Go to the county agricultural insurance center or social security center, or ask your village cadres should know.
Rural people can join the pension and medical insurance as freelancers. You'll be able to enjoy the same pension and health insurance benefits. The only thing is that when you pay the premiums, you pay the full amount, not just a portion of the premiums as you would if you were employed.
The following is an analysis of the current situation of rural medical insurance: reprinted from China Economic Net. You can take a look:
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I. The New Situation Facing China's Rural Medical Insurance
Currently, China's rural medical insurance, by and large, has cooperative medical care, medical insurance, coordinated settlement of hospitalization fees and Preventive health care contracts and other forms, of which cooperative medical care is the most common form. Rural cooperative medical system is supported by the government, the peasant masses and rural economic organizations *** with the financing, the implementation of mutual assistance in the medical care of a kind of medical insurance nature of rural health protection system. In the late 1970s, it "covered almost all of the urban population and 85 per cent of the rural population, an achievement unparalleled in low-income developing countries". During this period, the majority of rural residents were provided with the most basic medical care and preventive health services under the conditions of material deprivation and low productivity; at the same time, farmers were provided with preliminary diagnosis and treatment of common and frequent illnesses; the level of medical and health protection for farmers in this period was very low.
The realization of the household contract responsibility system in the 1980s reintroduced the family as the basic operating unit of agricultural production, and the cooperative medical care system, based on agricultural cooperatives, experienced a slippery slope. According to a survey in 1995, the number of villages practicing cooperative medicine dropped sharply from 90% in the past to 5%. 1989 statistics showed that only 4.8% of the villages in the country continued to adhere to the cooperative medical system. in the early 1990s, the only remaining cooperative medical system in the country was mainly located in the areas of Shanghai and Southern Jiangsu Province. This was mainly due to the emergence of township enterprises and small towns in these regions, and it was the township enterprise economy that supported the cooperative medical care system in rural Southern Jiangsu and brought it to its heyday. As a result of the historical achievements of the cooperative medical system, since the 1990s, although the government has introduced a series of documents, policies and measures in an attempt to revive and rebuild the cooperative medical system while pushing forward the reform of the township medical security system, the rural cooperative medical system has not been revived and rebuilt as much as hoped for, with the exception of some pilot areas and cities. Moreover, the model of cooperative medical care in rural areas of southern Jiangsu Province, which was once hailed by the World Bank and the World Health Organization as "the only model for solving the problem of health financing in developing countries", has declined sharply after a period of glory. Even in 1997, the year of the "climax" of the restoration and reconstruction of the cooperative medical care system, the coverage of cooperative medical care accounted for only 17 per cent of the country's administrative villages, and only 9.6 per cent of rural residents participated in cooperative medical care. The results of the Second National Health Service Survey, conducted by the Ministry of Health in 1998, showed that only 12.56 per cent of the country's rural population had some degree of medical coverage, of which only 6.5 per cent was cooperative medicine. This is an improvement over the 5 per cent in the late 1980s, but it is a far cry from the 90 per cent or more coverage of cooperative medical care in the 1970s. The reasons for this are as follows:
1. Insufficient funding for rural cooperative medical insurance. Restore and rebuild the rural cooperative medical insurance system. The most important thing is to solve the problem of funding sources. First of all, it is impossible for the government to take out a large chunk of its fiscal revenue for rural cooperative medical insurance. At present, rural cooperative medical insurance is merely a general call to action, and there are technical defects in the design of the system itself . The State has no clear funding policy, relying only on local governments to promote it by administrative means, and finances at all levels have never had a clear expenditure program for cooperative medical care. For many years, we have followed the idea of tilting towards the cities in our economic and social development. There is an imbalance in the allocation of health resources between urban and rural areas, with the rural population, which accounts for 70 per cent of the country's population, occupying only 30 per cent of the health resources; in 1998, the country's total health expenditure amounted to 77.6 billion yuan, of which the Government invested 58.72 billion yuan, and only 9.25 billion yuan was spent on rural areas. Moreover, health inputs to rural areas are mainly differential subsidies to health organizations on the basis of headcounts and hospital beds, and the method of compensation is unreasonable. Secondly, with the implementation of the rural tax and fee reform, the financial and collective income of townships and villages has plummeted, and the collective economy of many villages has been reduced to very little, with a considerable number of villages being heavily indebted; areas such as Southern Jiangsu have also lost their previous economic sources due to the restructuring and reorganization of the property rights of township enterprises, making it difficult for rural cooperative medical care to be sustained due to a shortage of funds. Thirdly, as the collective economic power of grass-roots communities declines, raising funds from farmers has become the main economic source for the establishment of cooperative medical funds. However, the degree of difficulty in raising funds from farmers depends mainly on the degree of farmers' awareness of and trust in rural cooperative medical care. "And farmers' willingness to pay is mainly subject to the consideration of expected benefits and expected costs. If the cost of visiting a doctor can indeed be (partially) solved with not too much input, it should be very attractive to farmers." The current situation of rural cooperative medical care across the country shows that the proportion of people participating in cooperative medical care is relatively small, and that farmers in most regions have a relatively low level of satisfaction with cooperative medical care and a low willingness to do so. From a survey on the plight of rural medical care in Ji, Shaanxi and Yu provinces, it was revealed that due to the current low level of financing for rural cooperative medical care, it lacks the ability to withstand the risk of major illnesses, thus making it unattractive to farmers. As a result, rich farmers are reluctant to join, and poor ones can't afford it, making it more and more difficult; another reason is that most farmers lack trust in township and village cadres to manage the cooperative medical fund, and at the same time, they don't have much trust in the medical standards and personal qualities of township health centers and village doctors. And the reason why farmers in rich areas such as Southern Jiangsu are dissatisfied with rural cooperative medical care is mainly because with the accelerated growth rate of farmers' per capita GDP and income level, the improvement of their living standard, the rapid increase of their health requirements and demands for medical care level, they are no longer satisfied with the low level of medical care provided by the cooperative medical care.
2. The unstable policies of rural cooperative medical care and the conflicting and contradictory policies concerned are also one of the reasons for the setbacks in the restoration of the cooperative medical care system. After the reform of the economic system, the state has taken a laissez-faire attitude towards cooperative medical care. Cooperative medicine has been transformed from a national policy into a local policy, with local governments often making decisions on their own as to whether or not to develop cooperative medicine in rural areas. This has deprived the development of rural cooperative medical care of the "mandatory" power of State policy, and, coupled with the division of interests and confrontation between localities and departments, has led to a significant decline in their initiative and a lack of sufficient motivation to promote the implementation of cooperative medical care policies. In addition, after the 1990s, the state in order to reduce the burden on farmers, canceled the "cooperative medical care" program, this policy conflicts with the state policy to support the development of rural cooperative medical care, thus increasing the difficulty of the development of rural cooperative medical care.
3. It is difficult for the rural health system to adapt to the demands of farmers, whose income levels vary greatly, for health care for all. China's rural economic development level is extremely uneven, the formation of the east, central and western income gradient, in 1995, east, central and western income ratio of 1:O.72:0.43 and this imbalance continues to increase the trend. And within the region due to the sharp division of rural labor force and large-scale non-agriculturalization, employee, farmers have different requirements for medical security, which has set up objective obstacles to the establishment of a unified rural medical security system, namely, the main body of rural medical security, projects, fund-raising, management, treatment standards of the unity of the obstacles.
4. Existing rural medical and health resources allocation is extremely unreasonable, and it is difficult to give full play to the benefits. First, in accordance with the administrative division of rural areas to set up health care outlets, so that many outlets actually insufficient business. Even dispensable. Farmers in many places can basically do without leaving their villages for minor ailments, and go directly to county or above-county hospitals for major ailments, as a result. The layout of one hospital in one township (town) has obviously failed to adapt to the new situation. This is a considerable number of township health centers to reduce the volume of business, a major reason for their own survival difficulties. Secondly, the county and township health system overlapping institutions, personnel bloat phenomenon is prominent . Resulting in a waste of health resources. County-level health care institutions, in addition to county hospitals, there are hospitals, health epidemic prevention stations, maternal and child health stations, family planning stations, as well as infectious and endemic disease control institutions, townships in addition to health centers also have family planning stations. Most of these organizations are self-contained, with their own small but comprehensive construction, which not only results in low-level duplication of construction of medical and health facilities and a waste of health technicians. Moreover, a large number of non-professionals have been added, increasing the cost of running the institutions. Therefore, it is necessary to break the limitations of the sectoral system to promote the flow and regrouping of health resources in counties and villages.
II. Ideas and Countermeasures for Improving and Perfecting China's Rural Medical Insurance
(I) General Ideas for Improving and Perfecting China's Rural Medical Insurance.
Improving and perfecting rural medical insurance is not only the objective needs of China's rural economic and social development, but also the urgent requirements of the masses of farmers, which is of great significance in safeguarding the basic rights and interests of rural residents, promoting social development, maintaining social stability, and promoting the development of the rural economy and the overall progress of society. With the rapid development of the rural economy, the incomes of rural residents have risen considerably; over the 20 years since the reform and opening up of China, the per capita net income of Chinese peasants has risen from less than 200 yuan to more than 2,200 yuan, an increase of about 10 times that of the current price, which provides a material basis for the improvement and refinement of rural social insurance. Considering the government's financial strength, China's tax revenues have increased K at a rapid rate in recent years, and it is also affordable for the government to appropriately increase some of its investment in rural medical insurance. Although most of the country's sub-county finances, especially township finances, are more difficult due to the decline of the collective economy at the grassroots level and the implementation of the tax-sharing system, however, this is only a problem of the financial structure, and in terms of economic strength, China should have more financial resources to set up rural medical insurance at present than it did 20 years ago.
Based on the above analysis, the general idea of improving and perfecting the rural medical insurance is that the establishment of the basic medical insurance system for farmers should adhere to the principle of state support, start from the actual situation of the rural areas, customize the system according to local conditions, and aim at guaranteeing the basic medical care of farmers . With the system construction as the core, and rural medical insurance service network construction to match. By combining basic medical insurance with farmers' personal inputs and contributions from the rural community economy, enterprises, charitable organizations and foreign-funded institutions, and by taking strong measures to speed up the pace of construction, the rural community health service system will dominate and play a leading role in the next 10-20 years. We will strive to realize the convergence of the rural health service system with that of the cities by the middle of this century, and ultimately establish an integrated urban and rural medical security system.
(2) Specific countermeasures to improve and perfect China's rural medical insurance.
1. Clarify the government's responsibilities in rural medical insurance.
The state should take the strengthening of rural medical and health care as a strategic priority and mention it on the agenda of governments at all levels. This is the basic embodiment of the functions of the state, but also the inevitable requirements for the establishment of a fair society. According to the objective reality of China's huge difference between urban and rural areas, in the short term it is impossible to make the urban and rural medical insurance system completely unified, the gap between urban and rural areas of the scope and level of medical insurance exists for a long time. However, to a certain extent, farmers are in greater need of State support and protection in the area of medical security than are urban workers, because their income levels are lower. Under these circumstances, our health policy should not merely make some of the healthy people healthier, but should promote basic health protection for those who do not have it. At the same time, medical protection, especially public **** health protection, is a typical social "public **** product", which should be oriented to the whole society, and not only limited to urban residents. This is an objective requirement for the establishment of a sound market economy, and it is also a public **** investment that maximizes the return to society as a whole. In addition, the establishment of a medical insurance system for all citizens, especially farmers, is also necessary to maintain the healthy operation of the basic medical insurance system for urban workers. With China's rapid industrialization and urbanization, the rural population continues to migrate to the cities and towns (the 2000 census showed that the proportion of the urban population has exceeded 36%), if we do not solve the problem of medical insurance for the farmers, it will inevitably cause a huge impact on the urban medical insurance system, affecting the smooth operation of the urban medical insurance system.
Therefore, in solving the problem of medical insurance for peasants, the government should not only adjust the health investment policy, give full play to the government's financial support for preventive health care and public ****health services, and increase the strength of financial funds tilted to the rural areas, but also, more importantly, should cause the government and the whole society to pay great attention to the medical insurance system for peasants and gradually incorporate the system of medical insurance for peasants into the overall planning of the country's social security, which is a national The responsibility is incumbent upon the State, but also the road to modernization.
2. Establishment of a scientific and reasonable mechanism for the mobilization of rural medical funds. At present, China's rural medical insurance system exists in the amount of funding is too small, the collective and government subsidies are insufficient, it is difficult to solve the farmers "due to poverty", "due to poverty" phenomenon occurs. In Jilin Province, for example, some farmers pay a maximum of 5 yuan and a minimum of 2 yuan per year for cooperative medical care. Although the government and village committees also contribute proportionally, the total amount of funds is difficult to maintain the normal operation of cooperative medical care. Even if it is barely maintained, it is still operating at a low level and is not helpful. Therefore, a scientific and reasonable financing mechanism must be established. Rural medical insurance funds should take the individual to pay the main fund, the collective subsidies as a supplement, the government to support the method. Collective subsidies should be based on the local collective economic situation, generally should account for 20% of the total amount of funds mobilized; governments at all levels should also have appropriate financial input to attract farmers to invest in their own medical security, the establishment of different levels of protection of farmers' medical insurance according to local conditions, if the national financial capacity is still difficult. The central and provincial governments should also provide poor farmers in poor counties with poor medical aid funds and cooperative medical aid funds; developed regions should put forward clear financing policies, and local governments, such as counties and townships, should invest in guiding funds to establish farmers' health insurance. Both collective and governmental input ratios should be increased accordingly with socio-economic development. In addition, in the development of rural health care public **** insufficient funds, and private capital and investment incentives in the reality of the entry of private capital can alleviate the lack of rural medical situation, the government can be recognized through the qualification and technical standards and norms and other measures to regulate the services of private medical institutions.
How much individual farmers pay for health insurance depends on three factors: first, the actual annual per capita expenditure on medicine; second, the amount of money farmers are willing to pay each year for health insurance; and third, the actual ability of farmers to pay and their psychological capacity. According to a survey of seven provinces, including Zhejiang and Henan, the per capita expenditure on medicine for rural residents in 1993 was 97 yuan, or 7.14 per cent of the previous year's per capita net income; the amount farmers were willing to pay in cooperative medical insurance funds accounted for 1.7 per cent of their per capita net income. According to the results of these surveys and China's rural reality, appropriate deduction of the collective and government subsidies and support may be part, and then in accordance with the principle of "income to determine expenditure, a little savings" to reasonably determine the reimbursement rate of medical expenses, farmers should pay the individual health insurance funds of the previous year's per capita net income of farmers of about 2% is appropriate.
3. China's rural medical insurance system model selection. The construction of rural medical insurance system to deal with the relationship between universal protection and the implementation of classification. Universal protection refers to the scope of the object of rural social security, including all members of rural society and all aspects of social security they need. The scientific mechanism of social insurance is that the majority of the population share the risks of the minority, and the larger the coverage, the more adequate the compensation received by each subject in the event of risk, which requires rural social security to be universal. Classified implementation means that the main body of rural social security, projects, fund-raising, management methods, treatment standards and other aspects should be adapted to local conditions, within the limits of their capacity, and focused on and differentiated in different areas and at different times. As mentioned earlier, China's rural areas are vast, and regional economic development is very uneven, creating objective obstacles to the implementation of a unified nationwide rural social security system in rural areas; at the same time, farmers' requirements for social security are also different, and it is therefore necessary to proceed from the actual situation in rural areas, rather than "one size does not fit all". For this reason, in our country should be developed areas, more developed areas, less developed areas in stages to implement different medical insurance system.
(1) the construction of rural medical insurance system in developed areas. In the eastern seaboard of rural and urban suburbs and other productivity levels and farmers living standards increased faster in affluent areas, comprehensively promote the construction of the rural social security system has basically have the conditions, should be comprehensively established rural social security system and service network, the construction of medical insurance system should be included in the integrated development of urban and rural areas, the farmer's health insurance system can be transition to the towns and cities, and even a combination of. These developed areas of the countryside have witnessed a sharp division of the rural workforce and a large-scale phenomenon of de-farming and workerization, with most peasants having more stable occupations and residences, which facilitates the exploration of a medical security system to achieve the goal of extending to the countryside and narrowing the urban-rural divide. These areas can be constituted by a three-tiered chain of hospitals in urban centers - township health centers - and rural community dispensaries as a central axis. This chain system is due to the fact that the community sending institutions are based on the township health centers, which in turn are sub-divisions of the urban center hospital group. A regional medical group is formed. As a rural community, it can be a collection of one or two villages, or more or larger and flexible, thus allowing relative freedom from the village establishment. Rational allocation of health resources can be better implemented according to population distribution. From the research in township communities such as Kunshan City in Southern Jiangsu Province, where the health insurance system has been implemented, it was found that the satisfaction level of farming families in these communities is high. It reached 74.2%, and more than 80% of the farm households participated. Showing a better trend.
(2) Construction of rural medical insurance system in more developed areas. In medium and more developed areas, on the basis of developing and improving the existing cooperative medical system, we can actively explore the reform of property rights structure, management system and operation mechanism. The Government can introduce market mechanisms and economic incentives to varying degrees through such means as work standardization, target assessment, rewards in lieu of allocations, purchase of services, and contract management. The setting up of rural health institutions need not correspond to the administrative system; according to geography and patient flow, and in conjunction with the consolidation of townships and the reform of the property rights system for health centers, duplicate health centers should be abolished and the layout of central health centers should be readjusted. At present, a number of regions have begun to adjust and reform their rural health service systems and farmers' medical insurance systems (e.g., the "mobile hospital in the mountainous areas" built in Hequ County in Sansi Province, the reform of the "integration of rural health organizations" carried out in Wuzhi County in Henan Province, the property rights system of township health hospitals in Haicheng City in Liaoning Province, and the reform of the property rights system of rural health hospitals in Haicheng City in Liaoning Province). Haicheng City, Liaoning Province, the township health center property rights system reform, etc.), although in different forms, but have achieved more satisfactory results.
(3) The construction of rural medical insurance systems in less developed regions. In less economically developed regions, the current focus is on health poverty alleviation work and medical assistance programs for the poor, in order to alleviate the phenomenon of poverty caused by illness and return to poverty due to illness. The poverty-alleviation programs implemented in China focus on economic poverty alleviation. Economic poverty alleviation should be organically combined with poverty alleviation through health care; through the support of the central Government and developed regions, the first step is to solve the problems of building health facilities and "lack of medical care" in impoverished areas, and to set aside a portion of the national poverty alleviation earmarked funds and the relevant poverty alleviation funds for the sole purpose of solving the problem of poverty alleviation through medical care in impoverished areas. For the rural poor in the regions, a medical assistance program should be implemented. The medical assistance program is an integral part of the medical security system, which in turn is an important element of the entire social security system. Poverty alleviation through health care should be incorporated into the social security system, especially the social assistance system, and the medical assistance scheme should be organically integrated with the entire social security system, for example, by means of the criteria of the rural minimum subsistence guarantee system, which determines the scope of the target group for the implementation of medical assistance. This can truly enable the poor to receive assistance, but also convenient and feasible to reduce organizational costs.
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