When it comes to publicly-funded medical care and medical insurance, netizen "Looking Up to Happiness" posted:

"The only people who have access to publicly funded health care are the state civil servants, who never have to pay for medical treatment themselves, and these people are only a small part of the country's population; Only qualified urban people can enjoy social medical insurance, and they are reimbursed for a certain percentage of medical treatment, and these people only account for a part of the national population; However, the vast number of urban poor and peasants, who account for the vast majority of the country's population, are excluded from medical insurance, and when they get sick, they can only pay for medical treatment at their own expense and out of their own pockets. Pen @ fun @ pavilion wWw. ｂｉｑUｇE。 ｉｎｆｏ

"This is the biggest injustice in the healthcare system today!

"I believe that the reform of the medical system is to make medical insurance cover the vast number of urban poor and peasants, who account for the vast majority of the country's population, cancel the public-funded medical care of state civil servants, and let the public-funded medical care and medical insurance 'merge', such a reform is fair and the best."

Subsequently, netizen "Seventy-two Changes" posted: "The popularization of medical insurance is only a step forward, and it cannot completely guarantee the equality of medical care."

"Those retired cadres enjoy a special medical insurance policy, and doctors can be reimbursed in full by medical insurance as long as they write 'treatment expenses' on the list, and there is no need to apply the names of other products that have entered the medical insurance catalog; the medical insurance for urban residents has a certain threshold fee every year, and they have to pay a large part of it for minor illnesses, and it is very likely that the medical insurance limit will exceed the limit for major illnesses, and only small and small diseases can make the medical insurance amount to the greatest extent If rural residents are universally covered by medical insurance, because the population base is too large, the proportion of reimbursement will certainly be lower than that of urban residents, and the total limit will be smaller, and they will soon be exhausted if they get seriously ill.

"The popularization of medical insurance cannot automatically solve the problem of indiscriminate charging in hospitals.

"I am an urban medical insurance person, and I know some information about the medical insurance department and the hospital. The medical insurance department has made various restrictions on hospitals in terms of fees, such as the restrictions on the total hospitalization expenses of insured patients, the restrictions on the proportion of self-financed drugs, the restrictions on the cost of each hospitalization, the restrictions on the average daily hospitalization expenses, the restrictions on the hospitalization expenses of a single disease, the restrictions on medical treatment in other places, and so on.

"Although most hospitals claim to be public, but the government funding is very small, need cost accounting and self-financing, if beyond the limit of medical insurance need to be borne by the hospital itself, it is undoubtedly the hospital to pay for it, so the hospital will either transfer to the department or doctors and nurses, or play the idea of medical insurance.

"Doesn't the medical insurance department stipulate that the proportion of drug expenses cannot exceed the limit? Then check more, increase the cost of examination, and the proportion of drug cost will naturally be reduced.

"In some designated hospitals for medical insurance, when CT and MRI examinations are done for medical insurance patients, the multi-part examinations that should be charged per person according to the regulations are broken down into multiple scan fees; Some designated hospitals should charge for one person when performing CT scans and enhanced examinations at the same time according to the regulations, but in fact, they charge both plain scan and enhanced scans. In order to avoid inspections, some designated hospitals allow patients to complete multiple scans by settling at different times and scanning only one part at a time, so that patients can be repeatedly visited to complete multiple scans, so as to charge multiple times.

"These behaviors have seriously damaged the legitimate rights and interests of the insured, increased the burden of medical treatment on the insured, and also caused a waste of the medical insurance fund.

"Doesn't the health insurance department stipulate that there is a limit on the cost of each hospitalization? Then let the medical insurance patients be discharged first, and then hospitalized two days later, and some even be discharged in the morning and admitted in the afternoon, so as to reduce the cost of each hospitalization.

"Doesn't the medical insurance department stipulate a limit on the cost of hospitalization for a single disease? Doctors also have a way to deal with it.

"Here's an example. For example, some medical insurance departments stipulate that laparoscopic cholecystectomy for gallstones is a single disease, and the upper limit of the cost is 8,000 yuan, which is more than some hospitals pay out of their own pockets.

"However, in clinical practice, patients often have heart disease, diabetes and hypertension, etc., and if the corresponding examination and treatment are done, it is easy to exceed the limit of 8,000 yuan, and some hospitals will deduct it from the doctor's salary. Therefore, the doctor assigned the preoperative examination to the outpatient clinic, so that not only the cost of hospitalization for a single disease was reduced, but also the examination fee could be overcharged.

"In addition, the restrictions imposed by the medical insurance department on medical insurance personnel seeking medical treatment in other places not only bring great inconvenience to medical insurance personnel, but also cause heavy economic burden to medical insurance personnel. I have a deep understanding of this.

"I had chronic prostatitis, and I was hospitalized in a hospital in a foreign country for work reasons, and the doctor gave me laser therapy, radiofrequency therapy, deep hyperthermia, etc., which cost me more than 40,000 yuan in about 10 days.

"When I went back to my hometown for reimbursement with the hospital's hospitalization expenses, I was told that the hospital in other places was not a designated hospital, and the expenses were not covered by the local medical insurance, and I should bear the medical expenses of more than 40,000 yuan. I'm so fucking wronged. ”

Netizen "Call of the Soul" also wrote in the post: "Many hospitals have violated the rules of indiscriminately charging for insured persons and obtaining medical insurance funds in disguise, and there are more and more means and methods.

"For example, through repeated charges, excessive standard charges, false inspections with fees but no inspections, by providing too many unnecessary items to arbitrage, through drugs exceeding the maximum retail price, illegal use of large medical equipment to arbitrage, through the charging of one-time material fees during surgery, exceeding the standard charge of digital photography laser dried films, through the non-strict implementation of the basic medical insurance 'drug catalog', the special selection of high-priced Class B drugs or self-financed drugs in the same kind of drugs, The cheap Class A drugs that can be reimbursed are used as little as possible to be arbitraged, and they are obtained by changing the type of disease and being hospitalized in a hanging bed, and so on.

"There are more and more ways to arbitrage medical insurance funds in disguise, making it impossible for the medical insurance department to control the vicious growth of medical expenses."

Netizen "scare you" is even more shocking, he wrote in the post: "Some public hospitals are arbitraging medical insurance funds, and a few private hospitals are simply defrauding medical insurance funds."

"The practice of these private hospitals is that the hospital borrows the medical insurance card from relatives and friends for a period of time through employees, and promises to give the borrower a certain benefit fee, perhaps promising that when the borrower uses the medical insurance card when he is sick, the hospital can reduce part of the treatment cost, and induce the insured who is not hospitalized to hand over the medical insurance card to the hospital.

"After receiving these medical insurance cards, the hospital carried out a streamlined fraud operation, and the doctors began to issue hospitalization certificates, fill in medical conditions and medical insurance medical records for these so-called 'patients' according to the basic information of the owners of the medical insurance cards.

After the completion of the examination, the inspector will issue a test certificate, the nurse will fill in the nursing record, and the staff of the billing office will enter the treatment into the network system of the medical insurance center according to the medical insurance card and forged medical records, and then hand over the medical records to the hospital medical record room for safekeeping, and then return the medical insurance card to the borrower.

Then, the hospital will report the forged patient's inpatient medical records, treatment expense bills and other information to the medical insurance center to apply for medical insurance payment, and the medical insurance center will remit the medical insurance pooling fund to the hospital account after review.

"In the end, the hospital will 'commission' the fund money to the medical staff involved in the fraud according to the pre-agreed proportion."

After reading the post of "Scared You", Niu Tiangou was not only "startled", but also broke out in a cold sweat.

Damn, if that's the case, it's too bold and lawless, right?

However, the world is so big that there are no surprises, and there are people who take risks for the sake of profit.

Grandma's, medical insurance is not "insurance", it is really shady and chaotic.

This medical insurance fund, which was originally the life-saving money for the treatment of the insured, was even "tricked" and "cheated" into the hospital, and finally fell into the pockets of private individuals in the form of bonuses and kickbacks!