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1999.04.01
Status: Valid Issue Date:1999-04-01 Effective Date:1999-04-01
Department of Issue:Liaoning Provincial Government
Issue Number:Liaozhengfa [1999] No. 14
Municipal People's Governments, Provincial Government Departments:
Now, we are issuing to you the Liaoning Province, the implementation of urban workers medical insurance system reform views issued to you, please combine with the actual situation of the region, the department, and conscientiously carry out the implementation.
The medical insurance system is an important part of the social security system. Urban workers medical insurance system reform, is the realization of state-owned enterprise reform and development goals of the urgent need to establish a socialist market economic system is an inevitable requirement, but also to improve the health of the majority of workers is an important measure. Actively promoting the reform of the medical insurance system for urban workers and improving the social security system is related to the overall situation of reform, development and stability, and to the realization of the cross-century strategic goal of China's socialist modernization. All regions and departments should attach great importance to this work, strengthen leadership and take strong measures to ensure the smooth progress of the reform of the medical insurance system.
Liaoning Provincial People's Government
April 1, 1999
Implementation Opinions on the Reform of the Medical Insurance System for Urban Workers in Liaoning Province
In order to actively and steadily push forward the reform of the medical insurance system for urban workers, speed up the establishment of the basic medical insurance system for urban workers, and promote the establishment of a social security system for the whole province, in accordance with the "Decision of the State Council on the Establishment of the The decision of the State Council on the establishment of the basic medical insurance system" (State Development (1998) No. 44), combined with the actual situation of the province, the formulation of "Liaoning Province, urban workers medical insurance system reform implementation views.
I. Tasks and Principles of Reform
The main tasks of the reform of the medical insurance system are: to establish a basic medical insurance system for urban workers, that is, to adapt to the socialist market economic system, according to the financial, corporate and individual affordability, to ensure that the workers' basic health care needs of the social medical insurance system.
The principles for the establishment of a basic medical insurance system for urban workers are: the level of basic medical insurance should be commensurate with the level of development of productive forces at the primary stage of socialism; all urban employers and their workers should participate in basic medical insurance, and local management should be carried out; the costs of basic medical insurance should be borne by the employer and the worker on both sides***; the basic medical insurance fund should carry out a combination of social co-ordination and individual accounts; and the "low level" principle should be maintained, with a view to ensuring that the basic medical needs of workers are protected. The basic medical insurance fund combines social coordination and individual accounts; and adheres to the principle of "low level and wide coverage" to protect the basic medical needs of workers.
Second, the main content of the reform and policy
(A) basic medical insurance coverage
Basic medical insurance is the government to protect the interests of employers and employees, the adoption of a mandatory social insurance. All employers in the province's cities and towns, including enterprises (state-owned enterprises, collective enterprises, foreign-invested enterprises, private enterprises, etc.), organs, institutions, social organizations, private non-enterprise units and their employees, are required to participate in basic medical insurance. It is up to each municipal government to decide whether township and village enterprises and their employees, owners of urban individual economic organizations and their employees will participate in basic medical insurance.
In order to enhance the ability of the medical insurance fund to help each other and resist risks, to improve the level of social management and service, and to take into account the differences in economic development and medical consumption between regions, the province's basic medical insurance is implemented at the municipal level with provincial municipalities as the coordinating unit. All urban employers and their employees within the administrative area of Liaoning Province are required to participate in the basic medical insurance of their municipalities in accordance with the principle of territorial management, and to implement a unified policy for the unified collection, use and management of the basic medical insurance fund. Railroad, electric power, ocean transportation and other cross-region, production mobility of enterprises and their employees, can be relatively centralized way to participate in the integrated area of the basic medical insurance off-site.
(2) The source of basic medical insurance premiums and the proportion of contributions
The level of basic medical insurance for employees can only be determined on the basis of the actual affordability of the state, employers and individuals. In order to clarify the responsibility of employers and employees, and enhance the individual's sense of self-protection, the basic medical insurance premiums by the employer and employee **** the same payment. Municipalities should be based on the local financial and enterprise's actual affordability to reasonably determine the employer contribution rate, generally controlled in the employee's gross salary of about 6%. The actual measured within 6%, can not be raised to 6%; do need more than 6%, must be reported to the provincial labor department, the Department of Finance review. Employee contribution rate is generally 2% of their wages.
(C) the establishment of basic medical insurance fund and individual accounts
In order to give full play to the basic medical insurance fund of mutual **** relief role, but also to enhance the individual awareness of saving medical expenses and self-protection ability, the basic medical insurance to implement the social co-ordination and individual, account combination. The basic medical insurance fund consists of a comprehensive fund and individual accounts. Social co-ordination, that is, the basic medical insurance fund to implement a unified fund-raising, unified management, unified transfer, unified use. The individual account is to establish a mechanism for self-restraint and accumulation of savings by employees. The basic medical insurance premiums paid by individual employees are all credited to their individual accounts. The basic medical insurance premiums paid by the employer are divided into two parts, one of which is used to establish a comprehensive fund and the other is allocated to the individual account. About 30% of the employer's contribution is transferred to the individual account, with the specific percentage determined by each municipality in accordance with the scope of payment of the individual account and the age of the employee, among other factors. The part of the unit's contribution transferred to the employee's personal account is based on the employee's own salary income.
The principal and interest of the individual account are owned by the individual and can be carried forward for use and inheritance.
(4) The scope and standard of payment of the centralized fund and individual account
In order to clarify the responsibility and avoid overdraft of the centralized fund on the individual account, the centralized fund and the individual account should be delineated in the scope of their respective payments and accounted for separately, and should not be crowded out by each other. The coordinated fund mainly pays for large medical expenses or hospitalization medical expenses, and the individual account mainly pays for small medical expenses or outpatient medical expenses. Municipalities may, according to the actual situation, determine the specific forms of management and use of the integrated fund and individual accounts.
Municipalities shall, in accordance with the principles of "income over expenditure" and "balance of income and expenditure" and the affordability of the employees, determine the starting standard and maximum payment limit of the integrated fund, as well as the proportion of the individual's burden of medical expenses above the starting standard and below the maximum payment limit. The threshold refers to the amount of medical expenses that must be borne by the individual according to regulations before payment is made by the integrated fund. In principle, the starting standard is set at about 10% of the average annual salary of local employees. In the case of a unified payment scope divided according to expenses, the starting payment standard can be determined according to a certain amount of accumulated medical expenses incurred in a year; in the case of a unified payment scope divided according to outpatient and hospitalization, the starting payment standard can be set for each hospitalization, and the starting standard can be lowered sequentially in the case of multiple hospitalizations in a year. The maximum payment limit refers to the upper limit of medical expenses that can be paid by the integrated fund in a year, i.e. the "ceiling line". In principle, the maximum payment limit is set at about four times the average annual wage of local employees. Medical expenses below the threshold are paid from the individual account or at the individual's own expense. Medical expenses above the starting standard and below the maximum payment limit are mainly paid from the coordinated fund, with individuals also bearing a certain percentage. Medical expenses exceeding the maximum payment limit can be solved through supplementary medical insurance, commercial medical insurance and social assistance.
(V) Management and supervision of the basic medical insurance fund
The management of the basic medical insurance fund is related to the normal operation of the entire basic medical insurance system and the immediate interests of the employees, and it is necessary to manage and utilize the fund effectively to ensure that the fund is used in a safe, appropriate and effective manner.
1. Municipal finance departments should work with the medical insurance agency, the basic medical insurance fund into the social security fund financial account, the implementation of the two lines of management, to ensure that the fund is fully used to protect the basic medical care for employees, any unit or individual shall not be crowded out and misappropriated, and shall not be used to balance the budget. Practical methods for the payment of basic medical insurance premiums should be formulated, and strong measures should be taken to ensure the collection rate of the basic medical insurance fund. Adhere to the income for expenditure, to ensure that the fund balance.
2. Municipalities should establish and improve the basic medical insurance fund budgeting system, do a good job in the preparation, approval and implementation of the budget, carefully analyze and check the fund's budget implementation, found that the problem of timely solutions to the problem, and to establish and improve the financial accounting system and internal audit system.
3. Municipal social insurance agencies are responsible for the collection, management and payment of the basic medical insurance fund. The business expenses of the social insurance agencies shall be settled by the financial budgets at all levels, and shall not be withdrawn from the fund. All localities shall, in accordance with the principle of streamlining and efficiency, reasonably determine the staffing of medical insurance organizations and the budgets for the personnel and public funds of the agencies, ensure timely disbursement, and establish a computerized management system for medical insurance settlements.
4. Labor security and financial departments at all levels, to strengthen the supervision and management of the basic medical insurance fund. Audit departments should regularly audit the fund income and expenditure and management of social insurance agencies. Municipalities are required to set up medical insurance fund supervisory organizations with the participation of representatives of relevant government departments, employers, medical institutions, trade unions and relevant experts to strengthen social supervision of the basic medical insurance fund.
5. The Provincial Department of Finance shall, in accordance with the Ministry of Finance's "Employee's Basic Medical Insurance Fund Financial System" and "Employee's Basic Medical Insurance Fund Accounting Methods", and in the light of the actual situation of the province, formulate the rules for the implementation of the financial system of the basic medical insurance fund, specify the specific policies and methods for the management and settlement of the basic medical insurance fund, strengthen the financial management of the basic medical insurance fund, prevent the squeezing and diversion of funds, and improve the efficiency of the use of funds. Improve the efficiency of fund utilization. To do a good job of training and improve the quality of accounting personnel.
6. The basic medical insurance fund bank interest-bearing methods: part of the current year's fund-raising, according to the interest rate of demand deposits; the previous year's carry-over of the fund's principal and interest, according to the three-month period of whole deposit bank deposit rate of interest; deposited into the social security financial account of the sedimentary funds, compared to the three-year zero deposit savings deposit rate of interest.
(F) the medical treatment of the personnel concerned
Retired personnel and the Old Red Army do not participate in the reform of the medical insurance system, the original medical treatment remains unchanged, medical expenses according to the original funding channels, payment of the difficulties, the people's government at the same level to help resolve. Retirees and the old Red Army medical management by the provincial government to formulate.
The medical treatment of the soldiers with revolutionary disabilities of grade B or above shall remain unchanged, and the medical expenses shall be solved according to the original funding channels, and shall be managed by the social insurance agency in a separate account. Any shortfall in the payment of medical expenses shall be met by the local people's government.
Retirees participate in basic medical insurance, individuals do not pay basic medical insurance premiums. Municipalities shall take appropriate care of the amount credited to the retiree's individual account and the proportion of medical fees borne by the individual. The proportion of the employer's contribution to the retiree's personal account shall be higher than that to the personal account of the active employee.
The basic medical insurance premiums for laid-off workers in state-owned enterprises, including unit contributions and individual contributions, are paid by the reemployment service centers on the basis of 60% of the average salary of the local employees in the previous year, and are transferred to the individual accounts in accordance with the prescribed proportion.
State civil servants enjoy the medical subsidy policy on the basis of participation in basic medical insurance. The specific measures are implemented in accordance with the relevant state regulations.
In order not to lower the level of medical consumption of workers in some industries and enterprises with good efficiency and high medical treatment, industries and enterprises are allowed to establish enterprise supplementary medical insurance on the basis of participation in basic medical insurance. Supplementary medical insurance premiums within 4% of the total wages, can be charged from the employee welfare costs, welfare costs are not enough to charge part of the approved by the financial sector at the same level and included in the cost.
Three, health care system reform
Reform of the employee health insurance system must be accompanied by health care system reform. Only to improve the supporting reform of the health care system, in order to fundamentally control the rapid growth of medical costs, in order to provide employees with good basic medical services, to ensure the smooth establishment of the employee health insurance system. Therefore, it is necessary to speed up the reform of the medical and health system.
(I) Determination of the scope and standard of services for basic medical insurance
Determination of the scope and standard of medical services that can be paid for by the basic medical insurance fund is the key to safeguarding the basic medical needs of employees. Provincial labor security administrative departments shall, in accordance with the scope and standard of basic medical insurance services, the settlement of medical expenses, the basic medical insurance drug catalog, diagnostic and therapeutic items, the standard of medical service facilities, and the corresponding management methods formulated by the State, organize the relevant departments to formulate the standards and methods for the implementation of the same.
(2) Basic medical insurance implements the management of designated medical institutions and designated pharmacies
In order to facilitate the promotion of fair competition among medical institutions, standardize medical practices, reduce medical costs, and improve the quality of services, a competitive mechanism is introduced in the determination of designated medical institutions and designated pharmacies. Employees can choose a number of different levels of designated medical institutions for medical treatment and purchase of medicines, but also with the designated medical institutions can be prescribed in a number of designated pharmacies to purchase medicines. The labor security department, in conjunction with health, finance and other relevant departments, will formulate methods for qualifying fixed-point medical institutions and fixed-point pharmacies. Municipal social insurance agencies shall be responsible for determining designated medical institutions and designated pharmacies in accordance with the principles of integrating Chinese and Western medicine, taking into account primary, specialized and comprehensive medical institutions, and facilitating employees' access to medical care, and shall sign contracts with designated medical institutions and designated pharmacies to clarify their respective responsibilities, rights and obligations. Municipal drug supervision and management departments are responsible for handling drug purchases and drug accidents in accordance with the state-developed measures for handling drug purchases and drug accidents in designated pharmacies.
(C) the establishment of separate accounting for medicine, separate management system
In order to help protect the interests of patients, establish a reasonable compensation mechanism for medical institutions, and promote the reform of the drug distribution system, the medical institutions to further strengthen the analysis of economic operation and cost accounting, the implementation of separate accounting for medicine, separate management system, to promote the rational use of medicines in health care institutions to reduce the burden on patients. The price charged for medical technology should be reasonably increased to reflect the value of medical labor; the proportion of drug income to business income should be reasonably determined to be lowered, and the income from drug sales should be handed over to the higher-level authorities for unified management and reasonable return; a system should be set up for unified procurement of medicines used in the medical sector by the health sector, so as to control the price of medicines and ensure the quality of medicines; and a mechanism should be set up to reasonably compensate medical institutions, and those that should be compensated by the government should be fully compensated by the government at all levels. The government should compensate in full and in a timely manner.
(D) deepen the reform of medical institutions, conversion or mechanism
closely focusing on "patient-centered" to carry out various reforms of medical institutions, the establishment of responsibility, constraints, competition, and vitality of the operating mechanism. We should pay attention to medical service management, formulate and strictly implement various medical service norms and standards, and promote the scientific, standardization and modernization of medical technology management and quality management; we should continuously improve the level of medical technology and the quality of medical services. To speed up and deepen the reform of personnel system, reduce the number of staff and increase efficiency, the introduction of competition mechanism, professional staff to compete for the post, and vigorously compress the administrative and logistical staff.
(E) adjust the layout of medical institutions, optimize the allocation of health resources
The direction of reform of the medical service model is that "major diseases" in the hospital, "minor diseases" in the community. The implementation of regional health planning should be synchronized with the reform of the employee health insurance system to establish and develop a social health service system with Chinese characteristics. Community health services should be actively developed, and the basic medical services provided in community health services should be included in the scope of basic medical insurance. Medical institutions are advocated to engage in various forms of union or merger, complementing each other's strengths and enjoying resources***. Medical institutions that do not meet the needs of society and whose technical equipment is outdated and outdated should be closed, suspended, merged or transferred, so as to expand into new areas of service that meet the needs of society. Improve the efficiency of the utilization of health resources, with less financial investment, so that the people get basic medical services, and promote the healthy development of health care.
Four, work progress and requirements
In accordance with the requirements of the State Council, the province should be initially established by the end of 1999, the basic medical insurance system for urban workers. Cities in the first half of 1999 must complete the basic work, before the end of September to complete the implementation of the formulation of square ning and related supporting policies, and reported to the provincial government for approval. The provincial government will be in line with the principle of maturity of one approved one, approval of the implementation of the municipal program, from October to implement one after another.
The reform of the medical insurance system is a strong policy, involving the immediate interests of the majority of workers, the relationship between national economic development and social stability. In order to do a good job, the provincial government requires:
1. To raise awareness and unify thinking. Municipal governments must attach great importance to this work, to be included in the important agenda, strengthen leadership, a clear mayor in charge of specifically responsible for the reform of the health insurance system to grasp the work; to seriously study and comprehend the CPC Central Committee, the State Council on the reform of the health insurance system, policies, awareness-raising, and firmly to do a good job in the reform of the health insurance system of the staff's confidence and determination.
2. To improve the organization, clear responsibilities. Medical insurance system reform policy, involving a wide range of complex, time-critical and difficult. To ensure that this year to complete the task of establishing a basic medical insurance system for urban workers, there must be strong organizational leadership, sound institutions, high-quality cadres and clear responsibilities. The provincial government has dispersed in the relevant departments of the original medical insurance management functions unified transfer to the provincial labor department. Cities should be in accordance with the requirements of the LiaoYuFa (1999) No. 7 document, as soon as possible to unify the city's medical insurance administrative functions, be sure to determine by the end of April institutions, staffing, personnel, and clear functions, so that the leadership, institutions, personnel, and work of the four in place.
3. To be carefully organized, carefully deployed. Medical insurance system reform is a systematic project. To focus on the basic medical insurance system innovation and mechanism conversion, and promote the socialization and institutionalization of medical insurance services and management. Municipalities to y understand and grasp the main tasks of the reform of the medical insurance system, the basic principles and policy measures, as soon as possible to organize forces to do a good job of investigation and research, scientific calculations and other basic work. To listen to a wide range of views on the basis of careful research, repeated argumentation, and urgently formulate in line with national requirements, but also meet the local reality of the basic medical insurance system reform program with operability. In the process of reform, municipalities should properly handle the connection between the old and new systems to ensure the smooth introduction and implementation of the new basic medical insurance system; they should adopt a positive attitude and take effective measures to properly solve the problem of participating in the insurance system of enterprises in difficulty, so as to protect the basic medical care of employees of enterprises in difficulty; they should formulate strong policies and regulations on the collection of funds and make efforts to improve the collection rate of the fund; and they should pay attention to the study of key points and hotspot issues arising from the reform, difficulties and hotspot issues arising from the reform, and to promote the establishment and implementation of a basic medical insurance system for urban workers as soon as possible.
4. To strengthen public opinion and publicity, and do a good job of ideological and political work. Reform of the medical insurance system involves the adjustment of the relationship between the interests of all parties, it is necessary to strengthen public opinion propaganda, in-depth and detailed ideological and political work to obtain the understanding and support of the majority of enterprises and the masses of workers, the central government's relevant policies and measures to speak thoroughly, so that all the units and workers can correctly deal with the partial interests and the overall interests of the relationship between the immediate interests of the long-term interests of the workers, and consciously participate in and support of this reform.
5. To strengthen collaboration and close cooperation. Urban workers health insurance system reform involves many departments, all relevant departments must play their respective roles, strengthen collaboration, close cooperation, labor security departments at all levels are responsible for health insurance system reform guidance, coordination, inspection and organization and implementation of work. Finance, health, physical reform, economic and trade, planning, drug supervision and management departments should be actively involved in accordance with their respective functions and division of labor, close cooperation, concerted efforts to support each other, *** with the reform of the basic health insurance system for urban workers.