reporter from the Xining Municipal Social Insurance Management Bureau, to further standardize the implementation of medical institutions classification treatment, strengthen the supervision of grading clinics, the convenience of the insured persons for medical treatment, a number of measures taken by Xining City, the implementation of effective power of the treatment classification system.
improve the medical insurance information system to establish a green referral channel
Perfect insurance for urban workers and rural residents medical insurance information system
Xining Social Security Bureau, the grading diagnosis and treatment policy docking with the medical insurance information system, transmission referral information through the implementation of medical insurance information system immediately, to avoid the insured patients back and forth errands handle referral phenomenon, and medical institutions according to the referral information, through hospital referral green channel, can arrange referral of the insured patients priority treatment and hospitalization, shorten the waiting time in the hospital bed, save time and cost of patient care.
implementation of differentiated Medicare Medicare payment policy classification
after referral in hospital step by step two or three designated medical institutions insured patients, Medicare reimbursement, deduction of patients in the hospital the next level of inpatient deductibles, patients only bear two hospitals pay line difference. The hospital to continue to lower hospital rehabilitation of inpatients insured patients, hospitalized from the pay line subordinate Hospital; of insured patients according to referral procedures directly to the two or three designated medical institutions and hospital patients their insistence on referral, or in accordance with the basic medical institutions for diagnosis and treatment of diseases by the clinic directly into the scope of a hospital, Medicare reimbursement, reimbursement ratio decreased 10% in the original basis; for no formalities to go directly to the foreign medical treatment outside the hospital, or because of non sudden emergencies in urban area of Xining city and town hospital employee medical insurance patients, Medicare reimbursement, based on 10% of the first personal care on the reimbursement of Medicare patients with a reduction of 10%; urban and rural residents, the Medicare reimbursement in accordance with the proportion of 30%.
simplify the insured remote medical reimbursement procedures
, medical insurance for urban workers and rural residents medical insurance to the province of medical staff due to illness, three hospitals through the province outside the right diagnosis processing services outside audit procedures, directly to the province of medical, do not need to advance to the municipal and district (county) social security bureau. At the same time due to tourism, visiting relatives, business trips, such as remote workers hospitalized in urban area of Xining city and abroad, do not need to provide travel tickets, visit the car during the certificate, proof of travel units, units to work certificate and other documents. Reimbursement of remote medical insurance expenses, hospitalization expenses invoice, only need to provide a list of expenses, hospital discharge certificate, medical treatment procedures can be avoided, the insured and the insured errands, and effectively facilitate the reimbursement of medical insurance cost.