First, the basic principles of medical insurance surgery expense reimbursement
The reimbursement of medical insurance operation expenses follows the principle of "basic guarantee, fairness and reasonableness, balance of payments and slight balance". According to the payment and medical insurance policy of the insured, the medical insurance fund compensates the operation expenses to a certain extent and reduces the economic burden of the insured.
Second, the factors that affect the reimbursement ratio of medical insurance surgery expenses
1. Regional differences: factors such as medical insurance policies, economic development level and distribution of medical resources in different regions will affect the reimbursement ratio of medical insurance surgery expenses. Generally speaking, the proportion of reimbursement in economically developed areas is relatively high.
2. Medical insurance policy: Medical insurance policy plays a decisive role in the proportion of reimbursement for surgical expenses. The reimbursement ratio, deductible line and capping line stipulated in the policy will directly affect the actual reimbursement amount of the insured.
3. Type of operation: The cost of different types of operations is quite different, so the compensation ratio of medical insurance fund for operation expenses will be different. Generally speaking, the reimbursement rate of basic medical insurance for common operations is high, but there may be some restrictions on some special and expensive operations.
Third, ways to improve the reimbursement ratio of medical insurance operation expenses
1. Strengthen the publicity of medical insurance policy: By widely publicizing the medical insurance policy, the insured's knowledge and understanding of the reimbursement ratio of medical insurance surgery expenses will be improved, which will help the insured to make better use of medical insurance resources.
2. Improve the medical insurance system: by constantly adjusting and optimizing the medical insurance policy, gradually increase the reimbursement ratio of medical insurance surgery expenses to better meet the medical needs of the insured.
3. Improving the utilization efficiency of medical resources: strengthening the rational allocation and effective utilization of medical resources and reducing the cost of surgery will help to improve the reimbursement ratio of medical insurance surgery expenses.
To sum up:
The reimbursement rate of medical insurance operation expenses is influenced by many factors, including regional differences, medical insurance policies, types of operations, etc. Insured personnel should understand and pay attention to the local medical insurance policy, so as to make full use of medical insurance resources when surgical treatment is needed. At the same time, the government and all walks of life should also work together in Qi Xin to improve the medical insurance system, improve the utilization efficiency of medical resources, and gradually increase the reimbursement ratio of medical insurance surgery expenses, so as to provide better medical security for the insured.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 28 provides that:
Medical expenses that meet the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency rescue shall be paid by the basic medical insurance fund in accordance with state regulations.
People's Republic of China (PRC) social insurance law
Article 30 provides that:
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.