among the payment methods of medical insurance, the prepayment system mainly includes the total prepayment system, payment by service unit, payment by head and payment by disease.

the total budget of a designated medical institution for one year can also be the total budget for the first quarter after consultation between the medical insurance institution and the designated medical institution. When the medical insurance institution pays the medical expenses of the designated medical institution, regardless of the actual medical expenses, it takes this budget as the maximum payment limit to control the payment compulsorily, and the designated medical institution must provide the prescribed medical services to all insured persons within the insurance scope.

medical insurance institutions pay the daily expenses of inpatients according to the pre-determined daily expenses standard of inpatient beds, and pay the expenses of outpatients according to the budget standard of each time. All patients in the same hospital pay the same and fixed daily hospitalization or outpatient fees, regardless of the actual cost of each patient's daily or each treatment.

It is also called average fixed payment. First, the medical insurance institution sets the reimbursement standard for each outpatient or inpatient, and then the medical insurance institution pays the medical expenses to the hospital according to the actual service provided by the hospital. This payment method is also a kind of prepayment system, and the income of the hospital increases with the increase of the number of patients. Also known as the fixed prepayment system according to the classification of diseases, according to the international classification standard of diseases, the inpatients' diseases are divided into several groups according to the diagnosis, and the different levels are priced separately, and they are paid to the hospital in one lump sum at this price.

Legal Basis

Social Insurance Law of the People's Republic of China

Article 2 The state establishes social insurance systems such as basic old-age insurance, basic medical insurance, work injury insurance, unemployment insurance and maternity insurance to protect citizens' rights to receive material assistance from the state and society in case of old age, illness, work injury, unemployment and maternity. Thirtieth the following medical expenses are not included in the scope of payment of the basic medical insurance fund:

(a) should be paid from the industrial injury insurance fund;

(2) It shall be borne by a third party;

(3) It shall be borne by public health;

(4) seeking medical treatment abroad.

the medical expenses shall be borne by the third party according to law. if the third party fails to pay or cannot determine the third party, the basic medical insurance fund shall pay in advance. After the basic medical insurance fund has paid in advance, it has the right to recover from the third party.