Investigation on the cross-province settlement of NCMS-covered inpatients in Tianjin: hospitalization cost analysis

Abstract

Objective To analyze the hospitalization costs of new rural cooperative medical system(NCMS)-covered inpatients received by tertiary hospitals in Tianjin with their expenses reimbursed in other localities, for reference of policy making by government departments. Methods NCMS-covered patients who were admitted by 23 tertiary hospitals from May to October in 2017 were followed up and analyzed using their online reimbursement data. Patient expenses were compared among groups of different sources and diseases, using one-way variance analysis and LSD-t for multiple comparison. Results The online reimbursement data of 118 NCMS-covered patients from eight provinces including Liaoning province were collected. The total cost per person averaged 26 744.92 yuan, with 8 890.68 yuan reimbursed, accounting for 33.24% of the expenses incurred. Conclusions The higher proportion of the out-of-pocket payment by patients′ results from such factors as higher ratio of non-covered drugs, the lower compensation rate by other provinces on expenses at tertiary hospitals, the medical charges outside the catalog and the medical materials at own expense. Therefore, the compensation policy and medical insurance payment policy should be improved to ensure that the NCMS patients enjoy more reasonable policy treatment. Key words: Rate setting and review; Rural health services; Nationwide networking; Cross-province reimbursement; Hospitalization expenses