In order to implement the spirit of the Central Committee of the Communist Party of China and the State Council's Decision on Further Strengthening Rural Health Work (Zhong Fa [2002] 13), establish and improve a new rural cooperative medical system that is suitable for the economic and social development level and farmers' economic affordability in our region, solve the problems of farmers' poverty and returning to poverty due to major diseases, and improve the health level of farmers in our region. According to "General Office of the State Council forwarded to the Ministry of Health" I. Objectives (1) To formulate the price of medical and health services in township hospitals (to be formulated separately by the health, finance and price departments of the autonomous region), standardize the behavior of rural two-level medical and health services, improve the management system of rural three-level health services, improve the level of rural health services and reduce the burden on farmers. (2) In 2003, the autonomous region selected three counties (cities) to carry out the pilot project of the new rural cooperative medical system. Since 2004, according to the work arrangements of the central and autonomous regions and the economic level of cities, counties (cities), cities have started the pilot work of the new rural cooperative medical system. By 20 10, the new rural cooperative medical system in the whole region will basically cover rural residents, and farmers can be encouraged to participate in medical insurance in economically developed rural areas. Second, the basic principles (a) voluntary participation, the principle of taking the household as the unit. All farmers with rural hukou voluntarily participate in the new rural cooperative medical system on a household basis, and implement the method of one village, one book, one household, one card and one voucher for medical treatment. (two) to ensure that five households and poor households enjoy the principle of new rural cooperative medical care. Governments at all levels should set up medical assistance funds to help rural five-guarantee households and poor households remit the expenses paid by individuals to participate in the new rural cooperative medical system, so that they can enjoy the new rural cooperative medical system and prevent the phenomenon of returning to poverty due to illness and causing poverty due to illness. (3) The principle of multi-party financing. The new rural cooperative medical system implements a financing mechanism that combines individual contributions from farmers, collective support and government funding. The minimum period of participation in cooperative medical care is one year, and those who quit halfway will not be returned, and the newly added population is allowed to participate halfway. Medical fund delivery should be paid at the beginning of each year. (4) The principle of ensuring moderation with fixed income. The subsidy of the new rural cooperative medical system is mainly hospitalization, and the subsidy of the rural cooperative medical system fund is within the limits of income, with a slight balance, so that farmers can get benefits and alleviate the phenomenon that farmers become poor and return to poverty due to illness. (five) the new rural cooperative medical institutions are non-profit organizations, and the state shall be exempted from relevant taxes and fees according to the nature of medical and health non-profit organizations. The designated service institutions of the new rural cooperative medical system are county-level medical and health institutions and township hospitals. (six) in order to actively and steadily implement and promote the cooperative medical system, the pilot counties (cities, districts) choose to carry out in areas that the government attaches great importance to, the economic level is good, and the enthusiasm of the masses is high. The number of participants in the pilot counties (cities, districts) must reach more than12 of the total number of farmers in the area under their jurisdiction, so as to ensure the normal operation of the pilot, ensure success, gain experience and gradually promote it from point to point. Third, organization and management (1) strengthen leadership. The government at or above the county level will incorporate the new rural cooperative medical system into the government's social development plan, prevent and put an end to the phenomenon of poverty caused by illness and returning to poverty due to illness, and ensure the continuous improvement of farmers' health level. (2) departmental cooperation. The health department should be a good government worker, responsible for the management, supervision, guidance and planning of the new rural cooperative medical system, and constantly promote the development of cooperative medical system; The financial department of the insured farmers every year, according to the government's commitment to do a good job in the budget of government cooperative medical subsidy funds, and included in the fiscal budget, to ensure that the funds are allocated in full and on time; The agricultural department assisted the propaganda and mobilization of the new rural cooperative medical system, and obtained the knowledge of * * * to reduce the burden on farmers; Civil affairs, poverty alleviation and other departments should give financial support to rural five-guarantee households and poor farmers' families to participate in the new rural cooperative medical system, effectively preventing the occurrence of poverty caused by illness; Propaganda departments and news media adopt various forms to publicize the new rural cooperative medical system; The audit department shall review and supervise the income and expenditure and management of the new cooperative medical fund to ensure earmarking. (iii) Organization 1. Establish a new rural cooperative medical management system according to the principle of streamlining and high efficiency. The people's governments of autonomous regions and cities (prefectures) set up a new rural cooperative medical management committee led by the main leaders of the government and composed of health, finance, agriculture, civil affairs, auditing, poverty alleviation and other relevant departments. The rural primary health care committee has been established, which can be fully responsible for the management of the new rural cooperative medical system and rural primary health care. The health administrative departments of autonomous regions and cities (prefectures) shall set up special rural cooperative medical management offices, which shall be adjusted by personnel. In principle, the establishment will not be increased, and its personnel and business funds will be allocated by the finance at the same level. The management office is responsible for the planning, inspection, guidance, supervision and daily business management of the new rural cooperative medical system at the same level. 2. The people's government at the county level shall set up a new rural cooperative medical management committee composed of relevant departments and farmers' representatives who participate in the new rural cooperative medical system, and be responsible for the coordination, management and guidance of relevant organizations. The Committee has an agency responsible for specific business work, and its personnel are adjusted by the people's government at the county level. According to the needs in the township (town) can set up institutions (personnel) or entrust the relevant agencies to manage. The wages and working expenses of the handling personnel shall be included in the fiscal budget at the same level. May not be drawn from the cooperative medical fund. Four. Financing standard (1) The individual payment standard of farmers is not lower than per person per year 10 yuan, and the payment standard can be increased in areas with good economic conditions. Whether the employees of township enterprises (excluding those who take farmers' families as units to participate in the new rural cooperative medical system) participate in the new rural cooperative medical system shall be decided by the people's government at the county (city, district) level. (2) Rural collective economic organizations shall give appropriate support to the new rural cooperative medical system in their villages, and the specific support standards shall be determined by the people's governments at the county (city, district) level. But the collective support part shall not be shared with farmers. Encourage social organizations and individuals to fund the new rural cooperative medical system. (III) Since 2003, for farmers participating in the new rural cooperative medical system, the finance of the autonomous region will subsidize 5 yuan per person per year through special transfer payments, and the financial subsidies of cities (prefectures) and counties (cities, districts) per person per year will not be lower than that of 5 yuan, and counties (cities, districts) with good economic conditions can appropriately raise the financing standards. V. Fund Management (1) The new rural cooperative medical fund is a private social fund with voluntary contributions from farmers, collective support and government subsidies. Management shall be carried out in accordance with the principles of revenue and expenditure, balance of payments and openness, fairness and justice. Do earmarking, special storage, shall not be misappropriated. (two) the new rural cooperative medical fund is managed by the county (city, district) level new rural cooperative medical management committee and its agencies. The new rural cooperative medical care agency shall set up a special account for the new rural cooperative medical care fund in the state-owned commercial bank recognized by the CMC to ensure the safety and integrity of the fund, establish and improve the management rules and regulations of the new rural cooperative medical care fund, raise funds reasonably in accordance with the provisions, and timely examine and pay the new rural cooperative medical care fund. (III) Funds paid by individuals and supported by rural collective economic organizations in the new rural cooperative medical fund shall, in principle, be collected annually by the agencies (personnel) set up by the new rural cooperative medical service agencies in townships (towns) and deposited in the special account of the new rural cooperative medical fund. (four) the new rural cooperative medical fund is mainly used to subsidize the large medical expenses or hospitalization expenses of farmers who participate in the new rural cooperative medical system. Where conditions permit, large medical expenses can be combined with small medical expenses, which not only improves the ability to resist risks, but also takes into account the interests of farmers. For the new rural cooperative medical fund that has not been used during the year or the balance of the previous year, a routine physical examination can be arranged for the insured farmers, and the specific physical examination items are formulated by the health administrative department of the county (city, district). Counties (cities, districts) should make overall consideration according to the actual number of farmers participating in the new rural cooperative medical system, farmers' financing standards and specific operation conditions, and scientifically and reasonably formulate the Qifubiaozhun, subsidy items and reimbursement ratio of the new rural cooperative medical system. (5) The allocation of government funds is 65,438+0. Autonomous region of the new rural cooperative medical management institutions responsible for the audit of the city, county (city, district) government last year subsidy of the new rural cooperative medical fund allocation and the number of participants, according to the provisions of the autonomous region government budget into the departmental budget plan, reported to the autonomous region finance included in the budget. 2. The city's new rural cooperative medical management institution is responsible for auditing the funds of rural cooperative medical care of the government at the corresponding level and the number of participants. According to the provisions of the government's budget at the corresponding level, the subsidy expenditure of rural cooperative medical care at the corresponding level will be included in the departmental budget plan, reported to the finance at the same level for inclusion in the budget, and reported to the new rural cooperative medical care management department of the autonomous region. 3. County (city, district) level of the new rural cooperative medical institutions responsible for the audit of the county (city, district) of the new rural cooperative medical insurance number and payment, according to the provisions of the government budget at the corresponding level will be included in the budget of the new rural cooperative medical subsidy expenditure at the corresponding level, and report to the municipal administrative department of the new rural cooperative medical system. 4. County (city, district) level new rural cooperative medical care agencies, at the end of each month 10 working days and village-level new rural cooperative medical care management institutions to settle accounts once, and to be posted. (VI) The financial subsidy of the autonomous region to the new rural cooperative medical system is: after the farmers voluntarily pay according to the standard, the funds are allocated by the municipal and county (city, district) governments and deposited in the special account opened by the agency of the new rural cooperative medical system in the state-owned commercial bank, and the autonomous region finances subsidize the municipal and county (city, district) finances through transfer payment, and then the funds are allocated to the special account opened by the agency of the new rural cooperative medical system in the state-owned commercial bank. (VII) Autonomous subsidies to the new rural cooperative medical system are included in the fiscal budget of the current year by the municipal and county (city, district) finances, and are allocated to the financial accounts of the new rural cooperative medical system at the county (city, district) level together with individual farmers' contributions. (eight) the rural cooperative medical fund supervision 1. At the county and township levels, supervision committees composed of government, finance, supervision, auditing, health, publicity, civil affairs, family planning and other relevant departments and participating farmers' representatives are established to regularly inspect and supervise the use and management of cooperative medical care funds. 2 county new rural cooperative medical management committee at any time to accept the supervision of the supervision committee and the masses, report to the people's congress at the same level every year, take the initiative to accept supervision. 3. County-level new rural cooperative medical care management institutions take measures such as posting to the village, and publish the specific income and expenditure of new rural cooperative medical care funds every quarter, so that farmers participating in the new rural cooperative medical care can directly supervise, ensure farmers' right to participate and know, and ensure that the new rural cooperative medical care system is open, fair and just. 4 the implementation of the cooperative medical fund regular audit system, the audit department at a higher level shall audit the income and expenditure and management of the cooperative medical fund of the agency every six months. Intransitive verb medical service management 1. Strengthen the construction of rural health service network and the industry management of rural medical and health institutions, actively promote the reform of rural health system, improve the capacity and level of health services, and enable farmers to obtain better medical and health services. 2. County-level medical and maternal and child health care institutions, and township hospitals are designated service institutions for rural cooperative medical care. Designated rural cooperative medical institutions must improve and implement various diagnosis and treatment norms and management systems, ensure service quality, improve service efficiency and control medical expenses. The purchase, supply and management of drugs in township hospitals must meet the requirements of integrated rural management. The new rural cooperative medical management committees at all levels strengthen the supervision of the designated service institutions of cooperative medical care and implement dynamic management. 3. The new rural cooperative medical service agencies shall implement the system of first diagnosis and two-way referral in township hospitals. After the insured farmers get sick, they should be treated first in township hospitals. After being diagnosed in township hospitals, those who cannot be cured or have no treatment conditions should be immediately transferred to county-level medical and health institutions for treatment. During the recovery period, county-level medical institutions will be transferred back to township hospitals to control medical expenses. Health technicians in township hospitals should seriously study their professional skills, improve their technical level, reduce misdiagnosis and ensure the health and safety of farmers. The referral or hospitalization expenses without the first visit of the health center are generally not compensated. There are exceptions under special circumstances. The two-way referral system shall be formulated by the local health administrative department. 4. The Health Department of the Autonomous Region shall formulate the catalogue of basic drugs and basic diseases of the new rural cooperative medical system in our region (later formulated). 5. The hospitalization expenses of non-designated hospitals are generally not allowed to be reimbursed. Only after the special circumstances are approved by the new rural cooperative medical system, can they be reimbursed in proportion. 6. Once found, those who fraudulently use the rural cooperative medical care card for hospitalization shall immediately terminate and cancel the compensation, send a notice to the families who provide the cooperative medical care card, fraudulently use the cooperative medical care card for hospitalization and receive compensation. After finding out the facts, in addition to recovering the compensation, the cooperative medical care card will also be recovered, and the paid overall funds will not be refunded. 7. Migrant workers who go to public hospitals for treatment due to acute diseases in other places should have certificates, medical records and invoices from emergency hospitals. If there is no fraud after inspection by management personnel, compensation shall be given according to regulations. 8. In any of the following circumstances, no reimbursement will be made for engaging in prostitution or contracting sexually transmitted diseases (1); (2) Traffic accidents and non-work-related accidents; (3) Expenses incurred due to drinking, fighting (including fighting between husband and wife), suicide and self-injury; (4) hanging a bed for hospitalization and family beds without approval; (5) The doctor thinks I can leave the hospital, but I don't want to leave the hospital; (six) the scope and variety of drugs used for cooperative medical compensation shall be in accordance with the drug varieties specified in the rural two-level basic drug list, and the expenses for drugs beyond the scope shall not be compensated. Seven. Organization and implementation (1) Strengthen the government's leadership over the new rural cooperative medical system. Governments at all levels should formulate the implementation plan of the new rural cooperative medical system, and lead and coordinate all departments to promote the in-depth development of the new rural cooperative medical system. Autonomous region or city (prefecture) people's government should choose pilot counties in accordance with the principles of high enthusiasm, strong financial affordability and good management foundation of insured farmers, and actively and steadily carry out the new rural cooperative medical care. (two) to strengthen the publicity of the new rural cooperative medical system. Take various forms to publicize the significance and specific practices of the new rural cooperative medical system to farmers, guide farmers to continuously enhance their awareness of self-care and mutual assistance, and mobilize farmers to actively participate in the new rural cooperative medical system voluntarily. The payment obligations performed by farmers participating in cooperative medical care cannot be regarded as increasing the burden on farmers. (3) The pilot counties (cities) of the new rural cooperative medical system focus on exploring the management system, financing mechanism and operation mechanism of the new rural cooperative medical system. The people's government at the county level shall, on the basis of investigation and study, formulate practical measures in combination with local conditions, and coordinate the relevant departments to organize and implement them under the leadership of the government at the same level.