What is the reimbursement ratio of the new rural cooperative medical system in Baoding City, Hebei Province?

I. The overall operation of the pilot work of the new rural cooperative medical system in our city. The pilot work of the new rural cooperative medical system in our city began in 2005. On June 65438+ 10/day, 2005, Laiyuan County was officially launched as one of the second batch of pilot counties of the new rural cooperative medical system in our province; On June 5438+ 10, 2006, the pilot work of new rural cooperative medical system in Zhuozhou, Dingzhou and Wang Du counties was officially launched. According to the unified arrangement of the provincial government, in 2007, our city added 8 pilot counties (cities) on the basis of the original increase of 10. As of April this year, 1, the pilot work of the new rural cooperative medical system in 22 counties (cities) in the city has all been carried out. At present, the new rural cooperative medical system covers 8851.2000 rural population and 6601.9800 farmers, with a participation rate of 74.79% (including 29653 rural five-guarantee households and 2963/kloc-0 farmers, with a participation rate of 99.93%; There are 38,088 rural poor people in the city, with a participation rate of 99.5438+0%. According to the central subsidy, 20 yuan, provinces, cities and counties will share in the ratio of 8: 6: 6, and 20 yuan and farmers will raise funds 10 yuan (national and provincial poverty-stricken counties, provincial burden 1 1 yuan, city burden 6 yuan, and county burden 3 yuan; Expand the county (city), provincial burden 14 yuan (municipal burden, county burden 6 yuan) standard, according to the total number of participants, * * * should raise 330 million yuan of cooperative medical care funds. At present, in addition to the central and provincial subsidies, municipal financial subsidies of 31573 million yuan, county (city) financial subsidies of 33.9345 million yuan, and individual contributions of participating farmers of 619800 yuan have all been put in place. Judging from the operation of four counties (cities) where the new rural cooperative medical system was piloted in our city in 2006, the implementation of the new rural cooperative medical system is a real measure to benefit the people that is welcomed by the majority of farmers. According to statistics, among the 4 counties (cities) 1 254,600, 306,000 people received medical compensation, with a total compensation amount of 40.748 million yuan (accounting for 88% of the total fund), with a per capita compensation of 747 yuan, and the compensation amount of 259 people exceeded110,000 yuan. It can be seen that through the implementation of the new rural cooperative medical system policy, the people have benefited, and the problems of difficult and expensive medical treatment for the people have been initially alleviated. Participating farmers generally report that their medical care has been taken care of and they can reimburse their medical expenses. This is another good policy issued by the party and the state to solve the practical difficulties of farmers after the implementation of the rural contract responsibility system and the exemption of agricultural tax. Second, the main practices of the pilot work of the new rural cooperative medical system in our city (1) strengthen organizational leadership and improve organizational structure. Carrying out the pilot work of the new rural cooperative medical system is a moral and political project involving thousands of families and helping each other. The municipal party committee and the municipal government attach great importance to this, and put this work into the "popular support project" to do good things for the masses and put it on the important agenda. The municipal government has set up a leading group to carry out the pilot work of the new rural cooperative medical system, with the deputy mayor in charge as the leader and the health, finance, development and reform, auditing and other relevant departments as members. The mayor's office meeting and the municipal government executive meeting have repeatedly studied the new rural cooperative medical system. In the morning after the just-concluded Fifth Session of the 12th Municipal People's Congress, the municipal government held a meeting on the pilot work of the new rural cooperative medical system in the whole city. Mayor Yu Qun personally arranged the deployment of this work, and clearly pointed out: "The pilot work of the new rural cooperative medical system is a popular project of" benefiting farmers, winning the hearts of the people, developing healthily and stabilizing the society "and is the first major event to implement the 2007 government work report. We must do this good thing well and do it. " In order to ensure the smooth development of the work, the governments of 22 pilot counties (cities) in the city set up a leading group or management committee of the new rural cooperative medical system with the county (city) head as the team leader or director. At the same time, the new rural cooperative medical system management center was established by sending special personnel to provide necessary transportation and office equipment and office space. Each township (town) has set up a new rural cooperative medical system office in the township (town) government or health center, which is responsible for the specific business work of the new rural cooperative medical system in this area, so that someone can manage and have money to handle affairs. At present, the organization of the new rural cooperative medical system in the city is sound, and the information transmission is rapid and timely, which effectively guarantees the solid development of the pilot work of the new rural cooperative medical system in the city. (2) Intensify publicity and mobilize farmers to participate extensively. It is the key to carry out the pilot work of the new rural cooperative medical system, let more farmers participate in it and publicize it widely. In the work, first, leading cadres should adopt the way of contracting rural films and widely publicize and mobilize. Second, the use of television, newspapers, internet, lectures, blackboard newspapers, radio, banners and other forms, widely publicized. Third, rural cadres go deep into farmers' homes and start thinking face to face. The fourth is to use people around us to talk about things around us, so that the participating farmers who benefit can talk about their personal feelings after benefiting and put forward their own views for publicity. Fifth, relying on rural primary and secondary schools to carry out "one family for life" publicity and education activities. Through various forms of publicity, the new rural cooperative medical system is deeply rooted in the hearts of the people and farmers are guided to participate in the new rural cooperative medical system. (3) Make scientific plans to ensure farmers benefit. In order to maximize the benefits of the limited cooperative medical fund, ensure that the participating farmers benefit and benefit the majority of participating farmers, according to the basic framework of the compensation scheme, our city scientifically and reasonably formulates, adjusts and improves the compensation scheme in accordance with the principle of "living within our means, living within our means, and making some savings". First, the basic mode of compensation is large medical expenses as a whole, supplemented by small expenses, that is, hospitalization as a whole+chronic diseases as a whole in large outpatient clinics+outpatient family account (farmers pay 65,438 yuan, including 8 yuan in family account and 2 yuan in serious illness as a whole)+normal delivery quota compensation. The second is to reduce the deductible of compensation and increase the proportion of compensation. For example, the county-level hospital in Laiyuan County was reduced from 1 10,000 yuan to 300 yuan, and the compensation ratio was increased to 50%; Medical treatment outside the county was reduced from 3,000 yuan to 1500 yuan, and the compensation ratio was increased to 30%-40%. The third is to implement the system of fixed compensation for normal delivery and large outpatient compensation for chronic diseases. Per capita fixed compensation for normal delivery 100 yuan. At the same time, leukemia, renal dialysis, malignant tumor, hypertension, diabetes and other 10 diseases will be included in the compensation scope. (4) Actively raise funds and strictly manage funds. The pilot counties (cities) adhere to the principle of farmers' voluntary participation, carefully formulate the implementation plan of cooperative medical care financing, clarify their work responsibilities, actively guide farmers to pay fees voluntarily on the basis of extensive mobilization, and ensure that the individual contributions of participating farmers and financial subsidies at the city and county levels are raised in full and on time according to the requirements. Counties (cities) strictly manage funds, conscientiously implement the provincial Measures for Financial Management of Funds and Measures for Accounting of Funds, and establish and improve various systems for financial management and accounting of funds. Strengthen the construction of internal control system, set up a special financial account of cooperative medical fund in state-owned commercial banks, ensure the safety of the fund both inside and outside the account, and implement closed operation of the fund and two lines of revenue and expenditure. (five) to strengthen the supervision of designated medical institutions, standardize medical service behavior. In order to reduce the burden of farmers' medical expenses, counties (cities) strengthen the supervision of designated medical institutions, standardize medical service behavior, and ensure the smooth and healthy operation of the pilot work of the new rural cooperative medical system. First, strengthen system construction and implement dynamic management. Pilot counties (cities) set out from reality, formulate management measures or implementation rules for designated medical institutions, strictly implement access measures for designated medical institutions, sign service agreements for medical institutions, implement dynamic management, and cancel designated qualifications for medical institutions that do not conscientiously perform service agreements. There are 7582 designated medical institutions in the city (86 at county level, 433 at township level and 7063 at village level). Second, strictly control medical expenses to ensure that participating farmers benefit. Pilot counties (cities) conscientiously implement the Ministry of Health's "Several Opinions on Strengthening the Management of Medical Expenses in Designated Medical Institutions of the New Rural Cooperative Medical System" and Hebei Province's "Catalogue of Essential Drugs", quantify the proportion of drugs used in the catalogue, the positive rate of large-scale inspection and other indicators, and the external use of drugs in the catalogue must be signed and agreed by patients or their families; At the same time, establish a strict referral system to reasonably control inpatients outside the county. According to the statistics of four pilot counties (cities) last year, the utilization rate of drugs in the catalogue reached more than 95%, the positive rate of major inspection reached more than 65%, and the average hospitalization expense was 262 1 yuan, which was 383 yuan lower than that in 2005 (3,004 yuan) and 2.7 percentage points lower than that in 2004, thus reducing the burden on farmers. The third is to standardize the behavior of diagnosis and treatment services to facilitate farmers to seek medical treatment. Standardize the diagnosis and treatment process and operation process of medical institutions, implement "one certificate pass" for participating farmers to seek medical treatment, issue reimbursement notices for hospitalization, and issue "one-day list", discharge statement and reimbursement compensation form every day. Designated medical institutions set up a convenient "reporting window" for participating farmers, and participating farmers can get compensation directly if they are hospitalized in the "reporting window". (six) to improve the management level and ensure fairness and justice. First, implement computer information management. In order to reduce the management cost, improve the management level and facilitate farmers' reimbursement, the pilot work of the new rural cooperative medical system has implemented computer information management. At present, computer management software of cooperative medical system has been installed in 10 counties (cities) such as Laiyuan, Wang Du, Zhuozhou, Dingzhou, Xu Shui, Levin, Mancheng, Xiongxian, Yixian, Gaobeidian, etc., and designated medical institutions are networked with the new rural cooperative medical system management center, realizing online audit, reimbursement and settlement. Anxin, Shunping, Rongcheng and Laishui counties are being debugged. The second batch of eight county (city) cooperative medical software agreements launched this year have all been signed, and the hardware, farmers' early information input, network and training work are being implemented to ensure the opening on May 1 day. The second is to implement the sunshine operation and regular publicity system. Counties (cities) set up publicity columns in the joint management center and the designated medical institutions at the county, township and village levels to disclose the rights and obligations of participating farmers, reimbursement regulations and procedures, referral procedures, drug lists and medical services to the whole society, and regularly publish the hospitalization expenses, compensation and reimbursement of participating farmers. And the establishment and publication of the new rural cooperative medical system to report complaints telephone. The third is to strengthen audit supervision. Each pilot county (city) has established a supervision and audit system for the new rural cooperative medical system, and established a "Rural Cooperative Medical Supervision Committee" composed of government, supervision, auditing and other relevant departments and participating farmers' representatives to regularly audit and supervise the use of cooperative medical funds to ensure the openness, fairness and impartiality of the pilot work of the new rural cooperative medical system. Three. Analysis of the problems and causes Since the pilot work of the new rural cooperative medical system in our city was launched, although it started well and ran smoothly from the overall situation, most people were satisfied and achieved phased results, but as the whole work is still in the pilot stage, there are still some problems and shortcomings. Mainly manifested in: (1) The understanding of the new rural cooperative medical system needs to be further improved. In the pilot work of the new rural cooperative medical system, although governments at all levels and health administrative departments attach great importance to it and the main leaders personally arrange the deployment, some county and village leaders do not know enough, and they are prone to fear of difficulties and war-weariness, and their work intensity is decreasing step by step. In terms of policy propaganda, although governments at all levels and joint management institutions carry out propaganda in various ways, there are still dead ends in propaganda. Some farmers don't understand the cooperative medical care policy, and they are not clear about the reimbursement procedures and proportions. They still have doubts about whether or not to participate in the cooperative medical system, fearing that their money will not be compensated, and have not yet formed an atmosphere in which the whole society supports and understands the pilot work of the new rural cooperative medical system. (2) The capacity of rural primary health service needs to be strengthened. Due to the influence of social environment and long-term insufficient investment, the infrastructure of grass-roots township hospitals is outdated, the medical equipment is aging, the working conditions are poor, the wages of medical staff are low, it is impossible to retain and attract talents, and the ability to serve people's health is shrinking. Although governments at all levels have increased their investment in township hospitals in recent years, the service capacity of township hospitals can not meet the needs of the pilot work of new rural cooperative medical care and the basic medical needs of participating farmers because the transformation planning lags behind the full coverage implementation of the pilot work of new rural cooperative medical care in our city. (C) The service process needs to be further optimized. In counties (cities) where the new rural cooperative medical system has been implemented, there are problems in reimbursement and referral procedures for participating farmers. Especially in the border areas between counties, because the cooperative medical fund is co-ordinated by counties (cities), participating farmers can't go to the nearest medical institutions, but only to the medical institutions in distant counties. Because some medical institutions above the county level have not strictly implemented the prescribed drug list and inspection regulations, the proportion of reimbursement and compensation for participating farmers in medical institutions above the county level is low. (D) Drug management needs to be further standardized. Due to the non-uniform drug use channels in rural medical institutions and the non-uniform price of the same drug, the benefit level of participating farmers is affected. In addition, due to the limitation of the new rural cooperative medical system drug list, some commonly used drugs and emergency drugs with good curative effect and low price are not included in the list. (E) The service level of cooperative medical management institutions needs to be improved. Individual counties (cities) have some difficulties in the normal operation of agencies due to insufficient funds, and the construction of information network management system is lagging behind, which can not effectively implement the dynamic monitoring of designated medical institutions. The staff of most county (city) organs are temporarily seconded, not formally transferred according to the approved establishment. The management team is unstable and the overall quality is uneven, which can not meet the needs of the new rural cooperative medical management.