Ji'nan launched the third batch of disease based payment pilot work, bile duct cancer surgery and other 10 diseases included in the settlement area.
Lu net September 24th news (reporter Liu Meiting) reporter learned today from the Ji'nan Social Security Bureau, according to the spirit of "the notice on improving the method of flexible settlement of the large amount of critical medical expenses," from Ji'nan this month The basic medical insurance will start the third batch of payment in the three level hospital according to the disease type. After the hospital declaration and the expert review, 10 diseases, such as the resection of the cardiac myxoma and the operation of the bile duct cancer, 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.
it is understood 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 projects) with similar diagnosis, similar treatment methods and similar medical expenses. The medical cost quota is calculated according to the average hospitalization expenses of the same disease (treatment item).
the cost of hospitalization 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. The medical insurance scheme in Ji'nan has formulated the standard of payment for the disease, and the social security agency accounts for the average hospitalization expenses of the hospital within ten percentage points higher than the quota. 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 expenses and not increase the additional burden of the insured. It is a further improvement of the reform of the payment mode of medical insurance in Ji'nan. It will reduce the unreasonable increase of medical insurance costs, lighten the burden of the insured and ensure the hospitalization of the insured. Medical care plays a positive role.
table
1 semi hip replacement
3 unilateral total hip replacement
4 single segment cervical fixation in
5 single segment lumbar internal fixation
6 single knee replacement
7 malignant lymphoma (diffuse large B cell type and follicular type)
8 lung malignant tumors radical
9 pulmonary aspergillosis 10 pulmonary lobectomy (except for malignant tumor radical resection)
11 cervical cancer operation treatment Br / > 12 intertrochanteric fracture operation fixed
13 coronary intervention (1 stent)
14 coronary intervention (2 and above stent)
16 ankle fracture (double malleolus, three ankle) fixation
17 acute hemorrhagic necrotizing pancreas
18 intracranial hematoma minimally invasive removal of
19 ovarian malignant tumor surgical treatment of
20 cerebral aneurysm intervention
21 cerebral artery stenosis intervention (including carotid, intracranial artery)
22 brain tumor operation treatment
23 radical prostatic cancer radical operation for
24 breast cancer (Dan Ce) surgical treatment of
25 radiofrequency ablation (atrial fibrillation)
26 radiofrequency ablation (supraventricular speed)
27 renal, ureteral and bladder malignant tumors radical
28 renal artery stenosis interventional therapy (PTA stent)
29 renal transplantation
30 esophageal malignant tumor surgical roots
31 bilateral total hip replacement
32 double segmental cervical internal fixation operation
33 double segment lumbar internal fixation operation
34 double knee replacement
35 gastric malignant tumor operation radical
36 inferior vena cava thrombus interventional therapy
37 small bowel and colon malignant tumor radical operation radical cure radical operation
38 heart valve replacement (1 valves)
39 heart valve replacement (2 and above)
40 heart bypass surgery
41 pancreatoduodenectomy radical
42 permanent pacemaker implantation (single chamber)
43 permanent pacemaker implantation (double chamber)
44 Surgical resection of primary hepatic malignant tumor
45 limb arterial cavity idioplasty (PTA)
46 limb arterial cavity (PTA 1 stents)
47 limb arterial cavity (PTA 2 stent)
48 rectal malignant tumor radical
49 aortic dissection intervention Treatment of
50 autologous hematopoietic stem cell transplantation
51 congenital heart disease (atrial septal defect, ventricular septal defect)
52 method of tetralogy of lolson's quadruple syndrome
53 cardiac myxoma excision treatment
54 liver cirrhosis portal hypertensive pericardial vascular dissection splenectomy for the treatment of
55 bile duct carcinoma hand Radical resection of
56 gastrointestinal stromal tumor laparoscopic surgery
57 bone tumor resection and internal fixation for
58 primary treatment of leukemia (AML)
59 via endoscopic submucous submucosal tumor resection for the treatment of