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Suggestions on Enhancing the Security Level of Cooperative Medical Treatment in the Rural Areas of This Municipality

 The system of cooperative medical service is the basic security system of medical service for peasants. The consolidating and improvement of the system of cooperative medical service is one of the important measures to carry out the scientific viewpoint of development in this Municipality, promote the coordinated development of cities and towns, settle the“three rural”issues, and build a moderate fairly well-off society in an all-round way. The system of cooperative medical service has been implemented for nearly 50 years in this Municipality, with fairly good general results in playing a very big role in safeguarding the health-related rights and interests of peasants.

However, the security level of cooperative medical service for peasants in this Municipality is still comparatively low, the problems of“Becoming poor due to diseases”or“Back to poverty due to diseases”still exist. For the purposes of further strengthening the peasants’capability of fending off the economic risks brought about by diseases, and narrowing step by step the gap between urban and rural residents in the field of medical service security, we hereby put forward the following suggestions on enhancing the security level of cooperative medical treatment in the rural areas of this Municipality in the spirits of the national working conference of year 2005 on the new type of pilot cooperative medical service, and in the light of the actual circumstances:

I. Adjusting the policy on raising funds for cooperative medical service

1. Objective

To continue consolidating and improving the current system of cooperative medical service, raise the payment level of individual persons, and intensify the government support. Up to the year 2007, the level of the per capita fund raising for cooperative medical service in all suburban districts and counties (hereinafter referred to as all districts/counties) shall not be lower than the level of the per capita fund raising in the whole Municipality in the year 2004, and a long-acting fund raising mechanism featuring year-by-year progressive increase in amount shall be set up so as to continuously enhance the security level of medical service for peasants in this Municipality, and gradually ease the problems of“Hard to get medical treatment”or“Expensive to have medical treatment”for peasants.

2. Principles

1) Guidance by the government, operation by the local people with aid from the public. The cooperative medical service in rural areas shall focus on easing the peasants’economic risks due to heavy diseases, with consideration given to the requirements of basic medical service for outpatients and emergency treatment. The government shall organize, and through support and guidance, encourage the peasants to join voluntarily such medical service by taking the household as unit. The coverage rate of cooperative medical service shall be further consolidated and improved, and the security level of cooperative medical service in rural areas shall be enhanced step by step through the enhancement of the individual payment level of the peasants, the intensification of the government support, and the active support of the collective economy and mass organizations.

2) Classified guidance and steady advancement. Differential treatment and classified guidance shall be carried out on the basis of the different economic situations of districts and counties and the situation of the fund raising for cooperative medical service in the year 2004. Different measures shall be adopted for the districts and counties that have reached the standard of the fund raising level and those that have not reached such standard, so as to narrow the difference between the districts and counties, and enhance the fundraising level of cooperative medical service year by year.

3) Strengthening the administration, and normalizing the operation. The Municipality and districts and counties shall strengthen the administration on cooperative medical service, and shall, on the premise of guaranteeing all participants’enjoyment of basic medical service, and efficient operation of the system of cooperative medical service, improve the efficiency of usage of funds, and ensure the safety of the funds. All districts and counties shall, in accordance with their capability of taking the burden of funds for cooperative medical service, carry out the practice of“Determining the expenditures against revenues”, and reasonably determine the usage ratio of funds and the compensation criteria.

4) Advancing in proper order and enhancing year by year. All districts and counties shall, in accordance with the situation of local social and economic development, and in the light of the requirements relevant to the settlement of“Three Rural Issues”and the situation of operation of cooperative medical service, solve one to two difficult problem(s) each year and, through the mode of“Step-by-step advancement at small paces”, further consolidate and improve the system of cooperative medical service in rural areas.

3. Requirements on Fundraising

1) To enhance the overall fundraising level of cooperative medical service year by year

Of the four districts and counties that did not reach the per capita fundraising level of this Municipality in the year 2004, Jinshan District and Nanhui District, Fengxian District, and Chongming County shall, in the years 2005, 2006, and by the end of the year 2007 respectively reach the per capita fundraising level of the whole Municipality for the year 2004. The districts and counties that have reached the per capita fundraising level of this Municipality for the year 2004 shall, in accordance with the situation of local social and economic development, further enhance the fundraising level of cooperative medical service.

2) To steadily enhance the level of individual payment

Up to the year 2007, the part of cooperative medical service fund paid by individual persons in all districts and counties shall constitute no less than 40 percent of the per capita expenditure of cooperative medical service, and this ratio shall, in accordance with the data released by the municipal statistics department, reach a level not lower than two percent of the per capita net income of local peasants in the year 2004. On the basis of the fact that the per capita payment of individual peasant in the year 2004 accounting for 1.3% of the per capita net income, all districts and counties may, in accordance with the actual economic bearing ability of peasants, enhance such ratio year by year, and the districts and counties that have conditions may reach or surpass such ratio ahead of schedule.

3) To intensify the government support for cooperative medical service

In the spirit of the“Suggestions on Further Deepening the Pilot Reform of Rural Taxes and Expenditures in This Municipality”(SMPG [2005] No.46) printed and distributed by the Municipal People’s Government, governments of all levels shall strengthen the leadership, and on the basis of bringing the sound fundraising and operation mechanism of cooperative medical service into full play, continuously improve the system of cooperative medical service, and increase the input in the cooperative medical service fund. From the year 2005, the average ratio of the funds provided by all districts and counties and town/township governments in support of cooperative medical service to the average funds paid by individual persons in the whole Municipality shall not be lower than 1:1. For the districts and counties that have not reached the per capita fundraising level of this Municipality for the year 2004, the supportive fund from the district/county and town/township governments for the cooperative medical service in the year 2006 shall be in place in advance, on the basis of the part matching the per capita fundraising level of this Municipality for the year 2004. After the year 2007, for the districts and counties that have met the requirements on the ratio at present, the ratio of the increment part of individual payment to be matched by the government shall reach 1:1.

The supportive fund of the government shall be borne by the district/county and town/township governments. From the year 2005, the Municipal People’s Government shall, in line with the actual number of persons joining the cooperative medical service in the year 2004, raise funds according to the criteria of 20 yuan per person, with emphasis laid on providing a subsidy on cooperative medical service fund to the districts and counties that have difficulties (The specific procedures shall be separately formulated).

After the staff and workers of town/village enterprises participate in the town/township medical insurance, the deficit in the fundraising of cooperative medical service incurred from the reduction of supportive funds of the town/village collective economy shall be balanced by all districts and counties themselves in principle, so as to ensure the steady enhancement of actual security level of cooperative medical service as enjoyed by the peasants. At the same time, in accordance with the requirements of differential policy, the financial departments at the municipal level shall provide subsidies to the districts and counties that have difficulties in economy.

In the spirit of the document SMPG [2005] No.46, all districts and counties shall, in accordance with the criteria of 100 yuan per person, list the old peasants aged over 65 that transfer the operation right to contracted land in the special accounts of risk fund for heavy diseases in cooperative medical service.

4) To bring the role of collective economy into full play in the fundraising for cooperative medical service

Enterprises and village collectives shall continuously implement the provisions of the“Suggestions on the Reform and Improvement of the System of Cooperative Medical Service in the Rural Areas of This Municipality”(SMPG [1997] No.13) approved and transmitted by the Municipal People’s Government, and pay the fund of cooperative medical service fund in time and in full amount. All district and county governments shall, on the principles of“Operation by the local people with aid from the public”, strengthen the overall planning for the cooperative medical service fund so as to ensure the fundraising for cooperative medical service is put in place.

5) To require relevant departments to continuously provide supports for the cooperative medical service fund

According to the requirements of the“Supplementary Suggestions on the Consolidation and Improvement of Cooperative Medical Service in the Rural Areas of This Municipality”(SMPG [2002] No.94) made by four departments including the municipal structural reform office and approved and transmitted by the Municipal People’s Government, the civil administration department and charity foundations, union of the handicapped and other mass organizations shall continuously provide subsidies on the participation in the cooperative medical service to the household enjoying the five guarantees, the household enjoying the low income guarantee, and the handicapped, and transfer the subsidy fund to the administrative department of cooperative medical service according to the actual number of the participants.

II. Enhancing the Security Level of Cooperative Medical Service

1. Normalizing the usage ratio of fund

Seventy to eighty percent of the cooperative medical service fund raised by the districts and counties, towns and township shall be used for the reimbursement of the expenses for outpatient service and emergency treatment and the hospitalization expenses below 5000 yuan. Among that, the total amount used for the reimbursement of medical treatment of community public health service center (town and township sanitation station) and village clinics shall not be lower than 70% of the fund. Twenty to thirty percent of the cooperative medical service fund shall be brought into the district/county level heavy disease fund pool for hospitalization expenses amounting to 5000 yuan or more.

2. Guaranteeing the compensation level of cooperative medical service

On the premises of guaranteeing the balance of revenue and expenditure of the cooperative medical service fund, the compensation ratio of the cooperative medical service in all districts and counties to the reimbursable part of the medical expenses for outpatient service, emergency treatment, or hospitalization expenses below 5000 yuan shall not be lower than 40%. The maximum amount of compensation level of the heavy diseases fund pool of cooperative medical service shall not be lower than 30000 yuan; for the districts and counties whose per capita fundraising level is higher than the average level of this Municipality in the year 2004, the maximum amount of compensation level may be raised to 50000 yuan.

3. Intensifying the succor for old peasants parting with cultivate land against the heavy disease risk

The old peasants aged above 65 that have transferred the operation right to contracted land shall be given an additional succor compensation in a certain ratio for the individually borne part that surpass 50% of annual per capita income in rural areas after enjoying the maximum compensation from the heavy disease fund pool (Detailed procedures of which shall be separately formulated).

If the personnel that have participated in the town/township medical insurance at the present stage apply to participate in the cooperative medical service for outpatients, the case shall be handled in accordance with the“Implementation Suggestions on Relevant Issues on Participation in Rural Cooperative Medical Service by the Participants in Small Town/Township Medical Insurance”(SMI [2005] No. 114) made by four departments including the Municipal Public Health Bureau, and district/county or town/township governments shall strengthen overall planning and coordination, and provide active support.

III. Further Strengthening the Supervision and Administration on Cooperative Medical Service

1. Strengthening the construction of the administrative system of cooperative medical service

The Municipal Administration Office of Cooperative Medical Service shall be set up to strengthen the policy research, gathering of information, training of personnel, investigation and survey, and coordination in connection with cooperative medical service. All districts and counties shall improve the working system of the cooperative medical service administration commission, regularly hold meetings, circulate or transmit in time relevant situations and information on cooperative medical service, research and coordinate the solving of relevant problems.

All districts and counties shall, in accordance with the provisions of the“Supplementary Suggestions on the Consolidation and Improvement of Cooperative Medical Service in the Rural Areas of This Municipality”(SMPG [2002] No.94), ascertain the authorized size of the personnel of cooperative medical service agency, and the finance department of the same level shall examine and verify in accordance with the provisions, and appropriate the personnel expenditures and administrative outlay as prescribed. Meanwhile, the construction of the information system of cooperative medical service throughout this Municipality shall be launched under the unified arrangement by the municipal public health department so as to raise the capability of administration and service.

2. Strengthening the administration of cooperative medical service fund

The principles of“Determining the expenditures against revenues, pursuing balance by oneself”and“Openness, Fairness, and Justice”shall be strictly followed. The cooperative medical service fund shall set up a special account at a State-owned commercial bank affirmed by the district/county cooperative medical service administration commission, and shall be in closed operation so as to ensure the safety of the fund. The administrative systems including the financial administration of cooperative medical service and the accounting procedures shall be set up and improved. The cooperative medical service fund shall be earmarked for its specified purpose only, used reasonably and entirely to guarantee the medical service for the peasants and shall not be misappropriated or embezzled.

3. Using the cooperative medical service fund reasonably

All districts and counties shall, according to the fundraising level and in the light of actual circumstances at the locality, scientifically and reasonably determine the scope, standard and specified amount of the payment of cooperative medical service fund. The cooperative medical service fund shall not only raise the capability of resisting the risk of heavy disease, but also take the benefit extent for the peasants into account. For the peasants that participate in the cooperative medical service but do not use the cooperative medical service fund in the current year, a routine physical examination may be arranged for them in accordance with the usage situation of the cooperative medical service fund. The modes and specific examination items of the routine physical examination shall be made public so as to avoid the over-expenditure or excess surplus of the fund.

4. Strengthening the supervision mechanism

The district/county cooperative medical service administration commission shall, jointly with the finance, auditing departments of the same level, supervise and examine the situations of the operation of cooperative medical service and the usage of its fund in its own district/county. The district/county cooperative medical service administration office shall regularly report to the district/county cooperative medical service administration commission on its work and take the initiative to accept the supervision of the latter, and regularly make public the usage situation of the cooperative medical service fund so as to guarantee the rights to know and to supervise for the peasants that participate in the cooperative medical service. The regular auditing system on cooperative medical treatment fund shall be set up, and the auditing work on the situation of revenue and expenditure of the cooperative medical service fund shall be regularly carried out by the auditing department with appropriate qualifications.

5. Normalizing the medical service

The community public health service center (town and township sanitation station) and village clinics in suburban areas shall lay stress on the prevention of diseases, comprehensively launch the community public health service, implement various kinds of diagnosis and service norms, and perfect the quality control. It is necessary to normalize the acts of service, guarantee the quality of service, enhance the efficiency of service, and actively push forward the comprehensive prophylaxis and treatment work on diseases in the community so as to reduce the incidents of diseases. The system of designated medical service and bidirectional transfer of patient for further medical treatment shall be pushed forward so as to control the unreasonable increase in medical expenditures. The public health department shall improve the system of administration and examination, and strengthen the supervision and administration on the service quality and the control of expenditures of the designated cooperative medical service agency in rural areas.

Shanghai Municipal Public Health Bureau

Shanghai Municipal Agriculture Commission

Shanghai Municipal Development and Reform Commission

Shanghai Municipal Finance Bureau

November 3, 2005

 

 

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