The proportion of overall payment refers to the proportion between the medical expenses paid by the medical insurance overall fund and the medical expenses paid by the patients themselves. The specific calculation formula is: the amount paid by the overall fund divided by the total hospitalization expenses-the amount of Class B drugs, etc. -Self-funded item amount-Qifubiaozhun-medical expenses outside medical insurance) times 100%. Among them, the medical expenses other than Class B drugs and medical insurance need to be calculated according to a certain proportion or standard. The proportion of overall payment refers to the proportion between the medical expenses paid by the medical insurance overall fund and the medical expenses paid by the patients themselves. The specific calculation method is as follows:

Overall fund payment amount = (medical expenses-out-of-pocket expenses-Qifubiaozhun) × reimbursement ratio

Among them, medical expenses are all medical expenses of patients during hospitalization, including examination fees, treatment fees, medicine fees, etc. Out-of-pocket expenses are the expenses that patients need to bear, such as special inspection fees and imported drugs. Out-of-pocket expenses are part of the scope of medical insurance, which are borne by patients according to a certain proportion, and the proportion varies according to different medical insurance policies; Qifubiaozhun is the minimum standard for medical insurance fund payment, and only the part that exceeds Qifubiaozhun can be reimbursed.

To sum up:

The calculation method of overall payment ratio needs to be calculated according to the specific medical expenses. It is necessary to determine the amount of class B drugs and medical expenses other than medical insurance first, and then calculate according to the formula.

Legal basis:

Article 26 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the treatment standards of basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.

Article 28 of the Social Insurance Law of People's Republic of China (PRC) stipulates that medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.

Article 29 of the Social Insurance Law of People's Republic of China (PRC) stipulates that the part of the medical expenses of the insured that should be paid by the basic medical insurance fund shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units. The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.