Opinions of the Ministry of Civil Affairs, the Ministry of Finance, the Ministry of Health and the Ministry of Human Resources and Social Security on Further Improving Urban and Rural Medical Assistance System

民政部、财政部、卫生部、人力资源和社会保障部关于进一步完善城乡医疗救助制度的意见

Promulgating Institution: Ministry of Civil Affairs; Ministry of Finance; Ministry of Health; Ministry of Human Resources and Social Security

Document Number: Min Fa [2009] No. 81

Promulgating Date: 06/15/2009

Effective Date: 06/15/2009

颁布机关: 民政部; 财政部; 卫生部; 人力资源和社会保障部

文      号: 民发[2009]81号

颁布时间: 06/15/2009

实施时间: 06/15/2009

To the civil affairs departments (bureaus), the financial departments (bureaus), the health departments (bureaus), the departments (bureaus) of human resources and social security (labor security) of all provinces, autonomous regions and municipalities directly under the Central Government, the Civil Affairs Administration, the Financial Administration, the Health Administration and the Administration of Labor Security of the Xinjiang Production and Construction Corps: 

For the purpose of implementing the spirits of the Opinions of the Central Committee of the CPC and the State Council on Deepening Medical and Healthcare System Reform (Zhong Fa [2009] No. 6) and the Notice of the State Council on Printing and Circulating the Plan of Implementing Key Procedures of Medical and Healthcare System Reform in Recent Periods (year 2009-2011) (Guo Fa [2009] No. 12), further improving urban and rural medical assistance system, and ensuring people with difficulties to enjoy basic medical and healthcare services, these Opinions are hereby promulgated as follows:

    各省、自治区、直辖市民政厅(局)、财政厅(局)、卫生厅(局)、人力资源社会保障(劳动保障)厅(局),新疆生产建设兵团民政局、财务局、卫生局、劳动保障局:

    为贯彻落实《中共中央、国务院关于深化医药卫生体制改革的意见》(中发〔2009〕6号)和《国务院关于印发医药卫生体制改革近期重点实施方案(2009-2011年)的通知》(国发〔2009〕12号)的精神,进一步完善城乡医疗救助制度,保障困难群众能够享受到基本医疗卫生服务,现提出如下意见:

1. Guiding ideology, basic principles, target tasks

(1) Guiding ideology: Guided by Deng Xiaoping Theories, important ideologies of the Three Represents and the Scientific Development View; adhering to the working concepts of human orientation and government for people in order to implement the spirits of deepening medical and healthcare system reform, constantly intensify government responsibilities, improve medical assistance system, innovate mechanisms, strengthen management, improve services, provide effective solutions to the basic medical issues that are realistic and urgent, and about which the urban and rural people in difficulties are most concerned, thereby striving to achieve the goal that people with difficulties will be able to receive proper medical treatment.  

(2) Basic principles: Insisting on the principle of satisfying the basic medical demands of people with difficulties by taking into account the actual situations of our economic and social development; insisting on the principle of overall planning and coordination thereby improving coherence between medical assistance system and relevant social security systems and exploring approaches to establish an urban-rural integrated medical assistance system; adhering to the principles of highlighting key points, carrying out classified rescue, and openness and convenience, thereby giving the full play to the role of medical assistance system in emergency and disaster relief; insisting on the principle of public participation under the leadership of government to vigorously develop medical charities. 

(3) Target tasks: To further improve medical assistance system and lay a solid foundation for medical security. In three years, establish a nationwide medical assistance system that has steady fund resources, standard management operation and evident assistance effect, which is able to offer convenient and fast services for people with difficulties.

       一、指导思想、基本原则和目标任务

    (一)指导思想:以邓小平理论、“三个代表”重要思想和科学发展观为指导,坚持以人为本、执政为民的工作理念,贯彻落实关于深化医药卫生体制改革的有关精神,不断强化政府责任,完善医疗救助制度,创新机制,加强管理,改进服务,着力解决城乡困难群众最关心、最现实、最迫切的基本医疗保障问题,努力实现困难群众“病有所医”的目标。

    (二)基本原则:坚持从我国经济和社会发展实际出发,保障困难群众基本医疗需求;坚持统筹协调,搞好医疗救助制度与相关社会保障制度的衔接,探索建立城乡一体化的医疗救助制度;坚持突出重点,分类施救,公开便捷,发挥医疗救助的救急救难作用;坚持政府主导,社会参与,大力发展医疗慈善事业。

    (三)目标任务:进一步完善医疗救助制度,筑牢医疗保障底线。用3年左右时间,在全国基本建立起资金来源稳定,管理运行规范,救助效果明显,能够为困难群众提供方便、快捷服务的医疗救助制度。

2. To establish a sound system to satisfy the demands of people with difficulties in basic medical services 

(1) Reasonably determining the scope of assistance. On the basis of practically including members of urban and rural households entitled to basic living allowances and households enjoying the five guarantees into the scope of medical assistance, we shall gradually bring members of other families with economic difficulties under the scope of medical assistance as well. Such other families with economic difficulties mainly include the low-income family members with serious illness and other persons with special difficulties as specified by the relevant local governments. Specific defining standards for assistance objects shall be formulated by local civil affairs departments in conjunction with financial or other relevant departments based on a variety of factors such as the economic conditions of local places, situations of the collection of medical assistance funds, affordability of people with difficulties and basic medical demands. The formulated standards shall be submitted to the people's government at same level for approval.  

(2) Providing assistance in various ways. With respect to the members of urban and rural households entitled to basic living allowances, the households enjoying the five guarantees or the members of other families with economic difficulties, we shall financially support them in participating in the basic medical insurance for urban residents or the new rural cooperative medical system, and grant subsidy for the basic medical expenses payable by themselves in accordance with relevant provisions. (3) Improving the contents of assistance services. We shall develop medical assistance services according to different medical demands of assistance objects. We shall focus on hospitalization assistance and attach equal importance to outpatient assistance. The former is mainly used to help settle the medical expenses under the individual share of assistance objects who are hospitalized due to diseases; the latter is mainly used to help settle medical expenses under the individual share of assistance objects who suffer from common diseases, chronic diseases, or require long-term medication, or seek emergency treatment and rescue as well as satisfy certain conditions. 

(4) Reasonably making the subsidy plans. All places shall use scientific approach to formulate medical assistance and subsidy plans based on the total amount of medical assistance funds of the then-current year. We shall gradually lower or cancel the threshold for medical assistance, reasonably set the ceiling thereof, and further raise the proportion of the basic medical expenses under the individual share of assistance objects after the compensation by basic medical security system.

       二、健全制度，满足困难群众的基本医疗服务需求

   （一）合理确定救助范围。在切实将城乡低保家庭成员和五保户纳入医疗救助范围的基础上，逐步将其他经济困难家庭人员纳入医疗救助范围。其他经济困难家庭人员主要包括低收入家庭重病患者以及当地政府规定的其他特殊困难人员。具体救助对象界定标准，由地方民政部门会同财政等有关部门，根据本地经济条件和医疗救助基金筹集情况、困难群众的支付能力以及基本医疗需求等因素制定，并报同级人民政府批准。

    （二）实行多种方式救助。对城乡低保家庭成员、五保户和其他经济困难家庭人员，要按照有关规定，资助其参加城镇居民基本医疗保险或新型农村合作医疗并对其难以负担的基本医疗自付费用给予补助。

    （三）完善救助服务内容。要根据救助对象的不同医疗需求，开展医疗救助服务。要坚持以住院救助为主，同时兼顾门诊救助。住院救助主要用于帮助解决因病住院救助对象个人负担的医疗费用;门诊救助主要帮助解决符合条件的救助对象患有常见病、慢性病、需要长期药物维持治疗以及急诊、急救的个人负担的医疗费用。

    （四）合理制定补助方案。各地要根据当年医疗救助基金总量，科学制定医疗救助补助方案。逐步降低或取消医疗救助的起付线，合理设置封顶线，进一步提高救助对象经相关基本医疗保障制度补偿后需自付的基本医疗费用的救助比例。

3. To simplify procedures and fully utilize the function of medical assistance in providing convenience for people and emergency relief 

Civil affairs departments at all levels shall, in conjunction with health and other departments, encourage appointed medical organizations to adopt instant settlement measures of medical assistance expenses. Civil affairs departments may offer necessary prepaid funds according to actual situations. The medical expenses, if duly paid covered within medical assistance, of members of urban and rural households entitled to basic living allowance and households enjoying five guarantees and other assistance objects, shall be instantly settled by the appointed medical organizations where they seek medical services at appointed medical organizations that practice instant settlement in virtue of relevant certificates or evidential materials. The assistance objects are only required to pay for the part under individual share. Appointed medical organizations shall conduct regular settlement with civil affairs departments. A local civil affairs department shall promptly accept application for medical assistance made by other persons with economic difficulties, or medical services request with an appointed medical organization that has not practiced instant settlement made by a medical assistance object; the civil affairs department shall also handle the examination and approval procedures thereof in accordance with relevant provisions in order to make people with difficulties access medical services in time. 

Where an assistance object needs to be transferred to a non-appointed medical organization for treatment due to therapy requirements, the appointed medical organization shall issue the referral certificate to him/her while the assistance object shall submit the certificate to the civil affairs department of local people's government at county level for approval and record-filing. In addition, all places shall explore measures for solving problems in relation to the application filed by mobile workers to seek medical services at places other than their hometowns and the relevant procedures for examination, approval and settlement thereof, provided such mobile workers belong to assistance objects, thereby providing convenience to people with difficulties to access medical services. 

At the same time when simplifying the operational procedures of provision of medical assistance, all places shall regulate their work flows, improve services and management and establish a complete democratic supervision mechanism for medical assistance work. They shall timely publicize the names of medical assistance objects, assistance standards, amount of assistance fund, etc., to the society to accept the supervision of people and the society. Thus keep the public informed of the relevant policies, utilization of the funds and objects entitled to medical assistance.

       三、简化程序，充分发挥医疗救助的便民救急作用

   各级民政部门要会同卫生等部门，鼓励和推行定点医疗机构即时结算医疗救助费用的办法，民政部门可结合实际提供必要的预付资金。对于城乡低保家庭成员、五保户等医疗救助对象，凭相关证件或证明材料，到开展即时结算的定点医疗机构就医所发生的医疗费用，应由医疗救助支付的，由定点医疗机构即时结算，救助对象只需支付自付部分。定点医疗机构与民政部门要定期结算。对于申请医疗救助的其他经济困难人员，或到尚未开展即时结算的定点医疗机构就医的医疗救助对象，当地民政部门要及时受理，并按规定办理审批手续，使困难群众能够及时享受到医疗服务。

    救助对象因治疗需要转诊至非定点医疗机构治疗的，应当由定点医疗机构出具转诊证明，由救助对象报当地县级人民政府民政部门核准备案。此外，各地要探索属于救助对象的流动就业人员异地就医的申报、审批和结算办法，方便困难群众就医。

    各地在简化医疗救助操作程序的同时，要规范工作流程，完善服务管理，并建立健全医疗救助工作的民主监督机制，及时将医疗救助对象姓名、救助标准、救助金额等向社会公布，接受群众和社会监督，做到政策公开、资金公开、保障对象公开。

4. To strengthen cooperation and link between the medical assistance system and relevant basic medical security system. When formulating implementation plans of medical assistance system, all places shall conduct overall coordination and better utilize the integral effects of all systems by taking into account establishment of the basic medical insurance for urban employees, basic medical insurance for urban residents and the new rural cooperative medical system. Based on dynamic changes, they shall gain a thorough and accurate understanding of the facts regarding the number of members of urban and rural households entitled to basic living allowance, households enjoying five guarantees and with economic difficulties, as well as their demand for medical service, thus determining assistance objects and methods. We shall enable the members of urban and rural households entitled to basic living allowance, those enjoying five guarantees and other families with economic difficulties to access the basic medical security system through granting subsidies for the basic medical insurance for urban residents and subsidies for individual contributions to the new rural cooperative medical system. We shall also help the aforesaid households to settle the part of expenses paid by individuals which is under the threshold standard for relevant basic medical security. An assistance object that has difficulty in bearing medical expenses after being compensated by relevant security systems, medical assistance in a timely manner shall be granted.

We shall strengthen the link between medical assistance and basic medical insurance for urban employees, basic medical insurance for urban residents and new rural cooperative medical system in the aspects of administration. We shall improve the settlement measures under all systems, explore the practice of "one-stop" management and service, gradually realize the sharing of information about persons, medical services and medical expenses between different medical security systems. We shall enhance our management and service efficiency to provide convenience for people with difficulties.

       四、加强配合，做好医疗救助与相关基本医疗保障制度的衔接

   各地在制定医疗救助制度实施方案时，要结合城镇职工基本医疗保险、城镇居民基本医疗保险与新型农村合作医疗制度的建立，统筹协调，更好地发挥各项制度的整体效能。要按照动态变化，全面准确掌握城乡低保家庭人数、五保户和经济困难家庭人员情况以及医疗服务需求，确定救助对象和救助方式。要通过对城镇居民基本医疗保险和新型农村合作医疗个人缴费部分的补助，使城乡低保家庭成员和五保户等经济困难家庭人员，能够享有相关基本医疗保障待遇;并帮助解决相关基本医疗保障起付线以下的自付部分。对经相关保障制度补偿后个人负担医疗费用有困难的救助对象，要及时给予医疗救助。

    加强医疗救助和城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗在经办管理方面的衔接，改进各项制度的结算办法，探索实行“一站式”管理服务，逐步实现不同医疗保障制度间人员信息、就医信息和医疗费用信息的共享，提高管理服务效率，方便困难群众。

5. To allocate more fund to medical assistance system and strengthen fund management.

(1) Raising fund through various channels. We shall enhance responsibilities of local governments; local financial departments at all levels, especially provincial financial departments, shall practically make adjustments to the structure of fiscal expenditure and increase input to further expand the scale of medical assistance fund. Central finance shall arrange special funds to subsidize areas with difficulties to develop urban and rural medical assistance. All places shall mobilize social forces to collect funds through various channels. 

(2) To strictly control the management and use of funds. Financial departments at county level shall set up special accounts of urban and rural medical assistance funds in the special financial accounts for social security funds to handle the collection and allocation of medical assistance funds. Civil affairs departments at county level shall properly carry out the payment work of medical assistance funds. We shall strengthen the management of urban and rural medical assistance funds and under the precondition of ensuring fund safety, accomplish basic balance between income and expenditure as well as with slight surplus. Places with comparatively more surplus shall actively adopt measures to gradually lower the surplus rate. Until the year 2011, the accumulated fund balance of all places shall be no more than 15 per cent of the total amount of collected funds of the current year. The accumulated fund balance shall be timely rounded up to the next year in accordance with provisions and shall not be misappropriated for other purposes. The financial department and the civil affairs department at next higher level shall reduce the subsidy funds or suspend the allocation of subsidy funds of a place with large amount of fund balance.

       五、加大资金投入力度，强化基金的管理

   （一）多渠道筹集资金。要强化地方政府责任，地方各级财政特别是省级财政要切实调整财政支出结构，增加投入，进一步扩大医疗救助基金规模。中央财政安排专项资金，对困难地区开展城乡医疗救助给予补助。各地要动员和发动社会力量，通过慈善和社会捐助等，多渠道筹集资金。

    （二）严格基金的管理和使用。县级财政部门要在社会保障基金财政专户中设立城市和农村医疗救助基金专账，办理医疗救助资金的筹集、拨付。县级民政部门要做好医疗救助资金的发放工作。要加强对城乡医疗救助基金的管理，在确保基金安全的前提下，做到基金收支基本平衡，略有结余。基金结余较多的地区，应积极采取措施，逐步降低基金结余率，到2011年，各地累计结余的资金一般应不超过当年筹集基金总额的15%，且要按规定及时结转下年使用，不得挪作他用。对于结余资金过多的，上级财政、民政部门应根据情况减拨或停拨补助资金。

6. To strengthen supervision by agreement and control unreasonable medical expenditure 

Civil affairs departments at all levels, in conjunction with relevant departments, shall establish the mechanism for appointed medical organizations entering and exiting medical assistance as well as adopt dynamic management. In principle, an appointed medical organization is selected from the scope determined by the basic medical insurance for urban residents and the new rural cooperative medical system. Health departments at all levels shall strengthen the supervision of appointed medical organizations for medical assistance, regulate the medical services and acts of appointed medical organizations as well as the use of basic drug lists and diagnosis & treatment catalogue. They shall encourage and guide appointed medical organizations to make reasonable and priority use of national basic drugs and appropriate diagnosis & treatment technologies in order to control unreasonable increase of medical expenses. Civil affairs departments shall conclude agreements with appointed medical organizations to clarify the responsibilities, rights and obligations of both parties while both parties shall strictly perform the agreements. Medical expenses incurred due to medication, diagnosis, treatment and medical service provision against the provisions shall not be settled from funds of urban and rural medical assistance.

       六、加强协议监管，控制医疗费用不合理支出

   各级民政部门要会同有关部门，建立医疗救助定点医疗机构的准入和退出机制，实行动态管理。定点医疗机构原则上在城镇居民基本医疗保险和新型农村合作医疗确定的范围内选择。各级卫生部门要加强对医疗救助定点医疗机构的监管，规范定点医疗机构的医疗服务行为和基本药物目录、诊疗目录的使用，鼓励并引导定点医疗机构优先、合理使用国家基本药物和适宜诊疗技术，控制医疗费用的不合理增长。民政部门要与定点医疗机构签订协议，明确双方责任、权利与义务，并严格履行。对不按规定目录用药、诊疗以及提供医疗服务所发生的医疗费用，城乡医疗救助基金不予结算。

7. To strengthen organization and leadership, thereby ensuring successful development of medical assistance work through close cooperation. 

The work of urban and rural medical assistance program is directly related to the practical interests of people with difficulties. It's also a public interest project of great significance. Under the leadership of local people's governments, the departments of civil affairs, finance, health, human resources and social security of all places shall attach great importance to the program and undertake corresponding responsibilities, closely coordinate with each other and jointly and properly carry out its implementation. Civil affairs departments shall fully utilize its role of being in charge of medical assistance work in the course of policy study and formulation and implementation thereof. They shall also properly link medical assistance to social charity assistance. Financial departments shall allocate subsidy funds to right places and strengthen supervision and inspection over fund management and use. Health departments shall improve service provision and management of the participation of people with difficulties in the new rural cooperative medical system and strengthen supervision over appointed medical organizations. Departments of human resources and social security shall improve the service provision and management of participation of people with difficulties in the basic medical insurance for urban residents. 

Each province, autonomous region or municipality directly under the Central Government shall respectively select two to three medical assistance projects as demonstration projects. Its selection shall be determined based on the actual work situations, the leadership criteria and the financial status of a place. Places that develop demonstration work for urban and rural medical assistance shall put emphasis on exploring how to reasonably determine their assistance objects, on exploring practical and feasible payment methods and settlement methods of medical assistance funds. They shall simplify the procedures for application, examination and approval as well as smoothly carry out the coherence with relevant security systems. All places shall fully utilize the guiding role of demonstration projects, guiding the districts of their jurisdiction to constantly make innovation and development as well as strengthen their management in order to enhance the practical effect of medical assistance work. 

The departments of civil affairs, finance, health, human resources and social security at provincial level shall, in accordance with the requirements hereof and considering the actual situations of local places, formulate specific implementing measures and urge the implementation thereof. Any situation or problem encountered during the progress of the implementation work shall be reported to relevant departments in a timely manner.

Ministry of Civil Affairs

Ministry of Finance

Ministry of Health

Ministry of Human Resources and Social Security

June 15, 2009

       七、加强组织领导，密切配合，确保医疗救助工作顺利开展

   城乡医疗救助工作直接关系困难群众切身利益，是一项重大的民心工程，各地民政、财政、卫生、人力资源社会保障部门要在当地政府领导下，高度重视，各负其责，密切配合，共同抓好落实。民政部门要充分发挥医疗救助主管部门作用，做好政策研究制定和组织实施工作，做好医疗救助与社会慈善救助的衔接;财政部门要落实安排救助资金，加强对资金管理和使用情况的监督检查;卫生部门要做好困难群众参加新型农村合作医疗的服务管理工作，加强对定点医疗机构的监管;人力资源社会保障部门要做好困难群众参加城镇居民基本医疗保险的服务管理工作。

    各省、自治区、直辖市要分别选择2-3个医疗救助工作示范点，示范点的选择要根据各地工作基础、领导重视程度、财政状况确定。开展城乡医疗救助示范工作的地区，要重点探索如何合理确定救助对象，探索切实可行的医疗救助资金支付方式和结算办法，简化申请审批程序，与相关保障制度搞好衔接等。各地要充分发挥示范点的引导作用，指导辖区内地方不断创新发展，强化管理，提高医疗救助工作实效。

    省级民政、财政、卫生、人力资源社会保障部门要根据本意见的要求，结合当地实际，制定具体实施办法，抓好督促落实。工作进展中的情况和问题，请及时报上级有关部门。

    民政部

    财政部

    卫生部

    人力资源和社会保障部

    二○○九年六月十五日