First, the outpatient co-ordination fund is included in the municipal budget. In 2022, Dalian incorporated the outpatient co-ordination fund into the municipal budget, realizing the merger of urban and rural residents' medical insurance and employee medical insurance outpatient co-ordination fund. This means that the management of outpatient co-ordination fund is more standardized and transparent, and the use efficiency is more optimized. Second, the proportion of reimbursement for outpatient expenses has increased. Since June 65438+ 10/day, 2023, the reimbursement rate of medical insurance outpatient expenses for employees in Dalian has increased from 50% to 60%, and the maximum reimbursement amount remains unchanged. This will effectively reduce the burden of medical expenses for employees and improve medical insurance benefits. Third, the deductible is reduced. Since June 65438+1 October1day in 2023, the deductible line of medical insurance outpatient service for employees in Dalian has been reduced from the original 200 yuan to 150 yuan, and the deductible line for employees who enjoy outpatient treatment for key groups has been reduced from 100 yuan to 75 yuan. This move will help improve the medical insurance benefits of low-income workers. Four. Classification management of outpatient reimbursement for new drugs Since June 65438+1 October1day, outpatient reimbursement in Dalian has been subject to drug classification management. According to the safety, efficacy and price of drugs, drugs are divided into three categories and eight grades. The reimbursement rates for staff outpatient service are 70%, 60% and 50% respectively. This will guide patients to choose more economical and applicable drugs and promote the healthy development of the drug market.
After the Dalian outpatient co-ordination fund is included in the fiscal budget, will the increase in the reimbursement ratio of outpatient expenses cause economic pressure on the medical insurance fund? The increase in the reimbursement rate of outpatient expenses will indeed increase the burden on the medical insurance fund, but at the same time, the reduction of the deductible line and the implementation of drug classification management will also effectively control the expenditure of medical expenses, thus alleviating the pressure on the medical insurance fund. In addition, Dalian will strengthen the price management of medical services, standardize the charging behavior of hospitals, optimize the payment methods of medical insurance and other measures to further improve the efficiency of the use of medical insurance funds.
The recent changes in outpatient reimbursement treatment of four employees in Dalian will effectively improve citizens' medical insurance treatment and promote the development of medical care. Employees should apply for outpatient reimbursement through formal channels, rationally choose medicines and medical services, and maximize the benefits of reimbursement.
Legal basis:
People's Republic of China (PRC) Social Insurance Law Article 4 Employers and individuals in People's Republic of China (PRC) pay social insurance premiums according to law, and have the right to inquire about payment records and personal rights and interests records, and require social insurance agencies to provide social insurance consultation and other related services. Individuals enjoy social insurance benefits according to law and have the right to supervise the payment of their own units.