A, the new rural cooperative medical basic policy new rural cooperative medical care is organized, guided, supported by the government, farmers voluntarily participate in the collective and government funding, to the main medical co-ordination of farmers' medical care mutual **** relief system. 1, the new rural cooperative medical care financing channels. According to the relevant provisions of the State, the current national pilot counties and cities of new rural cooperative medical care to raise funds for the main channels are two: one is the financial subsidies at all levels; the second is to participate in cooperative medical care for farmers to pay. From 2006 onwards. To carry out new rural cooperative medical care pilot counties and cities, according to the number of people participating in cooperative medical care, per person per year, the total funds for 50 yuan, of which the central financial subsidies 20 yuan, provinces, states, counties (municipalities) financial *** counting supporting 20 yuan, to participate in cooperative medical care for farmers to pay 10 yuan. 2, the nature of the new rural cooperative medical care is a "mutual ****ji ", that is, voluntary participation in cooperative medicine farmers, must pay a certain amount of money each year. The standard of payment can be based on the level of local economic development. The State Council State Office issued [2004] No. 3 document stipulates that the amount of individual contributions of participating farmers, in principle, no less than 10 yuan per person per year, economically developed areas can be based on the voluntary farmers, according to the level of farmers' income and the actual needs of the corresponding increase in the standard of payment. 3, the new rural cooperative medical care is a mutual assistance ****ji farmers basic medical security system. Since it is a mutual assistance **** relief, it must be a major disease co-ordination. That is, to solve the participating farmers suffering from serious illnesses, the urgent need for hospitalization of medical expenses. However, taking into account the enthusiasm of farmers participating in cooperative medicine, but also taking into account the actual situation of farmers in our state medical treatment, the cooperative medical funds into two parts, most of which are used as inpatient medical compensation fund, a small part of the farmers participating in cooperative medicine as outpatient compensation fund, the establishment of the family outpatient account. The family outpatient accounts of participating farmers are family-based, with each person withdrawing 6-8 yuan per year for the purpose of compensating family members for outpatient expenses in the current year. The account is to be used on a household basis until it is exhausted, and no compensation will be made for overspending. The balance of the current year is carried over to the next year for further use.4. New rural cooperative medical fund-raising and in place procedures. New rural cooperative medical financing principle is: "voluntary participation of farmers, collective and government funding", that is, on the basis of voluntary participation of farmers, first of all, farmers pay part, in accordance with relevant regulations, collected into the treasury, into the county and city of the new rural cooperative medical special f-] account, and then the county (city) in accordance with the number of actual financial participation, will be The county (city) finances will then allocate matching funds according to the actual number of participants, and apply for subsidies from the provincial and central governments. Farmers' contributions to the cooperative medical funds can be made by the farmers themselves or by the collective economy. Can also be donated by the community. 5, reported in the new rural cooperative medical care pilot must have the conditions. The State Ministry of Health, Ministry of Finance, Wei Nongwei hair 20051319 document provides that the provinces and municipalities in determining the pilot counties (cities), to continue to adhere to the standards of the pilot counties (cities): First, the local government attaches great importance to take the initiative to apply; Second, the farmers to participate in the cooperative medical care is highly motivated, the rural grass-roots organizations are relatively sound; Third, the local finances at all levels to ensure that subsidies are funded. And in a timely manner and in full; Fourth, the health administrative department has a strong management capacity, and the management of rural medical and health services is relatively complete; Fifth, township health centers are upwardly mobile to county-level management. Reforms are in place; sixthly, the medical aid system is being established simultaneously; seventhly, the establishment, staffing and funding of cooperative medical care agencies are guaranteed, and computers and other necessary office equipment are being purchased. Counties and municipalities must formally commit themselves in writing when they formally declare to their superiors. Second, the new rural cooperative medical special policies
1, the five guaranteed households, special hardship households, the disabled and other special (disadvantaged) groups to participate in cooperative medical care, the individual funds payable by the civil affairs department. 2, the one-child household, two female ligation households, such as family planning preferential households to participate in cooperative medical care, the individual funds payable by the family planning department. 3, all the participants in cooperative medical care hospitalized to give birth, are given fixed subsidies in accordance with the mode of delivery. According to the programs formulated by the counties and cities, the compensation for each case of flat birth is 150-250 yuan, and the compensation for each case of cesarean birth is 400-250 yuan. Cesarean sections are compensated 400-600 yuan per case. Pathological obstetrics is compensated according to the relevant regulations for hospitalized patients. Poor pregnant women who are hospitalized for delivery should also enjoy the poverty relief subsidy under "Reduction and Elimination". 4. Special diseases and chronic diseases that are treated on an outpatient basis all year round, such as tumors, aplastic anemia, cirrhosis of the liver, chronic bronchitis in the elderly, uremia, etc., are eligible for a certain amount of compensation each year within the basic medication directory of the cooperative medical treatment, with the standard and specific types of diseases to be determined by the counties and cities. The compensation standard and specific diseases are formulated by counties and cities. Third, the new rural cooperative medical compensation policy to participate in the cooperative medical care farmers, regardless of 1,] clinic or hospitalization, the actual incurred medical costs, as long as the relevant provisions of the cooperative medical care, will be able to obtain a certain percentage of compensation. 1, outpatient compensation. Participating farmers can receive compensation for their medical expenses incurred in outpatient clinics of designated medical institutions in accordance with the outpatient clinic compensation methods and compensation procedures formulated by the counties and cities, but no compensation will be made for those who seek medical treatment in non-designated medical institutions.2. Hospitalization compensation. Participating farmers who need to be hospitalized due to illnesses must be hospitalized in designated medical institutions for cooperative medicine, and their compensation methods and compensation ratios are to be compensated according to the implementation rules (programs) formulated by the county or city.
(1) Medical expenses incurred by participating farmers for hospitalization in designated medical institutions are compensated proportionally after first deducting the amount specified in the starting standard, and then deducting the cost of medicines beyond the scope of the basic medication catalog and the cost of relevant special examinations. The starting standard is set at different levels of medical institutions. The lower the primary medical institution, the lower the starting standard. The higher the level of medical institution, the higher the starting standard. It is divided into four levels: first-level hospitals (township health centers), second-level hospitals (county and city hospitals and some state-level hospitals), third-level hospitals, and provincial-level and higher-level hospitals. The starting payment standard is 100 yuan, 200 yuan, 400 yuan and 600 yuan respectively. When the counties and cities set the starting payment standard, in principle, they follow the above standards. It is normal for some counties and cities to appropriately lower the starting payment standard for grassroots designated medical institutions and raise the starting payment standard for upper tier designated medical institutions according to the actual situation. (2) When a participating farmer is hospitalized in a designated medical institution and incurs medical expenses, the amount of the starting payment standard is subtracted. Then subtract the amount of the part that should be paid out-of-pocket, which is the scope of calculation of compensation. This is the basis for calculating the scope of compensation. The specific amount that should be compensated to the participant is calculated 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-level and above hospitals. The specific ratios are 60%, 50%, 30% and 20% respectively. Individual counties and cities in the formulation of the program, appropriately increased the proportion of compensation for primary designated medical institutions, is a normal situation.
3. Reasonable determination of the maximum compensation standard.
4, belonging to the "excluded" medical expenses, cooperative medical care will not be reimbursed. Such as traffic accidents, fighting, alcoholism, suicide, self-inflicted injuries, beauty, orthopedic and so on. Fourth, the new rural cooperative medical other provisions 1, cooperative medicine designated medical institutions. Cooperative medicine designated medical institutions is to provide basic medical services for participating farmers, its main object is the government-run non-profit medical institutions, to meet the qualifying standards of the village health clinic can gradually enter the scope of the designated medical institutions, in order to facilitate the participation of farmers close to the outpatient clinic, to solve the problem of treatment of minor injuries and illnesses. Medical institutions within the scope of the object of designated medical institutions, must first obtain the "medical institutions practice license", and then apply for designated medical institution qualification with the relevant procedures. After the county and municipal health administrative departments and the cooperative medical management organization assessment, evaluation, meet the conditions, in the form of official documents to determine the cooperative medical designated medical institutions. If a fixed-point medical institution, in the course of its operation, suffers a medical accident of grade two or above, or if a medical dispute with a large social impact occurs, or if it uses improper means to obtain funds for cooperative medicine, the qualification of the fixed-point medical institution may be suspended or canceled according to the nature of the problem and the severity of the circumstances. Village health clinics are determined to be designated medical institutions, and must meet the qualifying standards and obtain a Medical Institution Practice License. Participating farmers who seek medical treatment at village health centers are only reimbursed for the outpatient subsidy portion. The village health office cannot carry out inpatient services.2. Establish a systematic and perfect reimbursement and compensation procedure, which not only facilitates enrolled farmers to report their accounts and receive compensation in a timely manner, but also ensures the safety of cooperative medical care funds. The cooperative medical management methods and implementation programs formulated by the pilot counties and cities of cooperative medical care have clear provisions on the reporting procedures, reporting requirements, and compensation methods. Both the staff of the cooperative management organizations and the participants in cooperative medical care must strictly abide by them. Participants are compensated for medical expenses incurred during outpatient visits to designated medical institutions. In general, compensation is paid on the spot, and compensation is registered in accordance with the relevant procedures. Compensation for hospitalization needs to be stratified according to the level of the medical institution and the amount of medical expenses. If the amount of compensation is less than 1,000 yuan, it is only necessary to be examined and approved by the township cooperative management organization, and the compensation will be made at the medical institution in which it is made. If the amount of compensation is more than 1,000 yuan, it must be submitted to the county or city cooperative management organization for examination and approval, and then the compensation will be made in accordance with the relevant procedures. In the case of major diseases, where the amount of compensation reaches the maximum compensation standard and secondary compensation is required, the leadership of the county or city cooperative management organization shall collectively study the matter and then compensate according to the relevant procedures. 3. The compensation of participating farmers is based on the system of advancing payment by the fixed-point medical institutions. That is, participating farmers hospitalized in designated medical institutions, only prepaid part of the self-payment. For example, if a disease is hospitalized in a township hospital, it is estimated that the total medical cost should be prepaid 3,000 yuan, and the participant only needs to prepay 1,500 yuan, which will be refunded after the patient is discharged from the hospital. Need to prepay another 150O yuan, advanced by the designated medical institutions, after the settlement, the county-level cooperative medical management institutions should be compensated for the compensation of participants, directly into the medical institutions. 4, the new rural cooperative medical care must have a whole set of leadership team, work team. Including the county (city) new rural cooperative medical care coordination and leadership group, county (city) new rural cooperative medical care management committee, county (city) new rural cooperative medical care supervisory committee, the office for the county (city) new rural cooperative medical care management bureau (or center). Supervision and management of cooperative medical care, audit, audit, etc. There is a set of perfect provisions, norms, procedures. 5, the new rural cooperative medical care adhere to the farmers to participate voluntarily, multi-stakeholder financing, the county run by the county, the principle of income to meet expenses, protection of the right amount. Farmers voluntarily participate in the new rural cooperative medical care, each person needs to pay only 10 yuan per year, and then through the financial subsidies at all levels, constituting the farmers' medical mutual ****ji system, such a system for the farmers to solve the problem of difficult to see a doctor, expensive, is undoubtedly one of the most effective ways and means. However, it must be only a form of mutual ****ji, participating farmers must also pay part of the medical treatment. It can only provide a moderate level of protection. At the end of each year's operation, the total funds for cooperative medicine must have a moderate balance, with a balance rate of about 20% being normal. In the next year of operation, participating farmers must pay another 10 yuan, and all levels of finance will continue to subsidize the program on an annual basis. In the long run, in a virtuous cycle, every year a significant portion of participating farmers enjoy hospitalization and outpatient compensation for their illnesses. Participation in cooperative medical care must be based on a household unit, with all family members participating and paying all fees.6. Cooperative medical care policy orientation. The cooperative medical policy, especially the compensation policy. Participating farmers are encouraged to seek medical treatment at primary hospitals first, and then to transfer to higher-level hospitals for problems that cannot be solved by primary hospitals. In this way, the burden of individual medical fees on participating farmers for hospitalization is reduced. Secondly, it promotes the standardization of the management of primary medical units, strengthens the construction of infrastructure, continuously improves the level of technology, creates a competitive mechanism, and strengthens the overall service function. Third, it saves cooperative medical expenses. Fourth, because the more grassroots hospitals, the fewer out-of-pocket payments for hospitalization, the higher the reimbursement rate, the more benefits the farmers get, and the higher the overall rate of compensation for cooperative medical care. 7. The financing of the new rural cooperative medical care is mainly based on financial subsidies at all levels. Participants pay only 10 yuan a year, so compensation fully reflects the nature of mutual assistance, and it is impossible to be absolutely even. The fact that it is a mutual assistance scheme means that if a participant does not receive compensation this year, he or she may be entitled to it next year or the following year. Family members, may be young and healthy did not enjoy, and the elderly or children to enjoy more opportunities.