Keywords: rural medical security cooperative medical care New rural cooperative medical care system security model
First, the emergence and development of rural cooperative medical system in China
Theoretically speaking, the cooperative medical system is a comprehensive medical measure that mainly relies on the strength of community residents, and according to the principle of "sharing risks, helping each other and helping each other economically", all funds are raised within the community to pay for medical, preventive and health care services of the insured and their families. China's rural cooperative medical system has its own development footprint, and it is also an inevitable choice under China's special national conditions. The World Health Organization once said in a report, "The formulation of primary health personnel was mainly inspired by China. The people of China have established a successful primary health care system in rural areas, accounting for 80% of the population, providing people with low-cost and appropriate medical and health technical services and meeting the basic health needs of most people. This model is very suitable for the needs of developing countries. "
The development of rural cooperative medical system in China is as follows:
1, the emergence of cooperative medical system
China's rural cooperative medical system can be traced back to the War of Resistance against Japanese Aggression period, when the medical and health undertakings were held in the form of "cooperatives", which was actually the bud of a rural medical security system. In the early days of the People's Republic of China, due to limited resources, we chose the principle of differential treatment between urban and rural areas, which means that most rural farmers are basically separated from the national social welfare system, and farmers who lack medical care and medicine take the form of spontaneous mutual assistance to solve medical problems. The cooperative medical system of mutual assistance appeared in the rural areas of China at the climax stage of 1955 rural cooperation. In some places, such as Shanxi and Henan, health stations organized by rural production cooperatives have appeared, and the method of combining members' "health care fees" with subsidies from production cooperatives' public welfare funds has been adopted, and the masses have raised funds for cooperative medical care and implemented mutual assistance. At the beginning of 1955, Mi Shan Township, Gaoping County, Shanxi Province established the first medical and health care station in China, which realized the farmers' desire of "preventing diseases early, making paper with diseases, saving labor and money, being convenient and reliable". [2]
2. Promotion and development of cooperative medical system.
After the Ministry of Health affirmed the practice of Mishan Town, its experience was popularized in some parts of the country. 1959165438+1October, the Ministry of Health affirmed the form of rural cooperative medical care at the national health work conference, which promoted its further rise and development. 1960 in February, the central government affirmed the cooperative medical care as a medical form, and forwarded the report of the field meeting of rural health work of the Ministry of Health, making this system a collective medical system. [3]1May 1960 18 "Health News" affirmed this method of financing medical system in the editorial "Actively Promoting the Basic Medical System", which played a certain role in promoting the development of rural cooperative medical system in China. At this time, the cooperative medical system organized by the National Agricultural Production Brigade has reached 40%. During the Cultural Revolution, the emerging rural cooperative medical system was vigorously promoted. According to the statistics of the World Bank (1996), the cost of cooperative medical care only accounted for about 20% of the national health expenditure, but it initially solved the medical problem of 80% of the rural population at that time. By 1976, about 90% administrative villages in rural areas of China have implemented the cooperative medical system.
3. The decline of cooperative medical system.
At the end of 1970s, due to the economic system reform with household contract responsibility system as the main content in rural areas, a two-tier management system combining unification and separation was established, the original social organization form based on "one university and two universities" disintegrated, and the rural cooperative medical system also declined greatly. Statistics from 65438 to 0989 show that only 5% administrative villages continue to adhere to the cooperative medical system. [4]
Second, the current situation of rural medical security in China after the decline of cooperative medical system
Let's take a look at various forms of medical security in rural areas of China:
1, social medical insurance
The ongoing reform of the medical insurance system in China is mainly aimed at employees of urban enterprises and staff of state administrative institutions, while farmers, who account for the majority of the population, are still excluded from the system arrangement. Therefore, it can be said that social medical insurance is basically a blank in the vast rural areas of China.
2. Commercial medical insurance
The lack of social medical insurance provides a certain space for the development of rural commercial medical insurance, which can be said to be a very important way to solve the problem of medical treatment for farmers. However, commercial medical insurance is profitable and voluntary. In order to ensure profits, commercial medical insurance companies often exclude the old, the weak, the sick and the disabled when choosing policyholders, and their medical insurance needs are the most urgent. In addition, because the government does not force farmers to participate in commercial medical insurance in the form of policies and regulations, and because the premium of commercial medical insurance is generally high, farmers will be very cautious when choosing, and he needs to consider whether he can afford medical insurance. Therefore, although commercial medical insurance has room for development in rural areas, this space is also very limited.
3. Social assistance-the scope of enjoyment is very limited.
At present, the "five guarantees" support system for the "three noes" who have no dependents, no sources of livelihood and no dependents (caregivers) in rural areas of China can solve the medical problems of this special group to a certain extent, but the coverage of this system is very limited.
4. Neighborhood assistance
Mutual support and help between neighbors has always been a fine tradition in rural areas of China, and the so-called "distant relatives are not as good as close neighbors" is the best interpretation of this behavior. This kind of neighborhood mutual assistance will also play a certain role in solving the medical security problem, but it can only happen in a small scope and at a relatively low level, and it seems a bit powerless for some serious diseases and serious illnesses. Therefore, neighborhood mutual assistance cannot fundamentally solve the problem.
In the 1990s, different modes of cooperative medical system were piloted in some places, including "welfare", "risk" and "welfare risk". Although the central government put forward that "by 2000, most rural areas should establish various forms of cooperative medical system", only 18% of administrative villages in China have implemented cooperative medical system, covering only 10% of the rural population, and 90% of farmers still need medical treatment at their own expense. From 65438 to 0998, after the institutional reform in the State Council, the Ministry of Labor and Social Security was responsible for rural medical and health matters, but the latter could not solve a series of policy problems such as related financial investment and farmers' burden reduction alone, resulting in a "vacuum zone" for rural medical security, and the medical problems of farmers were basically solved by family security.
Three, the implementation of the new rural cooperative medical system
1, new rural cooperative medical care policy and policy provisions
In the Notice of the General Office of the State Council on Forwarding the Opinions of the Ministry of Health and Other Departments on Establishing a New Rural Cooperative Medical System (2003), it was put forward: "The new rural cooperative medical system is a mutual medical supply system for farmers, which is organized, guided and supported by the government, with farmers participating voluntarily, financed by individuals, collectives and the government, and coordinated by serious illness. From 2003 onwards, all provinces, autonomous regions and municipalities directly under the Central Government should choose at least 2-3 counties (cities) to carry out pilot projects first, and gradually push them away after gaining experience. By 20 10, we will achieve the goal of establishing a new rural cooperative medical system that basically covers rural residents, reduce the economic burden of farmers who are poor due to illness, and improve their health. " [5] Subsequently, all localities took action to carry out the pilot of the new rural cooperative medical system and gained some experience.
2. The implementation of the new rural cooperative medical system-taking the pilot project in Shandong Province as an example.
The pilot of the new rural cooperative medical system in Shandong Province also began in 2003. In the Notice of the General Office of Shandong Provincial People's Government Forwarding the Opinions of Provincial Health Department and Other Departments on Establishing the New Rural Cooperative Medical System (Lu Zhengban Fa [2003]12), combined with the specific situation of Shandong Province, some guiding principles and opinions were put forward, which can be divided into three stages:
The first stage (March 2003 to February 2003) is a pilot stage. Seven counties (cities, districts) including Linyi, Wulian, Qufu, Qingzhou, Guangrao, Zhaoyuan and Laoshan were identified as the first batch of provincial pilot counties in the province. Cities according to the local actual situation, choose 0-2 townships to carry out municipal pilot, conditional cities can choose counties (cities, districts) to carry out pilot. Through the pilot, explore the management system, financing mechanism and operation mechanism of the new rural cooperative medical system. The conditions of the pilot unit are that local leaders attach importance to it, financial subsidies are in place, management institutions are sound, farmers' enthusiasm is high, and work foundation is good. Provincial pilot counties (cities, districts) shall be formulated by the people's governments at the county level who apply for the pilot, and submitted to the Provincial Health Department in conjunction with the Provincial Department of Finance and the Department of Agriculture for examination and approval. The municipal pilot implementation plan determined by each city shall be reported to the Provincial Health Department, the Department of Finance and the Department of Agriculture for the record. After the pilot, the provincial pilot counties (cities, districts) should write a summary of the pilot work, and the examination and approval department should organize the acceptance.
The second stage (from 1 in 2004 to 12 in 2005) is to expand the pilot stage. On the basis of consolidating the first batch of pilot projects, about 16 provincial pilot counties will be added each year (giving priority to the inclusion of the original municipal pilot counties in provincial pilot projects). Municipal pilot projects should also be expanded accordingly. By expanding the pilot, further exploring and summing up experience and improving the management system, the provincial government has formulated the management measures for the new rural cooperative medical system, and the municipal, county (city, district) governments have formulated the implementation measures and implementation plans respectively, laying a foundation for full implementation.
The third stage (2006 1 to 20 10) is the stage of full implementation. On the basis of earnestly summing up the pilot experience, it will be gradually popularized in the whole province, and by 20 10, a new rural cooperative medical system will be established, which will basically cover the rural residents in the whole province, and the degree of socialization and anti-risk ability will be continuously improved. [6]
Under the guidance of these principles, various cities in Shandong Province have carried out the pilot work of the new rural cooperative medical system:
(1) Laoshan Mountain in Qingdao, the eastern coastal area of Shandong Province.
Laoshan District is located in the east of Qingdao with a total area of 390 square kilometers. Jurisdiction over 4 streets, 139 communities. In 2003, the total population 199600, the agricultural population 14 10000, and the GDP151kloc-0/0000. Since June 5438+1 October12003, the cooperative medical system for major diseases in rural areas has been implemented, and it has been identified as the first batch of pilot units of the new rural cooperative medical system in Shandong Province. In 2004, on the basis of summing up the pilot experience, we carried out reform and innovation, introduced new measures, and established and improved a unique new rural cooperative medical system, which focused on overall planning of serious illness and gave consideration to preventive health care and serious illness relief. In 2003, there were 654,380+053,600 insured persons in the whole region, and the population coverage rate reached 92%. In 2004, the number of participants was 16 1380, and the population coverage rate reached 96.82%. 2 152 of the population of low-income households shall be paid by the district finance after being audited by the district civil affairs bureau. To raise funds for cooperative medical care, we should adhere to the principle of government subsidies and collective and individual fundraising. The per capita fund-raising amount increased from 30 yuan in 2003 to 50 yuan. In 2003, the cooperative medical system raised 4,665,438 yuan, and it should raise 8,069,000 yuan in 2004. All the remaining funds are carried over to the next year. The individual payment of the cooperative medical fund shall be collected by the community neighborhood committee on an annual basis, and the receipt issued by the district finance bureau shall be used uniformly; Community collective payment is extracted from its own funds, together with the funds paid by individuals and the registration form approved by the street cooperative medical office, and submitted to the street finance office before 65438+February 3 1 every year. After the street finance office raises funds, it will be submitted to the financial account of the district cooperative medical care together with the street subsidy funds. District financial subsidies, in the streets, villages, collectives and individuals to raise funds in place, according to the actual number of participants, the grant funds will be allocated to the district cooperative medical financial accounts. This fund is mainly used for compensation of medical expenses for serious illness. In 2003, 80% was used for medical expenses compensation, 15% was used for serious illness relief, and 5% was used for risk money. In 2004, 75% was used for medical expenses compensation, 65,438+00% for serious illness relief, 65,438+00% for preventive health care and 5% for risk fund. In 2003, the deductible line of hospitalization medical expenses compensation within the overall planning scope was: 800 yuan, a first-class hospital, 65,438 yuan for a second-class hospital and 2,000 yuan for a third-class hospital; In 2004, the deductible line of hospitals at all levels was lower than that in 2003 by 500 yuan, and the number of family beds was reduced from 1.500 yuan to 300 yuan. The compensation ratio and capping line of medical expenses were improved, and the compensation ratio was increased by 5- 10%. In 2003, 1868 people were compensated for medical expenses, with an expenditure of 2.8 million yuan, accounting for 76% of the budgeted expenditure of 3.68 million yuan. In 2004, it is estimated that 320 people will be compensated for serious illness, and the medical expenses will be 5.6 million yuan, accounting for 93% of the budgeted expenditure of 6.05 million yuan. The benefit rate is expected to reach 23% per capita, an increase of 2 1.9% over last year, and the family benefit rate will reach 50.8%, an increase of 47.3% over last year. [7]
(2) the central and western regions of Shandong Province