Original title: in 2020, the capping line of Beijing residents' medical insurance outpatient service will be increased to 4000 yuan / year
On the 30th, the reporter learned from Beijing Medical Insurance Bureau that from 2020, the medical insurance outpatient capping line for urban and rural residents will be adjusted from 3000 yuan / year to 4000 yuan / year.
Beijing Medical Insurance Bureau said that the adjustment of outpatient capping line will not increase the individual payment of urban and rural residents in 2020. The medical insurance and health management departments will further coordinate and link, standardize the medical behavior of medical institutions, strengthen the control of unreasonable medical expenses, severely crack down on fraud and insurance, seek benefits from management and protect the fundamental interests of insured personnel.
In the process of centralized medical insurance for urban and rural residents in 2020, the low outpatient capping line has always been the focus of the insured. In particular, the recent adjustment of Beijing medical insurance drug catalogue has included 227 conventional access varieties added by the state and 70 drugs such as cancer, rare diseases and chronic diseases successfully negotiated by the state into the Beijing medical insurance drug catalogue.
"Considering the affordability of the medical insurance fund for urban and rural residents, the current outpatient capping line will be adjusted from 3000 yuan / year to 4000 yuan / year from 2020." Beijing Medical Insurance Bureau stressed.
In terms of increasing the reimbursement proportion of district level III hospitals, in order to facilitate medical treatment for urban and rural residents and guide a reasonable medical treatment order, the Beijing Medical Insurance Bureau also increased the hospitalization reimbursement proportion of district level III medical institutions such as district hospitals and district traditional Chinese medicine hospitals by 3 percentage points, from 75% to 78%.
At the same time, we will further expand the scope of outpatient first consultation, from the original primary designated medical institutions to public medical institutions organized by district and town governments.
Beijing Municipal Medical Insurance Bureau said that according to the work deployment of the state, the municipal Party committee and the municipal government, a dynamic adjustment and improvement mechanism for financing and medical insurance treatment should be established in combination with the operation of medical insurance for urban and rural residents and the needs of insured personnel in basic medical treatment.
At the same time, start the research on the fund balance incentive mechanism, and explore and implement the incentive measures to improve the treatment of serious illness insurance for insured individuals who do not see a doctor or see a doctor less.
We will intensify efforts to crack down on fraud and insurance fraud, strengthen the application of big data in medical insurance, and strictly control unreasonable expenses.
Through the adjustment of reimbursement policy and further strengthening fund supervision, ensure that the limited medical insurance fund is most effectively used on insured patients.