What is the reimbursement ratio of outpatient service for urban and rural residents?

The proportion of reimbursement for outpatient service for urban and rural residents varies with regions and different types of insured persons (such as students, children, elderly people over 70 years old, etc.). ). The following are the compensation standards in some cases:

Students and children. The reimbursement rate in the first-class hospital (community health service center) is 65%, the second-class hospital is 60%, and the third-class hospital is 55%.

Older people over 70 years old. The reimbursement rate is 65% in the first-class hospital, 60% in the second-class hospital and 50% in the third-class hospital.

Residents of other cities. The reimbursement rate is 60% in the first-class hospital, 55% in the second-class hospital and 50% in the third-class hospital.

In addition, 60% of the expenses incurred in township hospitals (community health service centers, service stations and village clinics) that meet the requirements are reimbursed for Class A drugs and diagnosis and treatment projects, and 50% for Class B drugs and diagnosis and treatment projects.

The scope of reimbursement for outpatient expenses of urban and rural residents is as follows:

1. Medical expenses incurred in general outpatient service, three routine examinations and biochemical examinations.

2 Chinese medicine outpatient treatment of Chinese medicine, Chinese herbal pieces and other medical expenses.

3.x-rays, electrocardiogram and other seven special inspection expenses. X-ray examination, digital photography (DR, CR), black-and-white B-ultrasound routine examination, color Doppler ultrasound routine examination, color Doppler ultrasound examination of superficial organs, intracranial Doppler flow chart (TCD) and routine electrocardiogram examination.

4. Medical expenses for 30 kinds of special chronic diseases such as hypertension, diabetes, tuberculosis and chronic bronchitis.

5. Outpatient expenses for lowering blood pressure or blood sugar for patients with hypertension and diabetes but not yet identified as special chronic diseases.

General diagnosis and treatment service fees of designated medical institutions at the grass-roots level that implement the national basic drug system.

7. Chinese medicine diagnosis and treatment projects such as acupuncture, cupping, massage and moxibustion.

8 approved by the municipal government into other expenses paid by the outpatient co-ordination fund.

To sum up, the minimum payment standard and reimbursement ratio of basic medical insurance for urban and rural residents are determined according to the categories of insured persons, which are divided into three categories: students and children, elderly people over 70 years old and others.

Legal basis:

People's Republic of China (PRC) social insurance law

Article 30

The following medical expenses are not included in the payment scope of the basic medical insurance fund:

(a) shall be paid by the industrial injury insurance fund;

(2) It shall be borne by a third party;

(three) shall be borne by public health;

(4) Go abroad for medical treatment.

Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.