60 serious diseases in Ji'nan are included in disease payment, cholangiocarcinoma operation and so on.
source: Source: Ji'nan times Author: Zhao Lu
this month, Ji'nan basic medical insurance started the third batch of pilot work according to the disease type in the three level hospital, after the hospital declaration, the expert review, the cardiac myxoma resection, bile duct cancer operation and so on 10 The disease types are included in the scope of the quota elastic settlement. Since May 2012, 60 diseases have been included in the elastic settlement of large medical expenses.
reporter learned that the elastic settlement of the large amount of medical expenses is a kind of medical insurance settlement, which is divided into several diseases (treatment items) which are similar in diagnosis, similar in treatment and similar in medical expenses. The medical cost quota is calculated according to the average hospitalization expenses of the same disease (treatment item). The cost of hospitalization is calculated according to all the medical expenses (including complications) during the hospitalization of the insured, that is, the examination, diagnosis, operation, anesthesia, hospitalization, care, medicine and medical consumables during the whole process of hospitalization. By adopting the standard of payment of disease quota, the social insurance agency will settle the average hospitalization expenses within ten percentage points of the hospital. The standard of the elastic settlement of the disease type is determined by the disease. It can standardize the medical service behavior, promote the clinician to treat the disease, and promote the hospital to treat the severe patients on the premise of ensuring the medical quality.
"the implementation of this approach makes the social security fund effectively undertake reasonable medical costs and not increase the additional burden of the insured. It is a further improvement in the reform of the payment mode of medical insurance in our city. It will increase the irrational increase in the cost of medical insurance and reduce the burden and security of the insured persons. The inpatient care of the insured plays a positive role. " The relevant person in charge of the Municipal Social Security Bureau said.
60 kinds of diseases reimbursed for disease (treatment)
semi hip replacement Buga syndrome interventional therapy for unilateral total hip arthroplasty single segment cervical fixation surgery single segment lumbar internal fixation operation
single knee replacement malignant lymphoma (diffuse large B) Cell type and follicular type
radical
pulmonary aspergillosis resection of pulmonary aspergillosis (except radical resection for malignant tumor)
operation for cervical cancer surgery for intertrochanteric fracture of the femur fixed coronary intervention (1 stent) interventional therapy for coronary heart disease (2 and above stents)
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acute hemorrhagic necrotizing pancreatitis
minimally invasive removal of intracranial hematoma in the treatment of malignant tumors of the ovary; surgical treatment of
interventional procedure for cerebral artery aneurysm intervention (including carotid and intracranial artery).
radical operation of prostate cancer for the treatment of breast cancer (Dan Ce) surgical treatment of breast cancer (Dan Ce) surgical treatment of
renal transplantation esophagus malignancy Radical operation of
double segment cervical internal fixation with bilateral total hip arthroplasty operation of double segment lumbar internal fixation with
radical pacemaker implantation (single cavity) permanent pacemaker implantation (double chamber) resection of primary hepatic malignant tumor with
resection of malignant tumor of the rectum radical aortic dissection interventional therapy for autologous hematopoietic stem cell transplantation;
congenital heart disease (atrial septal defect and ventricular septal defect)
tetralogy of Fallot cardiac myxoma resection for the treatment of liver cirrhosis Treatment of
cholangiocarcinoma with splenectomy in the treatment of gastrointestinal stromal tumor resection of gastrointestinal stromal tumor laparoscopic surgery for bone tumor resection and internal fixation treatment for
primary leukemia (AML)
treatment of
hypopharyngeal carcinoma by endoscopic digestive tract submucous tumor treatment A radical cure