Medical insurance designated hospitals refer to medical institutions that have been reviewed and approved by the national medical security department and signed a service agreement with the medical insurance fund to provide medical expense settlement services for insured persons.The characteristic of this type of hospital is that medical expenses can be reimbursed directly through the medical insurance system, reducing the financial burden on patients. The main contents include: qualification requirements, application process, service scope, reimbursement ratio and patient precautions for medical insurance designated hospitals. The following will focus on these core contents to help readers fully understand the relevant policies and practical information of medical insurance designated hospitals.

The qualifications of medical insurance designated hospitals must meet strict national standards, including medical institution practice licenses, medical staff qualifications, medical equipment configuration and other hard conditions. The hospital needs to submit an application to the local medical insurance bureau, and after passing the review, it will be included in the medical insurance designated list. For example, tertiary-A hospitals usually automatically obtain qualifications, while private hospitals require additional assessment of service quality. When insured patients receive medical treatment in such hospitals, they can enjoyOutpatient service, hospitalization, medicines and examination itemsMedical insurance reimbursement, the reimbursement ratio varies by region and policy, generally 50%-90%.

When choosing a medical insurance designated hospital, patients should pay attention toHospital level, reimbursement scope and filing procedures. Some cities require insured persons to select 1-2 designated hospitals in advance, and reimbursement will not be possible if they are not registered. For medical treatment in other places, you need to register for referral through the "National Medical Insurance Service Platform" APP. In addition, only drugs and diagnostic and treatment items in the medical insurance catalog can be reimbursed, and self-paid items must be fully borne by the patient. For example, Beijing Medical Insurance stipulates that the minimum payment threshold for outpatient services in tertiary hospitals is 1,800 yuan, and the excess will be reimbursed at 70%.

The dynamic adjustment mechanism of management of medical insurance designated hospitals deserves attention. The medical insurance department will regularly assess the hospital’sService quality, cost control and patient satisfaction, those who fail may be disqualified. For example, in 2023, Shanghai canceled the designated qualifications of three hospitals due to excessive medical treatment. Patients can check the list of designated hospitals and the latest policies through the 12393 hotline or the official medical insurance website. At the same time, some Internet hospitals have been included in the medical insurance pilot. For example, the Internet hospital of the First Affiliated Hospital of Zhejiang University supports online medical insurance settlement for follow-up visits.

To sum up, medical insurance designated hospitals are a key link in the implementation of medical insurance policies, which not only protect the medical rights and interests of insured persons, but also standardize the service behavior of medical institutions. Patients should be familiar with local reimbursement policies, choose designated hospitals reasonably, and keep invoices, diagnosis certificates and other materials for reimbursement. In the future, as the medical insurance reform deepens, more primary medical institutions and specialty hospitals are expected to be included in the designated scope, further optimizing the allocation of medical resources.

Quote sources:
1. National Medical Security Administration's "Interim Measures for the Designated Management of Medical Security in Medical Institutions" (2021)
2. Beijing Municipal Medical Insurance Bureau’s “Notice on Adjusting the Reimbursement Ratio of Basic Medical Insurance in this City” (2023)
3. Shanghai Municipal Health Commission’s “Evaluation Report on Medical Insurance Designated Medical Institutions” (2023)