What is the national policy on rural cooperative medical care?

A, the new rural cooperative medical basic policy The new rural cooperative medical is organized, guided, supported by the government, farmers voluntarily participate in the collective and government financing, to the main medical co-ordination of farmers' medical mutual ****ji system.　　1, the new rural cooperative medical financing channels. According to the relevant provisions of the State, the current national pilot counties and cities of new rural cooperative medical care to raise funds for the main channels are two: one is the financial subsidies at all levels; the second is to participate in cooperative medical care for farmers to pay. From 2006 onwards. To carry out the new rural cooperative medical care pilot counties and cities, according to the number of people participating in cooperative medical care, per person per year, the total funds for 50 yuan, of which the central financial subsidies 20 yuan, provinces, states, counties (municipalities) financial *** counting supporting 20 yuan, farmers participating in cooperative medical care to pay 10 yuan.　　2, the nature of the new rural cooperative medical care is a "mutual ****ji", that is, voluntarily participate in the cooperative medical care of farmers, must pay a certain amount of money each year. Payment standards can be based on the level of local economic development. The State Council State Council issued [2004] No. 3 document, the amount of individual contributions of participating farmers, in principle, no less than 10 yuan per person per year, economically developed areas can be on a voluntary basis, according to the level of farmers' income and the actual needs of farmers to raise the standard of contributions.　　3, the new rural cooperative medical care is a mutual * * * * financial farmers basic medical security system. Since it is a mutual assistance **** relief, it must be a major disease co-ordination. That is, to solve the participating farmers suffering from serious illnesses, the urgent need for hospitalization of medical expenses. However, taking into account the enthusiasm of farmers participating in cooperative medicine, but also taking into account the actual situation of farmers in our state medical care, the cooperative medical funds into two parts, most of which are used as inpatient medical compensation fund, a small part of the farmers participating in cooperative medicine as outpatient compensation fund, the establishment of family outpatient account. The family outpatient accounts of participating farmers are family-based, with each person withdrawing 6-8 yuan per year for the purpose of compensating family members for outpatient expenses in the current year. The account is to be used on a household basis until it is exhausted, and no compensation will be made for overspending. The balance of the current year is carried over to the next year for further use.　　4, the new rural cooperative medical fund-raising and in place procedures. New rural cooperative medical financing principle is: "voluntary participation of farmers, collective and government funding", that is, on the basis of voluntary participation of farmers, first of all farmers to pay part, in accordance with the relevant provisions of the collection into the treasury, into the county and city of the new rural cooperative medical special f-] account, and then the county (city) in accordance with the actual number of participants, the financial will be The county (city) finances will then allocate matching funds according to the actual number of participants, and apply for subsidies from the provincial and central governments.　　　Farmers' contributions to the cooperative medical funds can be made by the farmers themselves or by the collective economy. It can also be donated by the society.　　5, reported in the new rural cooperative medical pilot must have the conditions. The State Ministry of Health, Ministry of Finance, Wei Nongwei hair 20051319 document provides that the provinces and municipalities in determining the pilot counties (cities), to continue to adhere to the standards of the pilot counties (cities): First, the local government attaches great importance to take the initiative to apply; Second, the farmers to participate in the cooperative medical care is highly motivated, the rural grass-roots organizations are relatively sound; Third, the local finances at all levels to ensure that the subsidies. And in a timely manner and in full; Fourth, the health administrative department has a strong management capacity, and the management of rural medical and health services is relatively complete; Fifth, township health centers are upwardly mobile to county-level management. Reforms are in place; sixthly, the medical aid system is being established simultaneously; seventhly, the establishment, staffing and funding of cooperative medical care agencies are guaranteed, and computers and other necessary office equipment are being purchased. Counties and municipalities must formally commit themselves in writing when they formally declare to their superiors.　　Second, the new rural cooperative medical special policies

1, the five guaranteed households, special hardship case, disabled people and other special (disadvantaged) groups to participate in cooperative medical care, the funds payable by the individual, by the civil affairs department.　　2. For one-child households, two-woman sterilization households and other preferential family planning households participating in cooperative medical care, the funds to be paid by the individuals shall be settled by the family planning department.　　3. All pregnant women participating in cooperative medical care who are hospitalized for delivery are given fixed subsidies according to the mode of delivery. According to the programs formulated by counties and cities, the compensation for each case of flat birth is 150-250 yuan. Cesarean section is compensated 400-600 yuan per case. Pathological obstetrics is compensated according to the relevant regulations for hospitalized patients. Poor pregnant women who are hospitalized to give birth should also be entitled to the poverty relief subsidy under the "Reduction and Elimination" program.　　4, special diseases, chronic disease outpatient treatment, such as tumors, aplastic anemia, cirrhosis, chronic bronchitis in the elderly, uremia and other diseases, can be in the basic medication directory of the cooperative medical care, enjoy a certain amount of compensation each year, the compensation standards and specific diseases by the county or city to develop.　　Third, the new rural cooperative medical compensation policy Farmers participating in the cooperative medical care, regardless of 1,] clinic or hospitalization, the actual incurred medical costs, as long as they meet the relevant provisions of the cooperative medical care, will be able to obtain a certain percentage of compensation.　　1. Outpatient compensation. Participating farmers can receive compensation for their medical expenses incurred in outpatient clinics of designated medical institutions in accordance with the outpatient clinic compensation measures and compensation procedures formulated by the county and city, but no compensation will be made for those who seek medical treatment in non-designated medical institutions.　　2. Hospitalization compensation. Participating farmers who need to be hospitalized due to illnesses must be hospitalized in designated medical institutions for cooperative medicine, and their compensation methods and compensation ratios must be compensated in accordance with the requirements of the implementation rules (programs) formulated by the county or city.

(1) Medical expenses incurred by participating farmers for hospitalization in designated medical institutions are compensated proportionally after first deducting the amount specified in the starting standard, and then deducting the cost of medicines beyond the scope of the basic medication catalog and the cost of relevant special examinations. The starting standard is set at different levels of medical institutions. The lower the primary medical institution, the lower the starting standard. The higher the level of medical institution, the higher the starting standard. It is divided into four levels: first-level hospitals (township health centers), second-level hospitals (county and city hospitals and some state-level hospitals), third-level hospitals, and provincial-level and higher-level hospitals. The starting payment standard is 100 yuan, 200 yuan, 400 yuan and 600 yuan respectively. When the counties and cities set the starting payment standard, in principle, they follow the above standards. It is normal for some counties and cities to appropriately lower the starting payment standard for grassroots fixed-point medical institutions and raise the starting payment standard for upper-level fixed-point medical institutions according to the actual situation.　　(2) When a participating farmer is hospitalized in a designated medical institution and incurs medical expenses, the amount of the starting payment standard is subtracted. Then subtract the amount of the part that should be paid out-of-pocket, which is the scope of calculation of compensation. This is the basis for calculating the scope of compensation. The specific amount that should be compensated to the participant is calculated according to the compensation ratio. The specific compensation ratio is also determined according to the level of first-class hospitals, second-class hospitals, third-class hospitals and provincial-level and above hospitals. The specific ratios are 60%, 50%, 30% and 20% respectively. Individual counties and cities in the development of the program, an appropriate increase in the proportion of compensation for primary health care institutions, is a normal situation.

3. Reasonable determination of the maximum compensation standard.

4, belonging to the "exclusion" of medical expenses, cooperative medicine will not be reimbursed. Such as traffic accidents, fighting, alcoholism, suicide, self-inflicted injuries, beauty, orthopedic and so on.　　Fourth, the new rural cooperative medical other provisions 1, cooperative medical institutions. Cooperative medicine designated medical institutions is to provide basic medical services for participating farmers, its main object is the government-run non-profit medical institutions, to meet the qualifying standards of the village health clinic can gradually enter the scope of the designated medical institutions, in order to facilitate the participation of farmers close to the outpatient clinic, to solve the problem of treatment of minor injuries and illnesses.　　Medical institutions within the scope of the object of designated medical institutions, must first obtain the "medical institutions practice license", and then apply for designated medical institution qualification with the relevant procedures. After the county and municipal health administrative departments and the cooperative medical management organization assessment, evaluation, meet the conditions, in the form of official documents to determine the cooperative medical designated medical institutions. If a fixed-point medical institution, in the course of its operation, suffers a medical accident of grade two or above, or if a medical dispute with a large social impact occurs, or if it uses improper means to obtain funds for cooperative medicine, the qualification of the fixed-point medical institution may be suspended or canceled according to the nature of the problem and the severity of the circumstances.　　Village health clinics are determined to be designated medical institutions, and must meet the qualifying standards and obtain a Medical Institution Practice License. Participating farmers who seek medical treatment at village health centers are only reimbursed for the outpatient subsidy portion. Village health offices cannot conduct inpatient services.　　2. Establishing a systematic and perfect reimbursement and compensation procedure, which not only facilitates enrolled farmers to report their accounts and receive timely compensation, but also ensures the safety of cooperative medical funds.　　The cooperative medical management methods and implementation programs formulated by the pilot counties and cities of cooperative medical care have clear provisions on the reporting procedures, reporting requirements, and compensation methods. Both the staff of the cooperative management organizations and the participants in cooperative medical care must strictly abide by them.　　Participants are compensated for medical expenses incurred during outpatient visits to designated medical institutions. In general, the compensation is made on an immediate basis, and the compensation is registered in accordance with the relevant procedures.　　Compensation for hospitalization needs to be stratified according to the level of the medical institution and the amount of medical expenses. If the amount of compensation is less than 1,000 yuan, it is only necessary to be examined and approved by the township cooperative management organization, and the compensation will be made at the medical institution in which it is made. If the amount of compensation is more than 1,000 yuan, it must be submitted to the county or city cooperative management organization for examination and approval, and then the compensation will be made in accordance with the relevant procedures. If the compensation amount reaches the maximum compensation standard and needs to be reimbursed twice, it should be collectively studied by the leaders of the county and city cooperative management organizations, and then reimbursed in accordance with the relevant procedures. 3. The compensation for participating farmers is implemented in the system of advance payment by the designated medical institutions. That is, participating farmers hospitalized in designated medical institutions, only prepaid part of the self-payment. For example, if a disease is hospitalized in a township hospital, it is estimated that the total medical cost should be prepaid 3,000 yuan, and the participant only needs to prepay 1,500 yuan, which will be refunded after the patient is discharged from the hospital. Need to prepay another 150O yuan, advanced by the designated medical institutions, after the settlement, the county-level cooperative medical management organization should compensate participants for the compensation fee, directly into the medical institutions.　　4, the new rural cooperative medical care must have a set of leadership, work team. Including the county (city) new rural cooperative medical care coordination and leadership group, county (city) new rural cooperative medical care management committee, county (city) new rural cooperative medical care supervisory committee, the office for the county (city) new rural cooperative medical care management bureau (or center). Supervision and management of cooperative medical care, audit, audit, etc. There is a set of perfect regulations, norms, procedures.　5, the new rural cooperative medical care adhere to the farmers to participate voluntarily, multi-party financing, the county run by the county management, to income and expenditure, protection of the principle of moderation. Farmers voluntarily participate in the new rural cooperative medical care, each person needs to pay only 10 yuan per year, and then through the financial subsidies at all levels, constituting the farmers' medical mutual ****ji system, such a system for the farmers to solve the problem of difficult to see a doctor, expensive, is undoubtedly one of the most effective ways and means. However, it must be only a form of mutual ****ji, participating farmers must also pay part of the medical treatment. It can only provide a moderate level of protection. At the end of each year's operation, the total funds for cooperative medical care must have a moderate balance, with a balance rate of about 20% being normal. In the next year of operation, participating farmers must pay another 10 yuan, and all levels of finance will continue to subsidize the program on an annual basis. In the long run, in a virtuous cycle, every year a significant portion of participating farmers enjoy hospitalization and outpatient compensation for their illnesses.　　Participation in cooperative medical care must be on a household basis, with all members of the family participating and contributing.　　6. Cooperative medical policy orientation. The cooperative medical policy, especially the compensation policy. Participating farmers are encouraged to seek medical treatment at primary hospitals first, and then to transfer to higher-level hospitals for problems that cannot be solved by primary hospitals. In this way, the burden of individual medical fees on participating farmers for hospitalization is reduced. Secondly, it promotes the standardization of the management of primary medical units, strengthens the construction of infrastructure, continuously improves the level of technology, creates a competitive mechanism, and strengthens the overall service function. Third, it saves cooperative medical expenses. Fourthly, because the more primary hospitals, the fewer out-of-pocket payments participating farmers make for hospitalization, the higher the reimbursement rate, the more benefits participating farmers receive, and the higher the overall compensation rate for cooperative medical care.　　7. The financing of the new rural cooperative medical care is based on financial subsidies at all levels. Participants pay only 10 yuan a year, so compensation fully reflects the nature of mutual assistance, and it is impossible to be absolutely even. The fact that it is a mutual assistance scheme means that if a participant does not receive compensation this year, he or she may receive it next year or the following year. Family members, may be young and healthy did not enjoy, while the elderly or children enjoy more opportunities.