Investigation Report on New Rural Cooperative Medical Insurance in Maotang Town, Lianyuan City
Without health, there will be no comprehensive development of people, and there will be no comprehensive well-being. The problems of 900 million peasants’ “difficulty in seeing a doctor”, “poorness due to illness” and “getting back to poverty” have deeply affected the hearts of the central leadership. To this end, the Third Plenary Session of the 16th CPC Central Committee clearly stated that it is necessary to improve the conditions of rural health care, actively establish a new type of rural cooperative medical care system, and implement medical assistance for poor farmers. In XX, the pilot program of the new rural cooperative medical system began to be implemented nationwide. In order to promote the smooth development of the popular project for the benefit of hundreds of millions of people, we came to the first pilot county of Hunan's new rural cooperative medical system, Maotang Town, Wuyuan City, and conducted relevant questionnaire surveys. Understand the development of the new rural cooperative medical system, as well as the peasants' personal experience and explore the problems.
In our 117 questionnaire surveys of four villages including Dao Tong Village, Persimmon Village and Gwangyang Village in Maotang Town, Wuyuan City, the surveyee’s education, age:
Table I:
Illiterate country, small country, middle school, high school, college, university or above 11 25 68 43 14 5
Proportion 9.4 21.3 58.1 36.7 11.9 4.2
Table 2:
Under 18 years old 18-40 40-60 60-90
Number of people 9 71 81 20
Proportion 5.3 36.9 47.3 11.7
Maotang Town is a relatively developed township in Wuyuan City, especially famous for the development of township enterprises. The town has 30,000-4,000 people, while those who do business or work in other places account for 67.6% of the respondents, relying on crops. There is only a relatively small portion of households that are the main source of income.
In the questionnaire, the monthly income of the peasant’s family was asked, accounting for 54% of the households below 800 yuan, 14.9% of the 800-1000 yuan, 31% of the 1,000 yuan or more, and the family medical expenses of less than 300 yuan per year. It has 44%, 300-900 yuan, 34.9%, and annual medical expenses more than 1,000 yuan, accounting for 20.6%. In recent years, farmers' income has increased a lot, especially in township enterprises like Maotang Town. In the developed towns, the living standards of farmers have been greatly improved. However, at the same time as the increase in income, the expenditure on medical expenses of farmers has also increased significantly. This is the question of the general reaction of farmers in the questionnaire survey. According to statistics, from 1990 to 1999, the average income of farmers nationwide increased from 686 yuan to 2240 yuan, an increase of 3.32 times. However, the outpatient expenses and hospitalization expenses for farmers to see medical treatment also increased from 10.9 yuan and 47 yuan to 79 yuan and 289 yuan respectively. That is to say, when the income of farmers increased by only 3.32 times, the expenses of outpatient and hospital expenses increased by 4.4 times and 3.7 times respectively. This means that farmers living in a hospital almost spend the entire year's income, medical expenses have increased too fast, the increase is too large, so many farmers do not go to the hospital after illness, need to be hospitalized, not hospitalized, poor and sick.
When asked about the biggest problem of doctors visiting doctors, 43.9% of them think that the cost of medicine in township hospitals is too expensive, and families can't afford them. When we surveyed in rural areas, farmers also reflected the medical expenses of township hospitals designated by rural medical insurance. More expensive. Moreover, according to the rural cooperative medical insurance system, only the expenses incurred in the designated designated hospitals can be compensated. The farmers did not get benefits. Another 33.2% of the people think that the hospitalization procedures in township hospitals are complicated, the quality of medical personnel is generally not high, the technical level is poor, the medical equipment is outdated, and farmers cannot obtain medical insurance from them. The peasants are seriously ill and do not want to go to the township hospital for medical treatment. At the same time, 7.9% of people think that township hospitals are too far away, and it is not convenient to seek medical treatment. Only 15% of them are satisfied with the current medical conditions in townships and towns.
The state introduced a new rural cooperative medical insurance system to the rural areas, and 80% of the farmers expressed support for this policy, which reduced the medical burden of farmers when they encountered major diseases. It can be seen that the enthusiasm of farmers for participating in insurance is high and their expectations are relatively large. 15.4% of people think that this policy has advantages and disadvantages, and they have other opinions. When asked about the concerns of farmers about the new rural cooperative medical insurance; 42.7% of the people worried that the new rural medical insurance policy is unstable, afraid of money, and 12.6% of them were worried that the funds could not be cashed when they received compensation. complex. There are also 25.5% of people who have no concerns about this, and believe that the policy brings great benefits and stability.
Investigating the rural understanding of the new rural cooperative medical insurance, 58.8% of the people have heard of it, and they have also participated in the insurance, but the specific content of the policy, such as compensation methods, is not clear, 21.8% of the people are concerned about this policy. I don’t know anything, I haven’t even heard of it.
Farmers receive compensation from rural medical insurance management institutions, which is also the most sensitive issue for farmers, and also the key to the implementation and implementation of new rural cooperative medical insurance. 41.6% of people think that it is inconvenient to obtain compensation from the management organization. It is more difficult to obtain compensation, the program is more complicated, and the efficiency of the work is not high. 29.6% of people admit that they are not familiar with the rural medical insurance policy. It is inconvenient to compensate, and only 24% of people think that it is more convenient and very satisfactory to handle rural medical insurance compensation.
From the above statistics and analysis of the questionnaire survey, we can see the initial stage of the launch of the new rural cooperative medical system. While farmers have received benefits and achieved certain results, there are also many problems. To sum up, there are three main points:
First, the medical expenses of township hospitals are too expensive, especially the fixed-point township hospitals in rural medical insurance, the medical expenses are more expensive, and the service quality is relatively poor. Farmers are reluctant to go to the township hospitals where they are going to see a doctor. According to the rural medical insurance policy, the rural medical insurance management unit will only compensate the medical expenses incurred by the designated township hospitals. Farmers generally report that they have to pay a considerable amount of money even if they have compensation. The township hospitals designated by such rural medical insurance institutions did not bring cheap medical services to farmers, nor did they bring the greatest benefits to farmers.
Second, the quality of medical personnel in rural township hospitals is generally not high, the level of medical technology is backward, the medical facilities of hospitals are outdated, and farmers are not getting medical insurance from township hospitals. This is the most urgent issue that farmers have reflected when we investigated in Maotang Town. Moreover, according to the policy of rural cooperative medical insurance, township hospitals as the first-level medical security institutions for farmers, the fixed-point township hospitals have a reimbursement quota of 30-60%, and the reimbursement rate is the largest. The reimbursement quota for county-level medical institutions is between 30-40%. Farmers not only have no place to look at the disease, but also can not enjoy the benefits brought by the medical insurance policy, and effectively reduce the burden of medicine.
Third, when farmers receive compensation from rural medical security, the general response is inconvenient and the procedure is complicated. There are two reasons for this: 1 It can be seen from the survey that although farmers know this policy, they do not know much about the relevant content of the policy. The rural medical insurance system has clear provisions for insurance and reimbursement. Compensation can only be obtained if the medical expenses incurred in accordance with the reimbursement conditions are met. Not all can be reimbursed, such as fights, fights, traffic accidents and sexually transmitted diseases, medical expenses, prescribed self-funded drugs, etc. are not compensated from rural medical insurance. But almost no farmers in the survey knew about these regulations. 2 When farmers receive compensation from medical insurance, they must pass the examination and verification of three levels of government agencies. Although the local county and township governments have set up a new type of rural cooperative medical insurance management office, but the work efficiency is not high, not professional, there is no professional unified auditing agency. There are even peasants who respond to individual management cadres to damage public fat and private, and "take kickbacks." All of these have seriously hindered the continued development of new rural cooperative medical insurance and reduced farmers' trust and support for rural medical insurance.
In order for farmers to get the most benefits, it is necessary not only to give farmers a place to see a doctor, but also to have money to see a doctor. It is necessary to continuously improve and develop the new rural cooperative medical insurance system. Correctly treat all kinds of problems that are present in front of us and objectively exist. Here are some personal suggestions:
First, to deepen the reform of township hospitals, the first thing to be solved is to let farmers have local medical treatment, good health, and medical security. This is the prerequisite for running rural cooperative medical insurance. This must deepen the reform of rural township hospitals to standardize medical services, update medical equipment, and improve the level of medical services. The reform of township hospitals has always been the "difficult" of rural health care reform in China. The vast majority of township hospitals in China now come from the development of administrative townships. Some townships and towns have only 30,000 to 40,000 people. They can be built together with surrounding towns and villages, making full use of medical resources and rational allocation. This town of 30,000 to 40,000 people in Maotang Town, Wuyuan City can be merged with the nearby towns and villages, and then the village doctors will be assigned to each village. This will not only optimize resource allocation, but also facilitate farmers to see a doctor. At the same time, township hospitals can also enter the market and let them participate in market competition, instead of the state to feed health centers, contracting or auctioning township hospitals, can solve the investment development of township hospitals, but the introduction of medical talents is also the development of township hospitals. An important part of it. Every year, many medical college students in China prefer to be medical representatives in big cities, and not to go to township hospitals as doctors. It is nothing more than low income and poor treatment in township hospitals. In the current situation of college employment, the Maotang Town Health Center does not have a regular college student, and even a college student. The state should introduce policies to publicize and encourage medical students to go to township hospitals for employment. This will inject vitality into the development of township hospitals. Farmers’ health care can also be guaranteed.
Second, to strengthen the regulation of drug purchase and sales have cheaper drugs, is an important guarantee for the healthy development of the new rural cooperative medical system, rural hospitals medical costs are too expensive, especially the township hospitals designated, must strengthen the supervision of the purchase and sale of drugs. It is possible to implement a township hospital village health center, which is led by a higher-level medical institution to directly purchase medicines from manufacturers, reduce intermediate links, reduce drug purchase prices, and encourage the use of low-cost, low-price, and affirmative drugs. It is necessary to formulate a new catalogue of essential medicines for rural cooperative medical care, implement drug price announcements, increase the supervision of peasant people, and let farmers clearly understand medicines and buy medicines, and effectively reduce the burden on farmers.
III. Strengthening the examination and approval and inspection of designated hospitals We learned from the investigations in Maotang Town and several nearby townships that the health centers in each township were automatically designated as medical insurance designated hospitals by the rural medical insurance department. For the determination of medical and pharmaceutical designated institutions, it is necessary to strengthen the examination and examination of designated hospitals. Regardless of the form of ownership, as long as the conditions are available, hospitals and pharmacies that are satisfactory to the people of the people can be used as fixed-point medical and pharmaceutical supply agencies. For those fixed hospitals and drug supply organizations that do not improve their own quality in time, manage slack, increase their prices privately, and falsify, they should promptly cancel the qualifications of rural medical insurance and strengthen dynamic supervision. Otherwise, this fixed-point hospital relies on medical care and maintenance, and the phenomenon of peasants suffering and complaining will seriously hinder the continued development of rural cooperative medical insurance. 4. Increase policy content and actively guide farmers to reflect the inconvenience of obtaining compensation, and all kinds of concerns about rural medical insurance. The key is to increase the content of medical insurance policies and actively guide them to further enhance the enthusiasm of peasant people to participate in cooperative medical care. The township government should make the policy superiority of cooperative medical care through various channels such as television, newspapers, leaflets, open letters, cadres and the countryside, implement compensation methods and various regulations, and everyone understands that this can make farmers dispel all kinds of concerns. To increase enthusiasm, the medical insurance management department can improve the efficiency of work and effectively make farmers more satisfied.
Doing a good job in cooperative medical care will help farmers to obtain basic medical services and constantly improve the social security system. It will help alleviate the burden on farmers, alleviate poverty caused by disease in rural areas, and return to poverty due to illness. It is conducive to promoting the all-round development of rural health, and is an important part of achieving the goal of well-off and modernization. In the initial stage of implementation, although we have encountered many difficulties, we only need to raise awareness of cooperative medical care, correctly treat existing problems, and constantly improve and develop new rural cooperative medical care systems to dispel doubts and confusions among farmers. I believe that this policy of serving farmers will be deeply rooted in the hearts of the people. Thereby promoting the all-round development of the socialist cause.
In our 117 questionnaire surveys of four villages including Dao Tong Village, Persimmon Village and Gwangyang Village in Maotang Town, Wuyuan City, the surveyee’s education, age:
Table I:
Illiterate country, small country, middle school, high school, college, university or above 11 25 68 43 14 5
Proportion 9.4 21.3 58.1 36.7 11.9 4.2
Table 2:
Under 18 years old 18-40 40-60 60-90
Number of people 9 71 81 20
Proportion 5.3 36.9 47.3 11.7
Maotang Town is a relatively developed township in Wuyuan City, especially famous for the development of township enterprises. The town has 30,000-4,000 people, while those who do business or work in other places account for 67.6% of the respondents, relying on crops. There is only a relatively small portion of households that are the main source of income.
In the questionnaire, the monthly income of the peasant’s family was asked, accounting for 54% of the households below 800 yuan, 14.9% of the 800-1000 yuan, 31% of the 1,000 yuan or more, and the family medical expenses of less than 300 yuan per year. It has 44%, 300-900 yuan, 34.9%, and annual medical expenses more than 1,000 yuan, accounting for 20.6%. In recent years, farmers' income has increased a lot, especially in township enterprises like Maotang Town. In the developed towns, the living standards of farmers have been greatly improved. However, at the same time as the increase in income, the expenditure on medical expenses of farmers has also increased significantly. This is the question of the general reaction of farmers in the questionnaire survey. According to statistics, from 1990 to 1999, the average income of farmers nationwide increased from 686 yuan to 2240 yuan, an increase of 3.32 times. However, the outpatient expenses and hospitalization expenses for farmers to see medical treatment also increased from 10.9 yuan and 47 yuan to 79 yuan and 289 yuan respectively. That is to say, when the income of farmers increased by only 3.32 times, the expenses of outpatient and hospital expenses increased by 4.4 times and 3.7 times respectively. This means that farmers living in a hospital almost spend the entire year's income, medical expenses have increased too fast, the increase is too large, so many farmers do not go to the hospital after illness, need to be hospitalized, not hospitalized, poor and sick.
When asked about the biggest problem of doctors visiting doctors, 43.9% of them think that the cost of medicine in township hospitals is too expensive, and families can't afford them. When we surveyed in rural areas, farmers also reflected the medical expenses of township hospitals designated by rural medical insurance. More expensive. Moreover, according to the rural cooperative medical insurance system, only the expenses incurred in the designated designated hospitals can be compensated. The farmers did not get benefits. Another 33.2% of the people think that the hospitalization procedures in township hospitals are complicated, the quality of medical personnel is generally not high, the technical level is poor, the medical equipment is outdated, and farmers cannot obtain medical insurance from them. The peasants are seriously ill and do not want to go to the township hospital for medical treatment. At the same time, 7.9% of people think that township hospitals are too far away, and it is not convenient to seek medical treatment. Only 15% of them are satisfied with the current medical conditions in townships and towns.
The state introduced a new rural cooperative medical insurance system to the rural areas, and 80% of the farmers expressed support for this policy, which reduced the medical burden of farmers when they encountered major diseases. It can be seen that the enthusiasm of farmers for participating in insurance is high and their expectations are relatively large. 15.4% of people think that this policy has advantages and disadvantages, and they have other opinions. When asked about the concerns of farmers about the new rural cooperative medical insurance; 42.7% of the people worried that the new rural medical insurance policy is unstable, afraid of money, and 12.6% of them were worried that the funds could not be cashed when they received compensation. complex. There are also 25.5% of people who have no concerns about this, and believe that the policy brings great benefits and stability.
Investigating the rural understanding of the new rural cooperative medical insurance, 58.8% of the people have heard of it, and they have also participated in the insurance, but the specific content of the policy, such as compensation methods, is not clear, 21.8% of the people are concerned about this policy. I don’t know anything, I haven’t even heard of it.
Farmers receive compensation from rural medical insurance management institutions, which is also the most sensitive issue for farmers, and also the key to the implementation and implementation of new rural cooperative medical insurance. 41.6% of people think that it is inconvenient to obtain compensation from the management organization. It is more difficult to obtain compensation, the program is more complicated, and the efficiency of the work is not high. 29.6% of people admit that they are not familiar with the rural medical insurance policy. It is inconvenient to compensate, and only 24% of people think that it is more convenient and very satisfactory to handle rural medical insurance compensation.
From the above statistics and analysis of the questionnaire survey, we can see the initial stage of the launch of the new rural cooperative medical system. While farmers have received benefits and achieved certain results, there are also many problems. To sum up, there are three main points:
First, the medical expenses of township hospitals are too expensive, especially the fixed-point township hospitals in rural medical insurance, the medical expenses are more expensive, and the service quality is relatively poor. Farmers are reluctant to go to the township hospitals where they are going to see a doctor. According to the rural medical insurance policy, the rural medical insurance management unit will only compensate the medical expenses incurred by the designated township hospitals. Farmers generally report that they have to pay a considerable amount of money even if they have compensation. The township hospitals designated by such rural medical insurance institutions did not bring cheap medical services to farmers, nor did they bring the greatest benefits to farmers.
Second, the quality of medical personnel in rural township hospitals is generally not high, the level of medical technology is backward, the medical facilities of hospitals are outdated, and farmers are not getting medical insurance from township hospitals. This is the most urgent issue that farmers have reflected when we investigated in Maotang Town. Moreover, according to the policy of rural cooperative medical insurance, township hospitals as the first-level medical security institutions for farmers, the fixed-point township hospitals have a reimbursement quota of 30-60%, and the reimbursement rate is the largest. The reimbursement quota for county-level medical institutions is between 30-40%. Farmers not only have no place to look at the disease, but also can not enjoy the benefits brought by the medical insurance policy, and effectively reduce the burden of medicine.
Third, when farmers receive compensation from rural medical security, the general response is inconvenient and the procedure is complicated. There are two reasons for this: 1 It can be seen from the survey that although farmers know this policy, they do not know much about the relevant content of the policy. The rural medical insurance system has clear provisions for insurance and reimbursement. Compensation can only be obtained if the medical expenses incurred in accordance with the reimbursement conditions are met. Not all can be reimbursed, such as fights, fights, traffic accidents and sexually transmitted diseases, medical expenses, prescribed self-funded drugs, etc. are not compensated from rural medical insurance. But almost no farmers in the survey knew about these regulations. 2 When farmers receive compensation from medical insurance, they must pass the examination and verification of three levels of government agencies. Although the local county and township governments have set up a new type of rural cooperative medical insurance management office, but the work efficiency is not high, not professional, there is no professional unified auditing agency. There are even peasants who respond to individual management cadres to damage public fat and private, and "take kickbacks." All of these have seriously hindered the continued development of new rural cooperative medical insurance and reduced farmers' trust and support for rural medical insurance.
In order for farmers to get the most benefits, it is necessary not only to give farmers a place to see a doctor, but also to have money to see a doctor. It is necessary to continuously improve and develop the new rural cooperative medical insurance system. Correctly treat all kinds of problems that are present in front of us and objectively exist. Here are some personal suggestions:
First, to deepen the reform of township hospitals, the first thing to be solved is to let farmers have local medical treatment, good health, and medical security. This is the prerequisite for running rural cooperative medical insurance. This must deepen the reform of rural township hospitals to standardize medical services, update medical equipment, and improve the level of medical services. The reform of township hospitals has always been the "difficult" of rural health care reform in China. The vast majority of township hospitals in China now come from the development of administrative townships. Some townships and towns have only 30,000 to 40,000 people. They can be built together with surrounding towns and villages, making full use of medical resources and rational allocation. This town of 30,000 to 40,000 people in Maotang Town, Wuyuan City can be merged with the nearby towns and villages, and then the village doctors will be assigned to each village. This will not only optimize resource allocation, but also facilitate farmers to see a doctor. At the same time, township hospitals can also enter the market and let them participate in market competition, instead of the state to feed health centers, contracting or auctioning township hospitals, can solve the investment development of township hospitals, but the introduction of medical talents is also the development of township hospitals. An important part of it. Every year, many medical college students in China prefer to be medical representatives in big cities, and not to go to township hospitals as doctors. It is nothing more than low income and poor treatment in township hospitals. In the current situation of college employment, the Maotang Town Health Center does not have a regular college student, and even a college student. The state should introduce policies to publicize and encourage medical students to go to township hospitals for employment. This will inject vitality into the development of township hospitals. Farmers’ health care can also be guaranteed.
Second, to strengthen the regulation of drug purchase and sales have cheaper drugs, is an important guarantee for the healthy development of the new rural cooperative medical system, rural hospitals medical costs are too expensive, especially the township hospitals designated, must strengthen the supervision of the purchase and sale of drugs. It is possible to implement a township hospital village health center, which is led by a higher-level medical institution to directly purchase medicines from manufacturers, reduce intermediate links, reduce drug purchase prices, and encourage the use of low-cost, low-price, and affirmative drugs. It is necessary to formulate a new catalogue of essential medicines for rural cooperative medical care, implement drug price announcements, increase the supervision of peasant people, and let farmers clearly understand medicines and buy medicines, and effectively reduce the burden on farmers.
III. Strengthening the examination and approval and inspection of designated hospitals We learned from the investigations in Maotang Town and several nearby townships that the health centers in each township were automatically designated as medical insurance designated hospitals by the rural medical insurance department. For the determination of medical and pharmaceutical designated institutions, it is necessary to strengthen the examination and examination of designated hospitals. Regardless of the form of ownership, as long as the conditions are available, hospitals and pharmacies that are satisfactory to the people of the people can be used as fixed-point medical and pharmaceutical supply agencies. For those fixed hospitals and drug supply organizations that do not improve their own quality in time, manage slack, increase their prices privately, and falsify, they should promptly cancel the qualifications of rural medical insurance and strengthen dynamic supervision. Otherwise, this fixed-point hospital relies on medical care and maintenance, and the phenomenon of peasants suffering and complaining will seriously hinder the continued development of rural cooperative medical insurance. 4. Increase policy content and actively guide farmers to reflect the inconvenience of obtaining compensation, and all kinds of concerns about rural medical insurance. The key is to increase the content of medical insurance policies and actively guide them to further enhance the enthusiasm of peasant people to participate in cooperative medical care. The township government should make the policy superiority of cooperative medical care through various channels such as television, newspapers, leaflets, open letters, cadres and the countryside, implement compensation methods and various regulations, and everyone understands that this can make farmers dispel all kinds of concerns. To increase enthusiasm, the medical insurance management department can improve the efficiency of work and effectively make farmers more satisfied.
Doing a good job in cooperative medical care will help farmers to obtain basic medical services and constantly improve the social security system. It will help alleviate the burden on farmers, alleviate poverty caused by disease in rural areas, and return to poverty due to illness. It is conducive to promoting the all-round development of rural health, and is an important part of achieving the goal of well-off and modernization. In the initial stage of implementation, although we have encountered many difficulties, we only need to raise awareness of cooperative medical care, correctly treat existing problems, and constantly improve and develop new rural cooperative medical care systems to dispel doubts and confusions among farmers. I believe that this policy of serving farmers will be deeply rooted in the hearts of the people. Thereby promoting the all-round development of the socialist cause.
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