2004013129 Chen Jianting
(Tsinghua University, School of Software, Beijing, 100084)
Abstract: This paper analyzes the current situation of rural medical reform in Taiping Town, Zhanjiang City, the hometown of the current full implementation of a new type of rural cooperative medical care system and the main problems that exist. problems, discussing the main factors restricting the promotion of new rural medical care in Taiping Town in the current situation, and putting forward a few suggestions for promoting rural medical reform on the basis of the research.
Keywords: new rural cooperative medical care, new socialist countryside, reform, exploration
I. Background of the research
In a research report, Li Peilin, deputy director of the Institute of Sociology of the Chinese Academy of Social Sciences, pointed out that at present, China has already seen the problems of expensive housing, expensive schooling and expensive medical care, which can be called the new three major problems of people's livelihood.
In October 2005, I made a phone call home and my family talked about the fact that at that time, in the implementation of the new rural cooperative medical system in the whole village, the village cadres, in order to fulfill the tasks assigned by their superiors, went so far as to force the villagers to participate in the rural cooperative medical system, or else the villagers will be denied unmarried certificates, poverty certificates and other certificates on the grounds of not participating in the rural cooperative medical system. I think there are some problems, so the project of the hometown of the new rural cooperative medical promotion situation and the problems encountered to do a winter vacation practice research.
Second, the new rural cooperative medical profile
1, the definition of the new rural cooperative medical system
The full implementation of the new rural cooperative medical system is the CPC Central Committee, the State Council in order to effectively solve the majority of farmers difficult to see a doctor, difficult to see a doctor and alleviate the return of poverty due to illness, poverty due to disease, is an important means of practicing the "Three Represents". It is an important embodiment of the practice of the "Three Represents" and an important part of the comprehensive construction of a moderately prosperous society; it is a medical assistance system that effectively protects the physical and mental health of farmers, and is organized, guided and supported by the government, with the voluntary participation of farmers, and the financing of individuals, collectives and the government, and is based on the co-ordination of major illnesses, supplemented by compensation for minor illnesses, and embodies the mutual aid ****ji's medical insurance system for farmers.
-Excerpts from the new rural cooperative medical information column in Taiping Town
2, the new rural cooperative medical system "new" where
The new rural cooperative medical system compared with the traditional cooperative medical care, it has "New" breakthroughs, mainly reflected in: First, the integration mechanism is new. Provincial financial subsidy of 25 yuan per person per year, the city financial subsidy of 6 yuan per person per year, the district financial subsidy of 4 yuan per person per year, increasing the financing efforts to improve the ability to resist risks. Second, the management mechanism is new. On the basis of strengthening internal audit and fund supervision and management also invited farmers' representatives to join the cooperative medical fund supervision and management committee to participate in fund supervision and management. Fourth, the national policy is stable in the long term. The Central Committee and the State Council decided that the rural cooperative medical care system would be implemented universally in rural areas throughout the country by 2010, starting with a pilot program in 2003 and then expanding it.
--from the Taiping Township, the village of Zaojia village affairs open bulletin board
3, the new rural cooperative medical fund allocation and use of
all levels of financial subsidies per capita ***35 yuan (see the specifics of the above point 2), the farmers to raise funds per capita of 15 yuan, for a total of 50 yuan, as the The total amount is 50 yuan, which is classified as a hospitalization compensation fund. In this way, in practice, farmers only need to pay 15 yuan, up to 4,000 yuan; serious illness, special hardship can also apply for an additional 3,000 yuan, ***7,000 yuan.
--Interview with Chen Qiuwen, secretary of the party branch of Taiping Township Zaojia Pipeline Area
4, hospitalization reimbursement starting line, reimbursement rate, ceiling line, and outpatient fee waiver requirements
Starting line: townships 200 yuan, municipal and above (including the municipal level) 500 yuan;
Reimbursement rate: 50% for townships, 30% for municipalities and above (including municipalities);
Cap line: 4,000 yuan. 3,000 yuan for major disease assistance;
Outpatient fee waiver: farmers holding cooperative medical cards go to their township health centers to enjoy a direct reduction in their household's outpatient registration fee. Auxiliary examinations are discounted by 20%.
Specifically, there is no starting line for hospitalized deliveries of parturients, and the reimbursement rate is 50 per cent for townships and 30 per cent for municipalities and above (including municipalities), capped at 200 yuan per person per year.
--Interview with Taiping Township New Cooperative Medical Care Office staff
5, which are the new rural cooperative medical care designated medical institutions
Municipal hospitals, hospitals, hospitals, health centers, townships and townships in the district.
--Interview with Taiping Township New Cooperative Medical Care Office Staff
6, which behaviors, diseases, medicines, inspections are not included in the scope of reimbursement
(1) work-related injuries, traffic accidents, suicides, self-inflicted injuries, drug abuse, alcoholism, natural disasters, fights, assaults, and medical expenses incurred in drug rehabilitation.
(2) Medical expenses incurred for venereal diseases, organ transplantation, short correction of vision, qigong therapy, cosmetic surgery, orthopedics, artificial organs, artificial limbs, various kinds of rehabilitation devices, and health care nutrition therapy.
(3) Various kinds of tonic and nutritional medicines: oral liquid, pills, ginseng, panax ginseng, asparagus, wine products made of Chinese herbal medicines, and high-protein medicines other than amino acids.
(4) CT, nuclear magnetic **** vibration, color B ultrasound, laser treatment fees, registration fees, patient meals, nutrition, hospitalization escort fees, consultation fees, consultation fees, surgical escort fees, anesthesia insurance and physical examination fees.
--Interview with staff of the new cooperative medical office in Taiping Township
Third, the urgency of promoting the new rural cooperative medical system
1, the allocation of health care resources is unreasonable.
Statistics show that 80% of China's medical and health resources are concentrated in cities and large hospitals, and there is a serious shortage of medical and health resources in the countryside, where conditions are poor, equipment is scarce and standards are low, and the lack of medical care in rural areas has not yet been fundamentally reversed. It is difficult for farmers to get effective treatment locally, and they have to go abroad and to large hospitals, which not only makes it difficult to see a doctor, but also greatly increases the economic burden of farmers.
From the overall actual situation in Taiping Township, there is only one township-level health center in the township. According to the visit to Taiping Township part of the natural village to get the information shows that the village can also exist before the barefoot doctor opened a private clinic, but a few years ago due to the occurrence of several barefoot doctor misdiagnosis led to the death of the patient's serious incidents, causing social concern, the municipal government issued a document to carry out a comprehensive rectification of the township health care institutions, so the township government has closed the vast majority of the private clinics across the board, did not close the government has also greatly increased the threshold for the opening of private clinics. The government also greatly increased the threshold for opening private clinics, which led to a drastic reduction in the township's medical and health resources. As a result, farmers have to go to the town to buy medicine or seek medical treatment for minor ailments in general, not to mention major illnesses, which, obviously, has greatly increased the burden of economic life on farmers.
2. Farmers lack basic medical insurance.
So far, the rural areas have not established a standardized medical insurance system. The new rural cooperative medical care is being piloted and promoted coverage is not high, and the level of financing is not high, the protection capacity is not strong. 80% of the rural population does not have any medical insurance, basically rely on out-of-pocket expenses to see a doctor. Even some areas of rural poverty due to illness, illness to poverty residents account for two-thirds of the poor population.
Before the promotion of the new rural cooperative medical system, Taiping Township farming population is like this, there is no medical insurance, all have to rely on out-of-pocket expenses to see a doctor. Some poor people can still go up the mountain to pick Chinese herbs to cure minor illnesses, but when they get a serious illness, they can only give up treatment in tears after selling all their belongings, and put their hopes for survival on superstitions.
3, rural health care investment is seriously insufficient and the drug circulation order is chaotic
Rural medical institutions are mainly dependent on the operating mechanism to the masses to maintain the operation and development of the fees. Some medical institutions blindly pursuing income, contrary to the humanitarianism of saving lives and harming the public interests of the phenomenon. And some drug distribution companies rely on kickbacks to sell drugs, coupled with the mechanism of drugs to support medical care led to some medical prescription, selling expensive drugs, increasing the burden of medical care on farmers.
It is reported that the vast majority of health care institutions in Taiping Township, consultation fees and drug costs remain high. In the interview process, some villagers reflected that some doctors even make such unethical things: some patients are not difficult to cure, and the doctor lacked some irrelevant, "no itch, no pain" prescription to the patient to eat, ate a few courses of treatment to earn enough money to the loss of the patient to prescribe the right medicine.
Four, to explore the promotion of new rural cooperative medical system in the process of some of the problems and recommendations
1, the publicity method is not reasonable and insufficient publicity
First of all, in the publicity of what is the new rural cooperative medical system to the farmers, I have come to the conclusion through the survey that: publicity should not be written and official way, but easy to understand some, close to the farmers. It should be easy to understand and close to the farmers. Because the cultural level of the farmers is after all limited, they will not care about what the cooperative medical system is an important means, what is the ultimate embodiment, what is the important content; they only care about things that are closely related to them, such as what kind of personal benefits it can bring to them. If the publicity does not let the villagers really understand what it can bring them tangible benefits, then the villagers will certainly not participate in the enthusiasm, but rather think that the government is again in the name of what enrichment, and often will be treated with resistance to the mentality.
Secondly, through the interviews with the villagers, I also felt that the relevant staff did not publicize this new system enough. The villagers are still not very clear about the content of this system and how it works. If a villager is eligible for reimbursement because he or she does not know how to operate the system, the medical expenses will not be reimbursed, which will add to the economic burden of the farmers. The farmers are the main participants in the new rural cooperative medical care, the lack of support from the masses of farmers, the promotion of the new system will only be a flash in the pan.
So, in the villagers to do publicity work staff must pay attention to the above two aspects, more to the farmers to publicize the promotion of the benefits of the new rural cooperative medical system, and always in the interests of the farmers, so that they are clear about the implementation of the new system of every process, so that the farmers to participate in the process of cooperative medicine to really appreciate that it can really bring benefits.
2, the new rural cooperative medical promotion means inappropriate
In the research before I inquired about the village cadres in the promotion of the new rural cooperative medical process to take coercive measures, resulting in a part of the villagers have resistance to psychology. Farmers have the right to choose to refuse to participate in the new rural cooperative medical care according to the situation, although it has gone through the national pilot experiment, but for other areas of farmers are still unfamiliar. And for the villagers who have just passed the subsistence level to run for prosperity, after all, the hand is still relatively tight, 15 yuan per person per year is still quite a large sum of money.
I think the solution to this problem should start at the source. In the nationwide promotion of the new rural medical system is led by the municipal level, to the district level, county level and county-level cities as a unit, according to the specific conditions of their units to develop appropriate programs to implement. First look at the Zhanjiang municipal level to develop the implementation of the program's overall objectives:
Clearly increase the establishment of a sound new rural cooperative medical work measures. First, the requirements of the city's counties (cities, districts) in 2006, the initial establishment of a relatively complete new rural cooperative medical system, to participate in the new rural cooperative medical coverage of more than 60% of the population; after 2006, based on the experience gained and the new situation to further study and formulate new policies and measures, and strive to 2010, to participate in the new rural cooperative medical coverage of more than 85% of the population.
Take a look at Zhanjiang City, a county-level unit is how to implement:
The meeting of the new rural cooperative medical work in 2006 to make deployments, and summed up last year's rural cooperative medical publicity and mobilization of experience, analysis of the situation, the requirements of all levels of the party committees and the government to heat up and drum up energy, from now on to blitz the 25 days to complete the 2006 farmers to participate in the coverage rate of 70% of the target tasks
The meeting was held at the same time as the meeting.
After the meeting, the towns acted immediately, has convened three levels of cadres to mobilize the General Assembly, and signed a work responsibility with the village committees, emerged from the sensational publicity and mobilization of the situation. Scammoniac town publicity and mobilization to grasp early, and the team members of a piece of work, go to the village, publicity and mobilization work is quite in-depth and meticulous. Dongshan Town, clear thinking, in the case of very difficult funding, take out 180,000 yuan to support the town's primary and secondary school students, five-guarantee households to participate in the 06 new rural cooperative medical care, to ensure that the town's coverage rate of more than 70%. Dongjian town good at grasping the two ends to promote the middle, first from the 2005 rural cooperative medical care 100% completion of the Longteng Village Council to do a demonstration of the leading role, and at the same time to grasp the more backward Longshui Village Council.
From the report we can see the implementation of the new rural cooperative medical system is the situation is a good, sensational. But through the phenomenon behind, deep into the peasant masses, we still appreciate the fact that there are many serious problems. Through interviews with front-line staff and some villagers in Taiping Township, Zaojia Village to implement the new rural cooperative medical care, I learned that the front-line staff can not afford to slacken off in the face of the major tasks issued by the higher authorities, or else they will be subjected to deductions of bonuses, wages, and even demotion or dismissal of serious penalties. So they used almost all the methods available to ensure that the tasks assigned 100% completion, so there is a "system of villagers have to participate in rural cooperative medical care, otherwise will not participate in rural cooperative medical care on the grounds that the villagers will not apply for unmarried certificates, certificates of poverty and other certificates," the strange phenomenon. And from some of the villagers reflect know that the villagers have dissatisfaction grievances. Some villagers have more children, have to pay a large sum of money, coupled with the approaching New Year, every place needs money, hand more nervous; some villagers are not clear about this new system is that this is the village cadres enrichment of new tricks. In addition, in the process of promoting the new cooperative medical system in most rural areas, there is the phenomenon of double charging. That is to say, some villagers have taken up positions such as teachers, in the unit to which they belonged to have participated in the medical insurance, but the front-line staff is still mandatory to require them to participate in the new cooperative medical system, which is obviously unreasonable.
Behind these facts we can clearly see that the farmers to accept the new rural cooperative medical system has to take a period of time and the process of adaptation, the development of the new rural cooperative medical system of this new thing is not smooth sailing. So how to make a good new rural cooperative medical system to promote it? I think one is the source of the municipal units should not be in the promotion of the exploration stage to set the goal too high. This will allow the lower levels and villagers to have a better process of tolerance and adaptation, and can make the promotion process pay more attention to the people-oriented humanistic spirit. Secondly, publicity should be stepped up, especially for the typical examples around us that can bring positive effects to the promotion of the new system. In the work can be utilized in the rural cooperative medical care in the masses to get the benefits of the present, so that the propaganda work closer to the masses, moving the hearts of the farmers, so as to enhance the effectiveness of the new system of publicity. Thirdly, the public medical fee reimbursement, good use of rural cooperative medical fund. Ensure that farmers should get the reimbursement must be able to get their hands on, to eliminate false events, so that the new system is y popular, the majority of villagers to support and support.
3, funds supervision and management is not transparent enough, participating farmers should have the right to know
Funds supervision and management regulations have provisions: in the strengthening of internal audit and funds supervision and management on the basis of farmers are also invited to join the cooperative medical funds supervision and management committee to participate in the supervision and management of funds. However, in fact, this situation will inevitably occur, that is, the farmers' representatives will be subjected to all kinds of pressure from various aspects, and thus lose the right to supervise. Therefore, all participating farmers should be given the right to know how the funds are being utilized, so that they will believe in and support the new system. A more feasible way is to regularly announce the use of funds under the supervision of all parties, so that the use of funds thoroughly transparent channels.
4, the scope of reimbursement is not large enough, participating farmers are still limited in the space of benefit
From the point of view of not included in the scope of reimbursement, the farmers from the benefits are still relatively small. For example, traffic accidents, such accidents farmers losses will be very serious, but not included in the scope of reimbursement. After interviews to understand that traffic accidents generally have a compensating party, it is not included in the scope of reimbursement. But what if there is no compensating party? I think it can be implemented in the process, should gradually relax the scope of reimbursement. After all, if farmers spend a lot of money instead of getting the appropriate reimbursement, it will make the new cooperative medical system has no new features and strong attraction.
V. Conclusion
The new rural cooperative medical system is a pilot in 2003 after part of the country, 2005 began to initially establish a more complete nationwide new rural cooperative medical system. Practice preliminary test and prove that it is in line with the immediate interests of the majority of farmers, in favor of the coordinated development of urban and rural areas in China and continue to narrow the gap between urban and rural wealth. The initial stage of its implementation has not been smooth, and there are bound to be many practical problems, which will require the accumulation of experience in the course of its promotion and the exploration of feasible methods that meet the actual situation of each region. I believe that under the continuous efforts of our Party and people, it will be a successful model in the reform of China's rural medical insurance business, and will add bricks and mortar to the current great cause of building a new socialist countryside.
Acknowledgements
In the process of this practical investigation has been Zhanjiang City, Taiping Township Government New Rural Cooperative Medical Office, Taiping Township Zaojia Village Village Committee, Taiping Township Tiao Lang Village Committee, Taiping Township Lvzhai Village Committee, and some of its villagers and their hospitality and help, I would like to thank.
References
1) Zhanjiang City, Taiping Township Government to implement the new rural cooperative medical system related to the first-line information
2) Zhanjiang City, health information network - Zhanjiang City, the new rural cooperative medical work conference 2005-11-