In medicine, there are many types of chronic diseases, perhaps hundreds or even hundreds. However, the number of chronic diseases included in the medical insurance reimbursement is not large, and there are generally only dozens. The level of economic development in various places is not the same, and the amount of medical insurance financing is also different, so the types of chronic diseases included in the medical insurance reimbursement are also different, but there are several common chronic diseases, which are stipulated by the National Health Insurance Bureau and must be included in the medical insurance reimbursement in various places.
The medical insurance system was established in 1998, and then in 2003, the New Rural Cooperative Medical System was launched. Basically, it is coordinated at the county level, and the reimbursement ratio and reimbursement scope of medical insurance in each county are different, so it is difficult to achieve uniformity. In 2018, the institutional reform, the National Medical Security Bureau was established, and all localities have successively established medical security bureaus, which are independent from the Human Resources and Social Security Bureau as the first component department, and the National Health Insurance Bureau began to implement a fairer medical security system.
After that, the National Health Insurance Administration issued a list of medical security benefits, and the regulations on chronic diseases have been unified to a certain extent, and five chronic diseases have been included in the reimbursement scope of medical insurance. They are: outpatient chemoradiotherapy for malignant tumors, anti-rejection** after organ transplantation, hypertension, diabetes, and uremia hemodialysis. These 5 chronic diseases are not only more common, but also very expensive, and being included in the scope of medical insurance reimbursement can greatly reduce the burden of medical treatment for insured patients.
As early as 2016, the National Health Insurance Administration began the direct settlement of inpatient cross-provincial and non-local medical treatment, and in 2022, it started the cross-provincial and non-local medical treatment settlement of outpatient chronic diseases, and the first batch of open settlement diseases are these 5 diseases, indicating that most places in the country have this chronic disease. Moreover, the current medical technology is very good, early intervention to control the disease, and can also have the same quality of life and survival life as normal people, and direct settlement of cross-provincial and remote medical treatment can reduce the burden of patients with chronic diseases who work and live in other places, which is more convenient and more cost-effective.
In recent years, with the continuous development of the economy and society, the amount of medical insurance financing is also increasing, and the payment of medical insurance for urban and rural residents has risen from 10 yuan in 2003 to 380 yuan now, plus more than 1,000 yuan in state subsidies, and the financing amount of medical insurance for employees is basically more than 5,000 yuan per year. The bulging pockets of medical insurance can provide better medical security treatment to the insured, expand the reimbursement scope of medical insurance and increase the reimbursement ratio of medical insurance.
In terms of reimbursement ratio, the reimbursement ratio was not high in more places in the past, and now most places have stipulated that chronic diseases will be reimbursed according to the reimbursement ratio of hospitalization. This reimbursement ratio is related to the level of the hospital, the more basic the medical institutions, the lower the reimbursement ratio, such as Jiangxi's employee medical insurance, its reimbursement ratio in first-level medical institutions is as high as 95%, even if it is resident medical insurance, the reimbursement ratio is as high as 90%. Therefore, if you are eligible, you should apply in time to reduce a lot of financial burden.
Moreover, there is no threshold for reimbursement of chronic diseases, but there is a ceiling for chronic diseases such as hypertension and diabetes.