Nearly 20 million people in Beijing have achieved direct settlement by holding cards for medical treatment.

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 Nearly 20 million people in Beijing have achieved direct settlement by holding cards for medical treatment.


In the aspect of direct settlement of cross-provincial medical treatment, all of Beijings 600 designated medical institutions with inpatient services have been included in the scope of direct settlement of cross-provincial and off-site medical treatment.

In addition, according to the Municipal Bureau of peoples Bureau, in April last year, after the comprehensive implementation of the comprehensive reform of Beijing medicine, the medical insurance department increased the investment of the medical insurance fund. The reform abolished the registration fee, medical treatment fee and drug addition. The medical service fee was set up specially. The Municipal Bureau of medical services also adjusted the medical insurance reimbursement policy synchronously and brought the medical service fee into the city. The reimbursement range of basic medical insurance and birth insurance for town and rural residents and urban and rural residents, medical service fees for out-patient services are reimbursed, and they are not restricted by the starting and paying line of medical insurance reimbursement and the top of the capping line.

After medical insurance reimbursement, the personal burden of one or two and three hospitals was 1 yuan, 2 yuan and 10 yuan respectively. Since the implementation of the comprehensive reform of separating medicine from medicine in Beijing for 15 months, adjusting the reimbursement policy for medical service fees alone will reduce the personal burden of 676 million yuan.

Focus 1

critical illness insurance

More than 50 thousand yuan can be reimbursed 70%, up no top

At present, the proportion of reimbursement in the outpatient community of Beijing city and town is 90%, the proportion of inpatient reimbursement is over 85%, the quota of out-patient reimbursement and the quota of inpatient reimbursement are 20 thousand yuan and 300 thousand yuan respectively. The proportion of inpatient reimbursement for urban and rural residents is increased to more than 75%, and the quota of out-patient and inpatient reimbursement is increased to 3000 yuan and 200 thousand yuan respectively.

According to the Beijing Municipal Peoples Social Bureau, the reimbursement policy of medical insurance is inclined to the grass-roots level, and the differentiated reimbursement policy is implemented for grass-roots health institutions and large hospitals. The medical expenses of urban workers in community hospitals were reimbursed by 90%, 20 percentage points higher than those in large hospitals.

The elderly people in urban and rural areas and the residents in the working age were first treated at the primary level, and the out-patient and inpatient communities were far lower than the large hospitals, and the reimbursement ratio was 5 percentage points higher than that of the large hospitals.

In the case of big disease insurance, Beijing has a unified urban and rural residents large disease insurance system. After enjoying the basic medical insurance treatment in the same year, urban and rural residents have high medical expenses in the policy range, which are reimbursed two times by the big disease insurance.

Reimbursement is less than 50 thousand yuan, 60%; more than 50 thousand yuan for reimbursement of 70%, not top. When the insured people declare, they do not need to run errands. After automatic accounting, the medical insurance system directly transfers the reimbursement expenses to the personal medical deposit book or bank card.

The Beijing Municipal Bureau of peoples society said last year that the medical insurance system in Beijing had benefited 22776 people from urban and rural residents and reduced the burden of personal medical expenses by 237 million yuan; since the implementation of the medical insurance system for major diseases, 95277 people in urban and rural areas have been benefited.

In addition, Beijing adjusted the inpatient reimbursement policy for the mentally ill for the difficult groups, especially considering the impact of the separate comprehensive reform of Medicine on hospitalized psychiatric patients. In the past, reimbursement according to proportion was adjusted to reimbursement according to fixed amount. Payment according to bedtime was carried out, and the staff and residents carried out a unified standard of fixed amount.

According to the introduction, from the personal burden of psychiatric patients, the burden of psychiatric inpatients has decreased by 54% for more than a year and before the reform. In particular, the average annual personal burden on Residents medical insurance has been reduced from 18 thousand yuan to about 4000 yuan.

Reimbursement range

Inclusion of nearly 20 valuable drugs for the treatment of malignant tumors

The medical insurance Department added the scope of multiple sclerosis and intraocular injection of macular degeneration into the special diseases of the outpatient department, adjusted the malignant tumor radiotherapy and chemical treatment to malignant tumor outpatient treatment, and synchronously adjusted the policy of reimbursement, and included nearly 20 valuable targeted drugs used in the treatment of malignant tumors. The scope of medical insurance reimbursement.

Through the adjustment of outpatient special disease policy, Beijing annually reduces the cost of medical care for seriously ill patients by about 350 million yuan. The person in charge said, for example, the target drug for the treatment of breast cancer, trastuzumab (Hessaitin), was more than 230 thousand yuan per year before the state negotiation, and the average annual drug cost of the negotiations was about 90 thousand. The individual burden of retirees after the special medical reimbursement for outpatients was reduced to more than 1 million yuan.

At the same time, Beijing included all the new drugs in the 2017 version of the drug catalogue and 36 kinds of negotiated drugs into the medical insurance, industrial injury insurance and reproductive insurance coverage, and 2986 varieties of medical insurance drugs.

In addition, the reimbursement scope of medicines for medical insurance in large hospitals and communities should be unified. All medicines that can be reimbursed in large hospitals can be reimbursed in communities. Hypertension, diabetes, coronary heart disease, cerebrovascular disease and other 4 chronic diseases can also enjoy 2 months long prescription reimbursement convenience.

Focus 3

Direct medical treatment

A special disease can be declared and filed one stop

The reporter has learned that at present, Beijing has opened a green channel for medical institutions in community health services and pension institutions to apply for medical insurance. There are more than 2000 residents in the citys community, accounting for 70% of the designated medical institutions in the city.

At the same time, in addition, in addition to the choice of 5 designated medical institutions, there are 19 a hospital as well as all Chinese medicine and specialist hospitals with more than 300 designated medical institutions.

In addition, there are 2853 designated medical institutions in Beijing, 457 designated retail pharmacies, covering 16 districts in the whole city. Fixed point retail drugstores can pay their cards in real time by presenting prescription and social security cards.

In the process of medical insurance participation in urban and rural residents, the Beijing Municipal Social Security Agency, according to the personnel information provided by the departments of civil affairs and the Agricultural Committee of the District, does no longer need personal errands, and has completed the formalities for the 13 kinds of people in Beijing to enjoy the government aid to the medical insurance of urban and rural residents.

At present, nearly 360 thousand people enjoy this kind of convenient service. The medical insurance Department of the city has completed the adjustment of the whole city special disease record process. The insured persons with special diseases can complete the procedures of declaration, record, treatment, settlement and treatment in the designated medical institutions of the designated medical institutions. The measure has benefited more than 7 thousands of patients.

Link

Inter provincial direct medical settlement is extended to permanent resident staff.

According to the Beijing Municipal Bureau of peoples society, according to the national unified deployment, Beijing has perfected the relevant policies of direct settlement of medical expenses for medical hospitalization across provinces, including the coverage of the insured personnel and the policy of reimbursement of medical insurance for direct settlement of medical expenses in Beijing.

At present, the medical insurance information system of Beijing and all the provinces and cities of China and Xinjiang Construction Corps can be connected directly with the information system, and the range of direct settlement record personnel is extended to long-term resident, permanent resident and foreign referral, and the basic medical insurance staff members of urban and rural residents. More than 600 designated hospitals have been included in the direct settlement area.