What is the specific proportion of medical insurance reimbursement in different places in Hubei Province? Is everyone clear? Come and have a look today!
1. Large Medicaid for outpatient (emergency) treatment
The maximum payment limit is 5500 yuan; Qifubiaozhun is 800 yuan, an on-the-job employee, 700 yuan, a retiree over 60 and under 70, and 600 yuan, a retiree over 70.
Reimbursement ratio: the reimbursement ratio of tertiary hospitals is 55%; The reimbursement rate of secondary hospitals is 65%; The reimbursement rate of first-class hospitals is 75%.
be hospitalized
Within a medical year, the threshold for first hospitalization is tertiary hospital 1.700 yuan, secondary hospital1.654,38+0.000 yuan, and primary hospital 800 yuan. Secondary and above hospitalization: tertiary hospital 500 yuan, secondary hospital 350 yuan, and primary hospital 270 yuan.
Reimbursement ratio: 85% of employees with a minimum threshold of 55,000 yuan will be reimbursed; Retirees are 90%.
For medical expenses ranging from 55,000 yuan to 6,543.8+0.5 million yuan, the reimbursement ratio of employees and retirees is 80%.
Old workers who took part in the work before the founding of the People's Republic of China were reimbursed 95% in tertiary and secondary hospitals and 97% in primary hospitals.
3. Large medical assistance
The maximum payment limit is 300,000 yuan, and the reimbursement rate for employees and retirees is 80%.
Further reading: Hubei's "universal health insurance" highlights the fair guarantee system
In recent years, with the economic and social development, population mobility has become more and more frequent, and the problems of repeated participation, repeated investment and insufficient treatment in the new rural cooperative medical system and the basic medical insurance system for urban residents have become prominent. In order to break the dual structure of the two systems in terms of payment standards and treatment enjoyment, the State Council issued a document and decided to integrate the basic medical insurance for urban residents and the new rural cooperative medical system to establish a unified basic medical insurance system for urban and rural residents.
A few days ago, the "boots" of integrating urban and rural medical insurance have been put in place all over the country, and Hubei Province, Jiangsu Province, Heilongjiang Province and other places have issued implementation opinions on integrating the medical insurance system for urban and rural residents. At this point, both urban residents and rural residents have become medical insurance participants for urban and rural residents. Within the same overall planning scope, the financing standards are unified and enjoy the same medical reimbursement policy. In the past few days, Changjiang Business Daily reporters have interviewed this.
New rural cooperative medical care and urban residents' medical insurance "merging"
A few days ago, the General Office of the Hubei Provincial Government issued the Opinions on the Implementation of the Basic Medical Insurance System for Urban and Rural Residents. This also means that Hubei's new rural cooperative medical system and residents' medical insurance are officially "binary in one". From March this year 1, all urban and rural residents are included in the coverage of medical insurance for urban and rural residents, and are no longer restricted by household registration.
According to the relevant person in charge of the Hubei Provincial Department of Human Resources and Social Security, due to the independent operation of the new rural cooperative medical system and urban residents' medical insurance, the number of repeated investments in system and system construction is amazing every year. The resulting problems such as poor transfer of medical insurance relationship, repeated participation of floating population, inconsistent settlement standards and inconvenient reimbursement are particularly prominent. These problems can only be solved by the integration of urban and rural medical insurance.
According to the opinions of the Changjiang Business Daily reporter, there is no "binary division" in the identity of Hubei basic medical insurance participants, and both urban residents and rural residents have become medical insurance participants for urban and rural residents. Within the same overall planning scope, it is necessary to unify the financing standards and enjoy equal medical reimbursement policies. Unified by the people's social system, using the same information system.
At the same time, urban and rural residents in Hubei implement the annual payment system, and take the family as the unit to participate in the insurance. The village (community) is responsible for the registration and payment procedures of individual residents. Students in school and children in the park (institute) register and pay fees in the school (park, institute) as a unit. The payment period is from September 1 day of the current year to February 3 1 day of the following year, and the corresponding medical insurance benefits for urban and rural residents are from September 1 day of the current year to February 3 1 day of the following year.
In terms of outpatient treatment, it is clear in the Opinions that outpatient medical insurance treatment for urban and rural residents includes general outpatient treatment and outpatient special chronic disease treatment. All localities in Hubei should reasonably determine the scope and treatment level of outpatient special chronic diseases, and gradually improve the level of outpatient security. The general medical expenses of primary health care institutions will be included in the scope of outpatient payment according to regulations, and daytime surgery will be explored.
After the medical insurance for urban and rural residents is "merged", all localities should reasonably determine the hospitalization Qifubiaozhun and payment ratio of the first, second and third-level medical institutions. Qifubiaozhun for hospitalization is determined in principle according to the proportion of average hospitalization expenses of urban and rural residents insured by medical institutions at the same level in the previous year 10%, and the proportion of hospitalization expenses within the policy scope is kept at around 75%, and the difference of payment proportions of medical institutions at all levels is controlled at around 15%. Gradually narrow the gap between the payment ratio within the scope of the policy and the actual payment ratio. Encourage all localities to reasonably determine the Qifubiaozhun and payment ratio for cross-regional referral hospitalization of insured persons, promote the construction of graded diagnosis and treatment system, and guide patients to seek medical treatment in a reasonable and orderly manner.
The "Opinions" also make it clear that the personal contribution funds required for participating in the insurance will be fully subsidized for the destitute groups, such as destitute dependents, orphans, family members with minimum living security, disabled people who have lost their ability to work, and patients with severe mental disorders. The Hubei Provincial People's Social Security System will also strengthen the medical insurance management service, and strive to realize the direct settlement of the expenses for inter-provincial resettlement of retirees in the first half of this year, and expand it to all those who meet the referral conditions before the end of this year.
In addition, according to the opinion, if either parent of the newborn participates in the basic medical insurance in the province and pays the fee according to the regulations, the newborn can go through the registration formalities at the place where either parent participates in the insurance, exempt from the insurance premium of the current year, enjoy the medical insurance benefits of the current year from the date of birth, and pay the insurance premium as the newborn himself in the following year.
Provide a fair medical security system for rural residents
"I used to participate in the new rural cooperative medical system in my hometown and pay hundreds of dollars a year. After I get sick, I can reimburse more than half of my medical expenses. " Wang Yu, a farmer from Xiantao, Hubei Province, said that after working in Wuhan, the reimbursement rate of the new rural cooperative medical system was not as high as that of his hometown, and some medicines prescribed could not be reported.
In the context of the transfer of rural labor to cities, many migrant workers have encountered this situation. Now, this situation has changed in Hubei.
At the beginning of last year, the State Council issued a document, and decided to integrate the two systems of urban residents' basic medical insurance and new rural cooperative medical care, establish a unified basic medical insurance system for urban and rural residents, and realize the "six unification" of coverage, financing policy, guaranteed treatment, medical insurance catalogue, fixed-point management and fund management.
In the past few days, Changjiang Business Daily reporter interviewed the heads of medical insurance departments of many primary medical institutions in Xianning and Xiaogan, Hubei Province. They all said that the "integration" of urban and rural medical insurance is to provide a fair medical security system for rural residents.
At present, China's medical insurance system has covered more than 95% of the urban and rural population, but the system is not unified. The Changjiang Business Daily reporter learned that the three systems of urban workers' medical insurance, urban residents' medical insurance and the new rural cooperative medical system are in parallel. Among them, employee medical insurance and urban residents' medical insurance are managed by the human and social departments, and the new rural cooperative medical system is managed by the health department.
"After the integration, the medical insurance catalogues of urban and rural residents in various places will be unified into the urban medical insurance catalogue according to the principle of' width is not narrow', and urban and rural residents will no longer be restricted by urban and rural status." The person in charge of the medical insurance department of a top three hospital in Wuhan said.
The reporter learned that after the integration of urban and rural medical insurance system, medical insurance management services have been integrated, the treatment of urban and rural residents has generally improved, and the drug list of the new rural cooperative medical system has been greatly expanded in many areas.
For example, the drug list of the new rural cooperative medical system in Inner Mongolia has increased from 1988 to more than 2,600, an increase of more than 30%, and the actual reimbursement ratio of the new rural cooperative medical system will gradually approach that of urban residents. Hebei Province will integrate the drug list of basic medical insurance for urban residents and the drug list of new rural cooperative medical system according to the principle of "high is not low". There are about 1000 drug catalogues of the new rural cooperative medical system and about 2400 drug catalogues of urban residents. After the integration, the list of basic medical insurance drugs for urban and rural residents can reach about 2900.
"Because there is a big gap between the existing medical insurance for urban residents and the individual payment standards of the new rural cooperative medical system in some areas, we can gradually transition by means of differential payment. Therefore, after the integration of the basic medical insurance system for urban and rural residents, the payment and reimbursement policies in different places will be different according to the actual situation. " Chu Fuling, director of China Social Security Research Center of Central University of Finance and Economics, said.
According to the implementation plan of Hubei, the catalogue of medical insurance drugs, the catalogue of diagnosis and treatment items, the scope of medical service facilities and the catalogue of payment standards for urban and rural residents will be integrated, and provincial management will be implemented, which will be uniformly formulated by the Provincial Department of Human Resources and Social Security in accordance with the principles of "clinical necessity, safety and effectiveness, reasonable price, appropriate technology and affordable funds". At the same time, in accordance with the requirements of "unified fund-raising standards, unified treatment policies, unified handling procedures and unified information systems", medical insurance for urban and rural residents is implemented at the municipal level in accordance with the principles of "budget management, fund adjustment and risk taking". Encourage qualified places to implement unified accounting management of city (state) funds. Municipalities (States) should be combined with the actual situation, clear county (city, district) people's government of urban and rural residents medical insurance responsibility.
In addition, by carrying out outpatient special chronic disease management or implementing single-disease payment, the original new rural cooperative medical system will be included in the pilot diseases of major diseases medical security work and the outpatient severe chronic diseases will be included in the medical insurance management scope of urban and rural residents to ensure that the original treatment will not be reduced.
Many provinces and cities in China have successively promoted the integration of urban and rural basic medical insurance.
It has always been the voice of people to establish a unified basic medical insurance system for urban and rural residents and realize the direct settlement of hospitalization expenses in different places. Last year, Ministry of Human Resources and Social Security issued a notice, proposing to accelerate the integration of urban and rural basic medical insurance, so as to realize the integration plan of all provinces (autonomous regions and municipalities) before the end of 20 16, and establish a unified medical insurance system for urban and rural residents in 20 17.
The Changjiang Business Daily reporter found that by the end of last year, 30 provinces, autonomous regions and municipalities and Xinjiang Production and Construction Corps had issued documents on the integration of medical insurance for urban and rural residents. Among them, Tianjin, Shanghai, Zhejiang, Shandong, Guangdong, Chongqing, Ningxia, Qinghai and Xinjiang production and construction corps established a unified system before the the State Council document was issued. After the the State Council Document was issued, 22 provinces issued new documents to clarify the basic policies of the points system and realize the "six unification".
Earlier this year, Hubei, Guangdong, Heilongjiang and other provinces issued implementation opinions. At present, Guangdong Province will further expand the pilot projects in qualified cities on the basis of this year's pilot experience. By the end of the "Thirteenth Five-Year Plan", an urban-rural integrated medical insurance system with unified coverage, unified financing standards, unified treatment level, unified fund management and unified handling services will be established. The participation rate of basic medical insurance is stable at over 98%. The proportion of payment within the basic insurance policy for employees and urban and rural residents is not less than 80%. The province will achieve full integration in 2020.
In the "Implementation Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents" issued by Heilongjiang Province last month, it is proposed to combine individual contributions with government subsidies to encourage collectives, units or other social and economic organizations to give support or funding. Since 20 17, the local financial burden of basic medical insurance for urban and rural residents has been shared by provinces, cities and counties in a ratio of 6: 4. All localities should consider the needs of urban and rural residents for medical insurance and serious illness insurance as a whole, and reasonably determine the unified financing standards for urban and rural areas in accordance with the principle of fund balance. In areas where there is a big gap between the existing medical insurance for urban residents and the individual payment standard of the new rural cooperative medical system, the difference payment method can be adopted, and it will take 2 to 3 years to gradually transition. The actual per capita financing and individual contributions after integration shall not be lower than the existing level. The individual contributions of the poor are partially subsidized by the medical assistance fund in accordance with regulations.
Many experts pointed out that after the establishment of a unified medical insurance system for urban and rural residents, it is possible to realize the overall use of residents' medical insurance and the new rural cooperative medical fund, which will undoubtedly play a positive role in preventing the overdraft of a certain fund and ensuring the financial security of the fund.
Relevant people are worried that the integration of medical insurance system for urban and rural residents will aggravate the concentration of medical personnel in big cities and hospitals. In this regard, some experts pointed out that it is imperative to establish a perfect and efficient grading diagnosis and treatment model in order to let the people better enjoy basic medical services.