Policy document on rural subsidized medical insurance

I. Basic Policies of the New Rural Cooperative Medical System The new rural cooperative medical system is an economic system of mutual medical assistance for farmers, which is organized, guided and supported by the government, with farmers participating voluntarily, and with multi-party financing from the collective and the government. 1, new rural cooperative medical care financing channels. According to the relevant regulations of the state, there are two main channels to raise funds in the pilot counties and cities of the new rural cooperative medical system: first, financial subsidies at all levels; Second, farmers who participate in cooperative medical care pay fees. Since 2006, according to the number of people participating in the new rural cooperative medical system, the counties and cities in which the new rural cooperative medical system is piloted have a total annual fund of 50 yuan per person, of which 20 yuan is subsidized by the central government, and 20 yuan is financially supported by the provinces, prefectures and counties (cities), and farmers pay fees 10 yuan. 2. The nature of the new rural cooperative medical system is "mutual assistance", that is, farmers who voluntarily participate in the cooperative medical system must pay a certain fee every year. The payment standard can be determined according to the local economic development level. The State Council Guofa [2004] No.3 document stipulates that the amount of individual contributions of participating farmers shall not be less than per person per year 10 yuan in principle. In economically developed areas, the payment standard can be raised on a voluntary basis according to the income level and actual needs of farmers. 3. The new rural cooperative medical system is the basic medical security system for mutual farmers. Since it is mutual assistance, it must be based on serious illness. That is, to solve the medical expenses of the farmers who are in urgent need of hospitalization after suffering from serious illness. However, considering the enthusiasm of farmers to participate in cooperative medical care and the actual situation of farmers seeking medical treatment in our state, cooperative medical care funds are divided into two parts, most of which are used as compensation funds for hospitalization of participating farmers and a small part as compensation funds for outpatient service, and family outpatient accounts are established. Participating farmers' family outpatient accounts, taking the family as a unit, set aside 6-8 yuan per person per year for family members to compensate for outpatient expenses in that year. Take the household as the unit, until it is used up, and the overrun will not be made up. The balance of the current year is carried forward to the next year to continue to be used. 4, the new rural cooperative medical care fund raising and procedures in place. The financing principle of the new rural cooperative medical system is: "farmers voluntarily participate, and the collective and the government raise funds through multiple channels", that is, on the basis of farmers' voluntary participation, the part paid by farmers is first collected into the f-] account of the new rural cooperative medical system in counties and cities in accordance with relevant regulations, and then the county (city) finance allocates matching funds in place according to the actual number of participants, and applies for subsidy funds from the provincial finance and the central finance. The cooperative medical fund paid by farmers can be paid by farmers themselves or by the collective economy. It can also be donated by the society. 5, the new rural cooperative medical system pilot must have the conditions. The document number of the Ministry of Health and the Ministry of Finance 2005 13 19 stipulates that all provinces and cities should continue to adhere to the standards of pilot counties (cities) when determining pilot counties (cities): First, local governments attach great importance to it and take the initiative to apply; Second, farmers' enthusiasm for participating in cooperative medical care is high, and rural grassroots organizations are relatively sound; Third, local governments at all levels can guarantee subsidy funds. Timely and fully; Fourth, the health administrative department has strong management ability, and the management of rural medical and health services is relatively perfect; Fifth, township hospitals implement county-level management. Reform is in place; Sixth, the medical assistance system was established simultaneously; Seventh, ensure the establishment, personnel and funds of cooperative medical service institutions, and purchase necessary office equipment such as computers. When a county formally declares to its superiors, it must make a formal written commitment. Second, the new rural cooperative medical special policy

1, for five-guarantee households, poor households, the disabled and other special (vulnerable) groups to participate in cooperative medical care, their personal funds should be paid by the civil affairs department. 2, one-child households, two female ligation households and other preferential family planning households to participate in cooperative medical care, the funds that individuals should pay, by the family planning department to solve. 3, who participated in the cooperative medical care of pregnant women in hospital delivery, according to the mode of delivery, were given a fixed subsidy. According to the plans formulated by counties and cities, the compensation for flat delivery is 150-250 yuan, and the compensation for cesarean section is 400-600 yuan. Pathological obstetrics shall be compensated according to the relevant regulations of inpatients. Poor pregnant women who give birth in hospital should also enjoy the poverty alleviation subsidy of "reducing consumption" 4, special diseases, chronic diseases, perennial outpatient treatment, such as cancer, aplastic anemia, liver cirrhosis, chronic bronchitis in the elderly, uremia and other diseases, can enjoy a certain amount of compensation every year in the list of basic drugs of cooperative medical care, compensation standards and specific diseases are formulated by counties and cities. Third, the compensation policy of the new rural cooperative medical system Farmers who participate in the cooperative medical system, whether 1,] are diagnosed or hospitalized, can get a certain proportion of actual medical expenses compensation as long as they meet the relevant regulations of the cooperative medical system. 1, outpatient compensation. Participating farmers in designated medical institutions for outpatient medical treatment, their medical expenses, in accordance with the county to develop outpatient compensation methods and compensation procedures, get compensation, but in non-designated medical institutions for medical treatment will not be compensated. 2. Hospitalization compensation. Participating farmers who need hospitalization due to illness must be hospitalized in designated medical institutions of cooperative medical care, and their compensation methods and compensation ratios are compensated according to the detailed implementation rules (schemes) formulated by counties and cities.

(1) After deducting the amount specified in Qifubiaozhun, the medical expenses incurred by participating farmers in hospitalization in designated medical institutions will be deducted from the drug expenses outside the scope of the basic drug list and related special inspection expenses, and will be compensated in proportion. Qifubiaozhun is determined according to different levels of medical institutions. The more primary medical institutions, the lower the minimum threshold. The higher the medical institution, the higher the minimum threshold. According to the first-level hospitals (township hospitals), second-level hospitals (county hospitals and some state-level hospitals), third-level hospitals and hospitals above the provincial level. The minimum payment standards are 100 yuan, 200 yuan, 400 yuan and 600 yuan respectively. Counties and cities in the formulation of Qifubiaozhun, in principle, in accordance with the above standards, some counties and cities according to the actual situation, appropriately reduced the basic designated medical institutions Qifubiaozhun, improved the designated medical institutions at a higher level Qifubiaozhun, which is normal. (2) The medical expenses incurred by the participating farmers in the designated medical institutions shall be deducted from the Qifubiaozhun amount. Subtracting the part that should be paid is the scope of calculating compensation. On this basis. Calculate the specific amount that should be compensated to the participants 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 and above hospitals. The specific proportions are 60%, 50%, 30% and 20% respectively. It is normal for individual counties and cities to appropriately increase the compensation ratio of designated medical institutions at the grassroots level when formulating plans.

3. Reasonably determine the highest compensation standard.

4, belong to the "except" medical expenses, cooperative medical care will not be reimbursed. Such as traffic accidents, fighting, alcoholism, suicide, self-mutilation, beauty, plastic surgery and so on. Four, the new rural cooperative medical system 1, other provisions of the designated medical institutions of cooperative medical care. Designated medical institutions of cooperative medical care are institutions that provide basic medical services for participating farmers, and the main targets are non-profit medical institutions organized by the government. Village clinics that meet the qualified standards can gradually enter the scope of designated medical institutions, which is convenient for participating farmers to seek medical treatment in the nearest outpatient clinic and solve the problems of minor injuries and ailments. Medical institutions within the scope of designated medical institutions must first obtain the Practice License of Medical Institutions, and then apply for the qualification of designated medical institutions with relevant procedures. After the examination and evaluation by the health administrative departments of counties and cities and the joint medical management institutions, those who meet the requirements are determined as designated medical institutions for cooperative medical care in the form of official documents. Designated medical institutions in the operation, the occurrence of more than two medical accidents or social impact of medical disputes, or by improper means to obtain cooperative medical funds, according to the nature of the problem and the seriousness of the case, suspend or cancel the qualification of designated medical institutions. Village clinics are designated medical institutions, which must meet the qualification standards and obtain the practice license of medical institutions. Participating farmers in the village clinic for medical treatment, only reimbursement of outpatient subsidies. Village clinics cannot carry out hospitalization business. 2. Establish a systematic and perfect reimbursement procedure, which not only facilitates the reimbursement of participating farmers, but also ensures the safety of cooperative medical funds. The management measures and implementation plan of cooperative medical care formulated by the pilot counties and cities of cooperative medical care have clear provisions on reimbursement procedures, reimbursement requirements and compensation methods. The staff of the joint management institution and the personnel participating in the cooperative medical care must strictly abide by it. Compensation for medical expenses incurred by participants in outpatient treatment at designated medical institutions. Generally speaking, compensation is made at birth, and compensation is registered according to relevant procedures. Hospitalization compensation should be based on the level of medical institutions and the amount of medical expenses. If the compensation amount is below 1000 yuan, it only needs to be audited by the township joint management institution and compensated in the medical institution where it is located. If the compensation amount is more than 1 1,000 yuan, the compensation shall be made according to relevant procedures after being reported to the county and city joint management institutions for review. Serious diseases, the amount of compensation to reach the highest compensation standard, the need for secondary compensation, to the county and city joint management institutions leading collective research, and then according to the relevant procedures for compensation. 3. The compensation for participating farmers shall be paid by designated medical institutions. That is, the participating farmers are hospitalized in designated medical institutions, and only the self-funded part is paid. The disease is hospitalized in a township-level hospital. It is estimated that the total medical expenses need to be paid in advance by 3,000 yuan, and the participants only need to pay in advance 1500 yuan. After the patient is discharged from the hospital, he should retreat more and make up less. The additional 150O yuan to be paid in advance shall be paid by the designated medical institution. After the settlement, the county-level cooperative medical management institutions will compensate the participants and directly allocate them to medical institutions. 4, the new rural cooperative medical care must have a set of leading institutions and working groups. Including county (city) new rural cooperative medical care coordination leading group, county (city) new rural cooperative medical care management committee, county (city) new rural cooperative medical care supervision committee, and the office is county (city) new rural cooperative medical care administration (or center). There is a set of perfect rules, norms and procedures for the supervision, management, audit and audit of cooperative medical care. 5. The new rural cooperative medical system adheres to the principles of farmers' voluntary participation, multi-party financing, county management, fixed income and appropriate guarantee. Farmers voluntarily participate in the new rural cooperative medical system, and each person only needs to pay 10 yuan every year, and then through financial subsidies at all levels, the economic system of mutual medical assistance for farmers is formed. This system is undoubtedly the most effective way to solve the problem of farmers' difficulty and expensive medical treatment. But it is only a form of mutual assistance, and farmers have to pay part of their own expenses for medical treatment. Only moderate protection can be achieved. After the annual operation, the general fund of cooperative medical care must have a moderate balance, and the balance rate is about 20%, which is normal. In the next operation year, the participating farmers must pay 10 yuan again, and the financial departments at all levels will continue to give annual subsidies. In the long run, a virtuous circle, every year a considerable number of participating farmers enjoy hospitalization and outpatient compensation after illness. To participate in the cooperative medical system, all family members must pay all the expenses on a household basis. 6. Policy orientation of cooperative medical care. Cooperative medical policy, especially compensation policy. Encourage participating farmers to seek medical treatment in primary hospitals after getting sick, and then transfer to hospitals step by step for problems that cannot be solved by primary hospitals. In this way, first, it reduces the burden of individual medical expenses for participating farmers. The second is to promote the standardized management of primary medical units, strengthen infrastructure construction, continuously improve the technical level, form a competitive mechanism, and enhance the overall service function. The third is to save the cost of cooperative medical care. Fourthly, the more grass-roots hospitals there are, the less the out-of-pocket part of participating farmers will be, the higher the proportion of reimbursement and compensation, the more benefits the participating farmers will get, and the higher the overall compensation rate of cooperative medical care. 7, the new rural cooperative medical care financing mainly by financial subsidies at all levels. Participants only pay 10 yuan a year, so the compensation fully reflects the nature of mutual assistance and cannot be absolutely average. Since it is mutual assistance, it means that the participants did not enjoy the compensation this year, and they may enjoy it next year or next year. Among family members, young and healthy people may not enjoy it, while the elderly or children enjoy more opportunities.

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