After all, there is a lot of talk about this medical treatment, and I write articles every three or five times.
To be honest, I took my children and the elderly to the hospital a lot this year.
Just ranking up and seeing a doctor is enough to choke, and the reimbursement of medical insurance and commercial insurance in the back also makes me feel deeply.
When people reach middle age, it is not easy to get a family to see a doctor and reimburse.
Medical care is one of the four mountains we are carrying at the moment, housing, education, medical care, and pension, but if you can solve two of them, I think it is at least a middle class.
Have you ever wondered?
We work hard every day, even if we save money, we don't dare to spend, why is that?
To put it bluntly, I am worried about the uncertainty of the future, I have no money to see when I am sick, and my pension is not enough to spend when I am old.
It's this instinctive worry that leads to a desperate attempt to save money.
Therefore, I will study the medical treatment and provide you with some ideas by the way.
Everyone knows that universal medical insurance, the state is vigorously promoting, the finance is subsidy, hospitals are fighting corruption, and drugs are being procured, and it seems that the future is promising.
But when it comes to individuals, it's not clear what the impact is on us.
Take the reimbursement instructions I went to Hubei Provincial Hospital of Traditional Chinese Medicine yesterday and took a picture of the front desk when I left.
At first glance, it is very concise and clear.
But there are some shortcomings.
First of all, why is there no medical insurance for employees, but not for residents?
There are 1 billion people in China's resident medical insurance, and most of them are properly accounted for.
Because there is no personal account for resident medical insurance, and secondly, the outpatient reimbursement is very small, and the annual limit of resident outpatient is 400 yuan, which is only about 10% of the employee outpatient clinic.
Some people say that medical insurance is unfair and that it is useless to pay it.
I can't say that, let's take a look at how much we pay, medical insurance is 380 yuan a year, and employees are more than 3800 a year, and 380 is still the first after two-thirds of the financial subsidy.
If you are a decision-maker, do you reimburse the people for daily colds and fevers, or reimburse the high expenses of hospitalization?Which one has more impact on the family?
The answer is self-explanatory.
If you want to reimburse the outpatient clinic, you can also choose to pay flexible social security and enjoy employee treatment, and the money in hand is a problem at this time.
The essence behind it is stratification, and it is impossible to say that everyone is really treated the same.
It is impossible to say that health insurance alone is enough.
Back to the reimbursement details, the reimbursement scope of medical insurance should be like this.
The starting line and capping line are easy to understand, and I'll talk about the A, B and C drugs in the middle.
Let's look at the picture first. 
There are 641 types of Class A drugs that can be reimbursed by medical insurance, and 151523 types of Class C drugs that are completely self-paying.
It's okay to have a minor illness and a small pain, but once you have a major illness, many drugs are not related to medical insurance and cannot be reimbursed.
Speaking of which, I have to mention the DRG DIP payment method reform
It is now the beginning of December 2023, two years have passed since the "Three-Year Action Plan for the Reform of DRG DIP Payment Methods" issued by the National Healthcare Security Administration, and there is still one and a half years left before the end of 2024, requiring all regions in the country to implement DRG DIP payment methods.
What does that mean?As long as you start to go through medical insurance, you have to be controlled by strict DRG, and even if you want to see a doctor at your own expense and take expensive imported medicines, it is impossible to have them.
Unless you pay for a doctor at your own expense at the beginning, you don't take the road of medical insurance.
A few days ago, I saw a doctor complaining on the Internet
Before the DRG was introduced, I was thinking about how to cure the disease and make it less expensive. After the implementation of DRG, I considered whether there was a balance in the DRG share of ** disease. If there is a high probability of surplus, admit them;If I don't have a balance, it means that I have to pay for the patient's treatment. If it's too serious and complicated, I won't accept it.
That is to say, once the medical reform is implemented, young and simple patients are the high-quality patients needed by the hospital, and those patients with serious and complex conditions, most of the expenses exceed the amount stipulated by the DRG, so they will naturally charge one compensation for one, and the hospital will find various reasons to refuse to accept it, in fact, the news has broken out frequently.
Of course, this is for serious illnesses, and it is also a clear card, and we still have time to prepare.
Regarding the reform, the interest game behind it is probably like this:
The above medical insurance bureau should control the cost and maintain the stability and continuity of the medical insurance, now the population is aging, and the growth rate of expenditure is much greater than the growth rate of income, and the pressure is very great.
The people below hope to be reimbursed more and pay less, but the actual ** is rising, and the reimbursement restrictions are increasing.
The hospitals, doctors, and pharmaceutical companies in the middle all want to make profits, but the payer is a strong medical insurance bureau, and it is determined to reform, so there is a high probability that it can only lie flat.
Now that you've figured this out, let's talk about how to deal with it
In my opinion, the most cost-effective medical insurance should be:
Resident medical insurance + million medical care
I'll give you a demonstration.
If I work in Guangzhou, the monthly salary is 20,000 yuan, and 2% of the monthly salary will be used to pay medical insurance**, and the payment ratio of the unit is 685%
Then the money that individuals + units pay for medical insurance in a month** is:
20,000 * (2% + 6.)85%) = 1770 yuan.
It costs more than 20,000 yuan a year, which is not a small expenditure.
Of course, we don't need such a high base of 20,000, assuming that it is calculated according to 5,000 yuan, it is 5310 a year
Compare the resident medical insurance, 549 yuan, which can save 4761 yuan.
Do I pay more than 5,000 or more than 500?
Calculated on the basis of hospitalization reimbursement:
Most of the reimbursement rates of employee medical insurance can reach more than 85%, the reimbursement ratio is a little higher, and the annual compensation limit is also higher.
Most of the reimbursement ratios of residents' medical insurance can reach about 70-80%, and the gap is not large.
Here's the point
If there is a million-dollar medical insurance, then whether it is an employee or a resident medical insurance, the final result is the same.
I'll give you an analogy.
It cost 100,000 yuan to be hospitalized, 60,000 yuan can be reimbursed by employee medical insurance, 30,000 yuan for one million medical treatment, and finally 10,000 yuan (10,000 yuan deductible).
It cost 100,000 yuan to be hospitalized, 50,000 yuan was reimbursed by resident medical insurance, 40,000 yuan was reimbursed by 100 medical treatment, and finally 10,000 yuan was paid out of pocket (10,000 deductible).
Whichever one is handed over, the final result is the same.
That's the one that pays cheaply.
Therefore, the two deficiencies of resident medical insurance, the reimbursement ratio and the limit, are no different from employee medical insurance after making up for one million medical treatment.
Of course, the lack of outpatient services mentioned earlier, which is a hard flaw.
*On the list, resident medical insurance + million medical care, within the age of 50, about 1,000 can be done.
And the employee medical insurance costs at least a few thousand yuan more.
So, if you are in financial difficulty, you are being laid off, and you are overwhelmed by the mortgage, you can try the method I said.
At last. For insurance consultation and program customization, you can consult Brother Dou.