The reality of a tertiary hospital's health insurance settlement deficit: hospitals often don't charge enough for medical services to cover costs.
Hospitals' fees for medical services are often insufficient to cover costs, especially for tertiary hospitals, which tend to have higher prices for medical services because of their high technology and advanced equipment. As a result, hospitals often need to rely on non-medical service fees such as drugs, tests and examinations to cover costs.
In the health insurance settlement, the reimbursement ratio of non-medical service fees is relatively low, and even some are not reimbursed, which leads to hospitals' losses in inpatient settlement and outpatient settlement. For example, the health insurance policy stipulates that in the inpatient settlement, the cost of medical services, drugs and consumables have a corresponding reimbursement policy, but some of the costs of auxiliary examination items are not included in the scope of the hospitals need to bear this part of the cost.
In addition, some social health insurance funds do not arrive on time and in full, which also puts pressure on hospitals. Tertiary hospitals are at greater risk of incurring losses in health insurance settlements. In order to avoid a decline in the economic efficiency of hospitals, managers need to strengthen cost control, increase the price of other non-medical services, optimize the structure of medical services, as well as strengthen communication and cooperation with the health insurance sector and other related parties to achieve the goal of ****-win.
Myths of medical insurance:
1, the wool comes from the sheep
Some policyholders believe that the annual claim amount of medical insurance is less than the premiums, which is very uneconomical, so you have to rely on your usual savings for hospitalization. In fact, the key role of medical insurance is to prevent and transfer the risk of disease, once the sudden onset of a major disease, the ability of the individual to resist is limited, therefore, should still be through the commercial medical insurance will be the risk of their own transfer.
2, only a serious illness, medical insurance plays a role
In fact, medical insurance is not only in the insured person suffers from serious illness to play a role. When an illness occurs, consumers not only face the burden of medical costs, but also have to bear the expenses other than medical costs. At this point, the reimbursement type medical insurance, which specializes in medical expenses, can help the insured. As for allowance-based medical insurance, it can subsidize medical expenses whether the policyholder is hospitalized or not.
3, young to buy claims less, old to buy premiums expensive
In fact, consumers can save for a rainy day, do a good job of life-long medical insurance planning, young to pay premiums, old to worry about.
Reference: Baidu Encyclopedia - Medical Insurance