Reimbursement ratio for special chronic diseases

At present, my country does not have a nationally unified reimbursement ratio for chronic special diseases. The approximate range is 70%-90% for employee medical insurance and 50%-80% for resident medical insurance (including New Rural Cooperative Medical System). The specific amount will fluctuate according to the policy of the insured area, the type of disease, the level of the medical institution, and whether it is registered.

Speaking of which, the special disease reimbursement policy is like home-cooked dishes in various places. The main ingredients are supported by the medical insurance co-ordination fund, but how much ingredients are used and whether the taste is salty or not depends on the local fund plate and the direction of insurance. In the past two years, I have helped the elderly at home and friends around me to register and reimburse special diseases seven or eight times. The most intuitive feeling is that the proportion on paper falls on everyone, and the difference is really big. Last winter, I helped someone who lived in a county in northern Guangdong. Oh, by the way, there are still many people who confuse the reimbursement logic of general outpatient clinics and special diseases. I met an aunt at the medical insurance bureau before. She had high blood pressure of level 3 and had been treated for special diseases for a long time.

My aunt pays RMB 350 per year for residents' medical insurance in a county in northern Guangdong. After registering for a special disease of level 3 hypertension, she can get 80% reimbursement for antihypertensive drugs at the town health center, but it drops to 65% when she goes to the county people's hospital. If she goes to a tertiary hospital in Guangzhou to get medicine, she can only reimburse 70%? No, 55%. She also has to register for special diseases in other places in advance. Without registration, she really can't reimburse her at all. My colleagues in Beijing are covered by employee medical insurance, and 90% of the special cases of diabetes are directly covered when taking medicines from community hospitals. The out-of-pocket cost of more than 800 medicines per month is only 80, which is almost no burden.

Of course, not all diseases fall within this range. For high-cost treatments such as radiotherapy, chemotherapy and uremic dialysis for malignant tumors, most areas will provide separate rates. Regardless of the level of the institution, the reimbursement rate can be more than 80%. The reimbursement rate for subsistence allowances and extremely poor people can be increased by another 10%-20%. Some places even directly waive the deductible or cap for such diseases.

I had a conversation with a friend in the medical insurance system about the issue of inconsistent proportions, and he complained that the two voices were now very loud. Many patients and experts have called for national co-ordination to be implemented as soon as possible to equalize reimbursement ratios across regions. Otherwise, 90% of the same disease can be reimbursed in Shanghai, but only 50% can be reimbursed in the central and western counties. This is too unfair to patients in underdeveloped areas. ； However, from the perspective of managers, the stock of medical insurance funds in various regions varies too much. If the ratio is forcibly unified, everyone will have objections to the reduction of benefits in developed areas, or the funds in underdeveloped areas will directly "undercut". In the end, the protection of some diseases may be cut off, which is not worth the loss. The current reimbursement for special diseases in other places is also a problem. In most areas, the reimbursement ratio for medical treatment in other places is 10%-20% lower than that in the insured place. People complain a lot. But if the ratio is equal to the ratio directly to the place of medical treatment, and they all go to big hospitals to prescribe expensive medicines, the funds in small places really cannot bear it.

Oh, by the way, the policies in the past two years have also been moving towards unification. More than a dozen provinces have achieved the same proportion of reimbursement for provincial-specific diseases, and direct inter-provincial settlement of outpatient chronic diseases is also being promoted. Last year, I helped my dad register for special diseases in other places. He was recovering from chronic obstructive pulmonary disease in a hospital in Shenzhen. He directly swiped his hometown's medical insurance card to settle the bill and claimed 65%. In the past, he had to advance money to reimburse himself, which took more than half a month.

If you or a family member have just been diagnosed with a special disease, don’t be too troublesome. Go to the official account or service window of the local medical insurance bureau to ask three things clearly: what is the reimbursement ratio for your disease, what are the designated institutions, and whether you need to review it every year. Don’t wait until you get the medicine to find out that you stepped on a trap and spent money in vain. To be honest, there are still many imperfections in the current ratio, but the expansion of disease types and improvement of ratios in the past two years have been really slow. Maybe in three to five years, everyone will get the same treatment for the same disease, no matter where they are.