What is the reimbursement rate for seeing a doctor in a community hospital?

The reimbursement rate of community hospitals is 35%-45%.

1, and the payment ratio of primary medical and health institutions is 85%;

2. The payment ratio of first-class medical institutions or non-grade medical institutions is 82%;

3. The payment ratio of secondary medical institutions is 80%;

4. The payment ratio of tertiary medical institutions is 65%;

5. The payment ratio of provincial medical institutions is 60%.

Scope of social security reimbursement:

1. outpatient expenses: including registration fees, medical treatment fees, examination fees, medicine fees, etc.

2. Hospitalization fee: including bed fee, operation fee, treatment fee, examination fee, medicine fee, etc. During hospitalization;

3. Special disease expenses: For special diseases, such as chronic diseases or serious diseases, social security may provide a higher proportion of reimbursement;

4. Maternity expenses: For eligible insured persons, the Social Security Association will reimburse maternity-related expenses;

5. Work-related injury expenses: Work-related injury insurance will reimburse the corresponding medical expenses according to the injury.

To sum up, the reimbursement rate of community hospitals is 35%-45%, while that of other medical institutions is 85%, 82%, 80%, 65% and 60% respectively.

Legal basis:

Opinions on integrating the basic medical insurance system for urban and rural residents

Article 27

The insured residents' hospitalization medical expenses within the policy scope of the designated medical institutions of basic medical insurance in the overall planning area, and the part above the minimum threshold shall be paid by the urban and rural residents' medical insurance fund in proportion: the township hospitals and community health service institutions shall not be less than 80%; County-level medical institutions are not less than 70%; Municipal medical institutions are not less than 60%. Each overall planning area reasonably determines the specific payment ratio according to the income and expenditure of urban and rural residents' medical insurance fund.