Legal analysis:
The reimbursement of the new rural cooperative medical system can be mainly divided into three categories: outpatient reimbursement, hospitalization reimbursement and serious illness reimbursement. The reimbursement ratio of the three categories is as follows:
1. The reimbursement ratio of the new rural cooperative medical system outpatient reimbursement
1. The reimbursement ratio of village clinics and health centers is 6%;
2. The reimbursement rate of township hospitals is 4%;
3. The proportion of small stroke in secondary hospitals is 3%;
4. The reimbursement rate of tertiary hospitals is 2%;
5. The reimbursement limit for township-level cooperative medical clinics is 5, yuan/year.
Second, the proportion of reimbursement for hospitalization of the new rural cooperative medical system
1. The supplementary examination items such as new electroencephalogram, X-ray fluoroscopy, filming, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance imaging are reimbursed to 2 yuan;
2. The deductible line of operation expenses shall be reimbursed according to national standards in 1 yuan, and it shall be reimbursed according to 1 yuan if it exceeds 1 yuan;
3. The hospitalization expenses and nursing expenses of the elderly over 6 years old can be reimbursed to 1 yuan every day, with a limit of 2 yuan;
4. The reimbursement rate of hospitals at all levels is: town hospitals reimburse 6%; 4% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 3%.
Third, the proportion of reimbursement for serious illness of the new rural cooperative medical system
1. The proportion of township and village subsidies for outpatient co-ordination increased to 65% and 75% respectively.
2. If the hospitalization expenses of first-class medical institutions are below 4 yuan, there is no deductible line;
3. The subsidy ratio of secondary medical institutions will be increased to 75%~8%;
4. The subsidy ratio of tertiary medical institutions will be increased to 55%~6%.
5. The subsidy ratio of provincial tertiary medical institutions will be increased to 55%.
6. The quota of subsidized diseases of the new rural cooperative medical system is 7% for 8 kinds of serious diseases such as congenital heart disease in children, and 7% for 12 kinds of serious diseases such as lung cancer.
Legal basis:
Reimbursement scope of the new rural cooperative medical system
Reimbursement scope:
A. Drug expenses: auxiliary examination expenses such as ECG, X-ray fluoroscopy, filming, laboratory tests, physiotherapy, acupuncture, CT and nuclear magnetic resonance imaging, limited to 2 yuan; Operation expenses (refer to national standards, and those exceeding 1 yuan will be reimbursed by 1 yuan).
B, the elderly over 6 years old are hospitalized in the town health center, and the treatment and nursing expenses are compensated to 1 yuan every day, with a limit of 2 yuan.
reimbursement ratio: 6% for town hospitals; 4% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 3%.
compensation for serious illness
compensation from the town's risk fund: all inpatients who participate in the cooperative medical care system should be compensated by stages if their accumulated medical expenses exceed 5, yuan at one time or throughout the year, that is, 65% for 5,1-1, yuan and 7% for 1,1-18, yuan.
The annual compensation limit for hospitalization and uremia outpatient hemodialysis and tumor outpatient radiotherapy and chemotherapy in town-level cooperative medical system is 11, yuan.
The special diseases reimbursed by the new rural cooperative medical fund are: chemotherapy and radiotherapy for malignant tumors; Hemodialysis and peritoneal dialysis of severe uremia; Anti-rejection therapy after tissue or organ transplantation; Schizophrenia with mental decline; Systemic lupus erythematosus (one of complications of heart, lung, kidney, liver and nervous system); Aplastic anemia; Anticoagulation therapy after cardiac surgery. The rest of the special diseases that can be reimbursed shall be subject to local specific policies.
Specific outpatient treatment for special diseases includes necessary supportive therapy and symptomatic treatment of systemic and local reactions during treatment, while general adjuvant therapy is not included in the reimbursement scope.