Index | Before | After |
---|---|---|
PTB classification | No | Ordinary PTB/PTB with comorbidities and complications/PTB pleurisy |
Medical insurance payment | Fee-for-services | Compensation mechanism with a full period of treatment |
Compensation plan | ||
Outpatient | Special diseases, according to hospitalization compensation | Outpatient (according to the norm standard, Table 2) |
Inpatient | Deductible is 600 RMB, The reimbursement rates for county, township, and village-level medical institutions are 50%, 55%, and 75%, respectively Medical institutions outside the county are not reimbursed | Full period (according to the norm standard, Table 2) Cancel the deductible and the non-reimbursable project expenses outside the medical insurance catalogue 70% reimbursement according to the norm standard Cancellation and project expenses and deductible health insurance directory can not be reimbursed |
Billing plan | ||
Medical institutions and medical insurance institutions | Hospital compensation amount = reimbursable expenses × reimbursement ratio Reimbursable expenses = total medical expenses − non-reimbursable expenses − deductible line | Hospital compensation amount = fixed payment standard × reimbursement ratio (70%) × number of patients |
Medical institutions and patients | Patient out-of-pocket expenses = total medical expenses − hospital compensation expenses | Patient out-of-pocket expenses = total medical expenses × out-of-pocket ratio (30%) |
Assessment standard | No | Whether to implement according to the clinical path, if yes, all funds are allocated according to the service package payment standard; if not, 10% of the funds are deducted |