Pilot project of new cooperative medical system
Problems in
The government's financial input is insufficient, and the gap in medical financing is too large. According to the new rural medical system, the cooperative medical fund is jointly funded by individual farmers, local finance and central finance. In 2006, the central financial subsidy increased by 10 yuan on the basis of the original 10 yuan, and the local financial subsidies increased accordingly. However, due to the backwardness of rural medical and health infrastructure and the serious shortage of overall medical security, the government's financial support for the overall rural medical security system is still insufficient, and the financing problem has become a roadblock for rural cooperative medical care. In the pilot process, many local governments have not allocated special funds for cooperative medical care, or their financial support is limited, so it is difficult to ensure the long-term stable investment of local governments in the new rural cooperative medical fund.
The cooperative medical system is not standardized and the supervision is weak. First, there is a lack of institutional guarantee, and many places are very casual. For the new rural cooperative medical system, the state emphasizes the principle of "government organization guidance and farmers' voluntary participation", and the construction of cooperative medical system is not guaranteed by laws, regulations and rules. Second, the main body of cooperative medical fund management is chaotic. Some take the health bureau as the main body of management, some take the county hospitals as the main body of management, and even some areas take the township hospitals as the main body of management, and these managers themselves are medical service providers, and their interest disputes make their management behavior prone to deviation. Third, the reimbursement system of cooperative funds is chaotic. Due to the lack of accurate calculation, the reimbursement starting point, reimbursement ratio and reimbursement capping line of cooperative medical care lack scientific basis, and cooperative funds lack a good basic system. In addition, the reimbursement procedures for medical expenses are very complicated, resulting in very high reimbursement costs; Moreover, farmers generally don't know the reimbursement scope of cooperative medical care, which leads to blindness in choosing drugs and receiving medical services.
The new cooperative medical care policy, which focuses on serious illness, is not conducive to the improvement of farmers' health level. For example, the policy direction of the new rural cooperative medical system in some areas is mainly serious illness, that is, both government subsidies and funds paid by farmers need to "mainly subsidize large medical expenses or hospitalization expenses", and only "arrange a routine physical examination" for those who have not suffered from serious illness during the year, resulting in the actual benefits of paying farmers only equal to the incidence of serious illness, which affects the enthusiasm of farmers to participate in insurance. The basic yardstick for the success of the new rural cooperative medical system is the improvement of farmers' health level and the reduction of medical burden, not just serious illness insurance. Therefore, dealing with the relationship between preventive health care and disease treatment, that is, the relationship between traditional cooperative medical system and new cooperative medical system, is directly related to the success or failure of the new cooperative medical system.
The reform of medical and health management system lags behind, and the conditions of rural medical and health services are poor. Over the years, the construction of rural health infrastructure has lagged behind, the financial input of township hospitals at all levels is generally low, the quality of medical staff is low, and some township hospitals are paralyzed, which is difficult to meet the diversified medical needs of farmers and affects their enthusiasm for insurance. The reform of health care institutions is not in place, the drug circulation market is not standardized, and there is a lack of effective management and supervision, which has caused the medical expenses to rise too fast and increased the medical burden of farmers.
policy advice
Strengthen government responsibility. The cooperative medical system has the characteristics of public goods. The state not only has the responsibility to organize investigation and study, design specific plans, formulate laws and regulations, and establish the scope of protection, but also has more financial responsibilities. The particularity of health service consumption, the passivity and uncertainty of consumption behavior and the monopoly of health service providers also determine that the government must strengthen support and intervention in the field of health services. The achievements of rural cooperative medical system in China in 1960s and 1970s also show that strengthening government responsibility, especially financial responsibility, is the key to the implementation of the new rural cooperative medical system.
At present, we should increase the proportion of finance in rural cooperative medical care. The central government should gradually increase the special transfer payment to the western rural areas, provide medical assistance to the poor, and give financial support to the construction of basic medical service facilities and the education and training of township health personnel; Local governments in the central region should provide financial subsidies for basic public health services and guide funds to establish community medical security; Local governments in developed eastern regions should provide government funds for social medical insurance.
Improve the management system of cooperative medical fund. In terms of capital investment, some local governments and collectives are too casual to be included in the budget at all; Give if you want, and it is more possible to give more and less. It is necessary to formulate the rural cooperative medical care law as soon as possible, strictly stipulate the input of the government and the collective, and incorporate it into the fiscal budget to ensure a stable source of funds, and put it in place in full and on time. The reimbursement procedure, scope and proportion shall be specified in detail. The system should be strictly open and the procedures should be simplified.
The function of cooperative medical care has changed from the simple guarantee of serious illness to the combination of prevention and treatment. It is reasonable that the new rural cooperative medical system mainly guarantees serious illness. But we must pay attention to the prevention and treatment of minor illnesses. At the same time, it can also increase the opportunities for participating farmers to benefit, thus promoting the popularization of cooperative medical care.
In addition, in view of the fact that the "net bottom" of the three-level medical prevention and health care network in many rural counties, townships and villages in China has been broken, and some extinct infectious diseases have resurfaced, which has seriously endangered farmers' health, it is necessary to combine the new rural cooperative medical system, increase financial input, repair and improve the three-level medical prevention and health care network in rural areas as soon as possible, implement the personnel, equipment and information network system, and enhance the rural health guarantee capacity.
Strengthen fund supervision. The cooperative medical fund is the "life-saving money" for farmers, who are very concerned about it. The collection, management, supervision and use of funds should be responsible for each other, restrict each other and strengthen management. The competent department of cooperative medical care is responsible for the collection, unified management by the Ministry of Finance, supervision by the auditing department, and provision of services by designated medical units. Accounts should be published regularly, and accept questions or consultations from farmers' representatives. When problems are found, they should be dealt with in time, and if the problems are serious, they should be investigated for responsibility. First of all, the establishment of new rural cooperative medical fund financial accounts, closed operation, earmarking, to ensure the safety of funds. Jiangxi Province stipulates that farmers' out-of-pocket expenses and financial subsidies at all levels must be deposited in the "financial social security special account", and the funds in this special account can only be transferred to the "cooperative medical fund expenditure account" set up by the cooperative medical office in commercial banks. "Double seal" is implemented when allocating, that is, in addition to the seal of the financial department, the special financial seal of the health administrative department at the county level must also be affixed. Secondly, cooperative medical management departments at all levels should absorb a certain number of farmers' representatives to participate in management and supervision; The budget and final accounts of the cooperative medical fund shall be reported to the people's congress at the same level for approval. Local audit departments should regularly audit the income and expenditure and management of rural cooperative medical fund, and correct the problems in time when found.
Deepen the reform of rural medical and health institutions, improve medical and health service conditions, and actively serve the broad masses of farmers. Rational distribution of rural medical and health resources, according to geographical location, population distribution and other factors, re-adjust the number, scale and layout of township hospitals. Towns close to the county seat and with convenient transportation can have fewer or no health centers, and places far from the county seat and with blocked traffic can check the size and personnel of township (town) health centers according to their service functions, service population, service scope and endemic diseases. In addition, village clinics should be actively developed to provide primary diagnosis and treatment services. At the same time, it is necessary to encourage the vertical cooperation of county, township and village health institutions, so that the technical services of county-level medical institutions extend to townships (towns), and the technical services of township (town) medical and health institutions extend to villages. Carry out training, effectively improve the professional quality and medical level of rural doctors, guide them to carry out rural community health services, establish health records for farmers (especially patients with chronic diseases and the elderly), conduct regular physical examinations and provide consulting services.