Implementation and effectiveness of the “One Card” of the New Rural Cooperative Medical System in Huzhou City
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Last year, the comprehensive construction of the “One Card” information exchange platform for the new rural cooperative medical care in Huzhou City was completed, and a four-level new rural cooperative medical system real-time reporting system was established at the city, county, township and village levels, which not only facilitates farmers’ reimbursements, but also provides administrative management. The department provides a real-time monitoring platform for the use of new rural cooperative funds to further regulate the management of new rural cooperative funds. At present, the city has fully opened the new rural cooperative medical system “all-in-one card” information system, breaking through the original three-level real-time reporting restriction of the new rural cooperative medical system based on counties and districts. The city’s participating farmers cross counties and districts and go to municipal hospitals to see a doctor. You can get real-time reimbursement by credit card for medical treatment.
1. Construction background and main methods
In recent years, Huzhou City has creatively established a new type of rural cooperative medical service “three guarantee lines” system with small reimbursements for townships, overall planning of major illnesses in counties and districts, and subsidies for people in need. The integrated real-time reporting system enables participating farmers to receive real-time reporting when seeing a doctor at the village-level community health service station, which is well received by the masses. However, the real-time reporting of the new rural cooperative medical system at the county, township, and village levels is limited to participating farmers in the county (district) area. Seeing a doctor in a municipal hospital or not in the county (district) area still adopts the previous “personal The method of “reimbursement before reimbursement” has a longer reimbursement cycle. Participating farmers at the junction of counties and districts do not enjoy the convenience of outpatient reimbursement. Participating farmers still feel that “reimbursement is troublesome and difficult”. In this regard, Huzhou City has innovated ideas and implemented market-oriented operations in accordance with the principle of mutual benefit. Through the city’s New Rural Cooperative Medical Management Committee Office and China Telecom’s Huzhou branch, it has developed a new rural cooperative medical care “all-in-one card” information system construction. In March 2009, the two parties signed a cooperative construction framework agreement, which made a detailed plan for the function, investment, and management of the system, and formulated a construction plan.
China Telecom Huzhou Branch invested 3.5 million yuan in system software and hardware and system integration funds in the first phase, and undertook the daily operation and maintenance of systems at all levels and the investment in networking circuits and related equipment. The total planned investment of the project is about 8 million yuan; at the same time, The Office of the Municipal New Rural Cooperative Medical Management Committee signed a 7-year lease contract with China Telecom Huzhou Branch, paying 1 million yuan for the system lease every year. After the plan was launched, a meeting was organized successively in which the county district directors, the heads of the New Rural Cooperative Medical Care Office, the directors in charge of municipal hospitals, and the chiefs of the information section participated in the meetings to unify their thoughts and understandings and require all counties, districts, and cities. Class-level hospitals actively cooperate with the telecom contractor to do the relevant work. At the same time, clarify the requirements for the construction of the “All-in-one card” information system for the new rural cooperative medical system, schedule the project construction schedule, establish a weekly report system for the construction of the “all-in-one card” project of the new rural cooperative, track and supervise the progress of the project construction, and coordinate existing projects in a timely manner. Problem to ensure the construction progress.
2. Initial results
The implementation of the new rural cooperative medical system is a systematic project that affects the interests of millions of farmers. It has a strong policy nature and involves a wide range of areas. As the level of financing increases year by year, the amount of funds involved is increasing, and its standardized management The requirements are getting higher and higher. Through the establishment of the city’s new rural cooperative medical “all-in-one card” information exchange platform, and the use of information management methods, the new rural cooperative medical data centers of all counties and districts can be connected to each other to achieve data sharing and achieve the purpose of sharing medical information in different places. While facilitating reimbursement by the masses, the standardized management of funds has been further strengthened. Mainly reflect the advantages of three aspects:
First, it is conducive to facilitating reimbursement by the masses and improving management efficiency. Through the establishment of a new rural cooperative reimbursement “all-in-one card” information system, the new rural cooperative data centers of cities, counties and districts can be connected to each other, and existing resources can be effectively used to realize the sharing of medical information in different places. The implementation of the new rural cooperative reimbursement “all-in-one card” allows participating farmers to receive real-time reimbursement services at designated medical institutions throughout the city, especially those who see a doctor in a city-level hospital and across counties. Rural cooperative offices or townships and towns settle expenses, shorten the reimbursement cycle, and use information technology to fundamentally solve the problem of real-time reimbursement for participating farmers for medical treatment in different places within the city. This kind of service that facilitates reimbursement by the masses also allows participating farmers to enjoy the benefits of reimbursement after seeing the doctor on the spot, which further stimulates farmers’ enthusiasm for participating in the reimbursement. Real-time reimbursement by the “all-in-one card” diverts the reimbursement workload of the new rural cooperative offices in all counties and districts, and various statistical reports are automatically generated, making it transform from a “business-oriented” to a comprehensive “management-oriented”, saving management costs and improving management efficacy. At the same time, it avoids errors or man-made frauds that are likely to occur due to manual operations, and ensures that the compensation fees for the new rural cooperative medical system are open, fair and just.
Second, it is conducive to strengthening the supervision of designated medical institutions and ensuring the safety of funds. After the establishment of the New Rural Cooperative Medical Insurance Reimbursement “One Card” information system, on the one hand, every treatment and medication of designated medical institutions on the network can be monitored in real time, including the identification of the disease and the patient’s identity and whether the diagnosis is consistent with the medication and medication. Monitoring whether the amount meets the diagnosis and treatment routines, whether the drugs and project comparisons meet the regulations of the new rural cooperative medical system, and the control of the proportion of self-funded drugs, so as to truly achieve the closed operation and safety of the new rural cooperative funds. On the other hand, in conjunction with the medical expense reimbursement of participating farmers, the payment method of “reimbursement shall be paid by designated medical institutions and approved by the management department” shall be implemented to include the increase in medical expenses, the quality of medical services, and the implementation of the cooperative medical system. For the scope of assessment of designated medical institutions, the assessment results are linked to designated qualifications and expenditures, which further improves the monitoring and evaluation system of designated medical institutions, and realizes the transformation from “ex post reimbursement” to “pre-management”.
Third, it is conducive to improving the evaluation system of the new rural cooperative medical system and providing a basis for scientific decision-making. The New Rural Cooperative Medical Insurance Reimbursement “All-in-One Card” information system can automatically collect various data and perform statistical analysis to ensure the accuracy, rigor and safety of various data. By collecting relevant business indicators such as outpatient and hospitalization expenses, average bed-day expenses, reimbursement and compensation, and medical distribution, etc., relevant statistical analysis reports are formed. The relevant leaders of the city, county and district governments and the new rural cooperative management department use the new rural cooperative reimbursement “all-in-one card” The information system query terminal can dynamically grasp the use of new rural cooperative funds in designated medical institutions and counties and districts, and timely grasp the increase in medical expenses, medical service costs, and the implementation of the cooperative medical system, which is conducive to forward-looking analysis of relevant policies , Provide a timely and accurate basis for scientific decision-making.
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