1. Limited medical resources: Medical resources are limited, including medical equipment, medicines and doctors. With limited resources, full reimbursement of medical expenses for the five guaranteed households may have an impact on the medical insurance of other groups. In order to ensure the long-term operation of the medical insurance fund and the interests of all insured persons, full reimbursement cannot be realized.
2. Sustainability of the MBF: Full reimbursement of the medical expenses of the five insured households will put a greater pressure on the MBF, which may result in the Fund not being able to operate in the long term. In order to ensure the sustainability of the health insurance fund, it is necessary to set a certain limit and percentage for the reimbursement of medical expenses of the five insured households.
3. Ensuring fairness: In the medical insurance system, there are other insured groups in addition to the five-guaranteed households. In order to ensure the fairness of the system, full reimbursement cannot be applied only to the five-insured households. Otherwise, it may trigger dissatisfaction and resistance from other insured groups.
4. Limitations of the current medical insurance system: According to China's current medical insurance system, the five-guaranteed households can enjoy the preferential policies of the New Rural Cooperative Medical Insurance (NRCMI), which is a new type of rural cooperative medical insurance. Under the new rural cooperative medical insurance system, the hospitalization expenses of the five guaranteed households can be reimbursed in accordance with a certain percentage of the drugs and general examinations within the drug catalog of the new rural cooperative medical insurance, while the costs of the drugs outside the catalog and some special examinations need to be borne by themselves. Therefore, not all expenses incurred by five-guaranteed households in the course of treatment can be reimbursed.
The five-guarantee households refer to the elderly, the disabled and minors in rural areas who are unable to work, have no source of livelihood, and have no fixed breadwinner or supporter. This group of people has a difficult life and lacks financial resources, so the state guarantees that their basic needs are met through the implementation of the Five Guarantees policy. The Five Guarantees policy includes guaranteed food, clothing, shelter, medical care and burial (or education for orphans). The five guaranteed households are a concrete manifestation of socialism and humanitarianism, and have received widespread social attention and help.
In summary, the five guaranteed households will not be fully reimbursed for medical treatment, the main reasons include limited medical resources, health insurance fund sustainability, fairness of protection and the current health insurance system restrictions. In practice, the five guaranteed households can enjoy a certain percentage of reimbursement policy, but still need to pay attention to the specific details of the reimbursement policy to ensure their rights and interests.
Legal basis:
The Law of the People's Republic of China on the Protection of the Rights and Interests of the Elderly
Article 23
The state implements a policy of preferential treatment for the elderly. Medical institutions shall provide the elderly with priority, preferential, and high-quality services, and, where available, may set up special outpatient clinics, wards, and family hospital beds for the elderly. Public **** transportation shall provide convenience and concessions for the elderly. Museums, art galleries, science and technology museums, memorials, public *** libraries, cultural centers, theaters and other public *** cultural and sports facilities, should be in accordance with the relevant provisions of the elderly to provide free or preferential services.