EXHIBIT 10.4
Agreement for Medicare Service
Agreement on the Medical Treatment Service of the Appointed Medical
Treatment Institutions in Charge of the Basic Medicare Service for the
citizen in Nanning
A: The Management Center of Social Medical Treatment Insurance of Nanning
B: Nanning Tongji Hospital Co. Ltd.
In order to ensure those insurants to enjoy medical treatment services and
accelerate the development of social security and health, according to Notice on
Printing and Delivering the Interim Procedures of the Management of Appointed
Medical Treatment Institutions in Charge of the Basic Medical Treatment
Insurance of the employee in Cities and Towns (No.14 [1999] issued by Ministry
of Labor & Social Security) ) by Ministry of Labor & Social Security, Ministry
of Health and State Administration of Traditional Chinese Medicine, Interim
Procedures of the Basic Medical Treatment Insurance of the employee in Cities
and Towns of Nanning (No.26 [2001] issued by Nanning People's Government) and
Procedures on Payment of the Costs of the Basic Medical Treatment Insurance of
the employee in Cities and Towns of Nanning (No.27 [2001] issued by Nanning
People's Government) enacted by Nanning People's Government, A has confirmed B
as the appointed medical treatment institution and both sides sign the following
agreements:
Chapter 1 General Provision
Article 1 A and B shall seriously implement the national regulations
concerned and Interim Procedures of the Basic Medical Treatment Insurance of the
employee in Cities and Towns of Nanning enacted by Nanning People's Government
and the regulations attached.
Article 2 A and B shall educate the insurant and medical personnel to accord
with the regulations of medical treatment insurance. Both sides are authorized
to provide the other side with reasonable suggestions and accuse the other side
of or complain about the violation to regulations.
Article 3 B must appoint a leader with academic level in charge of the
operation of the basic medical treatment insurance and employ full-time
(part-time) administrators to operate well the management on appointed medical
treatment service together with the operation organization of medical treatment
insurance. B is responsible for providing A with the information and data on
basic medical treatment insurance. B should offer assistance if A needs to look
up the information and case history of the insurant or inquire the person
involved.
Article 4 A should provide B in time with the information of the insurant
relating to B and pay the medical treatment expenses taken charge of by A to B
according to Procedures on Payment of the Costs of the Basic Medical Treatment
Insurance of the employee in Cities and Towns of Nanning and report the
variation of the policies in time, management system and operation rules of the
basic medical treatment insurance to B.
Article 5 After the contract is signed, B should hang up the unified xxxx of
the appointed medical treatment institution made by A in the noticeable place of
B. B shall provide the propaganda and consulting services to the insured by
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setting the propaganda column of the medical treatment insurance, publicizing
the contact telephone number and setting guidance service etc. The process of
out-patient and in-patient services shall be announced to provide convenience to
the insured. The name and price of the main service items and medicines shall
also be announced and the list of medical treatment expenses and hospitalization
daily costs shall be provided in order to guarantee the right to know of the
insured. The lists shall be in time, clear, accurate and real.
Article 6 B shall use the unified management software of the basic medical
treatment insurance provided by A and equip with relevant facilities and get
access to the Internet according to the requirement of the information system
establishment of medical treatment. The relevant information shall be input and
transmitted timely and accurately according to the management regulations of
medical treatment insurance and its accuracy and completeness shall be ensured.
B shall help A to establish and mature different data bases, vary and preserve
the information in time. A is responsible for the training on the personnel of B
and those using the computers. The personnel using the computers and their
administrators of B must be qualified only after they pass the examination
through the training above.
Chapter 2 Taking Medical Treatment Article 7 During the
procedure of diagnosis, B shall strictly follow the
first diagnosis principles and the principles of treatment that suits the
diseases and reasonably take examination, diagnosis and prescription , in order
to improve the quality of medical treatment.
Article 8 B shall insist on the principle of "base-on-patient" and provide
warm services to the insured. B shall take serious inspection if the insured
complain the staffs of B about their bad manners. The cases will be strictly
dealt with according to relevant regulations if the situations are true.
Article 9 If there is any medical accident happening to the insured during
the diagnosis of B, B shall inform A in written forms within 72 hours since the
accident happened. A can unilaterally terminate the contract if the medical
accidents have happened for many times causing serious consequences.
Article 10 B shall identify the identification and certificates of the
insured seriously during the diagnosis.
1) B shall examine seriously the insurance cards when the insurant register
at clinic and in-patient department, and check the validity of the certificates
according to the list provided by A. A is not responsible for any expenses
during the diagnosis with invalid certificates.
2) If B discovers that the patient is not in accordance with the certificate
of medical insurance, B will refuse to keep the account and will hold the
certificate and inform A in time.
Article 11 B shall establish case history of clinic and in-patient
department. The records shall be clear, accurate, complete and well kept for
examination. Clinic prescription shall be preserved for at least 2 years and
in-patient prescription shall be at least 15 years.
Article 12 B shall use the special case history, specific prescription,
specific application form of examination and settlement document which all
provided by A.
Article 13 B must promise to provide hospital beds in accordance with the
basic medical treatment service scope to the insured in this medical treatment
institution.
Article 14 B shall enhance the management of the hospital and ensure that
the insured can receive medical treatment in time. At the same time the
in-patient standard shall be strictly set and it is not allowed to lead the
insured to be hospitalized. A will not be responsible for the expenses of
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medical treatment if those insured that discord with the in-patient conditions
are hospitalized. B will take relevant responsibility if B denies those insured
that accord with the conditions.
Article 15 B shall go through the procedures of leaving hospital for those
insured that accord with the clinical recovery standard. It is not allowed to
force those insured that are not fully recovered to leave hospital. A shall not
be responsible for the expenses increased by those that stay in hospital only in
name or deliberately postpone the time staying in hospital. If the insured
refuse to leave hospital, B will stop recording the accounts since the day when
the insured are informed of leaving and deal with them as the patients using own
expenses. A shall be informed about this situation in time.
Article 16 If the disease can not be treated because of the technology and
equipment limitation of B, B shall go through the procedures of transferring
diagnosis and treatment for the insured according to relevant regulations. B
shall take the responsibility for the damage of the insured that accord with the
transferring conditions caused by the late handling of B. If the insured that B
is capable of treating are transferred, B shall be responsible for the expenses
of transferring. (Excluding the condition that the patient's condition has
passed the critical stage and can be transferred to the lower level appointed
medical treatment institution through the agreement of A and the insured)
Article 17 If the costs of the services and medicines provided by B have
exceeded the scope of the basic medical treatment insurance and the insured need
to pay with their own expenses, this must be permitted and signed by the insured
and their family members in advance according to the principals of the right to
know and agree. Otherwise the insured are authorized to refuse the payment with
their own expenses.
Chapter3 Management of Diagnosis and Treatment Items Article 18 B
shall strictly implement the regulations on the management of
diagnosis and treatment items by the state, municipality and Nanning city and
provide A with the diagnosis and treatment items lists and costs standard within
the business scope of A. When the level of the costs standard has been
increased, B shall provide materials to A according to the documents examined
and replied by the price department.
Article 19 B shall strictly follow the standard of medical treatment service
price and the relevant costs standard to keep accounts, charge fees and declare
prices. A is authorized to refuse the payment that exceeds the standards.
Article 20 Both A and B shall enhance the management on the one-off medical
materials and discuss together the measures of controlling costs.
Article 21 When the insured receive examination in other appointed medical
treatment institutions of A, B shall make good use of the result and avoid
unnecessary repeated examination.
Article 22 The income of the doctors for the examination of the insured is
not allowed to directly connect with the salaries in their own department. If B
violates this term after the examination by A, A can refuse to pay the relevant
costs and exclude the relevant items from those settled. If the circumstance is
serious, A can unilaterally terminate the agreement.
Article 23 After the contract is signed, if B implements new medical
treatment items outside the stipulations in the contract and these items are
included in the basic medical treatment items set by the department of labor &
social security, they will be dealt with under the following principles:
1. B applies A for adding new medical treatment items. 2. A will take
examination according to the application of B. During the
examination B shall provide A with the relevant materials (including
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application, instruction on medical treatment items, materials on curative
effect and purpose, value of the equipment and documents approved by price
department) and offer convenience to A when A carries out on-the-spot
investigation. A is obligated to keep secret on the materials provided by B.
3. A shall complete the examination within 20 working days after the
application of B (excluding the time when B makes supplementary application
because of the incompleteness of the materials). If the application is not
approved, B shall be informed with reasons. If the application is approved, the
payment standard will be confirmed at the same time and B will be informed in
time. If A gives no reply exceeding the deadline, it will be considered as
approval.
Chapter 4 Management of Medicine
Article 24 A shall report in time the management policy on medicines of the
basic medical treatment insurance. B shall ensure that the supply of the
medicines included in the list of medicines of the basic medical treatment
insurance and offer the reserved medicines list including the details such as
the commodity name, the common name, and types etc. A shall vary and maintain
the data base of the medicines in time according to the materials provided by B.
Article 25 B shall strictly implement the regulations of Medicine List of the
Basic Medical Treatment Insurance of Guangxi Zhuang Municipality. A will not be
responsible for the costs of the exceeding part.
Article 26 In the list of the medical treatment institutions over second
class level (including second class level) the reserve rate of western medicines
shall be more than 80% and the rate of patent traditional Chinese medicine more
than 50%; in the first class medical treatment institutions the rate of western
medicines shall be more than 50% and the rate of patent traditional Chinese
medicine more than 45%. In special medical treatment institutions the reserve
rate of special medicines shall be more than 85%. The medicines expenses shall
take less than 50% of the total medical treatment expenses in the second class
medical treatment institutions and less than 55% in the first class medical
treatment institutions.
Article 27 The out-patient medicines of the insured in one prescription are
mainly for one kind of disease or for two kinds at most. B shall prescribe doses
of 3 days for peracute diseases, doses of 7 days for chronic diseases, doses of
no more than 2 to 4 weeks at most for special chronic diseases, 1 to 2 kinds of
medicines for intravenous drip. The medicines the insured take out of the
hospital will be limited to doses of 3 days for peracute diseases, doses of 7
days for chronic diseases (at most no more than 2 weeks). In special conditions
the doses shall be counted according to the smallest packing. The medicines
brought away shall be limited for the diseases in the first diagnosis.
Prescriptions for a long time or human sympathy are not allowed.
Article 28 The insured can be allowed to buy medicines in the appointed
retail drug stores with the prescription in B and their purchase can not be
interfered. The prescription shall be clear and neat.
Article 29 A shall pay the expenses if B uses the pharmaceuticals produced
by B and listed in the scope of basic medical treatment insurance medicines. B
shall follow article 23 if the new pharmaceuticals produced by B apply for
entering the scope of basic medical treatment insurance medicines.
Article 30 If there are several choices for the medicines of the same type
(same common name but different commodity name) within the scope, B shall give
priority to those with higher efficiency and lower price under the same quality
standard (in accordance with the CMP standard).
Article 31 No matter whether B participates in the bids or not, the basic
medical treatment insurance medicines shall accord with the local bidding price
in principle. A will not pay the exceeding parts if the prices violate the price
policies and are higher than the price settled by state or autonomous region
price department or higher than the bidding price of the medicines in the same
period.
Article 32 If there are counterfeit and shoddy medicines that B provides to
the insured, A will not pay the costs of medicines and other relating medical
treatment expenses and will report to the medicine supervision management
department. If B or its staffs gather sales commissions of the medicines
illegally, A will take off all the expenses of those kinds of medicines after
confirming the truth.
Chapter 5 Payment
Article 33 B is ranked as the second class medical treatment institution.
Article 34 Both A and B shall strictly implement the regulations on the
settlement of
basic medical treatment insurance expenses established by the region. B can only
offer one receipt or xxxx and can not offer it for several times when the
insured are hospitalized or leave hospital.
Article 35 Term of payment
1. Dynamic quota settlement standard of accounting in-patient expenses of
classified medical treatment institutions. The average in-patient expenses per
capita accounted by the person-time and total in-patient expenses every month in
different types of medical treatment institutions (out-patient expenses for
special items refer to this standard, similarly hereinafter).
2. Monthly settlement according to quota settlement standard. The medical
treatment insurance operation organization will settle the accounts monthly in
every designated medical treatment institutions. The in-patient settlement
expenses are equal to that the in-patient person-time of that institution
multiplies the average in-patient expenses per capita of the medical treatment
institutions in the same type.
3. The personal expenses shall be deducted at first during the settlement.
Those violating the regulations will not be paid. The dynamic quota standard of
the special department hospital shall be established separately.
Article 36 Formula for settlement of medical treatment expenses of appointed
medical treatment institution
1. Total volume of settlement = Total volume of personal expenses + Total
volume of planning funds
2. Total volume of planning funds = Total volume of out-patient expenses for
settled items + Total volume of out-patient special examination and treatment
costs + Total volume of in-patient expenses (including special examination and
treatment costs)
3. Total volume of out-patient expenses for settled items = Expense quota per
capita for out-patient settled items during settlement x (Actual person-time +
Violation person-time) - The personal expenses of the insured
4. Total volume of out-patient special examination and treatment costs =
Different items x Person-time of the insured in out-patient examination - The
personal expenses of the insured
5. Total volume of in-patient expenses = In-patient expenses quota per capita
during settlement x (Actual in-patient person-time of the insured - Violation
in-patient person-time of the insured) - The personal expenses of the insured
6. In-patient expenses quota per capita during settlement = In-patient
expenses of designated medical treatment institutions of the same type in the
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city during settlement / Total person-time of designated medical treatment
institutions of the same type in the city
7. Expense quota per capita for out-patient settled items during settlement =
Total volume of out-patient expenses for settled items of designated medical
treatment institutions of the same type in the city during settlement / Actual
out-patient person-time for settled items of designated medical treatment
institutions of the same type in the city
Article 37 B shall report the expenditure list of the medical treatment
expenses of the insured last month to A before the 8th each month for A's
examination.
Article 38 If the insured have any medical accidents in B, they shall be
dealt with according to the management of medical accidents. A will not pay the
costs of the accidents or consequent expenses.
Article 39 A shall pay 90% of the reasonable medical treatment expenses to B
in 20 working days since the receipt of the expenses report offered by B and the
remaining 10% will be taken as the guarantee money. All the expenses will be
paid off according to the result of the annual examination.
Article 40 If A doubts the expenses reported by B, the payment of those
doubtful parts will be postponed. The period of the payment of the reasonable
medical expenses after examination and acceptance shall not exceed 30 days at
most.
Article 41 Those parts within the scope of the basic medical treatment
insurance but actually exceeding the quota settlement standard: 40% will be paid
by the social planning funds and 60% will be at B's own expenses. The total
volume of actual medical treatment expenses of B will be settled by the total
volume o actual costs if the expenses are equal to or less than the quota
settlement standard.
Chapter 6 Reward and Penalty
Article 42 A will report to the administrative department to submit spiritual
encouragement and proper material rewards to the regional people's government if
B can obey the medical treatment insurance system in accordance with the
following conditions.
1. If B consciously implements the policies and regulations of medical
treatment insurance with high quality and good manner of the services and no
complaint by the public and also is elected as the outstanding organization
after annual examination, some material rewards will be issued.
2. If the staffs of B make strict inspection according to the policies and
regulations of medical treatment insurance and reduce the waste or loss of the
resources and medical treatment insurance funds, material rewards will be
annually issued after examination.
3. The reporter of those behaviors or individuals violating the policies and
regulations of medical treatment insurance will be awarded properly after being
proved to be true.
Article 43 If B and its staffs have any behaviors as follows after being
proved to be true, the unreasonable expenses will be withdrawn and besides the
organization and the person in charge will be fined 5 to 10 times of those
expenses according to the seriousness of the circumstances. A criticism note
will be circulated and even the agreement will be terminated.
1. The charge exceeds the expenses standard approved by departments of price,
health and finance.
2. The insured are demanded to pay cash but actually it shall be recorded in
accounts by B according to the regulations.
3. The patients that this hospital is able to treat are transferred to other
hospitals with excuses; the patients are hospitalized in different stages or
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hospitalized twice because of transferring.
4. Violation to the principle of reasonable prescription; treatment
disaccords with diseases; prescription of many medicines for a small disease;
those prescribe for human sympathy and some well-nourished traditional Chinese
medicines.
5. The examination is not taken strictly and its scope is extended at will;
the inspection and approval disaccord with the stipulated procedures; the
special or unnecessary examinations are applied improperly; the rate of positive
actions does not reach the stipulated standard.
6. Those patients that come to hospital are not verified and as a result
those that are not the insured can come to hospital and record the accounts with
the certificate of others.
7. The normal regulations are not implemented; the standards of being
hospitalized and leaving hospital are not complied with; those patients that
disaccord with the standard of being hospitalized are accepted by the hospital
or the period of hospitalization is extended at will; those are hospitalized in
name or the patients are accepted in the super-standard xxxx without their
permissions.
8. The patients out of the scope of guard against serious diseases (CCU, ICU)
are accepted in the CCU, ICU wards or those that need to be transferred to
common wards are continually kept in the CCU, ICU wards.
9. B makes an untrue report on the expenses violating the agreement or its
staffs conspiring with the insured, which get the medical treatment insurance
funds by cheating.
Article 44 If A can not pay the expenses to B in time monthly according to
Interim Procedures of the Basic Medical Treatment Insurance of the Employee in
Cities and Towns of Nanning, the compensation for breaking the contract will be
paid by 0.2/oo of the arrears for each day.
Chapter 7 Dispute Resolution
Article 45 If there is any dispute during the implementation of the
agreement, B can apply for administrative reconsideration towards the same level
administrative department of labor security or bring administrative lawsuits to
people's court according to Administrative Reconsideration Law of the People's
Republic of China and Administrative Procedure Law of the People's Republic of
China
Chapter 8 Supplementary Provisions
Article 46 Term of the agreement: From October 1st, 2006 to September 30th,
2007
Article 47 If there is any adjustment of the national laws and regulations
during the implementation of the agreement, A and B shall amend the agreement
according to the new laws and regulations. Both sides can terminate the
agreement if no agreement has been reached. During the implementation of the
agreement B shall inform A about any variation of registered capital, service
conditions, service content, and legal representative etc.
Article 48 A and B can renew the agreement one month before the expiration
of the term.
Article 49 Those items unmentioned herein will be supplemented by exchange
of letters through the consultation between A and B and have the same legal
effect as this agreement.
Article 50 This agreement is in triplicate. Each party holds one and all
are of the same effect. The other one is reported and delivered to the
administrative management department of medical treatment insurance to keep on
record.
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A: The Management Center of Social B: Nanning Tongji Hosptal Co., Ltd
Medical Treatment Insurance of Nanning (Seal)
(Seal)
Legal representative (Sign): Legal representative (Sign):
September 30th, 2006 September 29th, 2006
