Interim Measures For The Agricultural And Pastoral Areas In Tibet Autonomous Region Medical Management

Original Language Title: 西藏自治区农牧区医疗管理暂行办法

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(May 28, 2003 Standing Committee of the Tibet Autonomous Region people's Government, the 11th review by people's Government of Tibet Autonomous Region, July 15, 2003, the 56th released) Chapter I General provisions article in accordance with the circular of the Ministry of health and other departments to establish a new rural cooperative medical system of the opinions of the spirit, for the further implementation of the national free medical policy on farmers ', establishing and perfecting the agricultural and pastoral areas based on free medical health care system, promote the development of agricultural and pastoral areas of health,
    Improve the level of health care of farmers and herdsmen, according to the State, autonomous regions the relevant provisions on further strengthening rural health work, based on actual Tibet, these measures are formulated.
    II agricultural and pastoral areas health care system is Government-led, voluntary participation by individuals, Government, corporate and personal finance, family accounts, serious illness and medical care combining medical cooperative system.
    Third agricultural and pastoral areas health care system, medical aid for agricultural and pastoral area wubaohu, the poor families of farmers and herdsmen.
    Article fourth agricultural and pastoral areas health care system, adhere to the voluntary and multilateral funding, in order to support and ensure an appropriate degree of principle.
    Five Governments at all levels should be established and improvement of agricultural and pastoral areas based on free medical health care system into the local economy and social development plan.
    Sixth chapter organization and management in agricultural and pastoral area health care system by County (city, district) in units of co-ordinating, counties (cities and districts) and township (town) management.
    Article seventh autonomous region, Prefecture (City) was established by the health, financial, agricultural, civil affairs, audit, social security, poverty alleviation and other departments of the agricultural and pastoral areas coordination group on medical, agricultural and pastoral areas is responsible for organizing, directing and coordinating medical work.
    Autonomous region, Prefecture (City) in agricultural and pastoral areas shall be established by the Administrative Department of health health authorities, with appropriate personnel, responsible for the management work.
    Article eighth County (city, district) and township (town) people's Government should be set up by the relevant departments and the agricultural and pastoral areas of medical management committee composed of representatives of farmers and herdsmen (hereinafter referred to as the HA), responsible for the Organization, coordination, management, guidance and supervision. The County (city, district) health administrative departments and township (town) people's Government should set up a medical office, is responsible for operational work.
    HA staff by the Government at the same level in the Office of prescription solution, personnel expenses and expenses included in the budget at the same level shall not be extracted from the medical fund. County (city, and district) medical tube will Office of duties is: (a) according to this approach developed work programme and the regulations, and by County (city, and district) medical tube will discussion through Hou organization implementation; (ii) organization implementation daily health publicity, and launched work; (three) management County (city, and district) medical big disease and manpower and medical Rescue Fund; (four) issued medical documents; (five) coordination solution implementation work in the of specific problem; (six) collection, and finishing, and analysis and reported related information; (seven) supervision, and
    Inspection and assessment of township (town) hospital and Office work.
    Xiang (town) medical tube will Office of duties is: (a) organization implementation County (city, and district) medical tube will Office developed of work programme and the regulations; (ii) Organization publicity, and mobilization HONGO (town) farmers and herdsmen voluntary participate in medical funding, and is responsible for registration registered and sent card work; (three) is responsible for farmers and herdsmen medical personal pay of raised and on time handed County (city, and district) medical tube will Office; Management family medical account Fund; (four) collection, and analysis, and finishing and reported related information.
    Chapter III health care fund raising agricultural and pastoral areas and manage the Nineth medical system of Government, individual pay, collective support and social support through various channels of financing mechanisms.
    Medical sources of funds: (a) financial arrangements for free medical special funds and Medicaid funding.
    (B) autonomous region, Prefecture (City) and County (city, district) Government financial arrangements for free medical and special funds.
    (C) medical financing for farmers and herdsmen's annual fee (standard of not less than 10).
    (D) the County (city, district) of administrative departments in the poverty relief fund for agricultural and pastoral area wubaohu to pay your personal finance.
    (E) the County (city, district) people's Government financial support for poor farmers and herdsmen families.
    (F) enterprises, institutions, social organizations and individual donors.
    (G) other.
    Article tenth participation in financing for medical personnel change of household registration, personal finance does not back up that year, by their family members continue to be used.
    New home or home population is bounded by June 30 of each year, attend before payment of all fees, attended after paying fees. 11th Medical Fund is divided into family accounts, serious illness and three types of medical aid. Fund accounts separately, expensed, continue to use surplus carried forward to the next year. Its proportion and purpose is: (a) the family account. 60% per cent of total medical fund. Mainly used for basic compensation for medical expenses of farmers and herdsmen.
    Failing to pay farmers and herdsmen for personal financing, financial arrangement free medical care from the State and the autonomous communities specific funding and cooperative medical assistance by 60% into the family account. (B) serious illness Fund. 35% per cent of total medical fund. Mainly used for large medical expenses or compensation for hospital medical expenses of farmers and herdsmen.
    Failing to pay farmers and herdsmen for personal financing, financial arrangement free medical care from the State and the autonomous communities specific funding in Medicaid funding and cooperation according to 35% into the catastrophic Fund. (C) Medical Fund. 5% per cent of total medical fund. Mainly used for agricultural and pastoral area wubaohu and medical assistance to poor farmers and herdsmen families. Failing to pay farmers and herdsmen for personal financing, financial arrangement free medical care from the State and the autonomous communities specific funding in Medicaid funding and cooperation by 5% classified as a medical relief fund.
    Specific measures formulated by the autonomous regions health, civil affairs, finance and other sectors separately.
    12th big illness and medical relief fund, administered by the County (city, district), medical office management, household account Fund is administered by the County (city, district) the HA will be allocated to the Office of township (town), medical office management.
    13th counties (cities, districts), Township (town) the Office of the Commission shall, in accordance with the relevant laws and regulations, and financial regulations, establishing and perfecting the agricultural and pastoral areas of medical management rules and regulations. Countries and financial arrangements for free medical care at all levels of the autonomous region special funds Medicaid funding and cooperation into all levels of the financial budget and final account. Medical Foundation special management, earmarked, and in State-owned commercial banks to set up special accounts, account stores, their interests would be incorporated into the health care Fund.
    No unit or individual is allowed to borrow a medical Fund, interception, misappropriation and misuse.
    Fourth chapter article 14th medical reimbursement of medical expenses compensation is for farmers and herdsmen after medical treatment in medical institutions at all levels in accordance with the regulations waive, write-off or reimbursement of medical expenses.
    15th medical expenses should be open, fair, equitable, timely and convenient principle. 16th article where pay personal funding of farmers and herdsmen in levels medical institutions medical claims or verification of proportion and the specific settlement approach by following provides implementation: (a) in Xiang (town) medical institutions and village health room (village doctor) medical by occurred of outpatient costs, by family medical account this in its family account Fund in the verification; in Xiang (town) medical institutions medical by occurred of hospital costs, from received 70%, in family account Fund in the verification 30%.
    The township (town) hospitals and village clinics (country doctor) with cancellation and waiving of medical charges with a valid ticket, and township (town) and County (city, district) medical offices are settled periodically.
    (B) in the County (city, district) medical costs incurred by hospitals for medical treatment, outpatient costs based on family accounts of the family medical account fund reimbursement; hospitalization costs with the family health and medical expenses of the account of the effective instruments in the catastrophic Fund reimbursement 70%, claims 30% in the family account.
    (C) in (City) medical costs incurred by the medical institution, with the family medical account, County (city, district) referral referral certificate and medical expenses in medical institutions effective instruments in the catastrophic Fund reimbursement 60%, claims 40% in the family account.
    (D) agricultural and pastoral area wubaohu, poor farmers and herdsmen families in medical costs incurred by medical institutions at various levels for medical treatment, family medical account in addition to the above (a), (b), (c) be dealt with, and visualization in medical assistance fund grant. 17th article where not pay personal funding of farmers and herdsmen in levels medical institutions medical claims or verification of proportion and the specific settlement approach by following provides implementation: (a) in Xiang (town) medical institutions and village health room (village doctor) medical by occurred of outpatient costs, by family medical account this in its family account Fund in the verification; in Xiang (town) medical institutions medical by occurred of hospital costs, from received 50%, in family account Fund in the verification 50%.
    The township (town) hospitals and village clinics (country doctor) with cancellation and waiving of medical charges with a valid ticket, and township (town) and County (city, district) medical offices are settled periodically.
    (B) in the County (city, district) medical costs incurred by hospitals for medical treatment, outpatient costs based on family accounts of the family medical account fund reimbursement; hospitalization costs with the family health and medical expenses of the account of the effective instruments in the catastrophic Fund reimbursement 50%, claims 50% in the family account.
    (C) in (City) medical costs incurred by the medical institution, with the family medical account, County (city, district) referral referral certificate and medical expenses in medical institutions effective instruments in the catastrophic Fund reimbursement 40%, claims 60% in the family account. Article 18th households of farmers and herdsmen account funds in savings in the current year, carried forward to the next year. Households of farmers and herdsmen account funds run out, at all levels of medical outpatient costs incurred by the institution, by individuals to take care of hospitalization costs respectively 16th, 17, reimbursed or provided free of charge.

    19th claims compensation cap line, by the County (city, district) hospital Office according to local pay levels, determined in accordance with to charge, the principle of balance, should be controlled at less than 3000 Yuan.
    Financing for individual farmers and herdsmen with serious illness, serious illness a large medical expenses or hospital medical expenses exceed the reimbursement of compensation of top line, counties (cities, districts) of HA should be according to the family's economic situation, the collective study, can be given a certain amount of medical aid from the Fund compensation. Article 20th counties (cities, districts), Township (town) the Office should strictly enforce these measures the Commission claims compensation is provided, on a rigorous examination of the documents and voucher checks, handling matters related to medical expenses reimbursement in a timely manner, without undue delay, denial.
    Eliminate the debt reimbursement and fraud and other acts.
    The scope of the article 21st medical compensation for expenses shall not be reimbursed: (a) poisoning, car accidents, alcohol, fights and other acts of medical costs.
    (B) the correction, beauty, dentures, spectacles, artificial limbs and other health products cost.
    (C) since the purchase of medicines and nutritional healthcare products, blood and blood products (apart from the maternal rescue use,), the cost of disposable medical materials.
    (D) recruitment, recruitment, entrance examination fee, nursing fee, transportation and referral referral to field costs of examination and treatment without approval (except for the emergency that occurred in the field).
    (E) registration fee, visits, etc.
    Fifth chapter of medical service management article 22nd County (city, district) and township (town) hospitals and village clinics (country doctor), is the subject of providing health care services for farmers and herdsmen, farmers and herdsmen should be provided, timely, convenient, quality, affordable health care services. 23rd the County (city, district) and township (town) medical institutions to establish a countryside tour to health care system should be implemented fully extended in order to facilitate medical.
    The County (city, district) health administrative departments of medical institutions should be organized for the farmers and herdsmen regularly carry out regular medical examinations, and township (town) medical institutions and gradually establish family health records. 24th the County (city, district) and medical institutions shall seriously implement the above referral referral system.
    Referral referral shall meet the following conditions: (a) critical or difficult cases, diagnosis of the disease is unknown, treatment, is absolutely necessary to the medical institution at a higher level for further examination and treatment.
    (B) the County (city, district) Medical Commission Office agree.
    25th medical organizations and personnel shall strictly abide by the professional ethics of medical, medical technology practice for agricultural and pastoral areas, and medical regulations and medical fees, as well as for illness treatment, reasonable examination, rational drug use, treatment, medical registration, medicine prescription, paying bills, and standardizing medical behavior.
    26th article of township (town) hospitals and village clinics (country doctor) should do the cost of clearing work, establish and improve the financial management system. 27th State health and pharmaceutical supervisory and administrative departments are responsible for developing counties (cities, districts) and township (town) list of basic drugs in medical institutions.
    Agricultural and pastoral areas using drugs in medical institutions, implement the bidding system. Sixth chapter medical document management article 28th of farmers and herdsmen to implement a certified doctor.
    The County (city, district) issued by the Office of the Commission for the households of farmers and herdsmen of the family medical account. Article 29th of the family medical account uniformly printed by the State Administrative Department of public health.
    The family medical account shall not be altered, forged or transferred.
    Seventh chapter medical supervision article 30th County (municipal and district) people's Government shall be established by the supervision and auditing, finance, health, agriculture and animal husbandry, civil affairs departments and the agricultural and pastoral areas of medical Oversight Committee made up of representatives of farmers and herdsmen.
    31st medical supervision includes daily supervision and special supervision and acceptance of people, reported complaints.
    Medical supervision mainly covers free medical special funding and cooperation of Medicaid funding in place, fund raising, management and compensation, medical services, drug management, and so on.
    Article 32nd auditing departments should periodically free health special funds, cooperative medical assistance and medical expenditure and management audit.
    Article 33rd counties (cities, districts), Township (town) the Commission shall regularly report on its work to the people's congresses and supervision Committee, take the initiative to accept supervision. The County (city, district), Township (town) the Office should regularly report to the Commission the County (city, district) and township (town) Council of the medical fund income and expenditure, the use of the HA.
    Specific payments to the Medical Fund and their operation should be posted on a regular basis, in order to ensure participation, knowledge and monitoring of the rights of farmers and herdsmen.
    Article 34th on the agricultural and pastoral areas in the medical problem that was discovered in the course of supervision, the departments concerned should be corrected or dealt with in a timely manner.
    Eighth chapter supplementary articles article 35th town residents who enjoy free medical care in accordance with the measures implemented.
    36th article of the approach by the health Administrative Department is responsible for the interpretation of the autonomous region. 37th article of the rules take effect on August 1, 2003.
    Rural cooperative medical management approach in the Tibet Autonomous Region (for trial implementation) (Tibetan Government issued [1999]53) repealed simultaneously.