The articles of association of the pilot units of the new rural cooperative medical system generally stipulate that farmers must pay cooperative medical insurance premiums on a household basis. However, there are many specific problems in the actual operation process: for example, in a peasant family, all family members are not necessarily farmers, but there are primary and secondary school students; There are migrant workers; There are employees of township enterprises; There are also staff of government agencies and institutions, and so on. At present, students in school generally require to participate in Ping An medical insurance (generally commercial insurance undertaken by insurance companies); Due to the enhancement of insurance awareness, most migrant workers participated in commercial insurance; The staff of township enterprises, government agencies and institutions generally participated in the medical insurance for urban workers organized by the Social Security Bureau; The local civil affairs department also handled medical insurance for farmers' subsistence allowances and special care recipients; All kinds of insurance are varied and intertwined. If we don't pay attention to the situation and blindly emphasize the household, the financing resistance is relatively large, and farmers think that the local government does not respect the principle of voluntariness. Of course, those old, weak, sick and disabled people who have already taken part in some kind of medical insurance are willing to take part in the rural cooperative medical insurance again, because they can get double insurance and enjoy the welfare treatment of paying more when they are sick with less compensation. If households are not the unit, it is easy to form "adverse selection", that is, when raising funds, strong young people do not participate, and farmers who are old, weak and sick all the year round take the initiative to participate, which will lead to insufficient financing, high cost and poor mutual assistance.
Practice has proved that there are various disadvantages in one person's multiple insurance claims. First of all, because the hospital can only issue bills and related medical records once after the insured person falls ill, it is impossible to issue bills and related medical records many times. What are the legal procedures for the insured to go to several insurance departments to make claims? Then only a copy or a medical unit will reissue the diagnosis certificate. This gives the insured time to drill freely, which may be fraud. In the process of closing the report, we found that many people used fake copies, fake certificates and altered copies; What's more, due to the development of modern science and technology, many problems such as forging color copies have been exposed one after another, which has brought trouble to audit, compensation and declaration, and also added many difficulties to supervision. Secondly, the total amount of compensation that one-person multi-insurance policyholders sometimes get in several insurance departments is actually higher than the total amount of medical expenses actually paid. Someone joked: "You can get rich even if you are sick."
Re-discussion on people who participate in both urban workers' medical insurance and new rural cooperative medical system in one-person multi-insurance, they can enjoy both urban workers' medical insurance reimbursement and new rural cooperative medical system compensation after illness. They will not reimburse the original medical insurance department, some of the hospitalization expenses that should be borne by individuals, and the expenses that should be paid by personal accounts for outpatient services, and then they will be compensated by the new rural cooperative medical system, enjoying the double welfare benefits that they should not enjoy. Some people call this phenomenon "competing with farmers for profits" and "wiping farmers' oil", which is contrary to the original intention of the government to hold the new rural cooperative medical system.
The new rural cooperative medical system is an important decision and measure taken by the government to coordinate urban and rural, economic and social development, effectively solve the "three rural issues", vigorously strengthen rural health construction, improve farmers' health level, and curb farmers' poverty caused by illness and returning to poverty due to illness. The author thinks that we should correctly handle the relationship between family insurance and one-person multi-insurance, strictly distinguish different insurance objects and choose different types of insurance. Adhere to the household as a unit, but also adhere to the principle of seeking truth from facts, according to different situations, different personnel to treat differently. For those who have already participated in the medical insurance for urban workers, they are generally not allowed to participate in the new rural cooperative medical system to avoid the phenomenon of "competing with farmers for profits and wiping off farmers' oil". Because these two kinds of insurance are jointly invested by the government and units, they have certain welfare nature. If the parties request to participate, different financing standards shall be formulated. At the time of reimbursement, the medical insurance department of urban workers stipulates that medical items that should be reimbursed at their own expense will not be reimbursed, and the new rural cooperative medical system will not be compensated. At the same time, the amount that has been compensated by another insurance department will be deducted and will not be reimbursed again. For primary and secondary school students, it is best for migrant farmers to join the new rural cooperative medical system first, and then voluntarily choose to participate in other commercial insurance. When making claims, it is necessary to standardize claims procedures and processes, do a good job of docking with relevant insurance institutions, and prevent cheating and fraudulent insurance.
In addition, in order to meet the multi-level needs of insured farmers, the new rural cooperative medical system can set up a variety of welfare benefits with different financing levels, different reimbursement ratios and different reimbursement ceilings according to the different economic incomes of insured farmers for farmers to choose independently. It is necessary to make the new rural cooperative medical system, a popular project, truly win the hearts of the people, make the people truly benefit, and never hurt them.
2. The relationship between outpatient medical expenses and hospitalization medical expenses compensation.
In the pilot work of new rural cooperative medical care, we should correctly handle the relationship between outpatient medical expenses and hospitalization medical expenses compensation of insured farmers. As far as I know, some pilot counties (cities) stipulate that only the hospitalization medical expenses of insured farmers are compensated, and the outpatient medical expenses are not compensated; In some pilot counties (cities), although the outpatient medical expenses of farmers participating in cooperative medical care can be compensated, the project is harsh and is referred to as "one high, two low and two no compensation". First, the starting point of outpatient medical expenses is higher than that of inpatient medical expenses; Second, the proportion of outpatient medical expenses compensation is lower than that of inpatient medical expenses compensation (outpatient compensation ratio is generally 10% ~ 25%, and hospitalization compensation ratio is generally 25% ~ 50%); Third, the outpatient medical expenses are lower than the maximum compensation for hospitalization medical expenses (the maximum compensation for outpatient service is sealed)