Proportion of medical insurance reimbursement for renal dialysis

The proportion of medical insurance reimbursement for renal dialysis varies with regions, hospital levels, medical insurance types and other factors.

Details are as follows:

1. Under normal circumstances, the proportion of medical insurance reimbursement for urban workers can reach over 95%, while the proportion of medical insurance reimbursement for residents is usually over 60%. 1

2. In first-tier cities, the reimbursement rate of dialysis may be between 90%- 100%. 2

3. In second-or third-tier cities, the reimbursement rate may be 60%-70%.

4. For a specific hospital level, such as a third-class hospital, the reimbursement ratio may be 20%-30%. Uremic patients can usually enjoy a high proportion of medical insurance reimbursement for outpatient and inpatient dialysis, reaching about 90%, and individuals only need to pay 10% of the cost.

Nephropathy dialysis is divided into inpatient dialysis and outpatient dialysis. Patients who have participated in the basic medical insurance can generally be reimbursed for hospitalization dialysis expenses in proportion; Outpatient dialysis expenses can be reimbursed after medical insurance for critical illness.

1. Hospitalization reimbursement: In most areas, basic medical insurance (medical insurance for urban and rural residents and medical insurance for employees) covers hospitalization dialysis treatment. According to the regulations of different regions, medical insurance will reimburse a part of dialysis expenses, generally more than 50%.

2. Outpatient reimbursement: If long-term outpatient dialysis is needed, it can also be reimbursed after handling serious illness insurance, and a higher reimbursement rate can be given to patients with high expenses and long treatment time.

To sum up, since 20 12 the State Council listed uremia in medical insurance for serious illness, the reimbursement policy has been adjusted. In some areas, 90% of hemodialysis expenses may be directly reimbursed by medical insurance, and the patient pays 10%. These policies are aimed at reducing the economic burden of dialysis patients with kidney disease.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 29

The medical expenses of the insured shall be paid by the basic medical insurance fund, and shall be directly settled by social insurance agencies, medical institutions and pharmaceutical business units.

The administrative department of social insurance and the administrative department of health shall establish a settlement system for medical expenses in different places to facilitate the insured to enjoy the basic medical insurance benefits.

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

1, which shall be paid from the industrial injury insurance fund;

2, should be borne by a third person;

3, should be borne by public health;

4. Go abroad for medical treatment.