China’s rural medical insurance policies and regulations

The Ministry of Human Resources and Social Security has proposed to accelerate the integration of urban and rural basic medical insurance, and at the same time strive to achieve the introduction of integration plans by all provinces (autonomous regions and municipalities) by the end of the year. In 2017, we will begin to establish a unified urban and rural basic medical insurance system. Resident medical insurance system.

The notice requires that the medical insurance payment mechanism be improved, the interest control mechanism be improved, and the people be guided to seek medical treatment in an orderly manner, so that hospitals have the incentive to rationally use drugs, control costs, and rationally admit and transfer patients, and stimulate medical institutions to standardize their behavior and Endogenous motivation to control costs.

At the same time, improve the medical insurance financing and benefit adjustment mechanism, gradually establish a stable and sustainable financing mechanism for basic medical insurance that is consistent with the level of economic and social development and the affordability of all parties, and improve the basic medical insurance benefits that are consistent with the level of financing. Adjustment mechanism. It is necessary to improve the critical illness insurance system for urban and rural residents.

In terms of accelerating the national network of basic medical insurance and direct settlement of medical treatment in other places, the notice requires that starting from next year, direct settlement of hospitalization expenses for retirees resettled in different places across provinces will be basically realized. Medical and hospitalization expenses are settled directly.

In addition, the notice also puts forward requirements such as improving the medical insurance handling mechanism, accelerating the establishment of a personnel compensation system that conforms to the characteristics of the medical industry, and mobilizing the enthusiasm and creativity of medical personnel.

17 provinces have achieved unified management of universal medical insurance and human resources and social security

Since the issuance of the "Opinions of the State Council on Integrating the Basic Medical Insurance System for Urban and Rural Residents", Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing Eight provinces (autonomous regions and municipalities) including Hunan, Hunan, and Guangxi have officially issued documents to make plans and arrangements for the integration of urban and rural residents’ medical insurance systems in their provinces, and have completed the first half of the State Council’s task requirements for the integration system as scheduled.

The above eight provinces have made plans and arrangements for the comprehensive advancement of the integration of systems based on the overall consideration of the "three-in-one" of straightening out the system, integrating the system, and improving efficiency. First, it is clearly proposed to merge the new rural cooperative medical management functions undertaken by the health and family planning department and the urban residents’ medical insurance management functions managed by the human resources and social security department, and unify them under the management of the human resources and social security department. Second, in accordance with the requirements of the "Six Unifications" in the State Council document, requirements are put forward to comprehensively establish a unified basic medical insurance system for urban and rural residents by integrating the two systems of urban residents' medical insurance and new rural cooperative medical care. The third is to clarify the division of labor for the integration work as well as the promotion timetable and roadmap, and also put forward specific requirements to ensure the smooth and orderly advancement of the integration work.

As of now, among the 32 provinces, autonomous regions and municipalities (including the XPCC) in the country, 8 provinces including Hebei, Hubei, Inner Mongolia, Jiangxi, Xinjiang, Beijing, Hunan and Guangxi have introduced integration plans, and Tianjin, Shanghai, Zhejiang, The nine provinces of Shandong, Guangdong, Chongqing, Ningxia, Qinghai, and XPCC have fully realized system integration before the issuance of the State Council document. The above 17 provinces have broken through the institutional barriers of urban and rural separation of medical insurance and made it clear that after integration, they will form a unified basic medical insurance for urban and rural residents. The system is placed under the management of the human resources and social security department, realizing the unified management of the universal basic medical insurance system and even the entire social insurance system. This fully demonstrates that the local party committee and government have a high degree of awareness of the unified medical insurance management system and the social security system with Chinese characteristics. Deep understanding.

From the perspective of local practice, system integration has achieved remarkable results: First, the masses have generally benefited and have an enhanced sense of gain from the reform. In practice, various localities have adopted the idea of ??"paying as low as possible rather than high, remuneration being as high as possible rather than low, and the catalog being broad rather than narrow". The fairness of the resident medical insurance system has been significantly enhanced, especially the level of utilization and security of medical services for rural residents. All have generally improved. The second is to improve public service efficiency and reduce administrative costs. Relying on the social insurance public service system, it has realized integrated management services such as insurance registration, fund collection, rights recording, and benefit payment, avoiding duplication of investment and multi-party construction, and reducing duplication of insurance participation and duplication of subsidies. Integration in Shandong Province alone eliminated 2.5 million people who were duly insured, saving more than 800 million yuan in duplicative financial subsidies that year. The third is to enhance the mutual aid and financial capacity of the medical insurance fund, which is conducive to giving full play to the basic role of medical insurance in medical reform. All localities pay attention to the laws of the social medical insurance system and promote the external incentives and constraints of medical insurance on medical services, providing a solid foundation for the reform of the three medical linkages.

China’s current basic medical insurance system

(1) Basic medical insurance for urban employees. It is a social medical insurance system that guarantees the basic medical needs of employees based on the affordability of finance, enterprises and individuals. It implements local management. Basic medical insurance premiums are jointly borne by both the employer and the employee. Basic medical insurance is subject to social coordination and individual accounts combined.

(2) Basic medical insurance for urban residents. It is a medical insurance system that mainly covers urban minors and unemployed urban residents who have not participated in the urban employee medical insurance; the basic medical insurance for urban residents is mainly based on family contributions, and the government provides appropriate subsidies;

(3) New rural cooperative medical care. It is a farmers' medical mutual aid financial system organized, guided and supported by the government, farmers voluntarily participate, individuals, collectives and the government raise funds from multiple sources, and focus on overall planning of serious diseases.

The State Council interprets the integration of basic medical insurance for urban and rural residents

1. Why is it necessary to integrate the basic medical insurance system for urban residents and the new rural cooperative medical system?

In 2003 and 2007 In 2009, my country established the New Rural Cooperative Medical Care System (hereinafter referred to as the New Rural Cooperative Medical System) and the Urban Resident Basic Medical Insurance (hereinafter referred to as the Urban Resident Medical Insurance) system for the rural population and the urban non-employed population. Since the establishment of the system, the coverage has been continuously expanded, the security level has been steadily improved, and the system has continued to operate smoothly. It has played an important role in improving the universal basic medical insurance system, meeting the people's basic medical security needs, and improving the people's health level.

In recent years, with the rapid economic and social development, the negative effects of the urban-rural division of the two systems have begun to appear, and there are problems such as duplication of insurance participation, duplication of investment, and insufficient benefits. On the basis of summarizing the operation of urban residents’ medical insurance and new rural cooperative medical insurance and the local exploration and practical experience, the Party Central Committee and the State Council clearly proposed to integrate the two systems of urban residents’ medical insurance and new rural cooperative medical care and establish a unified basic medical insurance for urban and rural residents (hereinafter referred to as urban and rural residents). Resident medical insurance) system.

2. What is the current progress of local efforts to explore the integration of urban and rural residents’ medical insurance systems? What is the implementation effect?

At present, some provinces, cities, and counties have achieved the integration of urban and rural residents’ medical insurance systems. All localities generally straighten out the administrative management system according to the path of "centralization first, integration later", unify policies according to the principle of "financing should be low rather than high, remuneration should be high rather than low, and the catalog should be wide rather than narrow", and adopt "one system". A unified basic medical insurance system for urban and rural residents has been established. Integrate handling and management resources and implement integrated handling services. Improve the level of information management by improving the medical insurance information management system. Properly handle special issues, ensure system integration and achieve smooth transition.

Overall, local exploration provides useful reference for integrating the medical insurance system for urban and rural residents nationwide. The integration in some regions has achieved preliminary results, expanding the fund's ability to resist risks and avoiding duplication of insurance, duplication of subsidies, and duplication of construction to a certain extent. However, due to the lack of top-level design and systematic promotion, the coordinated development of the medical insurance system and the medical service system needs to be further strengthened, and the financing fairness of the medical insurance system needs to be further improved.

3. At present, what is the significance of the central government’s decision to comprehensively promote the integration of urban and rural residents’ medical insurance systems?

Integrate the two systems of urban residents’ medical insurance and new rural cooperative medical care to establish a unified system for urban and rural residents. The medical insurance system is a major measure to promote the reform of the medical and health system, realize equal enjoyment of basic medical insurance rights for urban and rural residents, promote social equity and justice, and enhance people's well-being. It is of great significance to the coordinated development of urban and rural economic and social development and the building of a moderately prosperous society in an all-round way. The establishment of a medical insurance system for urban and rural residents will help promote more equitable security, more standardized management and services, more effective use of medical resources, and promote the sustainable and healthy development of the universal medical insurance system.

Four. What is the overall idea for comprehensively promoting the integration of urban and rural residents’ medical insurance systems? How to grasp the basic principles?

The overall idea is to start with policies, start with the easy and then the difficult, step by step, and "unify system, integrate policies, balance levels, improve mechanisms, and improve services.”

Emphasize the integration of system policies and implement "six unifications"; highlight the rationalization of the management system, integrate handling agencies, and provide integrated urban and rural handling services; highlight the improvement of service efficiency, achieve gradual transition and smooth integration, and establish a unified urban and rural residents' basic medical insurance system.

Basic principles: First, overall planning and coordinated development. Integrate the medical insurance system for urban and rural residents into the development of the universal medical insurance system and deepen the overall medical reform, highlight the linkage of "medical insurance, medical care, and medicine" and strengthen system connection. The second is to base on the basics and ensure fairness. Based on the level of economic and social development, the burden of urban and rural residents and the affordability of funds, fully consider and gradually narrow the gap between urban and rural areas and regional differences, and ensure that urban and rural residents enjoy basic medical insurance benefits fairly. The third is to adapt measures to local conditions and advance in an orderly manner. Strengthen the connection before and after integration to ensure smooth continuation of work and orderly transition, ensure that the basic medical insurance benefits for the masses are not affected, and ensure the safety of the fund and the smooth operation of the system. The fourth is to innovate mechanisms and improve efficiency. Adhere to the separation of management and operation, improve the management and operation mechanism, and further promote the reform of payment methods. Give full play to the role of market mechanisms and mobilize social forces to participate in basic medical insurance handling services.

5. How to implement the "six unifications" in the process of integrating the urban and rural residents' medical insurance system?

Integrate the urban and rural residents' medical insurance system from the perspective of policy, focusing on integrating its financing and benefit protection policies . On the basis of studying and comparing the differences between the two original systems and summarizing the practical experience of various places, the policy integration requirements of "six unifications" were put forward.

First, we must unify coverage. Urban and rural residents' medical insurance covers other urban and rural residents except the urban employed population. Migrant workers and people with flexible employment who have difficulty participating in employee medical insurance are allowed to choose to participate in urban and rural residents' medical insurance.

Second, we must unify financing policies. Adhere to multi-channel financing, reasonably determine unified financing standards for urban and rural areas, improve the dynamic adjustment mechanism of financing, and improve the financing sharing structure. In areas where there is a large gap between the individual payment standards of urban residents' medical insurance and the new rural cooperative medical insurance, differential payment methods can be adopted to gradually transition. Gradually establish a mechanism to connect individual payment standards with the per capita disposable income of urban and rural residents.

Third, we must unify protection benefits. Gradually unify the coverage and payment standards, keep the hospitalization fee payment ratio within the scope of the policy at around 75%, and gradually increase the level of outpatient coverage. Properly handle the connection between special security policies before and after integration, and gradually narrow the gap between the payment ratio within the scope of the policy and the actual payment ratio.

Fourth, we must unify the medical insurance catalogue. In accordance with relevant national regulations, each province follows the principles of clinical necessity, safety and effectiveness, reasonable price, appropriate technology, and affordable funds. Based on the existing urban resident medical insurance and new rural cooperative medical care catalogues, due consideration is given to changes in the needs of insured persons, and a unified Catalog of medical insurance drugs and medical services.

Fifth, we must unify fixed-point management. Unify the management methods of designated institutions, strengthen the management of designated service agreements, improve the evaluation mechanism, and implement dynamic access and exit. Adopt an equal treatment policy for private hospitals.

Sixth, we must unify fund management. Implement a unified fund financial system, accounting system and fund budget and final accounts management system, strengthen internal control management and external supervision systems, promote total payment control, improve fund operation risk early warning mechanisms, reasonably control fund balances, prevent fund risks, and improve usage efficiency

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