The medical insurance catalog is the range of expenses that can be reimbursed with basic medical insurance as stipulated by the National Health Insurance Bureau (NHIB), a **** consisting of three parts: medicines, diagnostic and therapeutic items, and standards of healthcare services and facilities.
The NHI regularly adjusts the health insurance catalog according to the actual needs of the nation, for example, 85 medicines were adjusted in FY2021; taking into account the impact of the epidemic, items related to the new crown test and treatment were also included in the scope of health insurance payment.
II. Drug Catalog
Currently, there are 2,860 drugs*** in the Medicare drug catalog, which are divided into two types according to the reimbursement method:
Category A drugs
Necessary for clinical treatment, widely used, with good therapeutic effect, and with relatively low price or treatment cost among the same kind of drugs. When using this type of drug, the cost of the drug is fully reimbursed at the rate specified by the medical insurance, and there are currently 641 types of ****.
2. Class B drugs
Clinical treatment can be chosen to use, the efficacy of the exact, in the same class of drugs in the price or treatment costs slightly higher. When using these drugs, we have to pay a certain percentage out-of-pocket first, and then reimbursement will be made according to the percentage set by the health insurance. The percentage of out-of-pocket payment is set by the provincial and municipal health insurance bureaus, and there are currently 2,219 of them ****.
Note: Drugs outside the medical insurance drug list, often called "Class C drugs", are paid for by the individual, and there are currently 151,523 of them.
Statistical table of drug reimbursement methods
Third, diagnostic and treatment items catalog
Diagnostic and treatment items refer to the technical labor items used by hospitals to save lives and treat people, including the use of medical instruments, equipment, and medical materials, and are divided into 2 types according to the reimbursement methods:
Full-rate coordinated items
All of them are included in the scope of reimbursement of the medical insurance and paid in accordance with the prescribed ratio. payment.
2. Partially integrated items
Individuals pay a certain percentage of the cost out of their own pocket, and the rest is paid by the medical insurance fund according to the prescribed percentage.
Description: Items outside the catalog, all need to be paid by the individual, such as the cost of guardianship instruments, first aid laboratory fees, prosthetic eyes, prosthetic limbs and other rehabilitative appliances.
Fourth, the standard of medical service facilities
Provided by the designated medical institutions, the participants in the process of receiving diagnosis, treatment and care of the necessary living service facilities. The scope and standard of reimbursement are not exactly the same in each region, but generally include inpatient bed fees and outpatient emergency detention bed fees.
V. Summary and highlights
Only expenses incurred within the three health insurance catalogs can be reimbursed through health insurance. Expenses outside the catalogs need to be borne by ourselves
2. The drug catalog includes 2,860 kinds of drugs, 641 kinds of fully reimbursed Class A drugs and 2,219 kinds of partially reimbursed Class B drugs
3. The catalog of diagnostic and therapeutic items, including fully coordinated items and partially coordinated items
4. The catalog of medical services and facilities, which generally includes inpatient and outpatient hospitalization and outpatient hospitalization bed fees
5.
References:
The Law of the People's Republic of China on Social Insurance;
Interim Measures for the Administration of Medicines Used in Basic Medical Insurance;
Opinions on the Establishment of a List System for Medical Insurance Treatment'
National Drug Catalogs for Basic Medical Insurance, Workers' Compensation Insurance and Maternity Insurance (2021);
Notice on the Issuance of Opinions on Strengthening the Scope and Payment Standards of Diagnostic and Treatment Items and Medical Service Facilities of Basic Medical Insurance for Urban Workers.