Notice on the New Rural Cooperative Medical Care Efforts

Counties (cities, districts) Health Bureau, the municipal units concerned:

In order to further develop and improve the new rural cooperative medical care (hereinafter referred to as the new rural cooperative) system, and effectively protect the interests of participating farmers, the successful completion of the health care reform task, according to the spirit of the relevant documents at the higher level, combined with the city's actuality, and now do a good job of the new rural cooperative work in 2012 to put forward the following views, please conscientiously carry out the implementation.

First, do a good job of fund-raising, to ensure the normal operation of the new rural cooperative system

At present, the 2012 annual individual contributions have basically ended, with the financing standards increased year by year and the number of participants continue to increase, the pressure on the local financial support funds is also increasing, the counties (cities, districts) to combine the local realities, and actively do a good job of communication and coordination, to ensure that the local supporting funds in a timely manner, in place in full, for the normal functioning of the NIC system to provide financial security.

Second, optimize the compensation program, and further increase the level of benefit to participating farmers

(A) unified compensation model, scientific distribution of funds. The city's unified implementation of inpatient co-ordination plus outpatient co-ordination mode. Outpatient co-ordination fund control within 15% of the total fund for the year, for outpatient medical fee compensation, primary health care institutions, general diagnosis and treatment fee reimbursement and chronic disease management; inpatient co-ordination fund and the current year to extract the risk fund shall not be less than 85% of the total fund for the year, outpatient co-ordination fund and inpatient co-ordination fund can be co-ordinated use. Risk fund extraction in accordance with the Shandong Provincial Department of Finance, Department of Health Lu Cai She [2008] No. 18 document implementation.

(b) Starting line and ceiling line. 2012, the city, county, township (only government-run township health center, community health service center) three-level designated medical institutions hospitalization compensation starting line were set at 500 yuan, 400 yuan and 100 yuan, hospitalization compensation starting line in the compensation scope of the cost of the deduction; new rural cooperative hospitalization compensation ceiling line citywide uniformly set at 100,000 yuan, hospitalization compensation ceiling line in the year the actual Receive compensation for the cumulative amount of compensation; compensation for chronic diseases and other special diseases, without a starting line, the ceiling is 10,000 yuan per person per year; outpatient co-ordination is generally in the township and village-level designated medical institutions compensation, without a starting line, the amount of compensation for the principle of health centers per person per day 15 yuan ceiling, the village health clinic per person per day 10 yuan ceiling, the yearly ceiling of 100 yuan per person per year.

(c) Scientific setting of compensation ratios.

1, hospitalization compensation: participating farmers must go to the new rural cooperative medical care designated institutions determined by the county and above the county health administrative department in order to enjoy the compensation, and the expenses incurred in non-designated medical institutions are not compensated. The hospitalized medical expenses incurred by participating farmers in designated medical institutions (except for those hospitalized due to accidental injuries) will be compensated according to the following ratios after deducting non-coordinated expenses and the starting line: 90% of hospitalized reimbursement for basic medicines in designated medical institutions at the township level that have implemented the basic medicines system, and 80% of reimbursement for other medicines and hospitalization in designated medical institutions at the township level that have not implemented the basic medicines system; 70% of reimbursement for hospitalization in designated medical institutions at the county level; and 70% reimbursement; 53% reimbursement for the integrated cost within 80,000 yuan (including 80,000 yuan) in municipal designated medical institutions, and 70% reimbursement for the portion above 80,000 yuan; for designated medical institutions outside of the city, the starting line is always 500 yuan, and reimbursement is 45% for medical institutions within the province, and 40% reimbursement for designated medical institutions outside of the province. The proportion of reimbursement is 45% for provincial medical institutions and 40% for non-provincial designated medical institutions; the proportion of reimbursement for medicines in the national and provincial basic medicines catalogs, traditional Chinese medicines and Chinese medical technology promoted by the Provincial Department of Health is floated upward by 10 percentage points.

For newborns born between the last contribution period and the next, whose mothers are enrolled in the New Farmers' Cooperative Program, the medical expenses incurred in the current year can enjoy the New Farmers' Cooperative Program in the capacity of their mothers.

For participating farmers who are hospitalized for accidental injuries (including trauma, poisoning and other unnatural diseases), the investigation, verification and recording of trauma and poisoning patients should be strengthened, and the investigation of the causes of trauma and poisoning should be treated with a high degree of responsibility, and no compensation will be given to those who have third-party responsibility; for accidentally injured patients who are not responsible for third-party responsibility, the portion of their hospitalized medical expenses above the starting line of reimbursable expenses shall be given at the rate of 40 percent The hospitalization of patients with accidental injuries without third-party responsibility will be compensated at a rate of 40% for the portion of the compensable medical expenses above the starting line, capped at 50,000 yuan; hospitalization of patients injured due to bravery or the execution of public welfare tasks such as disaster relief and rescue shall provide evidence of the circumstances issued by the relevant government departments at the county level or above, and the hospitalization compensation policy can be implemented according to the normal diseases; all patients who are included in the traumatic injuries and poisonings compensated by the New Rural Cooperative will have to keep the original discharge statement for inspection.

2, outpatient compensation: participating farmers in the township, village-level fixed-point outpatient clinics, the new rural cooperative reimbursement drugs within the cost of drugs and routine examination and treatment costs (excluding CT and other large medical equipment diagnosis and treatment costs) at a rate of 40% compensation; the national and provincial basic drug list of medicines, traditional Chinese medicines, and the provincial Department of Health promotion of Chinese medicine appropriate technology costs are compensated at a rate of 50%.

Chronic Disease Management: According to the Interim Measures for Chronic Disease Management of New Rural Cooperative Medical Care in Liaocheng City (Liaocheng Agricultural Cooperative Medical Care [2007] No. 5), the expenses can be integrated and compensated at a rate of 50%.

4. Major Disease Guarantee: Implemented according to the “Liaocheng City Pilot Work Implementation Plan for Improving the Level of Medical Guarantee for Major Diseases for Rural Children” (Liaowei Jiwu [2011] No. 4).

Third, strengthen fund supervision, standardize the use of funds

(a) Strengthening the construction of the management system. Actively implement vertical management at the county level for the personnel of the New Farmers' Cooperative Township-level agencies, and implement vertical management at the county level for the personnel of the New Farmers' Cooperative Township-level agencies within the coordinated area. Through off-site posting, cross-posting and other forms, county-level agencies have implemented the practice of posting agency directors, auditors, reviewers and other personnel to townships to ensure the independence of township agencies and personnel, and to realize the “separation of management and operation” of township NAC business, gradually establishing a vertical, full-time, regularly rotating, off-site posting system for the NAC agency. A system of new rural cooperative services is gradually being established, with vertical institutions, full-time personnel, regular job rotation, and off-site postings. The stationed personnel are directly managed by the county-level co-management office, and are uniformly deployed within the county (city and district); their salaries and benefits are paid by the establishment or the original unit, or may be transferred from the establishment or the original unit to the county-level health administration department or the county-level co-management office; the personal performance appraisal of the stationed personnel is based on the appraisal results of the county-level co-management office; and the issuing unit shall not default on the salaries and benefits of the staff of the new rural co-operation agency. Vertical management of the work duties and requirements of the stationed staff by the county-level co-management office to determine the actual work of the township to ensure that their work necessary conditions to ensure the smooth progress of the work. County and township levels of the new rural cooperative agency office expenses (excluding staff wages) based on the jurisdiction of the participating farmers population to be approved into the county-level financial budget, the annual allocation to the county-level joint management office unified management and use, to ensure that the normal expenses and effective operation of the agency.

(B) strengthen fund supervision. Counties (cities, districts) should be in accordance with the Ministry of Finance, Ministry of Health “on the issuance of a new rural cooperative medical fund financial system notice” (CaiShe [2008] No. 8) requirements, standardize the setup of the agency accounting, cashier, audit, information and statistics, audit and other positions and a clear division of responsibilities, accounting, cashier, auditing shall not be concurrently with each other, auditing and review can not be completed by one person; to standardize the audit process, the patient, To standardize the auditing process, conduct comprehensive auditing and regular review of the authenticity, consistency and reasonableness of patients, medical records, prescriptions and fees; to establish an auditing system, strengthen telephone inquiries and household visits, and conduct follow-up verification of patients who have incurred large medical expenses or who have traveled to a different place for medical treatment; to establish and improve the management and assessment systems, and to clearly define the responsibilities of the NPC management agencies and staff of NPC designated medical institutions at all levels, and implement accountability and veto of the safety of the NPC fund. The implementation of accountability and one-vote veto system; to increase penalties for violations of law and discipline, if necessary, joint disciplinary inspection, supervision departments of the arbitrage, fraudulent New rural Cooperative Fund institutions and personnel, in accordance with the relevant provisions to be seriously dealt with.

(C) standardize the use of funds. According to the General Office of the Ministry of Health “on regulating the use of the new rural cooperative medical fund management notice” (Wei Office of Agricultural Health Development [2010] No. 53) requirements, the new rural cooperative fund is different from the general financial funds and other governmental funds, with a clear scope of use, must be earmarked for the exclusive use of the fund must be used in full for the participants of the compensation of medical expenses, and minimize the burden of the participants of the individual cost of medicine. The funds must be used exclusively for the purpose of minimizing the burden of individual medical costs on participants. Counties (cities, districts) must be the new rural cooperative fund all for the medical expenses of participating farmers, shall not be used for public health service projects, health checkups and other project expenditures; according to the “Shandong Province, the new rural cooperative medical fund financial system” (Lu CaiShe [2008] No. 18) requirements, in accordance with the “income to determine expenditures, balance of income and expenditure, a small surplus In accordance with the principle of “to determine expenditure on the basis of income, balance of income and expenditure, with a slight surplus”, the fund balance should be controlled. The accumulated balance of the integrated fund should not exceed 25% of the total integrated fund raised in the year, of which the balance of the integrated fund in the year should not exceed 15% of the total integrated fund raised in the year (including the risk fund), and the counties (cities and districts) with a large cumulative balance should carry out the secondary compensation or relief for major diseases in due course; the risk fund is mainly used for the temporary turnover of the fund when the cooperative medical fund exceeds the expenditure in an abnormal manner. Need to use the risk fund, should be strictly in accordance with the provisions of the procedure for approval, the specific procedures in accordance with the Lu CaiShe [2008] No. 18 document implementation.

(D) actively carry out the payment method reform. According to the provincial health department “on the new rural cooperative medical payment mode reform pilot guiding opinions” (Lu Wei agricultural health hair [2010] No. 8) counties (cities, districts) to continue to accelerate the pace of the new rural cooperative payment mode reform pilot. 2012, the city's unified implementation of the total prepaid outpatient clinic and the general diagnosis and treatment fee total control, the counties (cities, districts) according to the sentinel medical institutions, service population, service capacity and the new rural cooperative fund in previous years, the new rural cooperative payment mode reform. The counties (cities and districts) should, based on the population served by the designated medical institutions, their service capacity and the proportion of outpatient compensation expenditure of the New Agricultural Cooperative Fund in previous years, reasonably determine the total amount of outpatient prepayment and the payment limit of the general diagnosis and treatment fees, and formulate the implementation plan; the counties (cities and districts) should, based on the actual situation, choose the appropriate way to carry out the reform of the integrated payment method for hospitalization and scientifically calculate and determine the standard of the integrated payment for hospitalization and the rules for the implementation of the integrated hospitalization payment method, and the reform of the integrated payment method for hospitalization should be fully implemented within the year.

Fourth, standardize the behavior of medical services, control the unreasonable growth of medical costs

(A) standardize service behavior. The designated medical institutions to establish and improve the rules and regulations, standardize work procedures, equipped with personnel and equipment to meet the needs of the new rural cooperative management. To strictly verify the identity of participating patients, to put an end to the phenomenon of impersonation, and take the initiative to remind the participating patients to bring all the materials required for instant settlement, to provide free list of hospitalization expenses and other materials, and to appropriately reduce the amount of pre-payment by participating farmers; to strictly implement the clinical path of the diseases formulated by the Ministry of Health, and the diagnostic and therapeutic technical specifications formulated by the provincial and municipal health administrations, to accurately grasp the indications and criteria for hospitalization, treatment, surgery, and discharge, and to establish a two-way referral system, and not to accept any medical treatment. Two-way referral system, shall not accept the enrolled patients who do not meet the hospitalization standards for admission, and shall not refuse to accept the patients who meet the hospitalization standards; shall implement the “three disclosures” of the service commitments, medical fees and drug prices, and adhere to the principles of treating the patients according to their illnesses, rational use of medicines, reasonable inspection and charging in accordance with the law, and shall prohibit the linking of the income from medical fees with the personal incomes of medical personnel, and shall strictly prohibit the indiscriminate use of medical fees and charges. Personal income, prohibit indiscriminate inspection, indiscriminate charges, shall not include the cost of out-of-hospital inspection, treatment and other costs in the hospital hospitalization costs for compensation, to take effective measures to control the unreasonable growth of medical costs; to strengthen the investigation, verification, records of patients with trauma and poisoning, to a high degree of responsibility to treat the cause of trauma and poisoning investigations, there is a third party responsible for the compensation will not be compensated; to the strict implementation of the New Rural Cooperative policy directory, shall not collude drugs and inspection items, shall not change drugs and inspection items, and shall not be compensated by a third party. No collusion of drugs and inspection items, strictly prohibited in the name of providing free medical treatment to the public and other various names, falsification, arbitrage New Rural Cooperative funds; to strengthen the knowledge of the basic drug system training, give priority to the use of basic medicines, enrolled patients discharged from the hospital with medicines should be carried out in accordance with the provisions of the prescription, and prohibited from exceeding the standard of self-medicine; to the implementation of the out-of-directory medication and diagnostic and treatment notification system, the proportion of out-of-directory medicine costs to the total cost of medicines in the village and the township, The proportion of out-of-catalogue medicine costs to total medicine costs in villages and township, county and municipal sentinel medical institutions should be no higher than 5%, 10%, 15% and 20%, respectively; do a good job of publicity, strengthen information communication with the New Rural Cooperation Agency, set up telephone numbers and mailboxes for reporting complaints, and take the initiative in accepting supervision; optimize the service process, simplify the procedures of medical treatment, and provide high-quality, convenient and inexpensive services for the participating farmers.

(ii) Strengthening the supervision of designated medical institutions. To strictly designated medical institutions access and exit mechanism, regular assessment and evaluation, the implementation of dynamic management; to effectively implement the New Rural Cooperative regular announcement system, the New Rural Cooperative agencies at all levels, designated medical institutions and village committees should be set up in the unit of a conspicuous position or population concentration of the area of the New Rural Cooperative notice board, the content of the notice should be comprehensive, with the conditions of the region synchronized with the implementation of the online notice. The content of the public notice of the organization should include the basic policy of the new rural cooperative, the reimbursement and compensation policy, the income and expenditure of the fund, the large amount of personal compensation, supervision and reporting telephone number. The content of the public announcement of the designated medical institutions should include the reimbursement and compensation policy, reimbursement of drug catalog and diagnostic and therapeutic items, consultation and referral process, and individual compensation, etc., to ensure that the public announcement is comprehensive, timely, and in place, and to avoid the formalization of the public announcement; the supervision and reporting system should be further improved, and a mechanism for verifying the content of letters and visits and feedback should be set up to give full play to the supervision of the society and the public opinion; an audit system should be set up, and the telephone inquiry and household visits should be strengthened. To follow up and verify the enrolled patients who have incurred large medical expenses or who have traveled to other places for medical treatment; to do a good job of letters and visits, focusing on investigating and dealing with cases of letters and visits reported by the real names; to increase the crackdown on illegal and disciplinary behaviors of the New Rural Cooperative, and if necessary, jointly with the disciplinary, inspection, supervision, auditing and other departments of the typical cases to be seriously investigated and dealt with.

V. Other Matters

Participating farmers hospitalized in the participation year and continue treatment across the year, the second year continue to participate in the implementation of the year of discharge compensation provisions, the second year no longer participate in the hospitalization costs of the year of participation only in accordance with the provisions of the year of participation to be compensated; the year did not participate in the hospitalization and treatment across the year, only to participate in the year of the cost of the provisions to be compensated.

The new rural co-operation is related to the vital interests of tens of thousands of farmers, the counties (cities, districts) health departments should give full play to the role of the competent authorities, in accordance with the principle of streamlining, unification, efficiency, coordination and implementation of the agency's staffing and working funds, establish and improve the internal management and assessment system, and further strengthen the training of personnel, and continue to improve the level of management and operation of the service level and efficiency. Each agency should further strengthen its responsibilities, step up its efforts, do a good job of supervising the fund and its services, and ensure that the benefits of the New Farmers' Cooperative Fund are effectively brought into play.

December 2011