[Photo via VCG]

Recently, the difference in reimbursement rates for medical bills between community health service centers and second-grade and third-grade hospitals has attracted public attention. Relevant medical staff said that reimbursement rates at community health service centers are higher than those at second-grade and third-grade hospitals, and they suggested that patients seeking minor illness treatment or first-time treatment for an illness should go to community health service centers.

Liu Xinying, Director of Fangzhuang Community Health Service Center, said that the difference in reimbursement rates between community health service centers and second-grade and third-grade hospitals is mainly caused by the basic medical insurance for urban and rural residents. With regards to the outpatient medical bills of participants of the basic medical insurance for urban and rural residents, the deductible at community health service centers is CNY 100, with a 55% reimbursement rate, while the deductible at second-grade and third-grade hospitals is CNY 550, with a 50% reimbursement rate. For inpatient medical bills, the deductible at community health service centers is CNY 300, with an 80% reimbursement rate, while the deductible at second-grade hospitals is CNY 800, with a 78% reimbursement rate, and the deductible at third-grade hospitals is CNY 1,300, with a reimbursement rate ranging from 75% to 78%.

"The deductible for inpatient medical bills applies to a patient's first hospitalization in a given year. It is halved for students, children, and second and any further hospitalizations for elderly people and residents of working age," said Liu Xinying, who suggested that patients with minor illnesses or on first visits choose community health service centers. By doing this, Liu said, they can not only avoid queuing up in large hospitals but also enjoy higher reimbursement rates for their medical bills.

Relevant staff at four community health service centers, including Jinsong Community, Beixiaguan Community and Xueyuan Road Community, all said that the reimbursement rates at community health service centers are higher than those at second-grade and third-grade hospitals, and the rates are uniform in Beijing.

As for medical insurance for urban employees in Beijing, the deductible for outpatient medical bills is CNY 1,800 per year for on-the-job employees and CNY 1,300 per year for retired people. The reimbursement rate for outpatient bills is over 70% for on-the-job employees and over 85% for retired people. The rate is 90% at community health service centers. According to a notice issued by the Beijing Municipal Medical Insurance Bureau, starting from January 1, 2023, Beijing no longer caps the reimbursement from the medical insurance for urban employees for outpatient medical bills. If the bill is under CNY 20,000, the reimbursement rate will remain unchanged. If the bill is over CNY 20,000, the reimbursement rate is 60% for on-the-job employees and 80% for retired people (the rate includes uniform supplementary medical insurance for retired people), without a cap.

When it comes to inpatient medical bills, the deductible is CNY 1,300 for employees in Beijing, which will be halved in the case of second and any subsequent hospitalizations in a given year. Any portion exceeding the deductible will be reimbursed in line with regulations. The reimbursement rate for inpatient medical bills ranges from 85% to 97% for on-the-job employees and from 90% to 99.1% for retired people, with the cap set at CNY 500,000. 

(Source: Beijing Daily)