How much will chronic diseases be reimbursed for?

At present, my country does not have a nationally unified fixed rate of reimbursement for chronic diseases. Generally speaking, the reimbursement rate for chronic diseases (generally included in outpatient chronic disease coverage) for employee medical insurance is mostly in the 70%-90% range, and the reimbursement rate for urban and rural residents' medical insurance (including the original New Rural Cooperative Medical Care System) is mostly between 50% and 80%. The final reimbursement amount is also affected by multiple factors such as the policy of the insured area, the level of the hospital where the patient is treated, whether the medication is in the medical insurance catalog, and the deductible cap.

If you often go to a community hospital to prescribe antihypertensive drugs or take commonly used chronic disease drugs such as insulin, the reimbursement rate will be much higher than if you go to a large hospital. After all, current medical insurance policies are geared toward the grassroots. A while ago, I helped a retired aunt in Jinan calculate her high blood pressure reimbursement. She had already applied for the qualification certification for door-to-door medical insurance. The annual minimum payment limit for local employee medical insurance for door-to-door insurance is 1,000 yuan. After exceeding the threshold, you can get 90% of the reimbursement by going to a community hospital to get medicines. She could get a reimbursement of 85% by going to a tertiary hospital near her home. Last month, she prescribed long-acting antihypertensive drugs for 300 yuan, which was just over the deductible for that year. She only paid 30 yuan when settling in the community. If she went to a tertiary hospital, she would have to pay 45. The difference is quite obvious.

If you pay for residents' medical insurance, the reimbursement rate will be slightly lower. I met a college student in Zhengzhou who paid for local residents' medical insurance and got a medical certificate for allergic asthma. If you go to the school hospital to get control drugs, you can get 75% of the reimbursement, and the one-year cap is 2,000 yuan. If you go to an off-campus tertiary hospital to get medicine, you can only reimburse 55%, and the cap is reduced to 1,500 yuan.

Nowadays, many friends complain about the problem of different reports for the same disease. I met a psoriasis patient before. When I was working in Jiangsu, psoriasis was included in the list of outpatient clinics, and I only paid more than 100 for targeted drugs every month. When I returned to my hometown in Anhui to work last year, the local area has not included this disease in the second-category outpatient insurance coverage, so I can only go to ordinary outpatient clinics for reimbursement. After a year exceeds the cap of 3,000 yuan for ordinary outpatient clinics, I have to pay for it all out of pocket, which costs hundreds more every month. This difference is essentially due to the fact that medical insurance is still coordinated at the prefectural and municipal levels, and the fund affordability and disease coverage priorities vary across regions. However, the national unified chronic disease catalog is also being steadily advanced, and the differences in coverage across regions will gradually narrow in the next few years.

By the way, I would like to remind everyone that if you have patients with chronic diseases in your family, don’t forget to go to the medical insurance bureau or government service center in the insured area to get the qualifications for outpatient care. Only if you pass the certification can you enjoy this high rate of reimbursement. Otherwise, even if you have a disease listed in the local catalog, you can only report as an ordinary outpatient without going through the certification process, which will result in a lot of losses.