The new rural cooperative medical fund is used to compensate the medical expenses of participating farmers. The compensation scheme of cooperative medical care mainly includes deductible line, capping line, compensation ratio and compensation scope.
(1) hospitalization compensation: hospitalization expenses are compensated in proportion, and deductible line is set up. For the services provided by township medical institutions, the deductible line is 50 yuan, and no subsection compensation is implemented, and the reimbursement ratio is not less than 50%. The services provided by medical institutions at or above the county level shall be compensated in two or three sections. The deductible line of county-level medical institutions is not less than that of 200 yuan, and the reimbursement ratio is not less than 30%. The deductible line of medical institutions outside the county is 500 yuan, and the reimbursement ratio is not less than 25%. The specific proportion of subsection compensation shall be formulated by each county. For the reimbursement of hospitalization expenses of participating farmers within one year, the ceiling line is 30 thousand yuan, calculated according to the actual compensation amount of the year. If the hospitalization expenses are paid according to the disease type, it is necessary to strengthen the audit management of the disease type confirmation and admission standards.
(2) Outpatient compensation: Outpatient compensation can be divided into two forms: family account and outpatient co-ordination. Family account Fund is jointly used by family members for outpatient medical expenses of family members. The balance of family account Fund can be carried forward to the next year, but it shall not be used to offset the payment funds for participating in cooperative medical care in the next year. Outpatient co-ordination, only after the family account Fund is used up, can a certain proportion of compensation be given in township hospitals and village clinics that implement integrated management. Guide farmers to see a doctor in township medical institutions. It is necessary to strictly control the medical expenses other than the basic drug list and diagnosis and treatment items of cooperative medical care, strengthen the control of outpatient medical expenses, and strengthen the supervision and management of the service behavior of designated medical institutions and farmers' medical treatment behavior.
(3) Delivery of pregnant women: The pregnant women who participated in the planned hospitalization for normal delivery were given a fixed compensation (100— 150 yuan), and the pathological obstetric hospitalization delivery was compensated according to the hospitalization compensation standard of diseases. For other medical projects with preferential expenses stipulated in the policy, the preferential policies should be implemented first, and the medical expenses that meet the scope of compensation for cooperative medical care should be compensated according to the provisions of the new rural cooperative medical care. The total subsidy shall not exceed the actual hospitalization expenses.
(4) Health check-up: A health check-up can be organized for farmers who participated in the cooperative medical system but did not enjoy compensation in that year, but it is necessary to reasonably determine the medical check-up items and charging standards, strengthen quality control, establish health records for farmers, earnestly strengthen farmers' health management, and give full play to the role of health check-up. To provide medical institutions with medical examination services, medical examination fees shall be paid according to the standards of service quality, quantity and cost, and direct pre-allocation shall not be adopted. Medical institutions undertaking physical examination tasks should give certain fee reductions and concessions.
(5) Give full play to the role of Chinese medicine in the new rural cooperative medical system, and increase the compensation ratio of Chinese medicine services (Chinese medicine, appropriate technology of Chinese medicine, etc.). ) and guide farmers to choose safe, effective and cheap Chinese medicine services.
(6) Appropriately increase the proportion of hospitalization compensation for mental illness.
(7) The public health service projects for which the government has arranged funds separately should not be included in the scope of compensation for cooperative medical care.