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Compensation plan
The city continues to implement a compensation model that combines outpatient coordination and inpatient coordination.
(A) Outpatient compensation program
1, general outpatient compensation. General outpatient compensation payment is limited to the use of village and township level medical institutions. Village-level New Rural Cooperative designated medical institutions outpatient compensation ratio of 80%, the ceiling line of 25 yuan, to the family as a unit *** with the use; township health centers compensation ratio of 50%, the cumulative compensation ceiling line of 200 yuan per capita per year.
2, chronic disease outpatient cost compensation. Hypertension III, diabetes, mental illness and other chronic diseases patients to the designated medical institutions outpatient clinic, the medical expenses incurred in accordance with the corresponding hospital inpatient reimbursement ratio reimbursement, reimbursement of the cost of the annual cumulative limit of 6,000 yuan. The determination of chronic diseases must be based on the diagnosis issued by a municipal level 2 or above medical institution. For malignant tumor radiotherapy (chemotherapy) and kidney failure dialysis to outpatient clinics of designated medical institutions, the medical expenses incurred are reimbursed in accordance with the reimbursement ratio for inpatient hospitalization in the corresponding hospital.
(2) hospitalization reimbursement
New rural cooperative hospitalized patients with medical reimbursement of 30,000 yuan (including), the implementation of zero starting line, graded and segmented proportional compensation method.
1, hospitalization reimbursement ratio
In township hospitals, up to 500 yuan reimbursement at a rate of 40%, 501 yuan - 2000 yuan reimbursement at a rate of 80%, more than 2001 yuan reimbursement at a rate of 60%.
Hospitalization at county-level designated medical institutions is reimbursed at 40% up to RMB 1,000, 65% from RMB 1,001 to RMB 4,000, and 50% from RMB 4,001 and above. The First People's Hospital of Dawa County and the First People's Hospital of Panshan County are pilot units of public hospital reform, and the reimbursement rate for the corresponding section has been increased by 5 percentage points (from the date of the implementation of the zero-differential rate sales of basic drugs).
Hospitalization in municipal designated medical institutions will be reimbursed at a rate of 40% for hospitalization up to RMB 1,500, 55% for hospitalization between RMB 1,501 and RMB 5,000, and 40% for hospitalization above RMB 5,001.
Hospitalization in hospitals above the municipal level will be reimbursed at a rate of 30% up to RMB 10,000 and 40% above RMB 10,000.
2. Compensation for Major Diseases (25 types)
Comprehensively promoting children's leukemia, congenital heart disease, end-stage renal disease, women's breast cancer, cervical cancer, severe mental illness, HIV opportunistic infections, multidrug-resistant tuberculosis, hemophilia, chronic granulocytic leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, acute cerebral infarction, colorectal cancer, rectal cancer, and other cancers.
Children with leukemia, congenital heart disease, end-stage renal disease, women's breast cancer, cervical cancer, AIDS opportunistic infections, multidrug-resistant tuberculosis, chronic granulocytic leukemia, cleft lip and palate, hypospadias, the scope of the designated medical institutions of the 10 diseases for the province, the city, the county three levels of the New Farmers' Cooperative designated health care institutions; hemophilia, lung cancer, esophageal cancer, stomach cancer, rectal cancer, colon cancer, pancreatic cancer, lupus erythematosus Payment is made on a per-bed-day basis.
Medical expenses incurred within the scope and limit of payment of the NPC (see Annex 1 for details) at the designated medical institutions of the NPC upon referral are compensated at a rate of 70%, while expenses above the limit are compensated at the same rate as those incurred at designated medical institutions of the same level.
3. Reimbursement ratio for traditional Chinese medicine and infectious diseases
The Chinese medicinal preparations, Chinese medicinal tablets, and Chinese therapeutic techniques required for the treatment of hospitalized patients in Chinese medicine hospitals at the city and county levels will be reimbursed at a rate of 70%, and the medical expenses other than these will be reimbursed in accordance with the reimbursement ratio for hospitalization in hospitals of the corresponding level.
The medical expenses incurred by infectious disease patients hospitalized in municipal infectious disease hospitals and municipal and county-level tuberculosis prevention and treatment institutes are reimbursed at a rate of 70%; medical expenses incurred by non-infectious disease patients hospitalized in municipal infectious disease hospitals and non-infectious disease patients undergoing non-infectious disease treatment are reimbursed in accordance with the inpatient reimbursement rate of the hospital at the corresponding level.
4. Subsidies for hospitalized deliveries
The standard for maternal subsidies for hospitalized deliveries is 500 yuan per case.
5. If a rural low-income household, marginal low-income household, three-no and five-guarantee household with special difficulties suffers from a major disease, the hospitalization (including outpatient treatment of major illnesses) treatment costs will be reimbursed at a rate of 90%, and the special difficulties will be managed under the real-name system.
6, accidental injuries, traffic accidents without responsibility, the hospitalization expenses incurred, the reimbursement rate of 30%, the ceiling line of 20,000 yuan, the New Agricultural Cooperative designated medical institutions will not be advanced, by the patient himself (or family members) with the relevant formalities to the county (district) of the New Agricultural Cooperative Management Office for reimbursement.
7, the drug catalog and diagnostic and treatment items
County (district) level and the county below the designated medical institutions to implement the "Liaoning Province, the new rural cooperative medical drug catalog" (including the national basic drug list and the provincial supplemental list of basic medicines) and the "Liaoning Province, the scope of the new rural cooperative medical treatment items", the municipal and municipal level and above the implementation of designated health care institutions of the "Liaoning Provincial Basic Medical Insurance, The designated medical institutions at the municipal level and above carry out the "Liaoning Provincial Basic Medical Insurance, Worker's Compensation Insurance and Maternity Insurance Drug Catalog" and the "Liaoning Provincial Basic Medical Insurance Diagnosis and Treatment and Medical Service Facilities Catalogue".
For more details, please refer to Panjin New Rural Cooperative Medical Care Guidelines 2015
.