I went to the hospital many times a year, why do I have to charge a threshold fee every time? What is the reason?

At present, China's social medical insurance includes basic medical insurance for urban workers and basic medical insurance for urban and rural residents. No matter which of these two kinds of insurance, when the insured is hospitalized, the amount of reimbursement is only a part, and it is only the part above the minimum compensation standard. Medical expenses below the maximum payment limit and the minimum payment standard cannot be reimbursed according to regulations.

Therefore, this has led to reflection. Why do the insured have to go to the hospital several times a year, and they have to accept the threshold every time? What is the reason? Please read this article with me. Maybe we can find the answer we need from this article.

1. What is the threshold fee?

Generally speaking, the threshold fee is the basic fee, the starting price and the minimum standard.

Why should the hospital set a threshold fee for payment? The purpose of this is to prevent some people from coming to the hospital for medical treatment, consuming medical resources, practicing fraud and so on. And ensure the role of medical insurance fund to the maximum extent, so that it can be really used for patients in need, rather than unreasonably consuming public resources.

The payment of medical insurance is that the state pays most of the money, and the collective economic organizations and individuals pay a small part of the money, which is concentrated in the medical management department as a medical fund to solve some problems of the insured.

Sick people can be reimbursed after hospitalization; After paying medical insurance, people who are not sick also consider it for the long-term benefit, just in case.

Of course, some people say that I seldom get sick once and seldom go to the hospital. If I pay medical insurance, I feel a little lost. But think about it from another angle. If I get sick one day, I may be able to use this thing. If I don't use it, my medical insurance fee will not be wasted. When other people are sick and need a lot of money, medical funds come in handy. This is also a public good, and it will not waste money and help others indirectly.

The medical insurance paid is generally managed by two accounts. The first account is a personal account, which is the money returned to the social security card according to a certain proportion, so the money in your social security card is also increasing. The sources here include three parts.

One is that all the fees paid by individuals are returned; Second, part of the fees paid by collective economic organizations are returned; The third is the interest generated by personal account funds.

The second account is the overall account of the medical fund, and the source of this account is the proportional income of all insured persons.

Personal account solves the problem of outpatient expenses.

You can buy medicine at a designated pharmacy or go to the outpatient department of a designated hospital.

With the establishment of outpatient economic security mechanism in various places, the proportion of personal accounts returned in many places is different. Even if retirees do not pay fees after retirement, they will be returned according to the proportion of on-the-job personnel.

The medical pooling fund account is used to solve the hospitalization or special outpatient expenses.

This part of the source of funds mainly depends on unit contributions and flexible employment personnel contributions. As long as the insured can enjoy this kind of welfare, there is another disadvantage that if he wants to enjoy this fee, he must reach a certain threshold.

This threshold should not only meet the requirements of hospitalization, special outpatient service and general outpatient service, but also pay a certain threshold fee.

The threshold fee is not set at will. The threshold fee is determined according to the level of the hospital. Community hospitals and township hospitals have the lowest threshold fees, while 3A hospitals have the highest threshold fees, which also reflects the problem of guiding doctors.

If the condition is serious, you can choose to go to the top three hospitals for treatment. Although the threshold fee is the highest, the reimbursement is also the strongest. According to local regulations, a threshold fee should be paid for each hospitalization, and a threshold fee should be paid once a year for special outpatient diseases and general outpatient services.

Why is this?

This is to prevent some people from going to the hospital regardless of serious illness and minor illness, and also using medical insurance cards for reimbursement; If you just run to the hospital with a fever and a cold, it will undoubtedly cause a certain workload for medical staff, which will not only increase their working hours, but also occupy medical resources, so a certain threshold fee will be set.

For people who are hospitalized many times a year, although a certain threshold fee is required for each hospitalization, the policies in each place are different, and some places will give corresponding subsidies. Although the insured needs to pay the threshold fee for multiple hospitalizations within one year, with the increase of hospitalization times, the threshold fee will be reduced, but it will not be lower than the minimum standard of the threshold fee.

Although every hospital will set a threshold fee, the insured will go to the hospital several times a year, and the threshold fee paid is also decreasing, but it will not be lower than the minimum threshold fee.

I wonder if you have found the answer you want? Please let me know in the comments.