Charge standard of new rural cooperative medical care in Kaixian county

First, what is the new rural cooperative medical system?

The new rural cooperative medical system is a medical assistance system for farmers, which is organized, guided and supported by the government, voluntarily participated by farmers, and financed by individuals, collectives and the government. It is an important part of the social security system.

Second, why should the rural cooperative medical system be established?

In most places, the medical expenses in rural areas are completely paid by individuals, and the burden on farmers is heavy. 20-30% of farmers are poor due to illness.

Many cases show that diseases are an important cause of farmers' poverty, and poverty makes diseases difficult to treat. So the most worrying problem for farmers is getting sick. Due to the low level of economic development in most rural areas, it is impossible to provide medical care for farmers.

The government or collective economy is unable to cover the medical security of farmers, and the current medical security problem of farmers can only be solved by implementing the new rural cooperative medical system.

Absolutely.

3. What are the benefits of farmers participating in rural cooperative medical care?

There is an old saying in China, "There are unexpected events in the sky, and people are doomed.". It is inevitable that people will not get sick. If a family is not sick, others may get sick. If you don't get sick this year, you may get sick next year. If one person in a family is seriously ill, it may drag down the whole family and affect production and life. Farmers' participation in cooperative medical care is first of all a personal benefit. According to the minimum standard, one person pays a fee for one year 10 yuan. If he is sick, the maximum compensation can reach 1 10,000 yuan, which is ten times that of an individual. If there are still great difficulties and the fund has a balance at the end of the year, you can also apply for "medical assistance for serious illness" to make compensation again according to the policy. Secondly, the new rural cooperative medical system is supported by the government, and all levels of finance provide 40 yuan for each person every year, which is four times that of individual contributions. Except for outpatient service, the rest are used for hospitalization compensation for serious illness, with the highest compensation 15 yuan. If farmers do not participate, they will not enjoy the compensation policy of the new rural cooperative medical system. Thirdly, even if you don't get sick for a while, it is equivalent to helping the villagers; If you do a good deed, you will have a chance to get insurance compensation if you get seriously ill in the future.

Four, how to participate in the new rural cooperative medical care?

Participants are rural residents in Kaixian County. Farmers participating in the cooperative medical system must first pay personal funds at the toll points designated by the local township government and sub-district offices, and the fee is 10 yuan per person per year. To join the cooperative medical system, the whole family must take the household as the unit, and each household has a "medical certificate" for continuous use and safekeeping. If lost, it shall promptly report to the county, township street joint management office. Farmers who joined the new rural cooperative medical system in 2008 must pay their personal funds 1 1 before the end of June 2007.

Five, why rural cooperative medical care financing does not belong to increase the burden on farmers?

A: Cooperative medical care is the medical guarantee for farmers to help each other. Every farmer voluntarily pays the cooperative medical care fee 10 yuan, which is a payment obligation to resist the risk of disease. It is the individual consumption expenditure of farmers, not the project undertaken by farmers. These funds are fully used for farmers' medical security, and the government and the collective will give more financial help, greatly reducing the hospitalization burden of farmers.

Six, our county cooperative medical reimbursement standard is how to provide?

(1) The outpatient account is per person 15 yuan, which can be used by the whole family. The outpatient expenses will be compensated according to the proportion of 40% of the total amount until the whole family runs out. After family account is used up, sick inpatients can still enjoy hospitalization compensation policy. (two) sick in hospital, in the township (center) hospitals deductible line for 50 yuan, the reimbursement rate is 45%; In the county hospital, the deductible line is 300 yuan, and the reimbursement rate is 30%; For hospitals above the county level, the deductible line is 1000 yuan, and the reimbursement rate is 20%. The maximum annual reimbursement for individuals is 6,543,800 yuan. (three) where family planning hospital delivery without other complications, in addition to the "reduction" project subsidies 200 yuan, the new rural cooperative medical compensation 100 yuan. Complications such as hospital delivery, according to the hospitalization, the new rural cooperative medical system compensation amount minus the "relief" project subsidy amount, and then the difference compensation. Hospital caesarean section, according to the hospitalization, the new rural cooperative medical system compensation amount minus the "minus" project subsidy amount, and then the difference compensation.

7. What documents and requirements do you need to bring to participate in farmer outpatient service, hospitalization and referral?

(a) participating farmers need to carry a "diagnosis" for outpatient treatment;

(two) the participating farmers need to bring the "diagnosis", identity card or the original residence booklet;

(three) trauma patients need to carry a "diagnosis", the original identity card or residence booklet, trauma certificate;

(four) referral to a higher hospital for treatment, the need to provide proof of transfer from the hospital.

Eight, how do the participating farmers report their accounts? Required procedures?

(a) the outpatient medical expenses incurred by the participating farmers in the designated medical units shall be reduced and signed by the designated medical units on the spot.

(two) the medical expenses incurred by the participating farmers in the designated medical units shall be reviewed in the hospital where they live when they leave the hospital, and shall be reduced or exempted on the spot and registered and signed. Trauma hospitalization must have the village Committee, witness certificate and township street joint management office audit opinion.

Nine, how to pay for the referral and migrant work of farmers outside the county? Required procedures?

(a) referral to the designated hospitals outside the county, patients pay their own expenses first, after discharge 1 month to the township street joint management office for preliminary examination, county joint management office for final examination, and settlement in the local health center.

(ii) Migrant workers are hospitalized in the public hospitals where they work. When leaving the hospital, the patient will advance the medical expenses himself. Before March of the following year, all materials shall be reported to the joint management office where the household registration is located for review. After the final review by the county joint management office, it settled in the township street health center where the household registration is located. Migrant workers who are hospitalized must report to the joint management office where the household registration is located within 3 days after hospitalization, and will not be reimbursed beyond the specified time.

(3) When applying for compensation, the patients referred to the hospital must hold valid computer invoices, daily bills, hospital diagnosis certificates, transfer certificates, discharge certificates, cooperative medical certificates, household registration books (ID cards) and other supporting materials.

(4) Migrant workers who are ill and hospitalized outside the county should also have: valid computer invoice, daily list, hospital diagnosis certificate, discharge certificate, cooperative medical care certificate, household registration book (ID card), work unit certificate, and approval certificate of township street management office. If the parties entrust compensation, there shall be a power of attorney from the parties; The customer must hold the original ID card.

10. What are the designated medical institutions that are hospitalized outside the county?

There are 9 designated hospitals outside the county determined by our county, namely: Southwest Hospital, xinqiao hospital, Daping Hospital, First Affiliated Hospital of Heavy Medicine, Second Affiliated Hospital of Heavy Medicine, Children Affiliated Hospital of Heavy Medicine, Chongqing Cancer Hospital, Chongqing Mental Health Center and Wanzhou Three Gorges Central Hospital. In addition to the above nine hospitals, the new rural cooperative medical fund will not compensate the referral from hospitals in the county to other hospitals inside and outside the county.

XI。 Types of chronic diseases and how to identify them.

The types of chronic diseases in our county are: coronary heart disease, chronic bronchitis (cor pulmonale), hypertension, diabetes, chronic rheumatic heart disease, recovery period of cerebrovascular accident, advanced treatment of malignant tumor and severe schizophrenia.

Farmers who need to identify chronic diseases should carefully read the Criteria for Identification of Chronic Diseases (which will be distributed to village committees and village clinics and posted), and fill in the application form for identification of chronic diseases with the original and photocopy of the Joint Medical Certificate, the original and photocopy of the ID card (or household registration book) and the recent one-inch bareheaded photos (3 photos) at the designated hospitals. The county sent an expert group to focus on the time and place for inspection and appraisal, and it will not be processed after the expiration.

12. Why do you charge registration fees and medical fees?

According to the spirit of the Notice of Chongqing Municipal Price Bureau and Chongqing Municipal Health Bureau on Printing and Distributing the Price of Medical Services in Chongqing (for Trial Implementation), the village clinic charges 1.5 yuan, which is a normal charge, conforms to the policy and reflects the service value of doctors.

Thirteen, which do not belong to the compensation scope of the new rural cooperative medical system?

one

, no scope of compensation

(1) service items:

(1) Registration fee, expert registration fee, home visit fee, consultation fee inside and outside the hospital, pre-hospital on-board treatment surcharge and ambulance fee.

(2) special medical service fees such as examination and treatment expedited fee (start-up fee), roll call operation fee, high quality and good price fee, and self-invited intensive care.

(3) Medical record fees, various medical record files fees and account fees.

(2) Non-disease treatment items:

(1) Various expenses of beauty, bodybuilding and non-functional plastic surgery, such as health massage, ear piercing, breast augmentation, tooth cleaning, porcelain, treatment of white hair, hair transplantation and hirsutism, and all expenses of using orthopedic and bodybuilding equipment.

(two) examination, treatment, surgery, medicine and other expenses. Used to lose weight, gain weight, increase height and correct physical defects (except organic diseases). For example, to treat bromhidrosis, cut off many fingers (toes) and open double eyelids.

(3) All kinds of health examination expenses.

(4) All kinds of preventive health care and diagnosis projects.

(5) Computer health consultation, clinical microcomputer consultation, computer consultation on prenatal and postnatal care, computer diagnosis of TCM experts and other medical consultations.

(6) Medical appraisal fees, judicial appraisal fees, work-related injuries, disabled labor and other medical appraisal fees.

(3) Treatment equipment and medical materials:

(1) positron emission tomography (PET), nuclear magnetic resonance (NMR), electron beam (examination and treatment items carried out by large medical equipment such as CT and ophthalmic excimer laser therapeutic apparatus), stereotactic radiotherapy device (γ knife,

χ-knife).

(2) Various corrective and health care appliances, such as glasses, artificial eyes, occlusal pads, dentures, artificial limbs, hearing AIDS, brain-strengthening devices, leather (steel) vests, lumbar rotation, steel head and neck, stomach pads, kidney pads, uterine pads, crutches, artificial limbs, wheelchairs, medicated pillows, medicated pads and other rehabilitation appliances.

(3) all kinds of self-use health care, massage, examination and treatment equipment.

(4) medical devices, equipment and medical materials that have not been approved by the relevant national or municipal medical devices, equipment and medical materials management departments are used for diagnosis and treatment projects.

(5) The municipal price department and the health department stipulate that disposable medical materials cannot be charged separately.

(6) Inspection and treatment projects of large medical equipment such as X-ray computed tomography (CT), cardiac and angiographic X-ray machines (including digital subtraction equipment), magnetic resonance imaging equipment (MRI), single photon emission computerized scanning equipment (SPECT), color Doppler instruments, medical linear accelerators, etc.

(7) Artificial organs, such as pacemakers, artificial joints, intraocular lenses and vascular stents. , placing materials inside.

(4) Treatment items:

(1) Organ source or tissue source of various organ or tissue transplants.

(2) Transplantation of kidneys, heart valves, corneas, skin, blood vessels, bones, bone marrow and other organs or tissues.

(3) Various auxiliary therapies, such as Qigong, music, suggestion, hypnosis, magnetic therapy and psychotherapy.

(4) Various treatments for infertility and sexual dysfunction.

(5) All expenses for teaching, scientific research and clinical verification.

(6) Hemodialysis and peritoneal dialysis.

(7) Cardiac bypass surgery, balloon dilatation of cardiac catheter, radiofrequency ablation of heart and laser drilling of heart.

(8) Anti-tumor cellular immunotherapy and fast neutron therapy projects.

(9) all kinds of microwave, spectrum, far infrared therapy and other auxiliary treatment projects.

(10) Sexually transmitted diseases (except those who do not enjoy free AIDS treatment)

(1 1) Tuberculosis (except free drugs that are not tuberculosis)

(12) blood transfusion and blood products.

(13) Other diagnosis and treatment items not included in the price policy management.

(five) the cost of living services and service facilities shall not be compensated.

(1) Transportation fee, TV fee, telephone fee, toilet paper fee, food incubator fee, electric stove fee, bottle pledge fee, refrigerator and public property damage compensation, self-provided electrical appliances electricity fee, daily necessities and personal living expenses of hospitalized participants.

(2) Hospitality and special life service fees.

(three) the cost of medical service facilities or self-determined fees raised by medical institutions themselves.

(4) Overstandard bed fee. Due to the lack of beds or other reasons, designated medical institutions must arrange the participants in the over-standard ward, and should obtain the consent of the participants or their families in advance.

(6) Others

(1) Expenses incurred due to fighting, alcoholism, self-mutilation, suicide, illegal crime, drug rehabilitation, traffic accidents, medical expenses increased due to medical accidents, and other medical treatment items caused by accidents.

(2) Overseas medical expenses incurred in going abroad for business or personal reasons and going to Hong Kong, Macao and Taiwan.

(3) the use of non-essential drugs and non-prescription drugs directory costs.

(4) Other items stipulated in the Implementation Measures of Kaixian New Rural Cooperative Medical System (Trial).

(seven) medical expenses incurred by the following medical acts

(1) All expenses for family bed occupancy.

(2) Medical expenses caused by premarital and extramarital sex.

(3) Family planning operation and medical expenses for work-related injuries.

(4) medical expenses borne by others (such as traffic accidents, medical accidents, sequelae, etc.).

(5) Medical expenses incurred during imprisonment.

(6) Medical expenses incurred by participants before training.

(7) The participants were hospitalized outside the county, without a list of hospitalization expenses, and did not go through the procedures of referral.

(8) medical expenses incurred in the treatment of large-scale dangerous and serious diseases caused by irresistible factors such as sudden epidemic diseases and natural disasters.

(9) The participants are hospitalized for visiting relatives, friends or working outside the home (except for emergency rescue) and fail to report to the township street joint management office where the household registration is located within 48 hours from the date of admission.

(10) The dog was injured by food poisoning outside the family banquet.

Fourteen, how to limit the price of new rural cooperative medical drugs in our county?

In order to effectively reduce the price of drugs and reduce the burden of medical expenses for participating farmers, we have implemented the policy of the same price of drugs in counties, townships and villages throughout the county, and implemented the maximum price system for 300 commonly used drugs, which has decreased by 15%-20% on average on the basis of the price limit of basic medical insurance for urban employees. The retail price of 300 kinds of traditional Chinese medicines rose by 25% according to the actual purchase price. At the same time, it is stipulated that those above the maximum price limit must be implemented according to the maximum price limit, and those below the maximum price limit may not increase the price.

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