Which reimburses more for chronic diseases or outpatient coordination

There is really no absolute answer to this question. It depends on whether you are qualified for chronic disease certification, what diseases the expenses correspond to, and whether you have reached the reimbursement threshold. In most cases, when insured people who have obtained a chronic disease certificate reimburse the expenses related to chronic diseases, the reimbursement ratio and amount for chronic diseases are much higher than those for ordinary outpatient services.

Take the account I helped Mr. Wang from the community settle last week. He is a retired employee of a company in Wuhan. He has been certified as a chronic disease of level 2 hypertension a few years ago. This year, he spent more than 7,200 on antihypertensive drugs and regular inspections for target organ damage. If employees are reimbursed for chronic diseases, the local retired employee’s chronic disease threshold is 200 yuan, and the reimbursement rate is 90%. In total, he only needs to pay 900 yuan. If he chooses to go through the outpatient co-ordination plan for ordinary employees, the local retiree outpatient co-ordination threshold is 500, the reimbursement rate for tertiary hospitals is only 50%, and the maximum co-ordination amount for a year is only 4,000. The maximum co-ordination amount for him is 4,000 for the 7,200, and he has to pay 3,200, which is more than twice the difference.

But it is not always more cost-effective to reimburse chronic diseases than outpatient services. I encountered a counterexample a while ago. A 32-year-old young man was just diagnosed with type 2 diabetes. Before he had time to submit the materials for chronic disease recognition, he went to get hypoglycemic drugs and a glycated hemoglobin test last month, which cost a total of 1,800. At this time, he was not qualified for chronic diseases and could not go through the chronic disease reimbursement channel. He could only go to the general outpatient department. After deducting the 300 yuan minimum payment line, he reimbursed 60%, which is equivalent to reimbursing 900. In this case, the outpatient coordinator will naturally reimburse more.

There is another rule that many people don't know. Chronic disease reimbursement is "dedicated". Only the relevant diagnosis, treatment and drug expenses for the diseases registered on your chronic disease certificate can go through this channel. If you apply for a chronic disease book for COPD and end up going to see allergic rhinitis for anti-allergic drugs, you will not be able to reimburse for this money even if you have more than 100,000 yuan left in the annual chronic disease quota. You can only go through the general outpatient department.

I usually help at community medical insurance service points, and people often ask me whether I need to apply for chronic disease qualifications in order to get more reimbursement. It is really unnecessary. There are clear medical standards for chronic disease recognition in various places. You must meet the corresponding disease course and complications requirements before you can pass the review. You cannot apply casually. If you don’t have any chronic diseases, you will only spend 1,800 on outpatient services throughout the year. You may not even reach the deductible for outpatient services, and you won’t be able to reimburse, so there is no need to worry about this.