1. What are the "three catalogues" of medical insurance?

The reimbursement scope of my country's basic medical insurance is managed by catalogue. The medical expenses in the catalogue are included in the medical insurance reimbursement, and are shared by the medical insurance fund and individual patients in proportion according to regulations. The medical expenses outside the catalogue will not be paid by the medical insurance fund. The catalog of drugs, medical consumables and medical service items included in the scope of medical insurance payment are what we often call the "three catalogues" of medical insurance.

2. Why should we implement the "three catalogues" management of medical insurance?

It is a common practice in all countries to manage the coverage of medical insurance by formulating reimbursement catalogues or lists. First, it is conducive to establishing a medical security system that is compatible with the level of economic and social development and preventing "welfare traps"; Second, it is conducive to adhering to the principle of "guaranteeing the basics" and curbing excessive medical demand; Third, it is conducive to improving the purchase efficiency of medical insurance funds and promoting the coordinated development and governance of the "three medical services".

3. How are the "three catalogues" of medical insurance determined?

The medical insurance drug catalog adopts the access method, which is mainly formulated by the state and dynamically adjusted. In principle, it is adjusted once a year. Since the founding of the National Healthcare Security Administration in 2018, more than 700 kinds of emergency and life-saving good drugs and innovative drugs have entered the catalog of medicines covered by national medical insurance system, including 446 new drugs added through negotiations. In 2023, the total number of western medicines and traditional Chinese medicines in the catalog of medicines covered by national medical insurance system has reached 3,088, and there are 892 kinds of traditional Chinese medicine pieces, which can basically meet clinical needs. On this basis, the provincial medical insurance department can, in accordance with the authority and procedures, include qualified ethnic medicines, medical institution preparations, and Chinese herbal pieces into the payment scope of the local medical insurance catalogue. The catalogue of medical consumables and the catalogue of medical service items are formulated by the state for medical insurance access and management policies. In principle, the provincial medical insurance departments adopt the access law and exclusion law in accordance with national regulations.

4. Which medical expenses are not included in medical insurance reimbursement?

Basic medical insurance mainly protects the disease treatment expenses of insured persons. According to the Social Insurance Law and the national medical insurance benefit list system, the scope of non-payment by the medical insurance fund includes the following situations: 1. It should be paid from the work-related injury insurance fund; 2. It should be borne by a third party; 3. It should be borne by public health; 4. Seeking medical treatment abroad; 5. Physical fitness, health care consumption, and physical examination; 6. Other expenses not paid by the basic medical insurance fund stipulated by the state.