What is the threshold fee for chronic diseases?

There is no unified fixed standard across the country, and there are considerable differences across regions. The low one is 0 yuan, and the high one can reach thousands of yuan. Currently, the chronic disease threshold fee for employee medical insurance in most coordinated areas in China is in the range of 200-800 yuan, and the residents' medical insurance (including the original New Rural Cooperative Medical Insurance) is in the 100-500 yuan range. For special groups such as minimum living allowances, special poverty, and severely disabled people, most places directly waive this part of the fee.

Many people may still be a little confused about the concept of "threshold fee". In fact, its official name is "Chronic Disease Outpatient Co-ordinated Minimum Payment Standard". To put it bluntly, it is the entry line for you to enjoy chronic disease reimbursement benefits - within a year, you have to pay enough for the compliance fees for seeing chronic diseases and prescribing chronic disease-related drugs. The excess can be reimbursed according to the local regulations. It is a bit like the pass threshold of an amusement park. Only after paying the admission fee can you enjoy discounts according to the rules.

A while ago, I accompanied the elderly at home to the community to register for hypertension and chronic diseases. The window staff specially calculated an account for us: the threshold fee for chronic diseases of our local employee medical insurance in Changzhou is 300 yuan. It costs about 120 yuan for the elderly to prescribe antihypertensive drugs every month, and the first two prescriptions are All the money had to be paid by myself. By the third prescription, the cumulative out-of-pocket amount had reached 240. As long as I paid another 60 yuan for the out-of-pocket part, the remaining 60 yuan could be reimbursed at a rate of 75%. After calculation, I only needed to pay 75 yuan for the third prescription, which was 45 yuan less than before. I later specifically checked the policies of other places, and the differences are indeed quite large. For example, in Shenzhen, there is no threshold fee for Class I chronic diseases (hypertension, diabetes, etc.), and compliance fees are directly reported at 70%. In many counties in Henan, the threshold fee for chronic diseases in resident medical insurance is only 100 yuan, and groups with special difficulties are directly exempted from payment.

After all, chronic disease co-ordination is still dominated by municipal or even county-level co-ordination. The affordability of medical insurance funds in different regions is different, and policies are naturally skewed. Places with developed economies and abundant fund pools are willing to lower the threshold to allow more people to enjoy benefits. However, some underdeveloped areas with greater pressure on medical insurance funds may set the threshold slightly higher to give priority to patients with chronic diseases who have greater expenses.

There are indeed different opinions about the setting of this threshold fee. Many friends in medical insurance management believe that setting a reasonable threshold fee can reduce fund waste. After all, some patients with chronic diseases only spend one or two hundred on medicines throughout the year. The burden is not heavy in the first place. If this part of the money is saved, it can be spent on those patients with severe chronic diseases who spend thousands on medicines every month. The money can be spent wisely.； But there are also many ordinary patients who feel aggrieved. For example, I met an old man who lived alone. He only had high blood pressure. He only paid fifty or sixty yuan for medicine every month. He couldn't make up the local threshold fee of 300 yuan in a year, which is equivalent to applying for chronic disease benefits and not being able to use them. You can't forcefully prescribe a bunch of unused medicines just to make up for the threshold, right? In recent years, many places have also gradually adjusted their policies, either lowering threshold fees or combining the deductibles for multiple chronic diseases, so that as many people as possible can enjoy the benefits.

There is another small detail that many people don’t know. If you register several chronic diseases at the same time, the threshold fee in most places is shared and accumulated. You don’t have to collect it separately for each disease. The annual accumulation is only for the current year and will not be transferred to the next year. If there is a difference of tens of dollars at the end of the year, it will be enough to cover the deductible. Just prescribe some commonly used chronic disease medicine. If you just add up enough, you can be reimbursed. It is not a waste.