Reimbursement ratio of employee medical insurance and urban and rural residents' insurance

The reimbursement rate for employee medical insurance is about 70%, and the reimbursement rate for urban and rural residents' medical insurance is about 50%, so there is a difference of about 20% between them. But in reality, the difference between the urban workers' health insurance and the urban and rural residents' health insurance is much more than the 20% reimbursement rate.

Nowadays, the level of medical technology is relatively high, medical equipment is advanced, medical supplies and medicines are not cheap, the doctor's salary and other expenditures are also relatively large, all the reasons lead to the hospital visit is very expensive. The cost of a slightly more serious disease can be as high as tens of thousands of dollars.

I am now in the era of universal health insurance, the vast majority of people have participated in the health insurance, urban and rural residents of the number of contributors to the health insurance amounted to 1.36 billion people, the number of urban workers health insurance contributors more than 300 million people.

Hospitalization can have medical insurance reimbursement, for example, a single hospitalization cost 50,000 yuan, the employee health insurance and resident health insurance can be reimbursed about how much, I came to give you a calculation today.

The reimbursement rate and the starting line will vary from place to place, but the calculation of the reimbursement is the same, Jiangxi is a central province, the level of economic development and the reimbursement rate of the health insurance is probably in the middle of the country, the reimbursement policy of Jiangxi can be a reference.

The hospital hospitalization reimbursement can only reimburse the items in the medical insurance directory, TV directory within the category B and C items also need to pay a part of the self-payment. The reimbursement rates and thresholds vary depending on the level of the hospital.

If the cost is 50,000 yuan, it is likely to be in a tertiary hospital, of course, a small number of county hospitals or secondary hospitals, the cost may also reach this figure. In the case of tertiary hospitals, items outside the medical insurance catalog and those in categories B and C will account for about 15 percent, or 7,500 yuan;

in the case of secondary hospitals, the proportion should be about 10 percent, or 5,000 yuan. This is the health insurance department and the health department of the hospital's approximate assessment of the number of costs outside the catalog can not be too high, will fluctuate up and down in this range.

The starting line of the second-class hospital of the employee health insurance is 500 yuan, the reimbursement rate is 92%, in this case, 50,000 yuan deducted from the directory of the health insurance, minus the starting line is about 44,000 yuan, 92% reimbursement can be reimbursed for 40,000 yuan, the second compensation can be reimbursed for 1500 yuan or so.

The starting line for a tertiary hospital is 700 yuan, 50,000 yuan into the health insurance reimbursement is about 42,000 yuan, the reimbursement rate is 90%, can be reimbursed about 37,000 yuan, the second reimbursement can be reimbursed about 2,000 yuan.

So the total reimbursement down, the second hospital health insurance can be reimbursed about 42,000 yuan; the third hospital health insurance reimbursement of about 39,000 yuan. The reimbursement rate is still OK, some civil servants can also enjoy the civil service supplemental insurance reimbursement part, can have a few thousand dollars, this is the end of the universe of benefits.

The urban and rural residents health insurance in the second hospital starting line is 400, 50,000 yuan into the health insurance reimbursement amount is 44,600 yuan, the second hospital reimbursement rate is 80%, can be reimbursed about 35,000; urban and rural residents of the starting line of major medical insurance is 13,000 yuan, the amount of money has not yet reached the starting line, so the total reimbursement of the second in the total is 35,000 yuan.

The starting line of the three hospitals is 600, I foreign aid into the medical insurance reimbursement amount is about 42,000 yuan, to find the three hospitals reimbursement rate of 60% can be reimbursed about 25,000 yuan, this reimbursement amount is to reach the starting line of the insurance of the major diseases, according to the 65% of the proportion of the insurance of the major diseases can be reimbursed 2500 yuan, the total reimbursement is about 2.8 million yuan.

It can be seen that compared to the urban workers' health insurance, urban and rural residents' health insurance reimbursement rate is still quite a bit less, even if the total amount of reimbursement of the second hospital can not catch up with the workers' health insurance reimbursement rate in the third hospitals, which may be adjusted in the future to narrow the reimbursement gap between the two types of insurance. Especially at the end of the universe of civil servants, under the protection of civil servants supplemental insurance, their own money is not much, the gap is really too big.