Notice on carrying out some key work of the new rural cooperative medical system

(en.nhfpc.gov.cn)

Updated: 2014-07-30

5. To strengthen the supervision on new rural cooperative medical funds and standardize fund use

On the basis of the review on the rural cooperative medical system in 2013, and in the light of the Mass Line educational practice, local authorities at all levels should continue to strengthen the supervision over the raising, storage and use of new rural cooperative medical funds and implement the supervision down to primary medical institutions. The historic balance of the fund should not exceed 25 percent of a single year’s revenue. The current year balance should not exceed 15 percent to the year’s revenue. Deficit spending should be avoided. The fund use should continue to be publicized at the town level, county level and village level, and letters and reports of the people should go through open channels and be dealt with timely. According to the judicial interpretation of Article 266 of China's criminal law, defrauding medical insurance and other social welfare commits crime of fraud on public property. The relative authority should report the violation cases so as to stop illegal acts. 6. To intensify payment method reform To change the payment method from “postpaid” to “prepay” is a key work of the new rural cooperation medical system. For those regions that are carrying out payment method reforms in county-level public hospitals, other contract medical institutions should be included too. For those regions that already launched reforms thoroughly, related authorities should continue to summarize experiences, perfect the reform, explore, and cover all patients by various payment methods including diagnosis-related groups, service units and retrospective payments. The incentive and restraint mechanism of the new rural cooperative medical system shall be enhanced by strengthening checks on hospital readmission rates, costs not covered by the list of essential medicines and average dispensing fees. The paying mechanism that the insurance companies, hospitals and pharmaceutical suppliers negotiate together for their own purchases should be expanded to a larger scale. We should also integrate critical illness insurance into the new rural cooperative medical system step by step on the basis of our experiences in the healthcare system of 22 major diseases, and based on the practices of clinical pathway and diagnosis-related groups under defined cost.