First, the implementation of the basic situation of the new rural cooperative
(a) Progress
1, the participation of farmers and fund-raising steadily increased. I county 25 townships, 479 administrative villages, 28 neighborhood committees. 2006 should participate in farmers 722,190 people, has participated in 510,873 people, participation rate of 70.74%, of which: civil affairs to solve the five-guarantee households, special hardship households, disabled people 68,436 people, accounting for 9.48%, family planning department to solve the one-child, the second female ligation households 3,400 people, accounting for 0.47%, the participation of the alloy of 210,405,700 yuan. The participation rate was 21.0457 million yuan. Of these, 5,108,700 yuan were self-financed by farmers, including 718,400 yuan from the civil affairs and family planning departments, accounting for 14.06 per cent of the self-financed portion. 742,898 farmers should have participated in the 2007 program, and 660,337 had already done so, a participation rate of 88.89 per cent, of which 33,645 (4.5 per cent) were five-guarantee households, special hardship case households, and persons with disabilities, and 37,710 (3.7 per cent) were one-child and two-daughter ligature households. In 2008, there were 776,244 farmers who should have participated in the program, and 720,848 of them participated, a participation rate of 92.86%. Among them: civil affairs to solve the five guaranteed households, special hardship households, the disabled 92,551 people, accounting for 11.92%, family planning departments to solve the one-child, two female sterilization households 3450 people, accounting for 0.44%, the participation of 32,418,400 yuan, farmers self-financed part of 7,208,480,000 yuan, including civil affairs and family planning departments to solve 960,000 yuan, accounting for farmers self-financed part of the 13.3%.
2, the fund payment ratio and the average hospitalization ratio up. 2006 outpatient and inpatient consultations 388,351, **** paid family account of hospitalization medical expenses compensation 9,163,000 yuan, the payment ratio of 43.54%, the average hospitalization compensation ratio of 33.16%. 2007 outpatient and inpatient consultations 509,931, **** paid family account and hospitalization medical expense compensation. Payment of family account and inpatient medical expenses compensation 29.414 million yuan, payment ratio of 91.08%, the average hospitalization compensation ratio of 70.59% (including the fund sinking after the study of major hospitalization compensation over the cap line after 10% of the secondary compensation for hospitalized patients other than the secondary compensation of 7.8228 million yuan, accounting for 24.22%, 26.74%).2008 1 -June outpatient and hospitalized patients 42,933, according to incomplete statistics and this work is still in progress, *** payment of family accounts and hospitalization of 4,007,800 yuan, the payment ratio of 12.36%.
(B) the main practices and measures
1, the establishment of leading groups at all levels, strengthen leadership, improve the office, determine the implementation of the program, the new rural cooperative into the government's work objectives and for the people to do practical things for the content, and effectively do the ideological importance of action to support the farmers to bring tangible benefits to them, so that they have a disease can be treated, can afford to see the sick, an effective solution to the disease of poverty, because of illness, the problem of returning to poverty. The problem of returning to poverty due to illness is effectively solved.
2, increase publicity, the right to information to the farmers, so that the new rural cooperative medical policy more y rooted in people's hearts, so that the farmers at the beginning of the clear participation in the obligations to be fulfilled and enjoy the rights.
3, compensation policy gradually improved.
First, at all levels of finance year by year to increase the standard of subsidies, per capita participation in the total amount of funds increased under the premise of determining the new rural cooperative designated medical institutions, and reasonably determined at all levels of medical institutions of the medical expenses of the graded compensation ratio, the starting line, the ceiling line, etc., to prevent too much sedimentation of the fund, to guide the patients to reasonable diversion of farmers to maximize the benefit of the three-year, three times to increase the proportion of compensation for the township, has reached 75%, two times to increase the proportion of compensation for the village. The compensation ratio at the township level has been increased three times in three years and has now reached 75%, the compensation ratio at the county level has been increased twice and has now reached 60%, and the compensation ratio at the county level and for those who work outside the county has been increased twice and has now reached 50% and 40%, respectively. the hospitalization compensation ceiling line for major illnesses has been increased four times and has risen from 15,000 yuan in 2006 to 30,000 yuan at present. the starting line of the hospitalization compensation at the township level has also been abolished in 2007, as the case may be.
The second is to adhere to the principle of people-oriented, so that the compensation process is more simple, the county compensation by the fixed-point medical institutions first advance, outpatient compensation to implement the local reimbursement.
Three is to adhere to the principle of major disease relief, and effectively reduce the incidence of high medical costs of poor farmers due to the economic burden of the disease, more than the ceiling line of the proportion of the second aid.
4, actively take effective measures to effectively solve the rural five guaranteed households, special hardship households, disabled people, two female sterilization households and other disadvantaged groups to participate in the alloy, expanding the farmers on the system of universal coverage.
(C) effect
After several years of exploration efforts, to 2006, the county's new rural cooperative medical work has basically formed a government-led, departmental cooperation, voluntary participation of the masses of the work pattern, the initial establishment and standardization of the organization and leadership system, the policy framework system, to explore the work of a new type of rural cooperative medical work in the organization and management, financing mechanisms, fund management and use, medical assistance, and supervision of health service organizations, and gradually standardized, improved and perfected. The implementation of the New Rural Cooperative Medical Care system has effectively eased the economic pressure on patients' families, curbed to a certain extent the phenomenon of poverty caused by illness and the return of poverty due to illness, and enhanced the image of the Party and the Government as working for the people. The new rural cooperation for a good policy for the people to do practical things, has been initially recognized by the general masses of farmers in general, the enthusiasm of farmers to participate in the cooperation is gradually increasing. Township health centers have become the main carrier of the new rural cooperative medical care, the total amount of funds is rising rapidly, in the new rural cooperative medical care system, the township health centers, the effective use of resources, health care personnel team building has been strengthened, the hospital's health care environment has been greatly improved, and the hardware and equipment has been to a certain extent to update and improve, all of these for the rapid development of health care institutions have injected a new vitality.
Second, the difficulties and problems faced
The new rural cooperative is a systematic and complex social engineering to benefit the people, after a few years of hard work, not a small achievement, and accumulated a lot of experience, but due to the intricacies of the many factors and some unpredictability, there are still some difficulties and problems need to be calmly treated.
1, publicity and guidance work is not deep enough to affect the enthusiasm of farmers to participate. The main performance of some village cadres did not go through a special systematic training, the new rural cooperative policy is not enough to understand the farmers can not answer the relevant questions, the township cadres and limited energy, can not be all, so that the farmers do not know enough about the relevant policies of the new rural cooperative, and then there is a mistrust, wait and see and forced to participate in the phenomenon, resulting in the initiative of some of the farmers to participate in the enthusiasm is not high. The survey found that some farmers in the designated hospitals do not know how to reimbursement, and even some participated in the New Rural Cooperative also do not know how to enjoy this policy.
2, the poverty level is large, the number of people working outside the home, some farmers participate in the awareness is not strong, the difficulty of raising, funding costs increase. The county's rural poor population of 226,000 people, accounting for 29% of the rural population of 776,000 people, of which 85,300 people in absolute poverty, accounting for 10.99% of the civil affairs on the 2008 also solved only 92,000 people. The remaining poor population is mainly distributed in poor villages with extremely poor living conditions, poor industrial conditions, insufficient per capita resources, low quality of labor force, single source of income, and weak household income, resulting in unstable income, low actual support capacity of farmers, and obviously insufficient fund-raising capacity, which potentially leads to a crisis of enrollment. 150,000 out-of-town wage earners' enrollment in self-financing partly depends on the relatives of the enrollment to pay on behalf of the operation of the New Farmers' Association, and also brings hidden dangers to the operation of the New Farmers' Association. Hidden dangers. Some farmers have a weak concept of healthy investment, *** financial concept and the concept of risk, in the rural economic conditions are not rich, farmers want to have the new rural cooperative, but there are medical consumption and a sense of chance, compared with food, clothing, children's schooling and other steel expenditures, spending money on medical treatment is secondary, random, lack of sufficient understanding of the potential medical risks, but also the existence of the farmers on the new rural cooperative, which is mainly based on the coordination of the new rural cooperative, lack of experience and experience. Lack of experience experience. These will increase the difficulty of fund-raising, which in turn will lead to the collection of the part of the personal burden of farmers every year need to relevant staff to spend a lot of time and energy to mobilize the masses, due to time constraints, heavy task, in some townships, two kinds of advances phenomenon, one is the cadres in order to complete the task of fund-raising advances; the second is to go out and work for the family members of the personnel or relatives advances, resulting in the name of the participant, the year of birth and the information of the participant with my own The information is not enough to match, to the medical card issued by the great difficulties, resulting in bills, enrollment information and other basic data intricate, difficult to straighten out, increasing the difficulty of compensation, for the new rural cooperative negative impact, but also increased the cost of financing.
3, the growth of farmers' demand for medical services, the primary health care institutions service capacity is not strong. First, the township health center medical staff serious shortage, the second is still unable to meet the clinical needs of the equipment, the third is the village health room in name only. The survey found that the spoon nest township health center only 1 building 360 square meters of housing, between the wards only 2 40 square meters, equipment and instruments piled up, can not be activated, 9 medical personnel removed for various reasons to draw out only 5 people to work, the village basically has no independent health room, the village health worker's home is the temporary village health center, medicine shortages, not to mention the lack of medical equipment, in addition to the village health worker's salary is still monthly 39 yuan, the lack of enthusiasm for work, the village health office has faced a crisis of survival and development, affecting the implementation of the policy of universal access to minor illnesses, reflecting the township health centers, the village health office medical conditions need to be improved, the township medical staff to be enriched, the village health worker's treatment needs to be improved.
4, the fixed medical institutions drug prices are high. We did not find the phenomenon of illegal purchase of drugs in the investigation process of the designated medical institutions, but a considerable part of the price of drugs is higher than the market pharmacy is an indisputable fact. In addition, too many out-of-pocket expenses for medicines, to a certain extent, affecting the enthusiasm of farmers to participate in the cooperative, farmers complained that "the cost of medicines is too high" is one of the main reasons why farmers are "dissatisfied" with the new rural cooperative medical care. Farmers believe that after participating in the new rural cooperative hospitalization reimbursement of the money was earned by the hospital, the burden of their own medical expenses and did not participate in the pre-differential.
5, the real poor still can not afford to see the disease. For those farmers who are still hovering on the edge of the subsistence level, not only do they not have the money to participate in the cooperative medical care, even if they have already participated in the cooperative medical care, but they have to pay for their own medical care first, and then reimburse them according to the proportion, the farmers need to bear a lot of the amount of money is still quite a lot of real poor people can not afford to go to the hospital.
6, the beginning of the fund is relatively conservative, the funds deposited too much, the compensation ratio to determine the need to explore. On the one hand, the payment ratio and the average hospitalization compensation is low, although high in 2007, but including major hospitalization compensation over the ceiling line 10% of the secondary compensation outside the hospitalized patients secondary compensation of 7,822,800 yuan, respectively, accounting for 24.22%, 26.74%, is not at the beginning of the measurement category. On the other hand, the township-level starting line, which had been abolished in 2007, was reinstated in June 2008, reducing the reimbursement rate for enrolled patients whose total hospitalization costs were less than 400 yuan, and they did not benefit from the 5-percentage-point increase in the reimbursement rate. These are reflected in the major illness assistance and benefit surface ratio measurement is not comprehensive enough to appear too much financial precipitation, affecting the attractiveness of the policy.
7, the daily workload, the construction and management of the organization is weak. First, the information technology construction work lagging behind, huge data information and reimbursement work still can only rely on half computer half manual way settlement, seriously affect the speed and efficiency of work. Thirdly, the township co-management office has no source of income, the work of the funds have not been fully implemented, it is difficult to mobilize the enthusiasm of the staff, to the work of the normal development of a great negative impact.
Third, countermeasures and recommendations
1, strengthen the publicity, optimize services. First, the village cadres to carry out professional and systematic training, so that they are widely and y carry out the policy and system publicity, to participate in the methods, rights, obligations, and audit and settlement process to tens of thousands of households, so that the majority of the public really understand, familiar with this system. Secondly, it is targeted to carry out specific, image, vivid typical examples of publicity, and to enhance the attractiveness of the system. Thirdly, the hospitalization compensation and reimbursement costs are announced on schedule, increasing transparency and improving farmers' trust in the New Rural Cooperative. The fourth is to strengthen the education and training of management personnel and medical staff, improve the level of business and work efficiency, change the service attitude, to participate in the new rural cooperative farmers to provide convenient, fast, thoughtful service.
2, effectively strengthen the construction of medical assistance system, improve the vulnerable groups of medical assistance. First, the development and introduction of medical aid implementation measures, appropriate expansion of the aid object, improve the standard of aid, reduce the threshold of aid, increase the aid beneficiary surface. The second is to actively seek entrepreneurs, rich people and other social assistance, give full play to the role of social forces, the establishment of a special fund for medical assistance, to make up for the inaccessibility of the current stage of the New Rural Cooperative Medical Insurance, and actively and steadily increase the level of protection.
3, to the village, village medical institutions to create space for survival and development. Effectively increase the rural village, village medical institutions of the capital investment, one is to maximize the gradual increase in the construction of rural health centers, village health clinics, for its purchase of updated medical equipment, change the village health worker 39 yuan of monthly wages, stabilize the health team, and at the same time to strengthen the quality of its construction, and constantly improve the rural village health care level of diagnosis and treatment to the countryside to create a space for the development of the countryside to create the survival of the health clinic, the real realization of the farmers! "Small illnesses do not go out of the village, big illnesses do not go out of the township", for farmers to improve the convenience and quality of medical and health services.
4, strengthen drug management, reduce drug costs. Continue to implement the drug bidding and purchasing system, take the centralized purchasing of drugs, public inquiry, bidding and regional distribution methods, reduce the purchase and sale of links, reduce the cost of drug purchase and sale. At the same time, the organization of the drug supervision department to increase the rectification of the rural drug market, strict rural drug wholesale and retail enterprise business access, to combat illegal business, purify the rural pharmaceutical market.
5, standardize medical behavior, control the use of drugs outside the directory. Strengthen the management of designated medical institutions, adhere to the regular assessment and dynamic management system, strictly regulate the diagnostic and treatment procedures and medication behavior, the designated medical institutions must strictly implement the province's unified development of the basic medication directory of cooperative medicine, for the same management, the same or similar efficacy of the drugs and different drug names, the medical institutions must be used within the directory of drugs, if the use of drugs outside the directory, the cost of the drugs by the health care institutions. The cost of medicines will be borne by the medical institution if they are used outside the catalog. This is to effectively control the unreasonable increase in the cost of medicines for farmers and to reduce the unreasonable burden on farmers.
6, strengthen research, improve the system. First, the basic principle of "income to determine expenditure, pay for what you earn, gradually adjust, protect the moderate", summarize experience, scientific calculations, fully justified, rationally determine the income and expenditure program, to prevent excessive precipitation of the fund, and timely adjustment of the compensation standard should be appropriately increase the compensation ratio, reduce the starting line, reduce the out-of-pocket expenses of medicines and their proportion, and to broaden the scope of compensation, the introduction of a chronic disease compensation program. the scope of compensation and introduce a compensation program for chronic diseases. Second, simplify the reimbursement procedures and procedures for reimbursement, and allow hospitalization within the county to be fully advanced to implement the reimbursement system, as well as allowing direct reimbursement in the designated hospitals for medical treatment. Third, improve the referral system, it is recommended to simplify the referral system, allowing participating farmers in the county to independently choose the fixed-point medical institutions.
7, the establishment of management and supervision mechanism, really do to win the trust of the people. The first is to give full play to the joint management committee (office) responsibilities, and effectively carry out the organization, coordination, management and guidance of the work of the medical sentinel hospitals to carry out occasional checks, checking the condition, checking the medical records, checking the prescription, to verify whether the patient is in line with the provisions of the compensation, the implementation of the doctor's orders is true, whether the medication is in line with the requirements of the various fees in line with the standard, the discovery of the problem of timely processing, prompted the hospitals to do the patients to the sentinel hospitals to do a The hospitals are urged to provide patients with a notification letter for admission, a billing statement for discharge, and a piece of understandable paper for compensation. Secondly, the construction of the organization has been strengthened. According to the regulations, we will implement staffing and working funds, improve the office conditions of the agencies, expeditiously improve the level of information technology, improve the working system and strengthen standardized management. The third is to improve the fund regulatory mechanism, develop regulatory provisions, the formation of a regular audit and supervision system to ensure that the fund operation is standardized, transparent and efficient, to ensure the fairness and impartiality of the system.
8, clear responsibilities, solid work. First, to promote the implementation of the new rural cooperative system, improve the basic health conditions in rural areas, improve the health of farmers, reduce the number of people who are poor and return to poverty due to illness, to ensure that the rural health expenditure funds as a function of departmental post target responsibility management, as an important part of the performance appraisal of the party and government leaders. Second, the party committee, the government should strengthen the organization and coordination of the relevant departments to do a good job in the implementation of the new rural co-operation system, to promote and supervise the work. Third, the health administration should give full play to the role of the competent authorities to speed up the change of functions, not only to become a good manager, but also to become a level of service, in promoting the implementation of the new rural cooperative system, take the initiative in accordance with the relevant national policies and local practice, regulating and balancing the interests of all parties, and constantly improve the system, operational measures and service system, and constantly standardize the implementation of the system.