basic content
Outpatient special diseases include coronary heart disease, hypertension III, diabetes, liver cirrhosis, psychosis, malignant tumor, renal dialysis, kidney transplantation, Parkinson's disease, rheumatoid arthritis, systemic lupus erythematosus, breast cancer (endocrine therapy), hepatolenticular degeneration, chronic heart failure, chronic renal insufficiency, epilepsy, bladder tumor (perfusion therapy), hepatitis C, liver transplantation, hematopoietic stem cell transplantation and prostate cancer.
Overall planning of medical insurance
Medical insurance co-ordination refers to the remaining part of medical insurance premiums paid by all employers for employees in a co-ordination area after being deducted from personal accounts. The medical insurance pooling fund belongs to all insured persons, and is managed centrally by social insurance agencies and used uniformly. It is mainly used to pay the medical expenses, operation expenses, nursing expenses and basic inspection expenses of the insured employees. The medical insurance fund shall be stored in a special account for special purposes, and no unit or individual may misappropriate it.
Progress everywhere
25 kinds of special diseases such as epilepsy in Hefei can be treated out-patient.
After continuous adjustment, residents in Hefei can apply for 25 kinds of outpatient special diseases, specifically: lentiginous pit disease, chronic heart failure, chronic renal insufficiency, hyperthyroidism, epilepsy, hepatitis C, breast cancer (endocrine therapy), prostate cancer (endocrine therapy), bladder tumor (perfusion therapy), liver transplantation, hematopoietic stem cell transplantation, renal dialysis, kidney transplantation and coronary heart disease.
Shaanxi 15 outpatient special diseases are included in medical insurance, and fever and cold are expected to be reimbursed.
In the past, due to the different medical insurance policies of cities in our province, there were seven or eight kinds of diseases that could be reported, and some of them could be reimbursed 10. In the future, this phenomenon will be improved, and our province will introduce policies to standardize outpatient special diseases. Zhao Yun, deputy director of the Provincial People's Social Welfare Department, said that the notice issued this time is to protect the rights and interests of the insured as much as possible. Municipalities will calculate the payment fees for outpatient special diseases according to the specific actual situation, reasonably determine the unified reimbursement ratio for outpatient special diseases in the city and adjust the annual maximum payment limit. For medical expenses such as radiotherapy and chemotherapy for malignant tumor outpatient service, peritoneal dialysis for chronic renal failure, hemodialysis and taking anti-rejection drugs after organ transplantation, the proportion of reimbursement from the overall fund and the maximum annual payment limit should be higher than other outpatient special diseases. According to reports, due to the different balance of medical insurance funds in different cities, their reimbursement standards may be different, and local cities will formulate implementation rules accordingly and implement them as soon as possible.
Tianjin: expanding the scope of reimbursement for three special diseases
In order to improve the management of outpatient special diseases and make the medical insurance benefits of urban workers and urban and rural residents better connected, the city has recently expanded the implementation scope of three types of outpatient special diseases that were originally suitable for children, such as epilepsy, aplastic anemia and chronic thrombocytopenic purpura, to urban workers and urban and rural adult residents in this city. The insured suffers from the above three diseases, and the medical expenses incurred in outpatient treatment are included in the reimbursement scope of the overall fund according to the medical insurance benefits for urban workers and urban and rural residents with special diseases.
Scope of reimbursement for epilepsy: EEG examination, blood-related examination, urine routine limit 1 time/month, ordinary CT (skull), magnetic vibration (domestic instrument (including enhancement)) limit of 2 times/year, blood drug concentration monitoring, and acupuncture expenses. The reimbursement scope of aplastic anemia: blood-related examination, urine routine limit 1 time/month, stool routine limit 1 time/month, bone marrow examination, cyclosporine blood concentration test 6 times/year, blood products and auxiliary drugs, laboratory expenses, treatment expenses, material expenses and bed expenses. Reimbursement scope of chronic thrombocytopenic purpura: blood related examination, urine routine limit 1 time/month, stool routine limit 1 time/month, bone marrow examination.