Legal analysis: Reimbursement ratio: At present, domestic drug stents are material expenses, and are generally included in the scope of medical insurance reimbursement at 50%.
Other expenses, such as hospitalization surgery and medical expenses, will be reimbursed at 85%-90% according to the regulations of medical insurance.
Expand explanation: Stent surgery performed in other places can still be reimbursed.
Generally, county-level hospitals reimburse 40%, municipal-level hospitals reimburse 35%, and provincial-level hospitals reimburse 30%.
In addition, the number of stents that can be reimbursed is determined based on about four times the average salary of employees in the city in the previous year.
Legal basis: "Opinions of the National Medical Security Administration on Supporting Measures for Nationally Organized Centralized Procurement and Use of Coronary Stents" (1) Standardize the platform's network connection and distribution work.
The selected products from the centralized procurement of coronary stents are listed on the provincial pharmaceutical centralized procurement platforms at the selected price. Medical institutions purchase them at the selected price and patients use them at the selected price.
For coronary stents other than the selected products, we must follow the principle of matching performance with price, consider a reasonable price comparison with the selected products, and guide and encourage relevant companies to adjust their prices to a reasonable level.
Provincial medical insurance departments must strictly implement the requirement that the selected companies independently select the distribution companies for the selected products.
It is necessary to strengthen the connection between supply and demand parties to ensure that the selected enterprises establish distribution relationships with all contracted purchasing medical institutions, deliver goods in time, and ensure use.
(2) Implement the policy of prepayment of medical insurance funds.
The medical insurance department in each coordinating region shall calculate the agreed purchase amount of each selected product based on the selected price of the selected product, the purchased products and quantities agreed between each medical institution and the enterprise.
Based on the total budget management of the medical insurance fund, a prepayment mechanism is established. After the medical institution signs a purchase agreement with the selected enterprise, the medical insurance fund is prepaid to the medical institution at no less than 30% of the annual agreed purchase amount, and the medical institution and the enterprise are required to settle the settlement in a timely manner.
The settlement time shall not exceed the end of the next month after the delivery acceptance is passed.
On the premise of implementing the main responsibility for payment of medical institutions, encourage medical insurance agencies or purchasing agencies to settle directly with enterprises.
Provincial medical insurance departments should monitor and supervise the implementation of prepayment policies and the collection of payments by medical institutions.