发布日期:2012-10-10 00:00:00浏览次数:12177来源:国家卫生部作者:云南省人口和卫生健康宣传教育中心
中国的新型农村合作医疗制度发展
国务院新闻办公室新闻发布会材料二
2012年是新农合制度实施十周年。十年来,在各级党委、政府的高度重视和正确领导下,有关部门通力合作,农民群众积极参与,新农合制度建设扎实推进,取得了显著成效。
一是实现全面覆盖,参合率稳定在较高水平。新农合制度自2003年开始试点,到2008年实现了全面覆盖,参合人口数从试点初期的0.8亿,逐年稳步增长,截至2012年6月底,参合人口达到8.12亿人,参合率达到95%以上。
二是筹资水平不断提高,保障能力逐步增强。新农合人均筹资水平由2003年的30元提高到2011年的250元。2011年,有13.15亿人次从新农合受益,次均住院补偿额为1894元。2012年,新农合政策范围内住院费用报销比例进一步提高到75%左右,最高支付限额提高到全国农民人均纯收入的8倍以上,且不低于6万。
三是确立了较为完善的符合中国国情的制度框架和运行机制。新农合建立了由政府领导,卫生部门主管,相关部门配合,经办机构运作,医疗机构服务,农民群众参与、费用补偿公开的管理运行机制;明确了以家庭为单位自愿参加,个人缴费、集体扶持和政府资助相结合的筹资机制;形成了以住院大额费用补偿为主,并逐步向门诊统筹扩展的统筹补偿模式,2011年在90%以上的地区开展了门诊统筹,参合农民受益范围更加广泛;建立了参合农民在统筹区域内自主就医、即时结报的补偿办法,2011年,已有超过2/3的省(区、市)实现新农合省市级定点医疗机构即时结报;建立了基金封闭运行机制和多方参与的监管机制;深入推进支付方式改革,2011年已有超过80%的地区开展了不同形式的支付方式改革,新农合制度合理有效控制医药费用的作用开始显现;积极推进商业保险机构参与经办新农合服务工作,探索“管办分开、政事分开”的新农合管理运行机制。
今后一个阶段,结合中央深化医改的总体部署,我们将重点推进以下几方面的工作:
一是稳步提高新农合筹资标准,2012年新农合人均筹资水平将达到300元左右,到2015年,新农合政府补助标准将提高到每人每年360元以上,个人缴费标准适当提高,并逐步探索建立与经济发展水平相适应的筹资机制。
二是加强新农合精细化管理,严格基金使用管理,加强对定点医疗机构的监管;全面推行新农合省市级定点医疗机构和村卫生室的即时结报工作,逐步推行省外异地结报;加快新农合信息化建设,结合居民健康卡的发放,快速推进“一卡通”试点工作;加强新农合与医疗救助等相关信息系统的互联互通,推行“一站式”即时结算服务。
三是推进提高重大疾病医疗保障水平试点工作,将儿童白血病、肺癌等20种疾病纳入保障范围。贯彻落实六部委《关于开展城乡居民大病保险工作的指导意见》,做好大病保险与新农合大病保障工作的衔接,优先将这20种重大疾病纳入大病保险范围。
四是加快推进新农合支付方式改革,用总额预付、按病种、按单元、按人头等支付方式替代按项目付费,控制费用,规范医疗服务行为,提高基金绩效。
五是加快推进委托有资质的商业保险机构参与新农合经办服务工作,扩大商业保险机构经办新农合的规模,建立新农合管理、经办、监管相对分离的管理运行机制。
六是认真总结新农合制度实施10年来的经验,推动《新农合管理条例》及早出台,尽快将新农合纳入法制化管理轨道。
Material for the press conference of the State Council Information Office II
The Development of
2012 marks the tenth anniversary of the implementation of the New Rural Cooperative Medical Scheme (NRCMS). Over the past decade, with Party Committees and governments at all levels attaching great importance to NRCMS and under their strong leadership, relevant departments have given full cooperation and farmers have actively participated in the scheme. Therefore, NRCMS has made solid progress and remarkable achievements.
First, NRCMS has almost realized universal coverage with the participation remaining stable at a high level. Since the pilot programs in 2003, NRCMS achieved a comprehensive coverage in 2008. The participation number has grown steadily every year, from 80 million in the early stage of the pilot programs to 812 million by the end of June 2012, with over 95% of the targeted population covered.
Second, the financing continues to grow and the protection level improves gradually. The per capita cost of the insurance package increased from 30 yuan in 2003 to 250 yuan in 2011. In 2011, 1.315 billion person-times benefited from NRCMS with average hospitalization compensation amounting to 1,894 yuan. In 2012, the reimbursement for hospitalization costs will reach around 75%, with an annual payment ceiling of no less than 8 times of farmer’s per capita net income (no less than 60,000 yuan).
Third, a comprehensive institutional framework and operational mechanism is established in line with China's national conditions, i.e. led by the government; in the charge of health departments; supported by relevant sectors; operated by the insurance agencies; with services provided by the health institutions; participated by farmers and transparent reimbursement of the medial costs. NRCMS is co-financed by individual contributions, farmers’ cooperatives and both central and local governments, with families participating on a voluntary basis. The coordinated compensation focuses on reimbursement for hospitalization costs and gradually expands to out-patient care. In 2011, over 90% of areas carried out out-patient compensation which benefited the farmers in a wider range. The insured farmers can choose independently the designated hospitals for treatment and get real-time reimbursement. In 2011, over 2/3 of provinces (autonomous regions or municipalities) adopted real-time reimbursement in their designated provincial and municipal hospitals. The funds are operated in closed-end mechanism and supervised by multi-sectors. In 2011, over 80% of areas carried out various payment reforms, which supported NRCMS to effectively control the medical costs. Commercial insurance agencies are encouraged to involve in the operation of NRCMS, which explores the operational mechanism of “separating supervision from operation, and separating government administration from medical institutions”.
In the next stage, integrating with the overall arrangements for deepening the reform by the central government, we will press ahead in the following aspects:
First, the financing for NRCMS should grow in a steady pace. The fund pooled per capita will reach 300 yuan by 2012. By 2015, government subsidies will reach 360 yuan per person per year. The individual contribution will grow as appropriate. A financing mechanism that suits the economic development in
Second, the NRCMS should be meticulously managed, including strict utilization of the funds and enhancing supervision on designated hospitals. Real-time reimbursement should be established in designated provincial and municipal hospitals as well as village clinics across the country. Reimbursement for medical costs outside of one’s registered province should be gradually realized. The information engineering of NRCMS should be accelerated, in combination with distributing the health cards for the residents, in order to press ahead the all-in-one-card pilot program. The information systems of NRCMS and related schemes such as the medical assistance scheme should be better synchronized, to provide one-stop real-time compensation service.
Third, the pilot program of compensation for major diseases should be promoted, including 20 diseases such as child leukemia, lung cancer etc. The Guiding Opinions on the Supplementary Insurance of Major Diseases for Urban and Rural Residents collectively issued by six ministries should be implemented. Supplementary Insurance should be well connected with NRCMS policy on the benefits for major diseases and should cover the mentioned 20 major diseases as preference.
Fourth, NRCMS payment reforms should be accelerated, in terms of using pre-payment of total medical cost, disease-based payment, service unit-based payment and capitation to replace fee-for-service. The reforms aim to control medical costs, modify health service behaviors and enhance fund performance.
Fifth, the engagement of entrusted qualified commercial insurance agencies in the operation of NRCMS should be accelerated; so as to establish an operational mechanism that to some degree separates the management, operation and supervision of NRCMS.
Sixth, the experience of the last decade should be diligently studied to facilitate the formulation of the Regulations on Administration of New Rural Cooperative Medical Scheme. The administration of NRCMS should be legislated as soon as possible.
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