If it is paid by flexible employees, why should we pay social security and reimburse 40% after hospitalization?

The reimbursement rate is high or low, and there are many influencing factors. For example, the reimbursement rate of the bottom hospitals such as village clinics or community health services is very high, but if you are hospitalized in a third-class hospital, the reimbursement rate is the lowest, but it is at least about 85%, and the highest is actually about 95%. The other is qifubiaozhun. The minimum qifubiaozhun for urban or community health services. For example, according to relevant regulations in Chengdu, the threshold for initial hospitalization in township or community health service institutions is 160 yuan, but the threshold is 800 yuan. The following expenses in Qifubiaozhun are not within the scope of reimbursement, so hospitalization in tertiary hospitals or in township hospitals or community health service institutions is also far from 640 yuan because Qifubiaozhun.

Another new project affected is a new self-funded project. Whether you are hospitalized in a first-class hospital or a third-class hospital, the so-called reimbursement ratio refers to the range above the deductible and below the maximum reimbursement amount. The scope of reimbursement within such a scope is also limited, that is, it is limited outside the file directory and within the directory. If the items examined are out of the file directory, new surgical treatment items, drug items, etc. New items outside the file directory are also not included in the reimbursement scope. After deducting such items, the nominal reimbursement rate is 85%. However, if deductible and out-of-pocket expenses are deducted, the proportion that exceeds the reimbursement limit needs all out-of-pocket expenses, which can reach 40% is already very high.

For example, if you are hospitalized in Chengdu, the overall hospitalization cost exceeds 6.5438+0 million yuan. If you see a doctor in a designated 3A hospital, you must first deduct the minimum payment standard of 800 yuan, and the application price for a single project except surgery is 20% of the cost of the new examination and treatment project in 200 yuan. The price of executing a single project is below 1000 yuan, and 10% of the medical expenses must be paid by myself; 10% The expenses of Class B drugs in the basic medical insurance drug list stipulated by the state and province must be paid by myself; The application of unique medical materials and the implementation of the overall fund to pay part of the cost of diagnosis and treatment projects should be paid by myself.

In addition to this conventional factor, medical insurance in different places is a very important objective reason. For example, according to relevant regulations in Chengdu, the minimum payment standard for medical treatment outside the city is 2,000 yuan, which is higher than that of local tertiary hospitals 1.200 yuan. In addition, the reimbursement rate in many places needs to be reduced by 10%. For example, the proportion of reimbursement for hospitalization in the local area is 80%, so medical insurance in different places or medical treatment outside the city can only be reimbursed 70%.

This kind of project adds up to 5,000 yuan, and the out-of-pocket expenses reach 5,800 yuan, and the remaining 4,200 yuan is reimbursed by 85%. The final reimbursement cost is only 3570 yuan, and all medical expenses incurred by oneself will be paid in addition to their specific reimbursement, so the specific reimbursement ratio will only be 35.7%. Qifubiaozhun needs to be raised to 1.200 yuan, which is also not reimbursed. In addition, the reimbursement rate needs to be reduced by 10% to reach about 25%, which is quite good.

Generally speaking, the proportion of medical insurance reimbursement is generally determined according to the level of the hospital. The highest proportion of reimbursement is for urban or community health services, and the lowest proportion is for top-three hospitals or medical hospitals transferred to other hospitals; The reimbursement category is medical expenses above Qifubiaozhun and below the maximum reimbursement limit. This kind of compliant medical expenses includes two aspects: first, the new medication and treatment items in the medical document catalogue; The second is the inspection fee and operation fee for the catalogue of medical documents. So your reimbursement rate is only about 40%, which I think is only a relatively normal situation.