1, increase the downward adjustment of drug prices.

According to the information of relevant departments, the price reduction of drugs is very strong. The State Council medical reform leading group meeting, the State Council executive meeting and deep reform committee meeting were held for many times to deploy drug price reduction work. Relevant departments also cooperated with Qi Xin to reduce the price of anticancer drugs and promote the price reduction of drugs in 4+7 cities (4 municipalities directly under the Central Government and 7 sub-provincial cities).

2. Increase the proportion of medical insurance reimbursement.

This reform takes safeguarding the safety of medical insurance funds as the primary task, and constantly strengthens the supervision of medical insurance funds. Committed to establishing a unified medical insurance system for urban and rural residents in an all-round way, improving payment and financing policies, further increasing the proportion of medical insurance reimbursement and increasing medical insurance projects. Improve the system of serious illness insurance and medical assistance, and establish a list of benefits. Insist on doing your best and doing what you can, and give full play to the role of medical security in precise poverty alleviation.

First, outpatient compensation

(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.

(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.

(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.

(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of medical examination fee and operation fee in 50 yuan and prescription drug fee in 200 yuan.

(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.

(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.

Second, hospitalization compensation

1. Reimbursement scope:

A. Drug expenses: auxiliary examination: the expenses for ECG, X-ray fluoroscopy, radiography, laboratory tests, physical therapy, acupuncture, CT and nuclear magnetic resonance are limited to 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan).

B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.

2. Reimbursement ratio: town health centers reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.

Third, compensation for serious illness.

Compensation from town risk fund: if the medical expenses of inpatients participating in cooperative medical care exceed 5,000 yuan at one time or for the whole year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan is 65%, and10001-8000 yuan is 75%.

The annual compensation limit of town-level cooperative medical system hospitalization, uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy is 1. 1 ten thousand yuan.

Four, does not belong to the scope of reimbursement of rural cooperative medical insurance.

1. Medical treatment at one's own expense (no designated hospital or referral form), drugs purchased at one's own expense, drugs that cannot be reimbursed according to the regulations of public medical care and medical expenses that do not meet the requirements of family planning;

2, outpatient treatment fees, visits, hospitalization fees, meals, escort fees, nutrition fees, blood transfusion fees (except for family blood storage, according to the relevant provisions of reimbursement), heating and cooling fees, ambulance fees, allowances and other expenses;

3. Medical expenses for car accidents, fights, suicides, alcoholism, industrial accidents and medical accidents;

4. Orthopedics, cosmetic surgery, dental implants, artificial limbs, organ transplantation, roll call surgery fees, consulting fees, etc. ;

5, within the scope of reimbursement, beyond the limit.

legal ground

People's Republic of China (PRC) Social Insurance Law Article 24 The state establishes and improves the new rural cooperative medical system.

Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.