1. Basic Policies of New Rural Cooperative Medical Care New rural cooperative medical care is a mutual medical aid for farmers under the organization, guidance and support of the government, farmers voluntarily participate, collective and government financing is provided, and the main focus is on serious illness coordination** *Economic system. 1. New rural cooperative medical financing channels. According to relevant national regulations, there are currently two main channels for raising funds in pilot counties and cities across the country for new rural cooperative medical care: first, financial subsidies at all levels; second, payments from farmers participating in cooperative medical care. Starting from 2006. Counties and cities that carry out new rural cooperative medical care pilots, based on the number of people participating in cooperative medical care, have a total annual funding of 50 yuan per person, including a central government subsidy of 20 yuan and a total matching of 20 yuan from the provincial, state, and county (city) finances. , farmers participating in cooperative medical care pay 10 yuan. 2. The nature of the new rural cooperative medical care is "mutual aid and financial aid", that is, farmers who voluntarily participate in the cooperative medical care must pay a certain fee every year. The payment standard can be determined according to the level of local economic development. The State Council Guobanfa [2004] No. 3 document stipulates that the individual payment amount of participating farmers shall, in principle, be no less than 10 yuan per person per year. Economically developed areas may increase payment accordingly on the basis of farmers' voluntary basis and based on farmers' income levels and actual needs. standard. 3. The new rural cooperative medical system is a mutual-aid and economical basic medical security system for farmers. Since it is a mutual aid system, it must focus on overall planning for serious illnesses. That is to solve the medical expenses of participating farmers who need urgent hospitalization after suffering from serious illness. However, taking into account the enthusiasm of farmers participating in the cooperative medical care and the actual medical conditions of farmers in our state, the cooperative medical care funds are divided into two parts, most of which are used as inpatient medical compensation funds, and a small part is used as outpatient services for farmers participating in the cooperative medical care. Compensation fund, establishment of family outpatient account. From the family outpatient account of participating farmers, each person can withdraw 6-8 yuan per year on a family basis to compensate for the outpatient expenses of family members that year. It will be used on a lump sum basis by the family until it is used up, and any overspending will not be reimbursed. The balance of the current year will be carried forward and used in the next year. 4. Procedures for fund raising and placement of new rural cooperative medical care. The financing principle of the new rural cooperative medical care is: "Farmers voluntarily participate, and collectives and governments raise funds from multiple sources." That is, on the basis of farmers' voluntary participation, the farmers' payment will first be collected and stored in the treasury in accordance with relevant regulations, and then entered into the county and city new rural cooperative medical care. Medical special f-] account, and then the county (city) finance will allocate matching funds in place according to the actual number of participants, and apply for subsidy funds from the provincial finance and the central finance. The cooperative medical funds paid by farmers can be paid by the farmers themselves, or they can be paid by the collective economy. Donations from the community can also be made. 5. Conditions that must be met for the new rural cooperative medical pilot program. Document No. 20051319 issued by the Ministry of Health and the Ministry of Finance stipulates that when determining pilot counties (cities), provinces and municipalities must continue to adhere to the relevant standards for pilot counties (cities): First, local governments attach great importance to it and take the initiative to apply; Second, farmers are highly motivated to participate in cooperative medical care, and rural grassroots organizations are relatively sound; third, local finances at all levels can guarantee subsidy funds. And timely and in full amount; fourth, the health administrative department has strong management capabilities, and rural medical and health service management is relatively complete; fifth, township health centers are under county-level management. Reforms are in place; sixth, the medical assistance system is simultaneously established; seventh, the establishment, personnel, and funding of cooperative medical management agencies are ensured, and necessary office equipment such as computers are purchased. When counties and cities formally report to their superiors, they must make a formal written commitment. 2. Special policies for new rural cooperative medical care

1. For special (vulnerable) groups such as five-guarantee households, extremely poor households, and disabled people who participate in cooperative medical care, the funds that they should pay individually shall be settled by the civil affairs department. 2. For households with preferential treatment for family planning such as households with only one child and households with two daughters undergoing sterilization, the funds that should be paid by individuals shall be settled by the family planning department. 3. All pregnant women participating in cooperative medical care who give birth in the hospital will be given fixed subsidies according to the mode of delivery. According to the plans formulated by each county and city, compensation for each case of average production is 150-250 yuan. The compensation for cesarean section is 400-600 yuan per case. The Department of Pathology and Obstetrics will be compensated according to the relevant regulations for inpatients. Poor pregnant women who give birth in hospital should also enjoy poverty relief subsidies under the "reduction and elimination" item. 4. Special diseases and chronic diseases treated in outpatient clinics all year round, such as tumors, aplastic anemia, liver cirrhosis, senile chronic bronchitis, uremia and other diseases, can enjoy a certain amount of compensation every year within the basic cooperative medical drug list. The compensation standard and specific disease types are formulated by counties and cities. 3. New Rural Cooperative Medical Care Compensation Policy Farmers who participate in cooperative medical care can receive a certain proportion of compensation for their actual medical expenses regardless of 1,] diagnosis or hospitalization, as long as they comply with the relevant provisions of cooperative medical care. 1. Outpatient compensation. The medical expenses of participating farmers who seek outpatient treatment at designated medical institutions can be compensated according to the outpatient compensation methods and compensation procedures formulated by the county and city, but those who seek medical treatment at non-designated medical institutions will not be compensated. 2. Hospitalization compensation. Participating farmers who need hospitalization due to illness must be hospitalized in designated cooperative medical institutions. The compensation method and compensation ratio must be compensated in accordance with the implementation rules (plan) formulated by the county and city.

(1) The medical expenses incurred by participating farmers for hospitalization in designated medical institutions will first be deducted from the amount stipulated in the minimum payment standard, and then the drug fees beyond the scope of the basic drug catalog and relevant special examination fees will be deducted. Prorated compensation.

The minimum payment standards are determined according to different levels of medical institutions. The more primary medical institutions are, the lower the minimum payment standard. The higher the medical institution, the higher the minimum payment standard. It is divided into four levels: first-level hospitals (township health centers), second-level hospitals (county and city-level hospitals and some state-level hospitals), third-level hospitals and hospitals at the provincial level and above. The minimum payment standards are 100 yuan, 200 yuan, 400 yuan, and 600 yuan respectively. When counties and cities set the minimum payment standards, in principle, they follow the above standards. Some counties and cities have appropriately lowered the minimum payment standards for grassroots designated medical institutions and raised the minimum payment standards for upper-level designated medical institutions based on the actual situation. This is normal. (2) The medical expenses incurred by participating farmers for hospitalization in designated medical institutions will be reduced by the deductible amount. Then subtract the part of the amount that should be paid out of pocket to calculate the scope of compensation. Use this as the base number. Calculate the specific amount that should be compensated to participants based on the compensation ratio. The specific compensation ratio is also determined according to the levels of first-level hospitals, second-level hospitals, third-level hospitals and provincial hospitals and above. The specific proportions are 60%, 50%, 30% and 20% respectively. It is normal for some counties and cities to appropriately increase the compensation ratio of grassroots designated medical institutions when formulating plans.

3. Reasonably determine the maximum compensation standard.

4. Medical expenses that fall under “excluded liability” will not be reimbursed by the cooperative medical system. Such as traffic accidents, fights, alcoholism, suicide, self-mutilation, cosmetology, orthopedics, etc. 4. Other provisions of the new rural cooperative medical system 1. Designated medical institutions of the cooperative medical system. Cooperative medical designated medical institutions are institutions that provide basic medical services to participating farmers. Their main targets are non-profit medical institutions organized by the government. Village clinics that meet qualified standards can gradually enter the scope of designated medical institutions to facilitate the nearest outpatient service for participating farmers. Seek medical treatment to resolve minor injuries and illnesses. Medical institutions within the scope of designated medical institutions must first obtain the "Medical Institution Practice License" and then apply for the qualification of designated medical institutions according to relevant procedures. After assessment and review by the county and city health administrative departments and cooperative medical management agencies, those that meet the conditions will be determined as designated cooperative medical institutions in the form of official documents. During the operation of a designated medical institution, if a medical accident of level 2 or above occurs or a medical dispute with a large social impact occurs, or if cooperative medical funds are obtained by improper means, the designated medical institution may be suspended or canceled based on the nature of the problem and the severity of the circumstances. Institutional Qualifications. The village clinic is determined as a designated medical institution and must meet the qualification standards and obtain a "Medical Institution Practice License". Participating farmers seek medical treatment at village clinics, and only the outpatient subsidy is reimbursed. Village clinics cannot conduct inpatient services. 2. Establish a systematic and complete reimbursement and compensation procedure, which should not only facilitate participating farmers to reimburse and receive compensation in a timely manner, but also ensure the safety of cooperative medical funds. The cooperative medical management methods and implementation plans formulated by cooperative medical pilot counties and cities have clear provisions on reimbursement procedures, reimbursement requirements, compensation methods, etc. Staff of joint management institutions and subjects participating in cooperative medical care must strictly abide by it. Compensation for medical expenses incurred by participants for outpatient treatment at designated medical institutions. Generally speaking, compensation is provided as soon as the patient is born, and compensation registration is completed in accordance with relevant procedures. Hospitalization compensation needs to be stratified according to the level of the medical institution and the amount of medical expenses. If the compensation amount is less than 1,000 yuan, it only needs to be reviewed by the township joint management agency, and compensation will be made at the local medical institution. If the compensation amount is more than 1,000 yuan, it must be reported to the county or city joint management agency for review, and then compensation will be made according to relevant procedures. For extremely serious diseases, if the compensation amount reaches the maximum compensation standard and secondary compensation is required, the leaders of the county and city joint management agencies must conduct collective research and then compensate according to relevant procedures. 3. Compensation for participating farmers shall be subject to an advance payment system at designated medical institutions. That is, when participating farmers are hospitalized in designated medical institutions, they only pay the out-of-pocket portion in advance. If a certain disease is hospitalized in a township hospital, it is estimated that the total medical expenses should be 3,000 yuan in advance, and the participant only needs to pay 1,500 yuan in advance, and the excess will be reimbursed after the patient is discharged and settled. The other 1500 yuan that needs to be paid in advance will be advanced by the designated medical institution. After settlement, the county-level cooperative medical management agency will directly transfer the compensation fees that should be compensated to the participants to the medical institution. 4. The new rural cooperative medical system must have a complete set of leadership and working teams. It includes the county (city) new rural cooperative medical care coordination leading group, the county (city) new rural cooperative medical care management committee, the county (city) new rural cooperative medical care supervision committee, and the office is the county (city) new rural cooperative medical care bureau (or center). There is a complete set of regulations, norms, and procedures for the supervision, management, review, and auditing of cooperative medical care. 5. The new rural cooperative medical system adheres to the principles of farmers' voluntary participation, multi-party financing, county management, revenue-based expenditures, and appropriate guarantees. Farmers voluntarily participate in the new rural cooperative medical care. Each person only needs to pay 10 yuan per year, and then through financial subsidies at all levels, a mutual aid financial system for farmers' medical care is formed. This system can solve the problem of difficult and expensive medical treatment for farmers. It is undoubtedly the most effective way and approach. However, it is only a form of mutual aid, and participating farmers must pay part of their own medical treatment. Only moderate protection can be achieved. After each annual operation, the total cooperative medical funds must have a moderate balance, and a balance rate of about 20% is normal. In the next operating year, participating farmers must pay another 10 yuan, and finance at all levels will continue to provide annual subsidies. If things go on like this, a virtuous cycle will occur, and a considerable number of participating farmers will enjoy compensation for hospitalization and outpatient treatment after illness every year.

Participation in cooperative medical care must be based on household units, with all family members participating and paying fees. 6. Cooperative medical policy orientation. Cooperative medical policies, especially compensation policies. Encourage participating farmers to first seek medical treatment in grassroots hospitals when they fall ill. If the problems cannot be solved by grassroots hospitals, they can then be transferred to higher-level hospitals step by step. In this way, firstly, the burden of personal medical expenses for hospitalization of participating farmers is reduced. The second is to promote the standardized management of primary medical units, strengthen infrastructure construction, continuously improve technical levels, form a competition mechanism, and enhance overall service functions. The third is to save cooperative medical expenses. Fourth, the more grassroots the hospital is, the less out-of-pocket expenses for hospitalization the participating farmers will have, the higher the reimbursement and compensation ratio, the more benefits the participating farmers will receive, and the higher the overall compensation rate for cooperative medical care will be. 7. The financing of new rural cooperative medical care is mainly based on financial subsidies at all levels. Participants only pay 10 yuan per year. Therefore, the nature of the mutual aid economy is fully reflected in the compensation, and it is impossible to be absolutely even. Since it is a mutual aid economy, it means that participants who did not enjoy the compensation this year may enjoy it next year or next year. Among family members, the young and healthy may not enjoy it, while the elderly or children may have more opportunities to enjoy it.