I. What is the basic medical insurance Diagnostic and treatment items The basic medical insurance diagnostic and treatment items refer to the following conditions of the various medical technical labor projects and the use of medical instruments, equipment and medical materials for diagnosis and treatment projects: (a) Clinical and diagnostic necessity, safe and effective diagnostic and treatment items at an appropriate cost; (b) by the price department has set the fee standard for diagnostic and treatment items; (c) by the designated medical institutions for the insured within the scope of medical services; (d) by the medical institutions to provide medical services to the participants. (c) Diagnostic and therapeutic items within the scope of medical services provided by the designated medical institutions for the insured. Second, the basic medical insurance medical treatment program should have what conditions (a) clear scope of the diagnosis and treatment program. In the clinical medical services, and diagnosis and treatment-related services are very much, but not all medical services are diagnostic and treatment programs. According to this definition, the diagnosis and treatment project refers to the medical technology labor project, such as the embodiment of medical labor diagnosis and treatment fee, surgery fee, anesthesia fee, laboratory fee, etc., the embodiment of nursing labor nursing fee, injection fee, etc., but does not include some non-medical labor, such as nursing, catering and other life services. Secondly, it refers to diagnostic and therapeutic projects using medical instruments, equipment and medical materials, such as laboratory instruments related to testing, diagnostic equipment such as ultrasound, CT, etc., and medical materials such as all kinds of fluids, catheters, artificial organs, etc. Some non-diagnostic and therapeutic instruments, equipment and materials do not belong to the scope of diagnostic and therapeutic projects, such as instruments and equipment used for hospital management and service facilities to improve the living environment. (b) Determine the basic medical insurance treatment program should have three conditions: 1, clinically necessary, safe and effective, appropriate cost of treatment program. Clinically necessary, that is, the clinical treatment of disease is necessary, is relative to non-disease treatment of diagnosis and treatment programs, such as cosmetic surgery, etc., as well as the main diagnostic and treatment means of disease treatment is relative to the auxiliary diagnostic and treatment means, such as music therapy, etc.. Safe and effective refers to mature items that have been widely recognized through long-term clinical use, as opposed to some diagnostic and therapeutic measures that are still in the research stage and whose efficacy is not certain, such as heart, lung and brain transplants. Appropriate cost means that the cost should be commensurate with the ability of the basic medical insurance fund to pay. Among the diagnostic and treatment programs with the same diagnostic and treatment effects, the reasonably priced diagnostic and treatment programs are selected. 2. Diagnostic and treatment programs for which the price department has set the fee standard. This is based on the current situation that the management of diagnostic and therapeutic programs is mainly determined by the pricing department. There are many kinds of diagnosis and treatment programs, different levels of economic development, different levels of medical technology, and the diagnosis and treatment programs that meet the conditions of the first can not be carried out in all provinces (autonomous regions and municipalities), according to the price department's charging standards, it is possible to set the diagnosis and treatment programs of the basic medical insurance in a clear range. 3. The diagnostic and treatment items within the scope of medical services provided by the designated medical institutions for the insured. Basic medical insurance implements the management of designated medical institutions, and only the various diagnostic and therapeutic items provided by designated medical institutions determined by the social insurance administration organization can be included in the scope of payment by the basic medical insurance fund. Diagnostic and treatment items provided by non-designated medical institutions will not be paid by the basic medical insurance fund. This condition is a condition that the coordinating area will control when the fund pays out, and it is also a means of rationally planning health resources from the point of view of medical insurance.
Legal Objective:Article 28 of the Law of the People's Republic of China on Social Insurance conforms to the standards of the basic medical insurance drug catalog, diagnostic and therapeutic items, medical service facilities, as well as the medical expenses for emergency treatment and rescue, and shall be paid out of the basic medical insurance fund in accordance with state regulations. Article 1 of the Circular on the Issuance of Opinions on the Management of Diagnostic and Treatment Items, Scope of Medical Service Facilities and Payment Standards of Basic Medical Insurance for Urban Workers Article 1 Basic medical insurance diagnostic and treatment items refer to diagnostic and therapeutic items that comply with the following conditions and are carried out with various kinds of medical technical labor items as well as with the use of medical instruments, equipment and medical materials (b) by the price department set the standard charges for diagnostic and treatment items; (c) by the designated medical institutions for the insured to provide designated medical services range of diagnostic and treatment items.