China is a big agricultural country. Whether it can solve the medical security problem of the vast rural population will directly affect the economic development and social stability of rural areas in China. The cooperative medical system in rural areas of China has played an extremely important role as the main medical security system for rural population under the planned economy system. Firstly, this paper reviews the development process of rural cooperative medical system: the emergence, popularization and development, and decline of cooperative medical system. Then, it makes a simple analysis of the current situation of rural medical security in China after the decline of cooperative medical system. The role of various forms of medical security in rural areas is very limited. The problem of farmers' medical treatment is still mainly solved by their families, and medical security, especially social medical security, is basically in a "vacuum zone". Therefore, in 23, the government of China proposed to establish a mutual medical assistance supply system for farmers, which is organized, guided and supported by the government, with farmers participating voluntarily, raised by individuals, collectives and the government in various ways, and focused on overall planning of serious illness. From 23 onwards, all provinces, autonomous regions and municipalities directly under the Central Government should choose at least 2-3 counties (cities) to carry out pilot projects first, and gradually push them away after gaining experience. By 21, we will achieve the goal of establishing a new rural cooperative medical system that basically covers rural residents, reduce the economic burden of farmers due to diseases, and improve their health. This paper mainly introduces the pilot implementation in two regions of Shandong Province-Laoshan District of Qingdao and Linyi County of Dezhou City. On this basis, it discusses the problems in the implementation of the new rural cooperative medical system and puts forward the basic direction of the development of rural medical security in China. Key words: rural medical security cooperative medical care New rural cooperative medical care system security mode 1. The emergence and development of China's rural cooperative medical care system Theoretically, the cooperative medical care system mainly relies on the strength of community residents and raises funds in various ways within the community according to the principle of "risk sharing, mutual assistance and economic assistance" to pay for medical care, prevention, health care and other service expenses of the insured and their families. The rural cooperative medical system in China has its own development footprint, and it is also an inevitable choice under the special national conditions of our country. The World Health Organization once said in a report, "The formulation of primary health personnel is mainly inspired by China. China people have developed a successful primary health care system in rural areas with 8% of the population, providing people with low-cost and appropriate medical and health care technical services to meet the basic health needs of most people. This model is very suitable for the needs of developing countries. " The development course of the rural cooperative medical system in China is as follows: 1. The emergence of the cooperative medical system can be traced back to the War of Resistance against Japanese Aggression period, when medical and health undertakings were held in the form of "cooperatives", which was actually the bud of a rural medical security system. In the early days of the founding of the People's Republic of China, due to the limited resources, we chose the principle of providing different benefits in urban and rural areas, which means that the vast majority of rural farmers are basically outside the national social welfare system, and farmers who lack medical care take the form of spontaneous mutual assistance to solve medical problems. It was in the climax of rural cooperation in 1955 that the cooperative medical system with mutual assistance appeared in rural areas of China. In some places, such as Shanxi and Henan, health stations organized by rural production cooperatives have appeared, and the method of combining "health care fees" from members and subsidies from production cooperative public welfare funds is adopted, and the masses raise funds for cooperative medical care and implement mutual assistance. At the beginning of 1955, Mi Shan Township, Gaoping County, Shanxi Province established China's first medical and health care station, which realized the farmers' desire of "preventing diseases early, making paper with diseases, saving labor and money, being convenient and reliable". [2]2. Promotion and development of cooperative medical system After the Ministry of Health affirmed the practice of Mi Shan Township, its experience was promoted in some parts of the country. In November 1959, the Ministry of Health affirmed the form of rural cooperative medical care at the national health work conference, which promoted its further rise and development. In February, 196, the Central Committee affirmed the cooperative medical care as a medical form, and forwarded the Report on the Field Meeting of Rural Health Work of the Ministry of Health, making this system a collective medical care system. [3] On May 18, 196, Health News affirmed this method of raising funds for medical care system in its editorial "Actively promoting the basic medical care system", which played a certain role in promoting the development of the national rural cooperative medical care system. At this time, the cooperative medical care system organized by the national agricultural production brigade has reached 4%. During the "Cultural Revolution", the emerging rural cooperative medical system was vigorously promoted. According to the report of the World Bank (1996), the cost of cooperative medical care at that time only accounted for about 2% of the national health expenditure, but it initially solved the medical care problem of the rural population accounting for 8% at that time. By 1976, about 9% administrative villages in rural areas of China had implemented the cooperative medical care system. 3. Decline of the cooperative medical system In the late 197s, due to the economic system reform with the household contract responsibility system as the main content, a two-tier management system combining unification and separation was established in rural areas, and the original social organization form based on "one university and two universities" disintegrated, and the rural cooperative medical system also declined greatly. Statistics in 1989 showed that only 5% of the administrative villages continued to adhere to the cooperative medical system. [4] Second, the current situation of rural medical security in China after the decline of the cooperative medical system. Let's first look at the situation of various forms of medical security in rural areas of China: 1. Social medical insurance The reform of the medical insurance system currently under way in China is mainly aimed at the employees of urban enterprises and the staff of state administrative institutions, while farmers, as the majority of the population, are still excluded from the institutional arrangements. Therefore, it can be said that social medical insurance is basically a blank in the vast rural areas of China. 2. The lack of commercial medical insurance social medical insurance provides a certain space for the development of commercial medical insurance in rural areas, which can be said to be a very important way to solve the problem of medical treatment for the broad masses of farmers. However, commercial medical insurance is profitable and voluntary. In order to ensure the profit, commercial medical insurance companies often exclude those who are old, weak and in poor health when choosing policyholders, and the demand for medical insurance for these people is the most urgent. In addition, because the government does not force farmers to participate in commercial medical insurance in the form of policies and regulations, and because the insurance premium of commercial medical insurance is generally high, farmers will be very cautious when making choices, and he needs to consider whether he can afford the medical insurance. Therefore, although commercial medical insurance has room for development in rural areas, this space is also very limited. 3. Social assistance-the scope of enjoyment is very limited. At present, the "five guarantees" support system implemented in rural areas in China for the "three noes" who have no support, no source of income and no dependents (caregivers) can solve the medical problems of this special group to a certain extent, but the coverage of this system is very high. 4. Neighborhood mutual support and assistance between neighbors has always been a fine tradition that exists in the vast rural areas of China. The so-called "distant relatives are not as good as close neighbors" is the best interpretation of this behavior. This kind of mutual assistance between neighbors will also play a certain role in solving the medical security problem, but it can only happen in a small scope and at a relatively low level, and it seems a bit powerless for some cases of serious illness and serious illness. Therefore, neighborhood mutual assistance cannot fundamentally solve the problem. In the 199s, different models of cooperative medical system were piloted in some places, including "welfare type", "risk type" and "welfare risk type". Although the Central Committee put forward in January 1997 that "all forms of cooperative medical care system should be established in most rural areas by 2", only 18% of the administrative villages in China have implemented cooperative medical care, covering only 1% of the rural population, and 9% of farmers still have to pay for medical treatment at their own expense. After the institutional reform in the State Council in 1998, the rural medical and health matters that were originally under the charge of the Ministry of Health were handed over to the Ministry of Labor and Social Security, but the latter could not solve a series of policy problems such as related financial input and farmers' burden reduction alone, which led to the fact that the rural medical security work was in a "vacuum zone", and the majority of farmers' medical problems were basically solved by family security. Iii. Implementation of the New Rural Cooperative Medical System 1. The introduction and policy provisions of the new rural cooperative medical system put forward in the Notice of the General Office of the State Council on Forwarding the Opinions of the Ministry of Health and other departments on the establishment of the new rural cooperative medical system (23): "The new rural cooperative medical system is a mutual medical assistance supply system for farmers, which is organized, guided and supported by the government, and farmers voluntarily participate, and individuals, collectives and governments raise funds in various ways, with serious illness as the main focus. From 23 onwards, all provinces, autonomous regions and municipalities directly under the Central Government should choose at least 2-3 counties (cities) to carry out pilot projects first, and gradually push them away after gaining experience. By 21, we will achieve the goal of establishing a new rural cooperative medical system that basically covers rural residents throughout the country, reduce the economic burden of farmers due to diseases, and improve their health. " [5] Subsequently, various localities took action in succession to carry out the pilot of the new rural cooperative medical system, and gained some experience. 2, the implementation of the new rural cooperative medical system-Taking the pilot in Shandong Province as an example, the pilot of the new rural cooperative medical system in Shandong Province also began in 23. In the Notice of the General Office of the People's Government of Shandong Province on Forwarding the Opinions of the Provincial Health Department and Other Departments on Establishing the New Rural Cooperative Medical System (Lu Zhengban Fa [23] No.12), combined with the specific situation of Shandong Province, some guiding principles and opinions were put forward, which were divided into three stages: Seven counties (cities, districts) including Linyi, Wulian, Qufu, Qingzhou, Guangrao, Zhaoyuan and Laoshan were identified as the first batch of provincial pilot counties in the province. Municipalities according to the local actual situation, choose 1 to 2 townships to carry out municipal pilot, conditional cities can choose counties (cities, districts) to carry out pilot. Through the pilot, explore the management system, financing mechanism and operation mechanism of the new rural cooperative medical system. The conditions of the pilot unit are that local leaders attach importance to it, financial subsidies are in place, management institutions are sound, farmers' enthusiasm is high, and the work foundation is good. The pilot counties (cities, districts) at the provincial level shall be formulated by the people's governments at the county level who apply for the pilot, and shall be submitted to the Provincial Health Department in conjunction with the Provincial Department of Finance and the Department of Agriculture for examination and approval. The implementation plan of the municipal pilot determined by each city shall be reported to the Provincial Health Department, the Department of Finance and the Department of Agriculture for the record. After the pilot, the provincial pilot counties (cities, districts) shall write a summary of the pilot work, and the approval department shall organize the examination and acceptance. The second stage (from January 24 to December 25) is to expand the pilot stage. On the basis of consolidating the first batch of pilot projects, about 16 provincial pilot counties will be added every year (priority will be given to bringing the original municipal pilot counties into the provincial pilot projects). Municipal pilot projects should also be expanded accordingly. By expanding the pilot, further exploring and summing up experience, improving the management system, the provincial government formulated the management measures of the new rural cooperative medical system, and the municipal and county (city, district) governments formulated the implementation measures and implementation plans respectively, laying the foundation for full implementation. The third stage (from January 26 to 21) is the stage of full implementation. On the basis of earnestly summing up the pilot experience, it will be gradually popularized in the whole province. By 21, a new rural cooperative medical system covering rural residents in the whole province will be established, and the degree of socialization and anti-risk ability will be continuously improved. [6] Under the guidance of these principles, the pilot work of the new rural cooperative medical system has been carried out in various places and cities in Shandong Province: (1) Laoshan District, Qingdao, the eastern coastal area of Shandong Province, is located in the east of Qingdao, with a total area of 39 square kilometers, governing 4 streets and 139 communities. In 23, the total population was million, the agricultural population was trillion yuan, and the fiscal revenue and expenditure were billion yuan. Since January 1, 23, the cooperative medical system for serious diseases in rural areas has been implemented, and it has been identified as the first batch of new rural cooperative medical system pilot units in Shandong Province. In 24, on the basis of summing up the pilot experience, we reformed and innovated, and introduced new measures to establish and improve the unique new rural cooperative medical system, which focuses on overall planning of serious illness and gives consideration to preventive health care and serious illness relief. In 23, the number of people insured in the whole region was 1,, and the population coverage rate reached 92%. In 24, the number of people insured was 1,, and the population coverage rate reached%. The part of the population of 2,152 low-income households that should be paid shall be fully borne by the district finance after being audited by the District Civil Affairs Bureau. To raise funds for cooperative medical care, we should adhere to the principle of government subsidies and collective and individual raising. The per capita fund-raising amount increased from 3 yuan in 23 to 5 yuan. In 23, 4.61 million yuan was raised for cooperative medical care, and in 24, 1, yuan should be raised for cooperative medical care. All the remaining funds were carried forward to the next year. The individual payment part of the cooperative medical care fund is collected by the community neighborhood Committee on an annual basis by households, and the unified receipt issued by the District Finance Bureau is used; The community collective payment is extracted from its own funds, and together with the funds paid by individuals and the registration form approved by the street cooperative medical office, it will be handed over to the street finance office before December 31 of each year. After the street finance office has raised the funds, it will be handed over to the district cooperative medical financial account together with the street subsidy funds. Part of the district financial subsidies, in the streets, villages, collective and individual financing in place, according to the actual number of participants, the grant will be allocated to the financial accounts of the district cooperative medical care. The funds are mainly used for medical expenses compensation for serious illness. In 23, 8% were used for medical expenses compensation, 15% for serious illness relief and 5% for risk money. In 24, 75% was used for medical expenses compensation, 1% for serious illness relief, 1% for preventive health care and 5% for risk money. In 23, the deductible line of hospitalization medical expenses compensation within the overall planning scope was 1,5 yuan for the first-level hospital 8 yuan, 2, yuan for the second-level hospital and 2, yuan for the third-level hospital; In 24, the deductible line of hospitals at all levels was lower than that of 23 by 5 yuan, and the number of family beds was reduced from 1,5 yuan to 3 yuan. The compensation ratio and capping line of medical expenses have been improved, and the compensation ratio has increased by 5-1%. In 23, 1,868 people were compensated for medical expenses, with an expenditure of 2.8 million yuan, accounting for 76% of the budgeted expenditure of 3.68 million yuan. In 24, it is estimated that the number of people compensated for serious illness will reach 32, and the estimated expenditure on medical expenses will be 5.6 million yuan, accounting for 93% of the budgeted expenditure of 6.5 million yuan. The per capita benefit rate is expected to reach 23%, up by% compared with last year, and the family benefit rate will reach%, up by% compared with last year. [7](2) Linyi County, the central and western region of Shandong Province, is subordinate to Dezhou City, located in the north of the Yellow River, and has jurisdiction over 7 towns, 3 townships and 859 administrative villages, with an area of 1,16 square kilometers and a population of 1,, of which the agricultural population is 1,. In February, 23, the Shandong Provincial Government held a provincial rural health work conference, and formally determined Linyi County as the first pilot county of the new rural cooperative medical system in Shandong Province. In June 23, on the basis of summing up the experience of pilot towns, the new cooperative medical system was fully rolled out in the county. By the end of 23, 1, farmers in the county had participated in the cooperative medical system, and the participation rate reached%. The second cycle of operation began in August, 24. Up to now, 1, farmers have gone through the relevant procedures, and the participation rate has reached%. In order to ensure the healthy development of the new rural cooperative medical system