Compensation scheme
The city continues to implement the compensation model combining outpatient co-ordination with hospitalization co-ordination.
(A) outpatient compensation measures
1, general outpatient expenses compensation. The scope of compensation payment for general outpatient service is limited to township medical institutions. The outpatient compensation ratio of village-level new rural cooperative medical institutions is 80%, and the top line is 25 yuan, which is used by families; The compensation ratio of township hospitals is 50%, which is the top line of cumulative compensation in 200 yuan per capita.
2. Compensation for outpatient expenses of chronic diseases. Patients with chronic diseases such as hypertension, diabetes and mental illness. To the designated medical institutions for outpatient treatment, the medical expenses incurred shall be reimbursed according to the reimbursement ratio of hospitalization in the corresponding hospital. The annual cumulative limit of reimbursement expenses is 6000 yuan. The determination of chronic diseases must be based on the diagnosis issued by medical institutions at or above the municipal level. Malignant tumor radiotherapy and dialysis of renal failure are treated in outpatient department of designated medical institutions, and the medical expenses incurred are reimbursed according to the proportion of hospitalization reimbursement in corresponding hospitals.
(2) Compensation measures for hospitalization
If the reimbursement amount of hospitalization medical expenses of the new rural cooperative medical system is less than 30,000 yuan (inclusive), the zero deductible line shall be implemented, and the compensation method shall be phased and proportional.
1, hospitalization compensation ratio
For hospitalization in township hospitals, 40% will be reimbursed within 500 yuan, 80% for 50 1 yuan-2,000 yuan, and 60% for 200 1 yuan.
For hospitalization in county-level designated medical institutions, 40% will be reimbursed for expenses below 1 0,000 yuan, and 50% for expenses above/0,006,5438 yuan in 0 yuan. The First People's Hospital of Dawa County and the First People's Hospital of Panshan County are pilot units for the reform of public hospitals, and the reimbursement ratio of corresponding departments has increased by 5 percentage points respectively (since the implementation of the "zero-difference rate" sales of essential drugs).
For hospitalization in municipal designated medical institutions, 40% will be reimbursed below 1500 yuan, 55% below 150 1 yuan-5,000 yuan, and 40% above 500 1 yuan.
For hospitalization in a hospital above the municipal level, 30% will be reimbursed below 10000 yuan, and 40% will be reimbursed above 10000 yuan.
2. Compensation for major diseases (25 kinds)
We will comprehensively promote childhood leukemia, congenital heart disease, end-stage renal disease, women's breast cancer, cervical cancer, severe psychosis, AIDS opportunistic infection, multidrug-resistant tuberculosis, hemophilia, chronic myeloid leukemia, cleft lip and palate, lung cancer, esophageal cancer, gastric cancer, type I diabetes, hyperthyroidism, acute myocardial infarction, acute cerebral infarction, colon cancer, rectal cancer, pancreatic cancer, lupus erythematosus, phenylketonuria in children and hypothyroidism in children.
10 designated medical institutions for childhood leukemia, congenital heart disease, end-stage renal disease, women's breast cancer, cervical cancer, AIDS opportunistic infection, multidrug-resistant tuberculosis, chronic myeloid leukemia, cleft lip and palate, and hypospadias, covering the designated medical institutions of the new rural cooperative medical system at the provincial, city and county levels; Designated medical institutions for hemophilia, lung cancer, esophageal cancer, gastric cancer, rectal cancer, colon cancer, pancreatic cancer, lupus erythematosus, type I diabetes, hyperthyroidism, acute myocardial infarction and acute cerebral infarction 12. The scope of designated medical institutions of the new rural cooperative medical system at the city and county levels; The designated medical institutions for children with phenylketonuria hypothyroidism are Liaoning Maternal and Child Health Hospital and Panjin Maternal and Child Health Station. The designated medical institutions for severe mental illness of poor families are the Second Staff Hospital of Liaohe Oilfield and the Kangning Hospital of Liaoning Province for demobilized soldiers, and they pay by the bed day.
After referral to the designated medical institutions of the new rural cooperative medical system, the medical expenses within the scope and limits of the new rural cooperative medical system (see Annex 1 for details) shall be compensated by 70%, and the expenses above the limit shall be compensated by the designated medical institutions at the same level.
3, Chinese medicine and infectious disease reimbursement ratio
Traditional Chinese medicine preparations, Chinese herbal pieces and Chinese medicine treatment techniques required by inpatients in city and county-level Chinese medicine hospitals are reimbursed according to the proportion of 70%, and other medical expenses are reimbursed according to the proportion of hospitalization reimbursement in corresponding hospitals.
Patients with infectious diseases are hospitalized in the Municipal Infectious Diseases Hospital and the tuberculosis prevention and treatment centers at the city and county levels, and the medical expenses incurred are reimbursed at the rate of 70%; Medical expenses incurred by patients with non-communicable diseases in hospital and medical expenses incurred by patients with infectious diseases in treating non-communicable diseases shall be reimbursed according to the hospitalization reimbursement ratio of corresponding hospitals.
4, hospital delivery allowance
The standard of maternity allowance for hospital delivery is 500 yuan per case.
5, rural low-income households, low-income marginal households, three households and five households in poor people suffering from major diseases, hospitalization (including outpatient serious illness treatment) treatment costs according to the proportion of 90% reimbursement, poor people to implement real-name management.
6, accidental injury, traffic accident liability hospitalization expenses, reimbursement rate is 30%, the top line is 20000 yuan, the new rural cooperative medical institutions will not advance, by the patient himself (or his family) to the county (District) new rural cooperative medical management office for reimbursement.
7, drug list and diagnosis and treatment projects
Designated medical institutions at the county (district) level and below the county level shall implement the drug list of new rural cooperative medical care in Liaoning Province (including the list of national essential drugs and the list of supplementary essential drugs in Liaoning Province) and the scope of diagnosis and treatment projects of new rural cooperative medical care in Liaoning Province, and designated medical institutions above the municipal level shall implement the drug list of basic medical insurance, industrial injury insurance and maternity insurance in Liaoning Province and the list of diagnosis and treatment facilities of basic medical insurance in Liaoning Province.
See Panjin 20 15 Guidance on New Rural Cooperative Medical System for details.