医保统筹支付、个人自付、个人自费分不清？看完你就明白了
<div class="wx_rich_media_content" id="jsWxContainer"><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">在医疗费用的支付过程中</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">我们常常会听到<strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'></strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'>“医保统筹支付”“个人自付”</strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'>和“个人自费”</strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'>它们有什么区别？</strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">今天就来给大家理清楚</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><span style='color: rgb(28, 104, 174);'><strong>医疗总费用包括哪些？</strong></span><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'></strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">医疗总费用=医保统筹（基金）支付+个人自付+个人自费</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><span style='color: rgb(28, 104, 174);'><strong>医保统筹支付是什么？</strong></span><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'></strong></strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">属于医保目录范围内，按规定由基本医疗保险统筹基金支付的医疗费用，<strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'>即医保直接报销的部分，这部分不需要自己掏钱。</strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">医保目录范围也就是常说的：医疗服务项目、药品、耗材“三大目录”。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'>职工医保医疗费用统筹支付</strong>包含基本支付和大额支付。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;visibility: visible;'>城乡居民医保医疗费用统筹支付</strong>包含基本支付和大病支付。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">使用医保统筹支付，需要达到医保统筹地区起付线标准。具体标准，根据参加的医保类型（职工医保/居民医保），以及医院级别的不同，所对应的标准均有所不同。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="image"></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><span style='color: rgb(28, 104, 174);'><strong>个人自付是什么？</strong></span><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'></strong></strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">指在医保目录范围内，需要由患者负担的医疗费金额。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">包括起付线以下、乙类先行自付、按比例自付、封顶线以上、目录范围内超限价部分等。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'>这部分费用可先由医保个人账户内的余额进行支付，不够的部分再用现金等方式支付。</strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="image"></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><span style='color: rgb(28, 104, 174);'><strong>个人自费是什么？</strong></span><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'></strong></strong></strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">指在医保范围外的药品、项目等，由参保人员全额支付。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="image"></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><span style='color: rgb(28, 104, 174);'><strong>举个例子</strong></span><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'><strong style='-webkit-tap-highlight-color: transparent;outline: 0px;'></strong></strong></strong></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">小张在医院住院看病，总花费4500元，其中纳入医保目录的医疗费用4200元，医保报销3600元，医保目录外医疗费用300元。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">个人自费就是医保目录外的医疗费用300元。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">个人自付是医保目录内经医保报销后，需要自己支付的费用，即4200元-3600元=600元。</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="image"></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: justify; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body"><br></p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">简单来说</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">医保统筹支付和自付支付</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">对象都是在医保范围内的项目</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">“个人自付”就是本次结算中</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">属于基本医保范围内</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">由个人负担的部分</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">“个人自费”指的是</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">不属于基本医保范围的</p><p style='margin-right: 0.5em; margin-left: 0.5em; text-align: center; color: rgb(0, 0, 0); letter-spacing: 1px; font-size: 17px; line-height: 1.75;' mpa-paragraph-type="body">由个人全额支付的费用</p><p style='display: none;'><mp-style-type data-value="10000"></mp-style-type></p></div> 门诊基本都是自付，不存在什么统筹
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