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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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