在广西，樊女士的情况并不是个例。2025年以来，广西住院分娩政策范围内费用个人花费低于10元 的情况并不鲜见。2025年1月1日以来，全区有2.8212万名宝妈经医保报销后，个人支付金额低于10元。 数据显示，南宁市还有4874人生娃一分钱没花。 近日，国家医保局提出"力争2026年全国基本实现政策范围内分娩个人'无自付'"，让不少生育家庭 充满期待。1月9日，记者从自治区医保局获悉，广西通过制度创新、技术赋能和服务升级形成政策合 力，为生育家庭提供全方位的有力支持，目前已有2.8万余名宝妈享受到生育保险报销政策范围内"无自 付"。 此外，广西结合灵活就业人员、新就业形态人员等群体的生育保障需求，指导有条件的地市将灵活 就业人员纳入生育保险保障范围，增强制度保障功能。目前，该政策已经在北海市、贵港市落地，符合 条件的最高可以享受生育津贴1万元。 前不久，南宁市职工参保人樊女士迎来了她的二胎宝宝。从产检到生育，樊女士一路都有报销。5 年前，她生一胎的时候，顺产花了5000多元，报销了3000元。现如今，她享受到的医保报销额度更高 了。 翻看医疗账单，樊女士算了一笔账，门诊产前检查医保报销了1500元，单胎顺产生 ...

三湘都市报12月30日讯 看病就医，医保少不了。怎样使用医保，才能让我们的医保报销更周全呢？12 月30日，长沙医保支招多个实用的医保报销"小窍门"，可以帮助参保人在看病就医过程中省下不少钱。 小病优先考虑社区医院 如果是常见病和多发病之类的小病，选择就近社区医院就诊更省钱，一般社区 医院的起付线更低、报销比例更高。同样的病症，在社区医院可能能够报销90%，在三甲医院可能只能 报销60%—70%。 起付线也不一样。以湖南省居民医保的起付线为例，基层医疗卫生机构（如乡镇卫生院、社区卫生服务 中心）为200元，一级医疗机构或不设等级医疗机构为500元，二级医疗机构为800元，三级医疗机构为 1200元，省部属医疗机构为2000元。一个结算年度内多次住院时，第二次及以后的起付标准按50%计 算，且年度累计不超过3000元。 门诊特定病种须通过审核确认 既往已确诊的参保人员，定点医疗机构可根据既往化验单、诊断书等予 以审核确认。通过审核确认后，参保人在门诊治疗该病时可以享受门诊特定病种医保报销待遇。 据了解，目前湖南省共47个病种可以申请门诊慢特病。获得门诊慢特病待遇保障的参保患者在门诊发生 的政策范围内费用，不设起 ...

生孩子有多痛？医学上将疼痛分为0—10级，而生孩子的痛可达7—9级。对想选择无痛分娩的产妇而 言，无痛分娩纳入医保，可以告别"自费纠结"，根据实际情况选择是否采用无痛分娩方式了。 四川省医疗保障局相关负责人介绍，根据国家医保局相关要求，四川省已将分娩镇痛项目单独立项，纳 入医保支付报销。目前，四川省已有500余家医疗机构完成服务准备，从成都、绵阳等城市的三甲医 院，到县域医疗中心，"舒适分娩"保障网络已全面铺开，产妇在家门口就能享安心服务。 分娩镇痛服务是通过将药物注入产妇的脊柱椎管内，极大缓解其生产疼痛。但是，产妇最终能否实施椎 管内分娩镇痛，需由产科医生和麻醉医生根据产妇的具体身体状况和产程进展进行专业评估决定。 今年6月，国家卫生健康委等部门公布相关工作通知，要求推动医疗机构广泛开展分娩镇痛服务，到 2025年底，全国开展产科医疗服务的三级医疗机构将全部能够提供分娩镇痛服务；到2027年，开展产科 医疗服务的二级以上医疗机构将全部能够提供分娩镇痛服务。 目前，全国将无痛分娩纳入医保支付报销的除四川外，还有江苏、浙江、广西、吉林、上海等地。 【未经授权，严禁转载！联系电话028-86968276】 川观新 ...

Core Points - The rumor of "clearing the medical insurance account by the end of the year" is a misunderstanding, as personal account funds accumulate over the years and do not disappear [1] - The annual reimbursement limit for outpatient pooling is what is referred to as "clearing," which is a shared fund rather than personal assets [1] Summary by Sections Medical Insurance Bill Components - The medical bill consists of three main components: insurance pooling payment, personal payment, and personal expense [3] - Insurance pooling payment is the most favorable part, covering eligible expenses directly paid by the insurance fund [3] - Personal payment refers to costs within the insurance directory that require the individual to pay a portion, including amounts below the threshold and above the cap [3][5] Personal Expenses - Personal expenses are completely outside the insurance safety net, covering items not included in the insurance directory, which patients must pay in full [5] - The term "personal burden" may vary in meaning, sometimes referring to costs incurred after the personal account is exhausted or encompassing all personal payments [5] Real-World Examples - A case study illustrates that if a patient incurs a total cost of 4500 yuan, with 4200 yuan covered by insurance, the personal payment would be 600 yuan, and personal expenses would be 300 yuan, totaling 900 yuan out-of-pocket [7] - Another example shows a total cost of 10000 yuan, with 8000 yuan covered by insurance, resulting in a personal payment of 4750 yuan after reimbursement [7] Family Account Mutual Assistance - The family mutual assistance mechanism allows the use of personal account funds for family members, enhancing the efficiency of fund utilization [8] Outpatient Pooling Annual Limit - The outpatient pooling policy provides coverage for ordinary outpatient expenses, with a set annual payment limit that does not carry over to the next year, leading to the "clearing" concept [10] - The insurance fund operates as a shared risk pool, emphasizing the collective nature of contributions and reimbursements among insured individuals [10]

"轻轻抬腿，慢慢往外伸，不疼吧？"甘肃陇南宕昌县人民医院住院部，骨科主治医师赵彤辉轻扶患者马 虎代连的左腿，进行肢体抬高检查和训练。住院一周，马虎代连即将出院，赵彤辉嘱咐更细。 要在以前，县城医疗能力有限，马虎代连这样的情况需到兰州或四川成都治疗。而现在，得益于"千县 工程"，宕昌这样曾经的贫困县也能完成微创手术。 2021年，国家卫生健康委启动"千县工程"，提升县医院综合能力，提出到2025年，全国至少1000家县医 院达到三级医院医疗服务能力水平，以脱贫地区、易地扶贫搬迁安置地区等地的县医院为重点。 在宕昌，兰州大学第一医院对县人民医院进行"组团式"帮扶，加上与山东青岛市南区的东西部协作助 力，2022年7月以来，县人民医院迎来4批次27名帮扶专家，坐诊、查房、手术等，提升当地医疗救治能 力。县人民医院还选派180多名医务人员到兰州、青岛进修，赵彤辉就曾到青岛大学附属医院、兰大一 院、兰大二院学习两年。 "管病人、上手术、出门诊……理论和实践水平都得到提升，关节镜手术实操技能就是在这期间学会 的。"赵彤辉说，回到宕昌，兰大一院专家还会继续带教，持续提升基层医疗人员能力。 同时，通过"千县工程"，县人民医院 ...

Core Viewpoint - The healthcare journey in Guanmiao Village, located in the Dabie Mountains of Anhui Province, reflects both the challenges and improvements in medical access for elderly residents, highlighting the importance of local medical support and insurance coverage in addressing their healthcare needs [1][7][9] Group 1: Healthcare Access and Support - The village has a significant number of elderly residents, with over half of the 144 chronic disease patients being over 65 years old, indicating a high demand for healthcare services [1] - Local healthcare providers, such as village doctors, play a crucial role in offering home visits and basic medical checks, which helps bridge the gap for those who may struggle to access healthcare facilities [3][4] - The timely response from local healthcare professionals, as demonstrated in the case of Grandma Tang, showcases the effectiveness of community healthcare systems in emergencies [2][3] Group 2: Financial Challenges - Despite having medical insurance, many elderly residents face financial burdens due to high medical costs, as seen in the case of a 75-year-old woman needing surgery for a brain tumor, which costs over 200,000 yuan [7][8] - The financial strain is exacerbated by the limited income of elderly residents, who often rely on minimal savings or family support, making it difficult to afford necessary treatments [8] - The closure of local pharmacies and the inability of elderly residents to navigate medication purchases due to illiteracy further complicate their access to necessary healthcare [8][9] Group 3: Community and Emotional Support - The presence of local healthcare workers who provide not only medical assistance but also emotional support is vital for the elderly, helping to alleviate feelings of isolation and anxiety [6][9] - The community's efforts to simplify the healthcare process, such as pre-arranging hospital visits and providing clear instructions for medication, demonstrate a commitment to improving the quality of life for elderly residents [5][6][9]

Group 1 - The article highlights the significant reduction in drug prices and the improvement in healthcare coverage for rural residents over the past fifteen years, particularly through the New Rural Cooperative Medical Scheme [1][3] - The reimbursement rate for inpatient care has increased from a low level at the start of the program to around 70% currently, indicating a substantial enhancement in financial support for medical expenses [3][8] - The article provides specific examples of individuals, such as Liu Guiying, who have experienced a decrease in monthly medication costs, with the price of a commonly used drug, Captopril, dropping from 28 yuan to 4 yuan per box, resulting in over a 50% reduction in her monthly drug expenses [2][4] Group 2 - Despite the improvements, there are still challenges faced by patients, such as the withdrawal of certain effective imported drugs from the reimbursement list, leading to increased out-of-pocket expenses for patients like Liu Guiying [4][6] - The disparity in healthcare benefits between different insurance schemes is evident, with urban employees enjoying better coverage compared to rural residents, as seen in the cases of Liu Guiying and Ai Fenglan [7][8] - The funding structure for urban employee insurance is more robust due to contributions from both employers and employees, while rural resident insurance relies heavily on government subsidies and individual payments, resulting in a smaller overall funding pool [8][9]

Core Viewpoint - Work-related medical expenses cannot be reimbursed through medical insurance and must go through the work injury insurance channel, as clearly stipulated by law. Misusing medical insurance not only results in invalid reimbursement but may also lead to fund recovery and fines, necessitating a strict distinction between the two保障体系 [1] Group 1: Legal Framework - The Social Insurance Law explicitly states that medical expenses that should be paid from the work injury insurance fund are not included in the medical insurance reimbursement scope [1] - For example, if a construction worker suffers a fall and is recognized as having a work injury, all related medical costs must be covered by the work injury insurance fund, and using medical insurance for these expenses could lead to recovery actions by the medical insurance department [1] Group 2: Work Injury Insurance Reimbursement - Reimbursement covers treatment costs that align with the work injury insurance directory, including surgical fees, medication costs, and examination fees [4] - Rehabilitation costs during the work injury recovery period, such as physical therapy and assistive device expenses, are also included [4] - Daily hospitalization allowances and travel expenses for medical treatment away from home are reimbursable, provided proper documentation is submitted [4] Group 3: Administrative Penalties and Employer Responsibilities - According to the Medical Insurance Fund Usage Regulations, those who commit fraud may face a suspension of medical insurance reimbursement for 3 to 12 months and fines ranging from 2 to 5 times the amount fraudulently obtained [5] - Employers who fail to pay for work injury insurance are responsible for covering all work injury costs and cannot offset these costs with commercial accident insurance [5] Group 4: Practical Recommendations - Timely recognition of work injuries is crucial; applications must be submitted within one year, including necessary documentation [6] - Maintaining complete records, such as work injury recognition documents and medical invoices, is essential for reimbursement claims [6] - Monitoring employer compliance with work injury insurance payments is important; employees can seek arbitration or complaints if the employer has not paid [6]

Core Viewpoint - The article highlights the challenges faced by hemophilia patients in accessing necessary medication due to tightening insurance reimbursement policies and the stigma associated with their condition, which has led to increased difficulties in obtaining treatment and maintaining a normal life [8][12][36]. Group 1: Patient Experiences - Patients like Xiang Huan experience significant pain and difficulty in accessing treatment, often spending hours in hospitals to obtain necessary medications [4][10]. - The tightening of reimbursement policies has made it increasingly difficult for patients to receive their required doses of clotting factors, leading to a cycle of emergency treatments rather than preventive care [8][9]. - Many patients report that they are now required to provide extensive documentation and proof of their condition to obtain medication, which was not previously necessary [10][12]. Group 2: Policy Changes and Impacts - Recent changes in insurance policies have restricted the reimbursement of clotting factors to only when patients are actively bleeding, which is a shift from previous practices that allowed for more flexible access [8][9]. - In regions like Zhejiang, stricter regulations have been implemented, resulting in significant savings for insurance funds but at the cost of patient access to necessary treatments [12][16]. - The article notes that the average treatment cost for hemophilia patients is around 276,000 yuan per year, with some patients needing up to 700,000 yuan to achieve international treatment standards [36][37]. Group 3: Stigma and Fraud Concerns - The article discusses how recent fraud cases involving hemophilia patients have led to increased scrutiny and stigma against the entire patient community, affecting their relationships with healthcare providers [17][18]. - Patients feel that they are being unfairly labeled as potential fraudsters, which has changed the dynamics of their interactions with medical professionals [17][20]. - The fear of being accused of fraud has made it more challenging for patients to advocate for their treatment needs, further complicating their healthcare journey [18][20]. Group 4: Economic Pressures - The financial burden of hemophilia treatment is significant, with many patients relying on insurance and charity to cover costs, leading to a precarious situation where any changes in policy can have dire consequences [36][42]. - The article emphasizes that the high costs of treatment and the uneven distribution of insurance coverage across regions exacerbate the difficulties faced by patients, particularly in less economically developed areas [37][38]. - Patients often resort to participating in clinical trials as a means to access necessary medications, highlighting the desperation and lack of options available to them [32][33].

Group 1 - The core concept of the "Medical Insurance Wallet" is that it allows insured individuals to transfer funds from their personal medical insurance accounts to their close relatives' wallets for medical expenses, enabling a "one account for the whole family" approach [2][3]. - The "Medical Insurance Wallet" feature has been fully launched in Henan Province, allowing for cross-province fund transfers for medical expenses, which was not possible before [2][3]. - The process for opening a "Medical Insurance Wallet" involves logging into the National Medical Insurance Service Platform and confirming the use of the wallet [6][8]. Group 2 - The transfer of funds is real-time, and recipients can use their medical insurance code or facial recognition for payments, with no restrictions on the location of medical services [3][29]. - Each "Medical Insurance Wallet" account has a daily transfer limit of three transactions, with each transaction not exceeding 2000 yuan, and transfers cannot be made between 22:00 and 06:00 [25][28]. - To assist family members in opening their wallets, users must download the National Medical Insurance Service Platform and follow the prompts to provide necessary information [29].