First, what is the basic medical insurance treatment project? The basic medical insurance diagnosis and treatment project refers to all kinds of medical technical service projects and diagnosis and treatment projects that use medical devices, equipment and medical materials that meet the following conditions: (1) Clinical diagnosis and treatment projects that are necessary, safe, effective and appropriate in cost; (two) the charging standards for diagnosis and treatment projects formulated by the price department; (three) the designated medical institutions to provide medical services for the insured within the scope of diagnosis and treatment projects. Two, the basic medical insurance treatment project should meet what conditions? (1) Define the scope of diagnosis and treatment items. In clinical medical services, there are many services related to diagnosis and treatment, but not all medical services are diagnosis and treatment projects. According to this definition, the first item of diagnosis and treatment refers to medical technical services, such as medical treatment fees, operation fees, anesthesia fees, laboratory fees and so on. , reflecting the service fee, nursing fee and injection fee of nursing staff. , but does not include some non-medical technical services, such as care workers, catering and other life services. Second, it refers to the diagnosis and treatment projects using medical instruments, equipment and medical materials, such as laboratory instruments related to inspection, diagnostic equipment such as B-ultrasound and CT, infusion, catheters, artificial organs and other medical materials. Some non-diagnostic instruments and materials do not belong to the scope of diagnosis and treatment projects, such as instruments and equipment used for hospital management and service facilities to improve living environment. (2) To determine the basic medical insurance diagnosis and treatment items, three conditions should be met: 1, clinically necessary, safe and effective, and appropriately expensive diagnosis and treatment items. Clinical necessity is the necessity of clinical treatment of diseases, and it is a diagnosis and treatment project relative to non-disease treatment, such as beauty, the main diagnosis and treatment means of disease treatment relative to auxiliary diagnosis and treatment means such as music therapy. Safe and effective refers to a mature project that is widely recognized after long-term clinical use compared with some diagnostic and therapeutic measures that are still in the research stage and have uncertain curative effects, such as heart, lung and brain transplantation. Appropriate expenses mean that it should be compatible with the payment ability of the basic medical insurance fund. In the diagnosis and treatment project with the same diagnosis and treatment effect, choose the diagnosis and treatment project with reasonable price. 2, by the price department to develop the diagnosis and treatment project fees. This is based on the current situation that the management of diagnosis and treatment projects is mainly decided by the price department. The level of economic development and medical technology are different, and there are many kinds of diagnosis and treatment projects. Not all provinces (autonomous regions and municipalities) can carry out diagnosis and treatment projects that meet the first condition. According to the charging standard of the price department, the diagnosis and treatment items of basic medical insurance can be set in a clear range first. 3, by the designated medical institutions to provide medical services for the insured within the scope of diagnosis and treatment projects. The basic medical insurance shall be managed by designated medical institutions, and only the various diagnosis and treatment items provided by designated medical institutions determined by social insurance agencies can be included in the payment scope of the basic medical insurance fund. The basic medical insurance fund will not pay for the diagnosis and treatment projects provided by non-designated medical institutions. This condition is a condition that can be mastered by the overall planning area when the fund is paid, and it is also a means to rationally plan health resources from the perspective of medical insurance.
Legal objectivity:
Article 28 of the Social Insurance Law of People's Republic of China (PRC) conforms to the basic medical insurance drug list, diagnosis and treatment items, medical service facilities and emergency and rescue medical expenses standards, and shall be paid from the basic medical insurance fund in accordance with state regulations. Notice on Printing and Distributing the Management Opinions, the Scope of Medical Service Facilities and the Payment Standard of the Basic Medical Insurance Diagnosis and Treatment Project for Urban Employees Article 1 The basic medical insurance diagnosis and treatment project refers to the diagnosis and treatment project, various medical technical services and medical instruments, equipment and medical materials that meet the following conditions: (1) Clinical diagnosis and treatment projects that are necessary, safe and effective and have appropriate expenses; (two) the charging standards for diagnosis and treatment projects formulated by the price department; (3) Designated medical services provided by designated medical institutions for the insured.