What is the meaning of medical insurance catalog

Article 28 of the Social Insurance Law implemented in 2011 stipulates that medical expenses in accordance with the basic medical insurance drug catalog, diagnostic and treatment items, medical service facilities, and emergency and rescue, shall be paid from the basic medical insurance fund in accordance with state regulations.

In other words, the medical insurance drug catalog, diagnostic and treatment items (medical supplies) catalog, medical service facilities range is what we often call the medical insurance "three directories".

The "three catalogs" of medical insurance clarify the scope of basic medical insurance to ensure that the insured enjoy basic medical protection.

First, the medical insurance drug catalog

National basic medical insurance, industrial injury insurance and maternity insurance drug catalog (referred to as the medical insurance drug catalog) is the basic medical insurance, industrial injury insurance and maternity insurance fund to pay for the standard of drug costs.

Since the establishment of the basic medical insurance system, the former Ministry of Labor and Social Security and the Ministry of Human Resources and Social Security released four versions of the medical insurance drug catalog in 2000, 2004, 2009 and 2017***. At present, the medical insurance drug catalog in use in our province is the 2019 version of the national medical insurance drug catalog.

The Interim Measures for the Administration of Basic Medical Insurance Drugs issued by the National Health Insurance Bureau will come into effect on September 1, 2020, which specifies that the following eight types of drugs are not allowed to be used. The approach makes it clear that the following eight categories of drugs are not included in the "Drug Catalog". 1. the main role of tonic drugs; 2. containing national precious, endangered wildlife and plant medicines; 3. health care medicines; 4. prophylactic vaccines and contraceptives; 5. the main role of the enhancement of sexual function, the treatment of alopecia, weight loss, cosmetology, smoking cessation, cessation of alcohol and other effects of the drug; 6. due to the inclusion of diagnostic and treatment programs, can not be charged separately Drugs; 7. Wine preparations, tea preparations, all kinds of fruit preparations (except for children's medicines in special circumstances), oral containing agent and oral effervescent (except for special circumstances), etc.; 8. Other medicines do not meet the basic medical insurance drug regulations.

Second, diagnostic and treatment items (medical supplies) catalog

1. Diagnostic and treatment items catalog

The scope of the diagnostic and treatment items for which the state stipulates that no fees are to be paid and part of the fees are to be paid. Our province to adopt the access method to develop a catalog of diagnostic and treatment items, the coordinating area can develop a specific out-of-pocket expenses.

Medical insurance does not pay the cost of the scope of treatment items: (1) service items: registration fees, out-of-hospital consultation fees, medical records fees, consultation fees, examination and treatment of expedited fees, name surgery surcharge, quality premiums, special nurses and other special medical services. (2) Diagnostic and treatment equipment and medical materials: the application of positron emission tomography device (PET), electron beam CT, ophthalmic excimer laser treatment instrument and other large-scale medical equipment for the examination, treatment programs; glasses, dentures, prosthetic eyes, prosthetic limbs, hearing aids and other rehabilitation devices; a variety of self-use health care, massage, inspection and treatment equipment; the provincial price departments can not be charged for the provision of disposable medical materials. (3) Non-disposable medical materials. (3) non-disease treatment programs: a variety of beauty, fitness programs and non-functional plastic surgery, orthopedic surgery, etc.; a variety of weight loss, weight gain, height projects; a variety of health checkups; a variety of preventive, health care diagnostic and therapeutic programs; a variety of medical consultation, medical appraisal. (4) Therapeutic items: organ or tissue source for all kinds of organ or tissue transplants; organ or tissue transplants other than kidney, heart valve, cornea, skin, blood vessel, bone and bone marrow transplants; myopic orthopedic surgery; qigong therapy, music therapy, health care nutritional therapy, magnetic therapy and other auxiliary therapeutic items. (5) Other: a variety of infertility (pregnancy), sexual dysfunction diagnosis and treatment program; a variety of scientific research, clinical verification of the diagnosis and treatment program.

Medical insurance to pay part of the cost of diagnostic and treatment projects range: (1) diagnostic and treatment equipment and medical materials: the application of χ-ray computed tomography device (CT), stereotactic radiography (γ-knife, χ-knife), cardiac and angiographic χ-ray machine (including digital subtraction equipment), magnetic **** vibration imaging device (MRI), single-photon emission computerized scanning device SPECT), Color Doppler, medical linear gas pedal and other large medical equipment for examination, treatment projects; extracorporeal shock wave lithotripsy and hyperbaric oxygen therapy; pacemakers, artificial joints, artificial crystals, vascular scaffolds, such as the body replacement of artificial organs, the body of the material placed; the provincial pricing departments can be charged separately for the disposable medical materials. (2) Treatment items: hemodialysis, peritoneal dialysis; kidney, heart valves, cornea, skin, blood vessels, bone, bone marrow transplantation; cardiac laser perforation, anti-tumor cellular immunotherapy and fast neutron therapy projects. (3) Provincial health insurance management department stipulates the price of expensive medical instruments and equipment for examination, treatment programs and medical materials.

2. Medical consumables catalog

Medical institutions can be charged separately for more than 600 medical consumables, of which about 360 are included in the medical insurance payment. Not included are mainly orthopedic, plastic, transplantation and other non-basic medical supplies.

Medical institutions can not be charged separately for medical supplies, are not allowed to charge the patient, does not involve health insurance payments: conventional devices and low-value medical consumables, (such as disposable sterile towels, disinfectant drugs, rinse saline, general sutures, dressings, etc.) in the pricing has been included in the cost of medical services to consider, are not separately priced. Test reagents.

Medical institutions can charge patients for consumables: interventional vascular use of guide wires, catheters, balloons, stents, filters, etc.; special medical consumables required in the operation, such as special puncture needles, ablation electrodes, ablation needles and accessories, special guide wires, catheters, stents, balloons, titanium clips, titanium ding, titanium plates, dilators, anastomoses, sutures, fixators; IOL, pacemakers, artificial joints and so on.

3. Scope of medical service facilities

Medical service facilities refer to the living service facilities provided by the designated medical institutions, which are necessary for the participants in the process of diagnosis, treatment and care.

The cost of medical service facilities mainly includes the cost of inpatient beds and outpatient observation beds. The basic medical insurance does not pay for the daily necessities and water, electricity and other costs that have been included in the inpatient bed charge or outpatient observation bed charge, and the designated medical institution shall not charge the insured person separately.

Medical service facilities using the exclusion method to provide for non-payment of living services and service facilities cost range.

Provinces set the medical service facilities catalog, and each coordinating area set the payment standards.

The basic medical insurance fund does not pay the cost of living services and services and facilities mainly include: (1) consultation (referral) transportation costs, emergency ambulance fees; (2) air-conditioning costs, television costs, telephone charges, baby warming box costs, food warming box costs, electric stove costs, refrigerator costs and compensation for damage to public property; (3) escort costs, nursing costs, cleaning costs, outpatient decoctions costs; (4) meals; (5) Recreational activities and other special living services.