Notice of Chongming County People's Government Office Forwarding the Implementation Opinions of Rural Cooperative Medical System in Chongming County formulated by County Health Bureau in 21

Chongfu Ban Fa [29] No.89

Relevant committees, offices and bureaus of people's governments of townships and towns, and relevant units in Chongshi City:

Rural Cooperative Medical System in Chongming County in 21 formulated by County Health Bureau

December 2, 29

Opinions on the implementation of rural cooperative medical care in Chongming County in p>21

The cooperative medical care system is a basic medical security system established by the CPC Central Committee and the State Council to solve the problem of rural residents' medical treatment, and it is an important measure to implement Scientific Outlook on Development and build a harmonious socialist society. In order to further consolidate and improve the rural cooperative medical security system in this county, according to the spirit of the document "Opinions on Consolidating and Developing the New Rural Cooperative Medical System" (Wei Nong Wei Fa [29] No.68) jointly issued by the Ministry of Health, the Ministry of Civil Affairs, the Ministry of Finance, the Ministry of Agriculture and the Bureau of Traditional Chinese Medicine, and the municipal government's "Opinions on Strengthening and Perfecting the New Rural Cooperative Medical System in this Municipality" (Hu Fu Ban [28] No.55), combined with The following implementation opinions are put forward on the rural cooperative medical care in this county in 21:

1. Security objects

(1) Participants

The rural permanent residents in agricultural registered permanent residence of this county who have not participated in the basic medical insurance for urban workers, medical insurance for small towns, basic medical insurance for primary and secondary school students and infants in hospitals and outpatient clinics, and basic medical insurance for urban residents should be.

(II) Participants

Rural residents of this county who have participated in the "medical insurance for small towns". You can participate in the cooperative medical care in the township where your household registration is located, but you can only enjoy the compensation for ordinary outpatient and emergency medical expenses.

II. Sources of funds

(1) Individual contributions

Establish and improve a stable, long-term and reasonable growth financing mechanism for the new rural cooperative medical system, and pay individual contributions at the rate of 2% of the per capita disposable income of rural residents in the previous year. In 21, the person who should participate in the county cooperative medical care is 15 yuan, and the person who can participate is 14 yuan.

(II) Support of enterprises and village collectives for cooperative medical care

Enterprises and village collectives should continue to implement the Notice of Shanghai Municipal People's Government on Forwarding the Opinions of Municipal Agriculture Commission, Municipal Health Bureau and Municipal Finance Bureau on Reforming and Perfecting the Rural Cooperative Medical System in this Municipality (No.13 [1997] of Shanghai Municipal People's Government) and the Notice of the General Office of Shanghai Municipal People's Government Forwarding the Opinions of Municipal Health Bureau and Other Five Departments on Strengthening and Perfecting the New Rural Cooperative Medical System in this Municipality () In 21, the village collective supported each 1 yuan according to the actual number of people participating in the rural cooperative medical system.

(III) Government Support

According to the principle that the new rural cooperative medical system is funded by individuals, enterprises and village collectives, and supported by the government, on the basis of individual contributions, enterprises and village collectives in the county, the county and township governments continue to increase their support. In 21, the county and township governments supported the cooperative medical care fund based on the actual number of people who participated in the rural cooperative medical care. The county financial subsidy was 3 yuan per person (including the municipal subsidy of 1 yuan), and the township financial support was 115 yuan per person.

iii. principles of fund use and compensation

(I) fund use

in p>21, the county-level cooperative medical fund continued to implement county-level overall planning to further improve its overall planning ability and efficiency. Improve the rural cooperative medical fund quota system, the year-end fund balance, transferred to the next year to continue to use, and does not affect the next year's quota; At the end of the year, if the funds exceed the quota, the county and township finance will share them in a ratio of 1: 1. Outside the island and sporadic reimbursement methods remain unchanged, still by the township cooperative medical fund management office to be settled, the county cooperative medical fund management office regular audit, regular transfer of funds, to ensure the normal operation of the fund.

(2) Compensation ratio

1. Outpatient compensation: 8% for seeing a doctor in the village clinic; In the township community health service center, 7% compensation; 5% compensation for medical treatment in county-level medical institutions; In the municipal medical institutions, 4% compensation; The outpatient expenses of village clinics are limited to 3 yuan each time, with no more than 5 visits per month, and the outpatient and emergency expenses of township-level and above medical institutions are limited to 12 yuan each time, with no more than 5 visits per month; The total amount of outpatient and emergency compensation for the whole year is 12 yuan.

2. Compensation for hospitalization: 7% for treatment in township community health service centers; In the county-level medical institutions, the compensation ratio is 5%; In the municipal medical institutions, the compensation ratio is 4%. If the outpatient service and hospitalization outside the island have not gone through the referral procedures of county-level hospitals, or the invoices in non-medical insurance format and no medication details, the compensation ratio will drop by 1 percentage points accordingly. The compensation cap is 5, yuan.

3. The expenses of outpatient hemodialysis, peritoneal dialysis, radiotherapy, chemotherapy and treatment (including anti-rejection drugs after renal transplantation) for patients with uremia, leukemia, tumor, hemophilia and aplastic anemia will be compensated according to the proportion of ordinary hospitalized patients, with a cap of 5, yuan. If other diseases occur in this kind of patients in the same year, the hospitalization medical expenses can be compensated according to the proportion of ordinary inpatients, but the total amount of compensation for various diseases in the year is still 5, yuan.

4. The hospitalization medical expenses of infectious patients and mental patients such as viral hepatitis A, tuberculosis, bacillary dysentery, typhoid fever, etc. shall be compensated with zero deductible, and the maximum reimbursement amount shall be 5, yuan. According to the spirit of Chongwei Medical Prevention [2] No.4 "Notice on Printing and Distributing the Implementation Measures for Hospitalization Expenses of Poor Mental Patients Causing Accidents in Chongming County (Trial)", if the hospitalization expenses of mental patients have been given a three-level burden, cooperative medical care will no longer be compensated.

(III) Scope of compensation

The scope of compensation for cooperative medical care: basically referring to the basic medical insurance coverage for urban workers. Implantable surgical materials such as pacemakers and high special treatment materials such as radiofrequency ablation are included in the reportable base according to the proportion of 5%; Those who have lived and worked in this city outside the county for a long time for more than one year, and I propose to seek medical treatment outside the county, can go through the medical treatment transfer procedures at the township cooperative medical fund management office where the household registration is located. Otherwise, the compensation ratio will drop by 1 percentage points.

the scope of non-reimbursement of cooperative medical care: the scope and items of non-reimbursement of basic medical insurance for urban workers; The cost of medical treatment in non-public institutions (including institutions that have been included in the scope of medical insurance); Expenses incurred by special wards and special hospitals set up by public medical institutions in this Municipality; Expenses for medical treatment in other provinces and cities (except emergency); The cost of organ transplantation; Expenses caused by various non-disease factors (car accidents, alcoholism, taking poison, fighting, work-related injuries, occupational diseases, self-mutilation, etc.) are not within the scope of reimbursement.

4. Consolidate and improve the subsidy fund system for serious illness and poverty alleviation and the risk fund system of new rural cooperative medical care

Strengthen the risk management of serious illness and fund operation of new rural cooperative medical care. According to the requirements of the Notice of the Ministry of Finance and the Ministry of Health on Printing and Distributing the Financial System of the New Rural Cooperative Medical Care Fund, 5% of the total fund in the current year (including the balance over the years) was used as the subsidy fund for medical expenses for serious illness and poverty alleviation, 1% was used as the risk fund of the new rural cooperative medical care, and the rest was used as the expenditure of the outpatient, emergency and inpatient co-ordination funds. The accumulated balance of the overall fund (including risk funds) generally does not exceed 25% of the total amount of funds raised in that year. The medical expenses subsidy fund for serious illness and poverty alleviation is mainly used for the low-income households and low-income family members who participate in the new rural cooperative medical system to enjoy the hospitalization or outpatient serious illness coordination and social medical assistance. If the one-time self-funded medical expenses exceed 1, yuan, they will be subsidized according to the proportion of 5% of the reimbursable part, and the highest subsidy standard is 5, yuan. The new rural cooperative medical risk fund is mainly used to make up for the temporary turnover difficulties caused by abnormal overspending of the fund.

V. Full implementation of real-time reimbursement system and total amount control system for medical treatment compensation in designated medical institutions

In order to facilitate reimbursement of medical treatment for farmers, from 21 onwards, the on-the-spot reimbursement system for outpatient and inpatient compensation expenses in designated medical institutions of cooperative medical care will be fully implemented in the county health system, and cooperative medical agencies will settle the advance expenses of designated medical institutions regularly. The annual expenses shall be controlled in total and used reasonably to ensure the safe operation of the fund.

VI. Increase the assistance of functional departments and social organizations to the cooperative medical system

Civil affairs departments, charitable foundations, disabled persons' federations and other social organizations continue to insist on giving subsidies to five-guarantee households, low-income households, disabled people and other people who participate in the cooperative medical system every year, so as to ensure that all insurance is guaranteed.

VII. Implementing county-level co-ordination of cooperative medical care funds and strengthening supervision, management and assessment

The county-level rural cooperative medical care funds are managed, used and compensated by the county-level cooperative medical care fund management office to improve the efficiency of centralized co-ordination and use of funds. The township governments should strengthen management, standardize operation and strictly control according to the implementation opinions. County cooperative medical fund management office should organize personnel to formulate management system, standardize operation process, strengthen supervision, strengthen assessment, and the assessment items should be included in the annual target management content of township governments.

VIII. Management and Guarantee System of Changxing and Hengsha Cooperative Medical System

On the basis of maintaining the original characteristics, the compensation structure will be appropriately adjusted according to this implementation opinion, and the rural cooperative medical system in Changxing Town and Hengsha Township will be gradually integrated with the county level.

IX. Supplementary Provisions

This opinion shall be implemented as of January 1, 21, and the contents not covered in the opinion shall be implemented in accordance with documents Chongfufa [25] No.14, Chongfufa [27] No.5, Chongfuban [27] No.55 and Chongfuban [28] No.55.

Chongming County Health Bureau

November 4th, 29