What is a designated medical institution for medical insurance?

Refers to the medical institutions identified by the medical insurance department and signed a service agreement to provide medical services for the insured persons of basic medical insurance.

First, the concept and significance of medical insurance designated medical institutions

Medical insurance designated medical institutions are an important part of China's medical security system. Its establishment aims to standardize the medical service market, protect the legitimate rights and interests of the insured, and ensure that the insured can enjoy high-quality, convenient and safe medical services in designated medical institutions. At the same time, medical institutions designated by medical insurance are also an important means for medical insurance departments to manage and supervise medical institutions, which is helpful to promote medical institutions to improve service quality and efficiency.

Two, the identification and management of medical insurance designated medical institutions

The identification of designated medical institutions for medical insurance needs to go through strict procedures and standards. Generally speaking, medical institutions need to have certain qualifications and conditions, such as medical technology, equipment and facilities, service quality, etc., before they can apply to become designated medical institutions for medical insurance. The medical insurance department will review and evaluate the applicant institutions, and the qualified institutions will be recognized as designated medical institutions for medical insurance and sign service agreements with them.

In terms of management, the medical insurance department will regularly inspect and evaluate designated medical institutions to ensure that they provide services in accordance with medical insurance policies. For institutions that violate the rules, the medical insurance department will take corresponding punishment measures, or even cancel the medical insurance qualification in serious cases.

Three, the significance of medical insurance designated medical institutions to the insured.

For the insured, choosing a designated medical institution for medical insurance can enjoy various conveniences and benefits. First of all, the designated medical institutions will charge according to the medical insurance policy, and the insured can enjoy the corresponding reimbursement ratio and preferential treatment. Secondly, designated medical institutions usually have high medical technology and service level, which can provide better and safer medical services for the insured. In addition, the designated medical institutions have established a close cooperative relationship with the medical insurance department, which can provide more convenient service processes for the insured.

To sum up:

Medical insurance designated medical institutions are an important part of China's medical security system. Their establishment and management are helpful to standardize the medical service market, protect the legitimate rights and interests of the insured, and promote medical institutions to improve service quality and efficiency. For the insured, choosing a designated medical institution for medical insurance can enjoy various conveniences and benefits, which will help reduce the medical burden and improve the medical experience.

Legal basis:

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

Article 29 provides that:

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.

Regulations on the administration of medical institutions

Article 4 provides that:

According to the planning of medical and health service system, the state has established various medical institutions at all levels.