I. The role of medical insurance
1 is conducive to improving labor productivity and promoting the development of production. Medical insurance is the inevitable result of social progress and production development. Conversely, the establishment and improvement of medical insurance system will further promote social progress and production development. On the one hand, it relieves the worries of workers who are ill and have no money for treatment, so that they can work with peace of mind, thus improving labor productivity and promoting the development of production; On the other hand, security can effectively promote the physical and mental health of workers and ensure the normal reproduction of labor.
2. Adjust income differences and reflect social equity. Medical insurance is an important means for the government to adjust the income difference and redistribute income by collecting medical insurance premiums and paying medical insurance service fees.
3. An important guarantee for maintaining social stability. Medical insurance helps patients economically, helps to alleviate social instability caused by diseases, and is an important mechanism to adjust social relations and social contradictions.
4. An important means to promote social civilization and progress. The social system of medical insurance and social mutual assistance is to share the risk of medical expenses among the insured, which embodies the new social relationship of "one party is in trouble and all parties support" and is conducive to promoting social civilization and progress.
5. Promote the reform of economic system, especially the welfare reform of state-owned enterprises.
Two. Scope of medical insurance reimbursement
Reimbursement of rural medical insurance:
1, outpatient compensation:
(1) village clinics and village center clinics are reimbursed 60%, and the prescription drug fee limit for each visit 10 yuan, and the prescription drug fee limit for temporary rehydration for doctors in health centers is 50 yuan.
(2) Reimbursement for medical treatment in town health centers is 40%. The limit of examination fee and operation fee for each visit is 50 yuan, and the limit of prescription drug fee is 100 yuan.
(3) The reimbursement for medical treatment in secondary hospitals is 30%, and the limit of each examination fee and operation fee is 50 yuan, and the limit of prescription drug fee is 200 yuan.
(4) 20% reimbursement for medical treatment in tertiary hospitals, with the limit of each examination fee and operation fee in 50 yuan and the limit of prescription drug fee in 200 yuan.
(5) The prescription attached to the invoice of traditional Chinese medicine is limited to 1 yuan.
(6) The annual compensation limit for rural cooperative medical clinics is 5,000 yuan.
2, hospitalization compensation:
(1) Reimbursement scope: A. Drug expenses: supplementary examination: examination expenses such as electrocardiogram, X-ray fluoroscopy, radiography, laboratory test, physiotherapy, acupuncture, CT and nuclear magnetic resonance, etc. 200 yuan; Surgical expenses (refer to the national standard, reimbursement exceeding 1000 yuan 1000 yuan). B, the elderly over 60 years old are hospitalized in Xingta Town Health Center, and the daily treatment and nursing expenses are compensated 10 yuan, with the limit of 200 yuan.
(2) Reimbursement ratio: town hospitals reimburse 60%; 40% reimbursement for secondary hospitals; Third-level hospitals are reimbursed 30%.
3. Compensation for serious illness;
(1) town risk fund compensation: where the medical expenses of inpatients participating in rural cooperative medical insurance exceed 5,000 yuan at one time or throughout the year, they should be compensated by stages, that is, 5001-kloc-0/0000 yuan will be compensated by 65%,10001-.
(2) The annual compensation limit for hemodialysis, radiotherapy and chemotherapy in the town-level cooperative medical system inpatient and uremia clinic is1.65,438+0.000 yuan.