outpatient co-ordination treatment. Qifubiaozhun 2 yuan, the outpatient (emergency) medical expenses occurred in a treatment year, 5% of which are paid by the fund in community medical institutions, 3% of which are paid by the fund in non-community medical institutions, and the annual fund payment limit is 3 yuan. The proportion of fund payment for elderly residents over 8 years old will increase by 5 percentage points on the basis of the above payment ratio, and the annual fund payment limit will increase by 1%.

the outpatient department shall set up the qifubiaozhun and the maximum payment limit as a whole. When the insured uses Class B drugs and medical services in the outpatient department, they should first pay according to the prescribed proportion, and then enjoy the relevant treatment according to the following provisions.

in a natural year, the medical expenses incurred by the insured in the outpatient clinic that meet the requirements of basic medical insurance, and the expenses below the minimum threshold shall be paid by the insured's personal account or cash; The expenses above Qifubiaozhun and below the maximum payment limit shall be shared by the overall fund and individual.

The outpatient department shall implement the first consultation and referral system with community health service institutions as the main body. The insured can make the first diagnosis in the designated community health service institutions of the basic medical insurance for urban workers or refer to the medical institutions managed by the community; Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs to be referred, the first-visit medical institution shall be responsible for the referral, and emergency treatment and rescue are not subject to this restriction. After the outpatient chronic disease subsidy limit is used up, it will be included in the outpatient overall settlement from the next expense, and there is no need for referral for chronic diseases in the original door. After the outpatient specific project subsidy limit is used up, you must go through the referral procedures according to the provisions of outpatient co-ordination and use ordinary medical records before you can enjoy the outpatient co-ordination treatment. Buying drugs in pharmacies does not enjoy the overall treatment of outpatient service.

In a natural year, the insured person's outpatient department will co-ordinate the medical expenses that meet the requirements, and the expenses below Qifubiaozhun will be paid by the insured person; The expenses above Qifubiaozhun and below the maximum payment limit shall be shared by the overall fund and individual.

what is the outpatient co-ordination process?

the insured can make the first visit in the designated community health service institutions of urban workers' basic medical insurance or refer to the medical institutions managed by the community (secondary and below medical institutions).

Specialized hospitals can be used as the first medical institutions for all insured persons. If the insured person needs to be referred, the first-visit medical institution shall be responsible for the referral (see the table below for the list of referral hospitals), and emergency treatment and rescue are not subject to this restriction.

Legal basis

The Guiding Opinions of the General Office of the State Council on Establishing and Perfecting the Security Mechanism for Outpatients with Basic Medical Insurance for Employees

Article 3 strengthens the security function of outpatient clinics. Establish and improve the overall guarantee mechanism for the general outpatient expenses of employee medical insurance, and gradually include the general outpatient expenses of frequently-occurring diseases and common diseases into the payment scope of the overall fund on the basis of doing a good job in the medical security work for chronic diseases and special diseases (hereinafter referred to as chronic and special diseases in outpatient clinics) with heavy burdens on the masses such as hypertension and diabetes. The general outpatient service covers all the insured employees in medical insurance as a whole, and the proportion of payment within the policy scope starts from 5%. With the strengthening of the affordability of medical insurance funds, the level of protection is gradually improved, and the payment of benefits can be appropriately tilted towards retirees. According to the characteristics of outpatient medical service, scientifically calculate the minimum payment standard and maximum payment limit, and make a good connection with the hospitalization expense payment policy. Simultaneously improve the outpatient co-ordination of basic medical insurance for urban and rural residents, and gradually improve the level of protection.

according to the affordability of the medical insurance fund, the scope of outpatient chronic and special diseases paid by the overall fund will be gradually expanded, and some outpatient expenses of diseases with long treatment cycle, great harm to health and heavy cost burden will be included in the * * * economic security, and some special treatments that are suitable for outpatient service and more economical and convenient than hospitalization can be managed with reference to hospitalization treatment. Constantly improve the outpatient service * * * economic security mechanism, and gradually transition from disease protection to cost protection. Will meet the conditions of the designated retail pharmacies to provide medication security services into the scope of outpatient services, support the settlement and dispensing of external prescriptions in designated retail pharmacies, and give full play to the convenience and accessibility of designated retail pharmacies. Explore the inclusion of qualified "internet plus" medical services in the scope of protection.