The status quo and countermeasures of new rural cooperative medical care

In order to speed up the establishment of a rural medical security system, improve the health standards of farmers, and better promote the coordinated development of urban and rural social and economic development, over the past year or so, according to the spirit of the CPC Central Committee and the State Council’s Decision on Further Strengthening Rural Health Work, Governments at All Levels Leading the deployment, the relevant departments carefully organized and implemented, the majority of rural people actively participated, the city initially established the "sick disease co-ordination, medical assistance and rural community health services" three-in-one new rural cooperative medical system. In order to effectively consolidate this system, we will further explore and establish a long-term mechanism for healthy and sustainable development, and conduct a special investigation on the operation of new agricultural doctors in our city. Through research, summarize and summarize the status quo and effectiveness of the system, study and analyze existing problems and difficulties, and propose development strategies.

First, the status quo and effectiveness

In 2003, there were 132 townships and towns and villages with 3,914 village committees and a resident population of 5,490,700. Among them, the agricultural population is 3.8 million, the number of households is 1.4174 million, and the per capita net income of farmers is 6221 yuan. There are 155 township health centers, 2,838 village clinics, and 3,273 rural doctors. Since Zhenlin District took the lead in launching the pilot project of new agricultural medicines on July 1, 2003, all the counties and districts have been fully opened except Haishu District. As of the end of December this year, 109 towns and towns in the city, accounting for 83%, 2,694 insured villages, accounting for 69%, the number of participants reached 2.754 million, accounting for 76.4% of the city's agricultural population.

Main work results:

Strengthen leadership, meticulous implementation, and standardized management, and initially established a benign operational mechanism for the new agricultural medical system.

The first is to strengthen leadership. The municipal party committee and the municipal government and the county and township party committee governments attach great importance to the new agricultural doctors, proceed from the practice of the important thinking of the "three represents" and the major strategy of coordinating urban and rural development, earnestly strengthen leadership, study policy systems, improve organizational structure, and implement support and safeguard measures. In 2003 and 2004, the municipal government included the implementation of new agricultural work in the government's practical projects for two consecutive years. According to the guidance of the municipal government and the local conditions, the counties and districts formulated the new agricultural practices and related systems; The head of the group, the new agro-medicine coordination group participated by the responsible persons of relevant departments, and set up a handling agency. The municipal and county governments have included the implementation progress and implementation results in the assessment of the government's target management responsibility system; the special funds at all levels of the financial arrangement ensure that the funding for the new agricultural medical government is in place.

The second is to implement it carefully. Governments at all levels have established special work teams, determined implementation plans, convened mobilization meetings, widely publicized the superiority of the new agricultural medical system, actively guided and mobilized rural people to participate; health, finance, civil affairs, agriculture, publicity and other relevant departments actively Business guidance, policy propaganda and explanation, and work supervision; the National People's Congress, the CPPCC and other departments have also given high attention, support and supervision; the majority of party members in the grassroots towns and villages have taken part in the work, and have undertaken organization launch, personnel registration, and fund collection. A lot of basic work such as the issuance of medical insurance cards. Due to the attention of leaders at all levels of government and relevant departments, the work is solid and the enthusiasm of the people is high, ensuring the successful completion of fundraising work and the smooth implementation of the system.

The third is standard management. The county has established a new agricultural medical management committee and set up a special new agricultural medical office. The townships and towns have also set up leading groups and offices. The administrative villages have established new agricultural medical liaisons and the establishment of a three-level organization network. Provided organizational guarantee for the standardized management of the new agricultural system. After the formal implementation of the system, the agencies at all levels will continue to improve the rules and regulations, standardize the management of designated medical institutions, simplify the reporting and review process, implement service commitments, and strive to provide quality services. At the same time, strengthen fund supervision, formulate fund management methods, and establish funds. Special accounts for revenue and expenditure, strict cost review, establishment of major reporting amount review system, elimination of unreasonable and illegal compensation expenses, regular notification and publication of fund operations, improvement of fund operation transparency, and acceptance of financial and auditing departments at the same level and the majority Public supervision.

Adhering to principles, adapting to local conditions, and informally, we have creatively developed various modes of operation for new agricultural doctors.

First, fully respect the wishes of farmers and adhere to the principle of implementation. In the process of fundraising, local governments insisted on government organization, guidance, and support. Farmers voluntarily participated in households. Since the propaganda and guidance work was in place, the participation rate in all counties was more than 80%, including Zhenhai and Beilun. , Zhangzhou, Jiangbei, etc. reached more than 90%, greatly breaking the expected goal. In the fund-raising mechanism, the principle of combining individual farmers' contributions, collective support and government subsidies has been adhered to. Among the city's 221.93 million major illnesses, among them, 80.93 million are invested by individuals, 49.107 million are financed by townships, and 56.565 million are financed by the county. A total of 38.391 million has been funded, reflecting a more reasonable composition ratio. In the use of the fund, we adhered to the principle of “receiving expenditures, measuring expenditures, and ensuring appropriateness. Most counties have also established risk adjustment funds to ensure the normal operation of cooperative medical care.

Second, according to the level of social and economic development of each locality, the level of financing and the level of compensation should be determined according to local conditions. Due to the comprehensive consideration of the per capita income of local farmers, the local finance, the number of guarantees and the different foundations of the original rural cooperative medical care system, local governments have slightly higher levels of personal contribution, financial support and compensation. The “Southern Three Counties” are relatively low. The city jurisdiction is relatively high. Overall, the fundraising level of the whole city is basically above 75 yuan, higher than the average level of 47 yuan in the province; government funding at all levels is generally above 45 yuan, the most 65 yuan, while the province is generally 22-25 yuan; The compensation level is between 25% and 35%, which is also higher than the provincial average.

The third is to informally explore various management modes and mechanisms. At present, there are three main types of operation modes of new agricultural doctors in various places: the health sector operation type—including Cixi, Yuyao, Jiangbei, Jiangdong, Daxie, Zhenhai, which dominates, establishes regional fixed-point referrals, and controls medical expenses; The combination of rural community health services, actively carry out health checkups for insured farmers, establish health records, implement outpatient preferential relief, and support new agricultural doctors. The operation mode of the social security department—Yuzhou District actively explores the unified operation mechanism of urban and rural medical insurance management by the labor and social security department, and uses the management organization, personnel network and software system of urban medical insurance to implement the new agricultural medical system. The government entrusts commercial insurance companies to operate – Beilun District and Ninghai County are operated by life insurance companies, and government departments strengthen management. The beneficial exploration of the operation mechanism of new agricultural doctors in various places has opened up ideas for the implementation of this system, which is worth trying and exploring.

Coordinating major illnesses, medical assistance, and rural community health services, and focusing on building a trinity of rural basic medical security.

First, the implementation of major disease co-ordination, so that the health of the majority of farmers have a certain guarantee. According to the size of the hospital, the medical expenses incurred by the insured personnel in the hospitalized treatment of the designated medical institutions are in accordance with the size of the hospital, and are calculated according to the medical expenses, segmented calculation, and progressive compensation. Yuyao, Cixi, Zhenhai, Beilun and Ninghai also implemented certain compensation for the outpatient medical expenses of certain special diseases. By the end of December this year, the city had reported 75,456 person-times, with a total compensation of 1,291.32 million yuan and a per capita compensation of 1,711 yuan. The actual subsidy accounted for 25.0% of the total hospitalization expenses, accounting for 29.3% of the effective expenses; 669 outpatient compensation, and compensation amount of 884,000 yuan. .

The second is to implement medical assistance and increase the medical assistance of vulnerable groups. While implementing the overall disease coordination, we will actively explore the establishment of a medical assistance system. Rural five-guarantee peasants, rural low-income families, key special care recipients, and disabled persons with basic incapacity for work, their major AIDS co-ordination personal contributions are paid by the county, township and township finances; at the same time, the two-level financial contribution is 5-20 yuan per person. In addition, a special fund for medical assistance will be set up to implement medical assistance in addition to major illnesses for the above-mentioned subjects and individuals who have incurred large medical expenses and seriously affected their basic living. At present, counties with new agricultural doctors have implemented medical assistance systems. For example, Zhenhai District has given at least 5,000 yuan to such subjects with effective medical expenses of 50,000 yuan or more. By the end of September, the city had received 14.660 million bailout funds. The poor people who have subsidized the subsistence allowances, the five guarantees, the key special care, and the major diseases have 5,500,000 people, and the total amount of subsidies is 1,356,500 yuan. The subsidies for the economically underdeveloped areas are 6.59. Ten thousand people, the amount of subsidies was 882,900 yuan; the number of medical expenses for the disabled was 5,177, and the amount of assistance was 7.633 million yuan.

The third is to implement rural community health services and gradually realize the peasants' minor illnesses. After the implementation of the new agricultural medical system, the local community organic services and the new agricultural doctors were organically combined, and various forms of rural community health service activities were carried out by taking the urban community health service practices. Zhenhai, Yuyao, Jiangbei and other places arrange special funds, through the rural community health service center to make appropriate profits, take the combination of the necessary inspection items and the farmers' self-selected items, the combination of on-site physical examination and concentrated physical examination to conduct health checkups for the insured personnel, and establish Health file. Cixi City explored the mechanism of benefiting from minor illnesses. After the village clinic was approved, it was converted into a rural community health service station. The county and township finances gave an average of 30,000 yuan per year to each service station. The service station participated in the new service. The villagers of agricultural doctors provide outpatient discounts, and the drug costs are given a certain percentage of profits, exempt from registration fees, medical treatment fees and injection fees, and the expenses for business use, water, electricity, etc. are subsidized by the collective economy. Beilun District set up a special fund for rural community health services, which is invested 4 yuan per person per year in accordance with the number of people participating in major illnesses. It is mainly used for patrolling medical treatment in the countryside, health education and supporting rural community health services in remote areas to solve the problem of rural residents in remote areas. Difficult question. In addition, the standardization construction of the rural community health service center in the city has been started, and 52 rural community health service centers have been included in the standardization construction. The municipal government will invest 10 million yuan each year, and the county and town governments will support 1:2.

In short, the implementation of the new agricultural medical system has initially established the prototype of rural basic medical security in the city. The majority of the peasant people have earned practical benefits and played a positive role in promoting the urban and rural social and economic development of the city. In the words of a farmer, this is the deepest memory. After the implementation of the household contract responsibility system in rural areas, the party and the government have done a good job for the farmers. According to a sample survey of 995 people in 302 households in the city, The satisfaction rate with the system reached 93.1%.

Second, difficulties and problems

The new agricultural doctor is a long-term and arduous social security project. At the beginning of its implementation, there are still many difficulties and problems. In general, there are four main aspects:

The propaganda and guidance work is not deep enough, and the enthusiasm of farmers to participate in insurance needs to be improved. In the process of implementing the new agricultural medical system in various places, on the one hand, due to tight time and heavy tasks, policy propaganda and guidance work is still not deep enough. On the other hand, farmers lack experience and experience in the new agricultural doctors who are mainly responsible for major illnesses, and the old system. Obscured, lack of confidence in long-term implementation, resulting in some farmers are not motivated to participate in the insurance, and there is not much voluntary participation.

The review and settlement process is still complicated, and the farmers' settlement procedures for settlement are subject to further simplification. Due to the short implementation time of the system, the specific regulations are still not perfect, the coverage of a county is mature, and the construction of the network information management system of the whole city has not yet started. The public still has more opinions on the process and services for review and settlement, although it is timely. Adjustments and improvements have been made, but the review and settlement process and services need to be further simplified and optimized.

The policy system needs to be improved, and funds in some areas have been deposited too much. As the new agricultural doctors have just started, there is a lack of ready-made experience for specific programs, and the fund is relatively conservative. There are some unscientific and reasonable places in the system. It is prominently manifested in the excessive precipitation of funds in some counties, which has affected the attractiveness of the system and the enthusiasm of the people.

The construction of regulatory organizations needs to be strengthened, and the implementation of regulatory functions needs to be standardized. The responsibility of the New Agricultural Medical Management Committee and the Fund Supervision and Management Committee is not very clear. Although the corresponding organizations have been established in various places, they have no clear obligations on their obligations and rights, and lack of standardized operations. Most of them are still directly borne by government departments. Democratic management system. The auditing supervision of the income and expenditure and management of the new agricultural medical fund has not yet formed a standardized program. There is no basis for how to strengthen the supervision of the funds entrusted to commercial insurance companies, which affects the normative and authoritative nature of fund supervision to some extent.

In addition, with the promotion and implementation of the new agricultural medical system in various places, there have been many new situations that require special attention and research. There are mainly: First, the problem of "medical insurance blind spots". The main target of the new agricultural medical system is the peasants. The urban medical insurance is targeted at urban workers. Those non-agricultural non-urban medical insurance objects have become “medical insurance blind areas” and should be studied and resolved as soon as possible. The second is the issue of “high threshold for medical assistance”. As a supplement to the overall disease, the current medical assistance system is an effective way to solve the problem of poverty due to illness and returning to poverty due to illness. However, in the actual operation, a considerable number of counties are controlled at more than 50,000 yuan in order to be able to provide assistance in proportion to the maximum amount of 20,000 yuan. The difficult targets are often unable to withstand high medical expenses, and cannot enjoy this policy. Medical assistance is needed. The object and the low line of salvation make a new definition. The third is the issue of “the development of rural community health service centers”. After the implementation of the drug price, some rural community health service centers in the city suffered serious losses. After the implementation of the new agricultural doctors, the government also required these institutions to appropriately reduce the registration fee, injection fee, medical treatment fee and preferential medical expenses for the insured personnel. To achieve the policy of minor illness and inclusiveness for the insured personnel, to promote the sustainable development of new agricultural doctors, the rural community health service center is overburdened when the financial compensation mechanism is not yet in place and the rural public health system is not yet fully developed. The public health service function faces the crisis of survival and development, and it needs to give due attention and timely financial support policies.

Third, countermeasures and recommendations

Overall development goal: Full implementation in 2005, covering more than 85% of the city's rural residents' insurance coverage; 2006-2019, improving the policy system year by year, expanding coverage and enhancing support capacity; establishing a more perfect rural basic medical security around 2019 The system is gradually integrated with urban medical insurance, and finally establishes a social basic medical security system that is integrated with the urban and rural development standards of the city.

The overall work idea: focus on building “three major systems” First, the new rural cooperative medical care is the leading factor, and grasp the breakthrough of rural basic medical security; second, medical assistance is supplemented, highlighting the medical assistance of rural vulnerable groups and enhancing the pertinence of the system. To make up for the inaccessibility of the new rural cooperative medical insurance at the present stage; the third is to complement the rural community health services, expand the benefits of the system, enhance the inclusiveness of the system, and overcome the weakness of the new rural cooperative medical care benefits. Clearly establish "three positionings" First, target positioning: The ultimate goal is to establish a basic medical security system in rural areas, integrate with urban medical insurance, achieve urban and rural integration, and grasp the development goals and directions of the system in implementation; second, stage positioning: "low level, The wide coverage will start, the system will have a long stage of primary development, and the implementation will emphasize the stability and consolidation of the system; the third is the process orientation: on the basis of consolidating the effectiveness of the primary stage, actively and steadily improve the level of protection, expand the coverage and Benefits, implementation of the improvement and development of the system. To ensure that the "three in place" is the responsibility of the government, it is necessary to implement individual obligations, but also to emphasize government responsibility and establish a sound organizational management system; second, propaganda and guidance should be in place, not only to respect the wishes of farmers, but also to emphasize scientific guidance. Form an atmosphere in which farmers participate actively; third, financial support is in place. It is necessary to adhere to individual funding, but also to ensure reasonable financial support and establish a scientific financing mechanism.

Specific development strategies:

Further strengthen leadership and explore the establishment of a sustainable development mechanism.

First, from the perspective of social security, clearly define the nature of the new rural cooperative medical care system, strengthen government responsibility, highlight social management, emphasize individual participation, and clarify their respective rights and obligations; second, introduce medium- and long-term development planning and phased guidance. Opinions, handle the short-term goals and long-term goals of the system, means and objectives, the relationship between stability and development, strengthen guidance to the grassroots, grasp the development direction and establish a sustainable development mechanism; third, actively explore new modes of personal financing, Scientifically guide the peasant people to voluntarily pay fees voluntarily to alleviate the pressure on grassroots cadres; Fourth, the relevant business departments and relevant academic institutions strengthen the research on theory and practice, and on the basis of the relatively mature system design and practice, the relevant local laws and regulations are brewed. Standardize from the perspective of the rule of law.

Further strengthen publicity and increase the enthusiasm of rural residents to participate in insurance.

First, through various channels such as newspapers, television, and the Internet, the policy system will be widely and intensively promoted, and the insurance measures, the rights and obligations of the insured, and the review and settlement process will be publicized to thousands of households so that the general public can truly understand Familiar with this system; secondly, carry out targeted, specific, vivid and typical case propaganda, and present the traditional virtues of dedication, love, and mutual assistance, so that the people can truly feel the meaning and benefits of the system and strengthen the system. The attraction is to further enhance the awareness of conscious participation; the third is to actively strive for the attention and support of the NPC, the CPPCC and all sectors of society for the new rural cooperative medical work, and create a good working atmosphere.

We must do a good job of consolidation and improvement, and enhance the rationality and scientificity of the system.

The first is to effectively consolidate the implementation results. Summarize experience, scientifically calculate, fully demonstrate, reasonably determine the fund's income and expenditure plan, prevent excessive precipitation or overdraft of funds, and maintain the stability and continuity of policies. According to the development of rural social economy and the income level of rural residents, in principle every two to three In the year, appropriate adjustments will be made to the funding standards and subsidy standards, and the fiscal year will be rationalized in a timely manner. Second, efforts will be made to expand funding channels, enhance the strength of the fund, and raise the level of compensation year by year. According to financial resources, governments at all levels have rationally increased financial input. Individual financing depends on the per capita income of rural residents and the degree of recognition of the system. The village self-governing organizations must give certain investment according to the collective economic situation, actively strive for social donations, and strengthen through multiple channels. The strength of the fund will gradually improve the compensation level of the insured patients; the third is to strengthen the information construction, simplify the review and settlement procedures, reduce the unreasonable intermediate links, and strive to facilitate the people to report to the medical treatment, improve the service level and efficiency; Fourth, seriously investigate and agree Relevant departments explored the issue of medical security for non-agricultural non-urban medical insurance targets. At the same time, where there are conditions, the compensation mechanism for setting different personal financing levels and different compensation levels can be explored according to the different needs of the people for rural medical insurance.

Improve the management and supervision mechanism and truly win the trust of the people.

First, give full play to the responsibilities of the new rural cooperative medical care coordination group or the management committee, earnestly perform the tasks of organization, coordination, management and guidance, report regularly to the people's congress at the same level, and actively accept supervision; second, strengthen the construction of the handling organization and implement the staffing according to the regulations. Work expenses, improve the work system, and strengthen standardized management; third, improve the fund supervision mechanism, formulate supervision and management regulations, form a regular audit supervision system, ensure that the fund operates in a standardized, transparent and efficient manner, and ensure the fairness and justice of the system; Standardize the management of designated medical institutions, rationally divert the source of the disease, rationally diagnose and treat, effectively control the ratio of medical expenses and non-effective medical expenses, and reduce unreasonable medical expenses.

Actively promote the construction of rural community health services and expand the benefits.

First, strengthen the construction of rural community health service institutions, optimize and reorganize existing rural medical and health resources, and focus on promoting the infrastructure of township health centers and the service functions of first aid, maternity insurance, child protection, prevention, and obstetrics, and promote township and village medical care. The second is to combine the new rural cooperative medical care and rural public health system construction, continuously improve the rural community health service function, rural family planning guidance and disability rehabilitation into the community health service construction, and gradually develop chronic disease management, community health education, health Services such as medical examinations; third, the introduction of policies for the benefit of minor illnesses, the establishment of a mechanism to promote the benefit of minor illnesses, and the attraction of the new rural cooperative medical system; the fourth is to strengthen the construction of rural community health service teams and introduce preferential policies to ensure rural public health personnel. Prepare and work funds, encourage graduates of medical colleges to work in rural community health services, carry out health support activities, strengthen theoretical and practical training for incumbents, and establish mechanisms for personnel training, access, elimination and renewal; Health service demonstration site construction The introduction of policies to support the development of specific construction standards, advancing step by step construction of rural health institutions and community functions.

Effectively strengthen the construction of the medical assistance system and improve the medical assistance of vulnerable groups.

First, the relevant departments will formulate measures for the implementation of medical assistance, appropriately expand the targets of assistance, raise the standard of assistance, lower the threshold for salvage, and increase the benefits of assistance; second, the medical assistance of the new rural cooperative medical system, and the medical assistance of the civil affairs department, and Unified implementation, it is recommended to increase financial support, actively strive for social donations, establish a special fund for medical assistance; third, establish a combination mechanism with new rural cooperative medical care, and participate in the new rural cooperative medical care as a pre-emptive obligation to enjoy medical assistance, low The part of the vulnerable groups of the policyholders, the five-guarantee households, the key care recipients and other vulnerable groups participating in the new rural cooperative medical care will be subsidized by the medical aid fund; the fourth is the conditional area to establish the compensation mechanism for the outpatient expenses of the vulnerable groups, and to treat the malignant tumors and organs. Vulnerable groups of chronic and malignant special diseases such as transplants and uremia, implement outpatient compensation and focus on improving medical assistance.

Accelerate the establishment of a rural medical security system, improve the health standards of farmers, and better promote the coordinated development of urban and rural social and economic development. Over the past year or so, according to the spirit of the CPC Central Committee and the State Council's "Decision on Further Strengthening Rural Health Work," governments at all levels have unified leadership. The deployment, the relevant departments carefully organized and implemented, the majority of rural people actively participated, the city initially established a "new disease co-ordination, medical assistance and rural community health services" three-in-one new rural cooperative medical system. In order to effectively consolidate this system, we will further explore and establish a long-term mechanism for healthy and sustainable development, and conduct a special investigation on the operation of new agricultural doctors in our city. Through research, summarize and summarize the status quo and effectiveness of the system, study and analyze existing problems and difficulties, and propose development strategies.