What is the reimbursement rate for hospitalization for chronic diseases?

We often talk about hospitalization reimbursement for chronic diseases. In fact, there is no fixed rate across the country. People covered by employee medical insurance can generally reimburse 70%-95%, and the reimbursement range of resident medical insurance (including the original New Rural Cooperative Medical Care System) is generally 50%-80%. The final reimbursement depends on the policy details of the insured area, the level of the hospital where you are treated, and whether the chronic disease you have is in the local chronic disease directory.

Last month, I helped my uncle who lives in Xi'an calculate his hospitalization reimbursement for hypertensive cerebral hemorrhage: He is a retired employee, and he lives in a local top-level hospital. The total cost is 21,000, excluding the 1,500 deductible, and there are still more than 2,000 that are not in the medical insurance directory. For the self-paid neurotrophic drugs, 90% of the remaining compliant part was reimbursed. In the end, I only paid more than 4,000. The actual reimbursement ratio was almost 78%, which was lower than the nominal 90%, just because of the self-paid part.

Many people think that the reimbursement ratio for the same disease is the same. This is not the case. If it were a non-retired employee or a resident medical insurance participant, the reimbursement amount would be even more different. For example, for the same disease in the same hospital, if the local urban and rural residents are insured, the reimbursement ratio for the compliance part will only be 65%, and the minimum payment line will be increased to 2,000, so the amount of money you have to pay will almost double. If you go to other places for medical treatment without filing in advance, the reimbursement rate will be reduced by another 10%-20%, which is a very big gap.

There is now a lot of discussion about hospitalization reimbursement for chronic diseases. Many patients and their families feel that chronic diseases require long-term medication and follow-up, and the financial pressure is greater than ordinary diseases. The hospitalization reimbursement ratio should be raised, especially for those rare chronic diseases that require long-term hospitalization, such as ALS and pulmonary hypertension. Many treatment items and specific drugs have not been included in the catalog, and the actual reimbursement ratio is often less than 50%. It is difficult for ordinary families to afford it. However, some friends who work in medical insurance agencies said that there is already a lot of pressure on local pooling funds. If the hospitalization reimbursement ratio of all chronic diseases is blindly calculated, it may crowd out the reimbursement amount for common diseases. It is better to first include all commonly used treatment items and urgently needed drugs for high-incidence chronic diseases such as hypertension and diabetes into the scope of reimbursement. The actual burden reduction effect will be more substantial.

If you really have patients with chronic diseases at home who are going to be hospitalized, you might as well call the local medical insurance bureau in advance to ask for a few details. Especially if you are going to see a doctor in another place, you should register for medical treatment in another place in advance. The reimbursement rate can be much higher, but don’t suffer from poor information.