen the level of benefit; Fifth, until 2008, the family accounts have all been transformed into the patient co-ordination, Senate combined masses benefit was extended. There are many inadequacies the new IICA run also. First, the new rural cooperative times are faster to new rural cooperative fund run great risks; hospitalization costs growth rate two quite different outpatient service fund cost overruns and balances, outpatient service fund scientific calculation, outpatient cost control and regulatory difficult; outpatient service overall is in the beginning stages of the current low proportion of outpatient actual compensation, attractive Farmer Participation is not great; individual districts to reflect the actual research complex outpatient reimbursement procedures, to the increase in rural doctors workload. (2) sample region outpatient the total prepaid overall status and problems until 2009, the 10 sample areas have all been implemented outpatient service, five sample areas in the implementation of outpatient total prepaid. Has been the implementation of outpatient in co-ordinating proportion of outpatient fund divided between 20% -40% higher division ratio of Nanhui District, Shanghai, .43.4% of the Fund's total funding; The existing outpatient total calculation method is calculated in accordance with the volume of services and two categories, both calculation method according to the poll estimates there are some reasonable, but overall simple considerations; overall follow overruns do not fill in the year-end flexibility settlement balances normalized been \In addition, the total amount of prepaid multi-covering rural two medical institutions; Nanhui District, to implement the global prepaid degrees, times are outpatient costs decreased by 32.14% and reduce the cost of outpatient medical effect is very obvious. The outpatient total prepaid problems for: outpatient Fund imbalances; simple outpatient total estimated considerations; Third year-end the elastic settlement methods need to be improved; outpatient information system is not perfect in the central and western regions, to the outpatient The total prepaid estimates, supervision and evaluation have brought great difficulties. Outpatient total prepaid payment to explore the the outpatient total prepaid program designed primarily to be followed live within our means and guarantee basic medical principles, the principle of reasonable compensation for side feasibility principle, relatively stable and timely changes in four principles. The proposed new rural cooperative the outpatient fund allocation accounted for about 20% -30% of the annual overall fund. On the basis of the increase in the fund-raising, and has gradually increased the proportion of new rural cooperative medical clinic co-ordinate the Fund's total fund. The total prepaid calculation method is divided into cost estimation method, counting method, by actual calculations law, Press Services for measurement method and five poll calculating method. Explore outpatient status quo combined with China's new rural cooperative medical insurance premiums were roughly Law, summed up the total amount of prepaid calculation method suitable for China's new rural cooperative outpatient, and its formula is: where: M is the total outpatient prepaid; A for times outpatient expenses standards, when times are cost varied according to the actual situation, combined with costs hierarchical medical institutions, service capabilities and economic development level of the medical institutions; outpatient utilization of S (S = p × service population Popu) for outpatient services amount of predicted value, in the case of certain service population, the lower the rate of outpatient medical institutions may be appropriate to relax the appropriate strictly higher utilization of outpatient medical institutions; R is the actual compensation ratio; C growth factor; F insurance factor; i on behalf of the county-level medical institutions; j represents the township level medical institutions; k on behalf of the village-level medical institutions; n is the number of county-level medical institutions; m is the number of township-level medical institutions. The outpatient estimates of the total is a forward-looking forecast, its actual value is affected by many factors, in order to reduce the unpredictability of factors affect, it is recommended that the end of the year to implement flexible settlement. First, determine the reasonableness of the cost overruns and balances. Unreasonable cost overruns and balances should be some punishment. Reasonable cost overruns, the 60% -75% of the cost overruns compensation to medical institutions, to make up for their health care costs; balances when the total outpatient prepaid balance ≤ outpatient medical cost savings × (25% -40%), balances are all normalized already; When the total outpatient Prepaid balances gt; savings of outpatient medical expenses × (25% -40%), which does not exceed the portion of normalized already. Unreasonable cost overruns and balances to be punished. Supervision and evaluation aspects of the establishment of the publicity, assessment and supervision system, the establishment of evaluation index system, examination results and performance-related. Implementation of the the new IICA outpatient Total prepaid two basic conditions for coverage tertiary health information network system construction and implementation of rural integration management. The 3 of Anhui Province outpatient total prepaid typical case analysis Nanling County, Anhui Province, to meet the basic conditions of the implementation of outpatient total prepaid, according to this thesis is estimated, based Nanling County, Anhui Province in 2009 data, estimates its 2010 foundation outpatient total of 5.3635 million yuan growth coefficient of 1.087, three outpatient medical institutions in Nanling County, Anhui Province in 2010 adjusted budget amounted to 5.8301 million yuan. 2010 outpatient actual expenditure of funds for 5,469,700 yuan, the total estimated results is only 6.52% more than the the actual outpatient fund total compensation, which illustrate the calculation method is more realistic fund expenditures, with the practical application of significance. Compared outpatient data from 2009 and 2010 found that outpatient Total Prepaid good control of the total outpatient costs, control the excessive growth of outpatient medical costs while ensuring the the outpatient fund balance of payments, promote the use of outpatient services, improve the The masses of the level of benefit. (B) to discuss a flexible basis for settlement due to data limitations, the settlement of labor costs in the year-end elastic settlement is only the income structure of rural doctors a cursory analysis of the lack of analysis of the cost of medical institutions at the township level and county-level structure. 2 total estimates discussed in a corresponding adjustment to the actual total outpatient estimates. Exist at the township level medical institutions under quite different circumstances, according to the actual situation, the development times are outpatient costs of different grade levels standards. Actual calculations for the township and village level medical institutions, average real compensation than to measure theoretically more fairness. Essential drug system and the total amount of prepaid relations in a typical case study, Nanling County, Anhui Province in 2010, outpatient total prepaid, as well as implementation of the essential drug system zero difference system. From a theoretical analysis of the zero difference of essential drugs and outpatient total prepaid can reduce outpatient costs, and require long-term observation of the total prepaid control fee. (C) Recommendation based on reality is the premise of the new rural cooperative medical outpatient total prepaid NCMS outpatient co-ordinating the implementation to be built on the basis of patient compensation level reaches a certain level, and at the same time leaders attach importance to and has a high-quality management team of the new rural cooperative . At the same time need to strengthen policy advocacy, guidance and communication with the medical institutions. 2 Information Systems is a prepaid basis of total new rural cooperative medical outpatient clinical information system played an important role in terms of outpatient costs of collection, statistics, real-time supervision. It includes computer network and software facilities, the most important computer operator. The inputs suggested county finance mainly to encourage the introduction of social capital. 3 scientific measurement is a the new IICA key outpatient clinic Total Prepaid Total Prepaid is a forward-looking forecast, influencing factors many, it is prone to the actual gap. Total estimated outpatient scientific and reasonable, on the one hand, to establish on the basis of data and information collected; the other hand, close to reality. 4 elastic settlement NRCMS the regulation total outpatient total prepaid prepaid estimates is a forward-looking estimates The flexible settlement can compensate for the many uncertain factors cause the estimates inaccurate defect to the medical service capability enhancement and cost overruns institutions the cost of compensation, the medical institutions of the active control costs to give economic incentives, appropriate penalties Poor medical practices, is the means of implementation of the outpatient Total prepaid swap. 5 supervision and evaluation of the protection of the new rural cooperative medical outpatient total prepaid system of supervision and oversight team, establish a system of regular supervision and evaluation of the medical practices of medical institutions, the smooth implementation of the prepaid protection outpatient total.

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