According to the annual work arrangement of CPPCC 20 10, since March, under the leadership of Zhao Nanjun, vice chairman of CPPCC, some committees of CPPCC Social Legal Committee, together with the municipal human resources and social security bureau and other relevant departments, have conducted a special investigation on the urban and rural old-age care and medical security in our city. The special research group listened to the introduction of human resources and social security, health, civil affairs, finance and other relevant departments; Go to various districts and Jiangdu City to hold a forum for the heads of street (town), village (community) and other departments and grass-roots units to understand the situation of old-age care and medical security in our city, listen to opinions and study and inspect in other places. The investigation is hereby notified as follows:

First, the basic situation of urban and rural pension and medical security in our city

In recent years, in the process of building a well-off society in an all-round way and coordinating urban and rural development, our city has adhered to the people's livelihood-oriented, initially established an urban and rural social security system with pension and medical care as the core, and strived to let all urban and rural residents share the fruits of reform and development, which has promoted coordinated economic and social development and maintained social stability.

1. The Party committee and government attached great importance to it, and good progress was made in urban and rural old-age medical security. Since 2002, the Municipal Party Committee and the Municipal Government have paid attention to people's livelihood, guaranteed people's livelihood and improved people's livelihood in the form of Document No.1 for nine consecutive years, and issued relevant policies and opinions on people's livelihood issues such as pension, security, medical care, housing and education, and gradually built a relatively perfect social security system, with the level of security constantly improving. In 2009, the Municipal Party Committee and the Municipal Government issued the "Implementation Opinions on Promoting Urban Areas to Take the Lead in Coordinating Urban and Rural Development", which set clear goals for accelerating the improvement of the rural social security system and gradually improving the social security level of urban and rural residents. In the same year, Weiyang District Party Committee and District Government issued the Opinions on Accelerating the Integration of Urban and Rural Social Security in the Region, which initially formed an all-round, multi-level, integrated and convertible social security situation. City, county (city, district) public finance is inclined to people's livelihood, and the proportion of rural pension and medical security investment in fiscal expenditure is increasing year by year. From the old-age subsidies for landless farmers to the basic medical insurance for urban residents, the new rural cooperative medical system and the new rural insurance, the governments at all levels give each person a certain proportion of payment subsidies every year. For example, the financial subsidies of the New Rural Cooperative at all levels increased from the per capita 20 yuan in 2003 to 2,065,438+. According to statistics, in 2009, the expenditure of municipal and district finance for urban and rural residents' insurance subsidies was 86.59 million yuan. All relevant departments actively perform their duties, strengthen services, and actively promote urban and rural old-age care and medical security. Social security departments constantly improve social insurance policies, expand social insurance coverage through inspections and services, and strengthen the collection and payment of social insurance premiums; Health departments constantly improve the new rural cooperative medical service network, comprehensively deploy and promote the construction of new rural cooperative medical network, strive to supervise the service behavior of medical institutions, and coordinate the allocation of health resources and the provision of medical services to meet the medical service needs of farmers and benefit more farmers; Civil affairs departments have strengthened social assistance work, comprehensively established a social assistance system with complementary policies such as urban and rural five guarantees, poor medical care and temporary assistance, and implemented the "three noes" pension subsidy project in urban and rural areas. The standards have been gradually improved and the scope has been continuously expanded.

2. The urban and rural old-age security system was basically established, and the docking channel began to get through. The basic old-age insurance for employees of urban enterprises, the basic living security for landless farmers and the new rural social old-age insurance constitute the basic old-age security system covering urban and rural areas. The basic old-age insurance for employees in urban enterprises has been implemented for many years, and the system is relatively perfect. At present, it covers 32010.4 million urban employers and flexible employees, and 92,500 retirees receive monthly pensions. Pension benefits have been increasing for nine consecutive years, and the current urban per capita is 1.395 yuan/month. In 2005, the basic living security system for landless farmers, including providing for the aged, was established, with a coverage rate of 65,438+000%, covering 73,000 landless farmers in cities and towns. In 2007, the new rural social endowment insurance was launched in our city, which was financed by three parties: individual contributions, collective subsidies and government subsidies, and combined with individual accounts and overall accounts, with 89,000 farmers participating in the insurance in cities and towns. In order to coordinate the development of urban and rural areas, Weiyang and Jiangdu actively explored the methods of connecting urban and rural residents' old-age insurance, formulated the methods of connecting rural insurance with urban insurance, and opened up the conversion channel between rural insurance and enterprise employee old-age insurance.

3. The basic medical security system covers urban and rural areas. The basic medical insurance for urban workers, urban residents, new rural cooperative medical care and medical assistance constitute the basic medical security system for urban and rural residents. The basic medical insurance for urban workers is running well, and the reimbursement treatment is improving steadily. By the end of 2009, there were 462,300 employees in cities and towns, and the average hospitalization reimbursement rate of employees and retirees reached 80% and 90% respectively. In 2007, the basic medical insurance system for urban residents was implemented. Through the medical insurance for residents with different payment and subsidy standards, "elderly residents, destitute residents, minor residents and ordinary residents" outside the scope of employee medical insurance were included in the medical insurance, achieving full coverage of the medical insurance system for urban residents. At the end of 2009, 259,000 people in cities and towns participated in residents' medical insurance, including 77,000 college students, whose financing level was 400 yuan/year, which was included in the catalogue. In 2009, the financing level of the new rural cooperative medical system was per capita 1.20 yuan, of which individuals paid 30 yuan. Due to the low personal payment standard, the hospitalization compensation is mainly outpatient, and the average reimbursement rate is 45%. The upper limit of reimbursement for serious illness is generally more than 8 times the per capita net income of local farmers, and the highest is 1 10,000 yuan, which has been recognized by the majority of farmers and improved their enthusiasm for participation. By the end of 2009, the participation rate reached.

Two, to promote the city's urban and rural old-age care and medical security work needs to be studied and solved.

With the acceleration of urbanization, it is urgent to smooth the channels of urban and rural social security, promote the development of urban and rural basic old-age insurance and medical insurance, expand the scope of overall planning, and implement provincial-level overall planning of basic old-age insurance. At present, the rapid development of social economy provides opportunities and lays an important foundation for promoting the development of urban and rural old-age medical security. However, due to the high degree of aging in our city, the population over 60 accounts for 18.57% of the total population, and the pressure of financial subsidies is increasing. There is a lack of convergence between the policies introduced year by year, and the promotion of basic old-age care and medical insurance faces some contradictions and problems that need to be solved urgently.

1, the coverage is not comprehensive, and the pension and medical security are not fully realized. Old-age insurance: First, after the implementation of the new rural insurance, there are still two types of residents in urban and rural areas who are not included in the old-age security system. One is unemployed urban residents who have reached the age of 60 and women who have reached the age of 55 but under the age of 70, and the other is unemployed among farmers whose land was expropriated before 2005. There is still a gap in the old-age security system. Second, there are still a few development zone (park) enterprises, catering and entertainment service enterprises with strong mobility and labor-intensive enterprises that have not paid insurance premiums for all employees who should be insured; Employees of restructured enterprises and some unemployed people who have been included in the old-age insurance for urban employees were bought out at one time because of the high payment standard for renewal insurance. Third, unemployed urban residents and some low-income workers can choose freelancers to participate in social security, but they are divorced from social security because they have no economic ability. Fourth, the new rural social endowment insurance in our city has just entered the preparatory stage, and the relevant implementation rules have not yet been issued. Medical insurance: First, because people who have participated in the enterprise employee pension insurance (including flexible employees) cannot participate in the residents' medical insurance with low payment level, it is difficult for some low-income employees to renew their pension insurance while losing their medical insurance; Second, some employees in difficult enterprises are unable to pay the difference between the minimum payment period and the "remaining life" fee at one time when they retire, and may face the possibility of losing their insurance.

2. The development is unbalanced, and there is a big gap between urban and rural areas in the level of old-age care and medical security. First, the gap between urban and rural basic old-age security benefits continues to widen. The pension for retired employees of urban enterprises has been increasing at the rate of 10% for 9 consecutive years. At present, the per capita pension of retired employees of enterprises at the city level reaches 1395 yuan/month. In rural areas, the pension benefits are relatively low. The average basic pension for participating in the new rural endowment insurance is 60 yuan/month, and the average pension subsidy for landless farmers is only 140 yuan/month, which has not yet reached the minimum living standard. Second, there is a gap between urban and rural medical security benefits. In recent years, although the new rural cooperative medical system enables most farmers to enjoy medical security by paying 30 yuan every year, because most of the high-quality medical resources are concentrated in cities, and the reimbursement rate of the new rural cooperative medical system decreases with the improvement of the hospital level, most of the expenses for farmers to go to the city to see a doctor are still borne by themselves, and most areas cannot report immediately, so the actual treatment of medical security enjoyed by rural residents is lower than that of urban residents. Third, there is a big gap between urban and rural informatization construction. Urban social security informatization construction has high investment, good foundation and high efficiency of social security management; However, the informatization construction of rural social security is still lagging behind, and the working methods and management methods can not meet the actual needs.

3, the policy is not connected, it is difficult to effectively switch social insurance. First, at present, the old-age medical insurance in Weiyang, Guangling and Development Zones has been reported online with the Municipal Social Security Center, and the relevant systems and policies are relatively unified. However, the policies and regulations of Hanjiang District are inconsistent with the city, and the collection base, collection ratio and treatment are inconsistent with the city. The information data system has not been docked with the municipal social security center, which has not substantially formed a municipal overall plan; Regionally, there is no channel to transfer rural insurance to urban insurance. Second, the basic living standards of landless peasants are different and lack of sustainability. Before 2005, landless farmers had no basic living security system. However, depending on the amount of one-time transfer, the basic living security established after 2005 enjoys the minimum 60 yuan/month and the maximum 230 yuan/month, while others are mostly 1 10 yuan, 135 yuan, 170 yuan/month and other compensation standards. Third, the social insurance system is self-contained and lacks an effective linkage mechanism. The document "Opinions on Further Expanding the Coverage of Social Insurance and Strengthening the Collection of Social Insurance Fees" issued by Yangfufa [2008] 140 in our city stipulates in principle that land-expropriated farmers, registered farmers and people who participate in rural insurance will participate in or transfer to urban insurance, and the medical insurance for urban workers and residents will be connected and effectively connected. However, there are many financial and technical problems in actual operation. For example, how to convert individual accounts of land-expropriated farmers into urban insurance payment years, how to pay urban insurance premiums after the conversion of payment years, medical insurance is relatively independent, and the payment years cannot be mutually confirmed, so it is impossible to achieve real financing and effective convergence. Fourth, the management resources are scattered and the policy mechanism is "fragmented". The health department is in charge of the new rural cooperative medical system, the human resources and social security department is in charge of the medical insurance for urban workers and urban residents, and the civil affairs department is in charge of social assistance. Relevant policies, regulations and working mechanisms are different, and each has an independent database management system, which is not connected with each other. There is a lack of communication and coordination when introducing policies, and there is a waste of management costs and conflicts between policies. For example, the new rural cooperative medical system requires family-based insurance, which causes family members who go out to work and study to participate in medical insurance repeatedly, and the policy clearly stipulates that they cannot be reimbursed repeatedly. Another example is that employees of township enterprises can participate in the endowment insurance for urban employees and the new rural cooperative medical system, but they cannot be transferred to the medical insurance for urban residents.

4. The publicity is not in place and the relevant policies are not popularized enough. First, we should further improve our understanding of the urgency of accelerating the urban and rural old-age care and medical security for urban residents in Puhui. Second, the training and publicity of a series of laws, regulations and policies intensively promulgated by the central and local governments in recent years, such as the labor contract law, the reform plan of the medical and health system, the new rural endowment insurance system, the national transfer of endowment insurance, and the trans-regional and inter-institutional transfer of migrant workers' medical insurance, are still not in place. In the survey, community cadres generally reflect a lack of understanding of specific policies, and it is difficult to answer public consultation.

Three, promote the urban and rural old-age care and medical security work in our city.

Promoting urban and rural old-age care and medical security, so that all urban and rural residents can share the fruits of reform and development, is an important content of creating a national civilized city, and an important foundation for realizing the goal of "adhering to the people-oriented principle and building a happy Yangzhou", promoting the coordinated economic and social development of the city and building a harmonious society. To this end, the research group put forward the following suggestions:

1. Intensify the work and strive to realize the old-age medical security from system coverage to object coverage. First, continue to vigorously promote the expansion of social insurance. In accordance with the principle of ensuring basic and wide coverage, starting from the level and conditions of economic and social development in our city, the spirit of document No. In 2008 140, the municipal government refined policies and measures, formulated supporting regulations, eliminated the blind area of security, and continued to expand the scope of old-age medical security. On the one hand, in view of the low participation rate of labor-intensive private enterprises and service industries, in accordance with the spirit of the municipal government document, more employees are encouraged to participate in the urban social security system through phased deferred payment; On the other hand, human resources and social security departments should further strengthen labor inspection and social security audit to urge all employers to participate in insurance in time and pay in full. The second is to introduce specific implementation measures to accelerate the work of new rural endowment insurance in cities and towns. It is necessary to actively raise funds for the new rural endowment insurance, ensure that the funds are in place, and introduce policies where conditions permit to encourage rural residents to participate in a higher level of pension and medical security system. On the basis of expanding coverage, we will steadily solve the problem of old-age security for rural residents. The third is to distinguish the objects and put the insurance assistance system in place. Take active measures to promote urban residents with difficulties to participate in social insurance, so that special groups who have interrupted social insurance relations can continue social insurance relations. For example, for laid-off workers with older age, lower income and poor employability, preferential policies are introduced to encourage participation by conscientiously implementing the relevant social security subsidy policies in our city; For marginalized people who have failed to participate in insurance due to other historical reasons, increase assistance and strive to ensure that all insurance is guaranteed; It is suggested that relevant government departments study specific policies to bring unemployed urban residents who meet relevant conditions into the basic old-age security to ensure their old-age security. The fourth is to effectively solve the problem of medical insurance for residents. Break down the barriers of medical insurance system for urban workers and urban residents, and allow employees with difficulties and flexible employment with low economic affordability to choose medical insurance for urban residents by strengthening auditing, so as to solve the medical insurance problem from scratch; According to the survey, in order to solve the problem that some retirees with flexible employment status and retirees from difficult enterprises lack medical security, in 2005, Guangling District adopted a "three-thirds system" financing model, that is, the financial, collective and individual * * * payment model, which solved the medical security problem of all retirees in the whole region, and this practice can be popularized.

2, increase investment, narrow the gap between urban and rural pension and medical security benefits. First, accelerate the transformation and upgrading of economic development, accelerate the transfer of rural labor force through the process of industrialization and urbanization, increase financial input and income of urban and rural residents, and narrow the gap between urban and rural development. The second is to increase rural capital investment, rationally allocate financial resources, establish and improve the mechanism of public financial investment tilting towards rural areas, and gradually increase new financial expenditures on social security and people's livelihood such as pension and medical care. According to Yangzhou's economic and social development level, reasonably determine the level of urban and rural old-age security, appropriately improve the level of rural residents' old-age security, steadily increase the proportion of medical reimbursement for urban and rural residents, gradually narrow the gap between urban and rural areas, and achieve an appropriate balance between urban and rural treatment. The third is to study the social security of landless peasants and landless peasants. This is a prominent personalized problem that needs to be solved in urban areas at present. According to the survey, if the social security problems such as old-age care and medical care for landless farmers are not solved well, it will bring a heavy financial burden to the local area within three to five years, become a complex social problem and affect stability. It is suggested that the government strengthen in-depth research on the situation of landless peasants and landless peasants, including the situation before the implementation of the immediate insurance system, collect information, find out the basic figures, and gradually establish a security system integrating basic old-age care, basic medical care and employment training according to the actual situation, so as to create conditions for bringing landless peasants into the social security system as soon as possible and solve worries. The fourth is to coordinate urban and rural medical security resources. Develop rural public health undertakings, establish and improve a stable mechanism, guide high-quality health resources to flow from cities to rural areas, strengthen the construction of medical and health teams, guide high-level medical technicians to support rural areas, solve the problem of difficult medical treatment for rural doctors, improve the level of primary medical technology and services, increase necessary medical facilities, and strengthen the power allocation and information construction of primary joint management offices; Strengthen the supervision of medical institutions, especially large hospitals above the municipal level, and improve the performance evaluation mechanism of medical and health institutions. Jiangdu city has implemented dynamic management of designated hospitals by signing the new rural cooperative medical system agreement, which has achieved good results and can be used for reference and promotion. Smooth and simplify the processes of registration, payment, declaration, settlement and verification, so that farmers can enjoy better and higher medical resources nearby and get more benefits. Fifth, after the implementation of the old-age subsidy for urban and rural residents over 70 years old, according to the financial affordability, the old-age subsidy system for urban and rural residents aged 60-70 years old will be gradually implemented.

3, intensify innovation, and effectively realize the effective transformation of different old-age medical security systems. First, it is suggested that the government study and classify the different practices in our city, sort out the problems left over from various places, issue relevant guidance on the basis of investigation and study, and gradually formulate policies and measures that are interrelated, interconnected, unified in principle and flexible throughout the city. According to the implementation opinions of social insurance provinces and cities as a whole, around the goal of "unified system and policy, unified payment standards, unified payment items, unified calculation and payment methods, unified management procedures", the urban social security policy should be "the same standard and the same treatment in the same city" as soon as possible. First, it is necessary to solve the problem of Hanjiang District entering the municipal overall planning and create conditions for the transition to the provincial overall planning. Second, based on the basic principle of "wide coverage, basic security and sustainability", actively explore ways and means to solve the connection between urban and rural pension and medical security systems in our city, provide relevant principles and regulations, support relevant operating rules, and smooth the channels for social insurance transfer and connection. It is suggested that we should learn from the relevant practices implemented in other places, gradually break the identity boundaries, establish a unified urban and rural old-age medical security system, fully consider the actual income gap between urban and rural residents, and explore the establishment of a multi-form social security "package system" according to the principle of equal rights and obligations, and set up multi-level payment standards and multi-level treatment options. Urban and rural residents can choose to pay according to their own needs, which ultimately reflects the difference in treatment. Third, give full play to the role of the social security joint meeting system, hold joint meetings attended by relevant departments on a regular basis, strengthen research, study relevant policies and formulate work measures around outstanding problems in social security work. Before the introduction of major social security policies involving the vital interests of the public, such as old-age care and medical care, the public's right to know and participate will be protected in a democratic way through various channels such as "publicity system" and "hearing system", so that urban and rural residents can truly benefit from knowing and doing good things. Clarify the lead department, strengthen the authority of work, ensure policy continuity, inter-departmental policy convergence, and make scientific decisions. The fourth is to establish an interoperable management information platform to improve the management service level. From the reality of our city, we should integrate supervision and management, straighten out the management relationship between urban and rural old-age care and medical security in our city, and avoid multi-door and multi-head management. Strengthen the construction of pension information management system including new rural insurance and new rural cooperative medical system. It is suggested that the "Golden Insurance Project" system should be used to establish urban information database, realize resource integration and information sharing, realize "the same person, the same city and the same library" for insured persons, realize the "one card" for medical insurance, standardize business processes and handling services, and gradually realize the mutual transformation and connection between urban and rural pension and medical security systems.

4, increase publicity, improve the understanding of pension and medical security work and the popularity of related policies. First, leading cadres at all levels should fully realize the significance of promoting urban and rural social security work, improving urban and rural endowment medical security system and improving urban and rural endowment medical security system for promoting urban and rural development and social harmony. It is suggested that the performance evaluation of leading cadres should not only consider GDP, but also pay attention to people's livelihood, and the evaluation lever should gradually tilt towards people's livelihood. Second, make full use of mainstream media such as radio, television, newspapers and the Internet, set up social security columns, special editions, special topics and other programs, actively and widely publicize the purpose, significance, specific provisions and related operational procedures of various old-age medical security policies in the form of community windows, so that the social security policies that benefit the people's livelihood are deeply rooted in the hearts of the people, and guide enterprise employees and all urban and rural residents to understand and support relevant policies and actively participate in insurance. The third is to strengthen the policy and business knowledge training for the staff of grass-roots working institutions and various enterprises and institutions. Through in-depth study of various social security policies and regulations on old-age medical care issued by the state, the province and our city, especially the newly issued policies and regulations, we will improve their policy and business level, enable them to deeply understand and master various social security policies, enhance their work initiative, and push the urban and rural old-age medical security work in our city to a new level through solid basic work.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.