Ji'nan workers' health insurance new regulation will carry out serious illness and other serious diseases.
http://www.chinanews.com/jk/2013/03-25/4672050.shtml
recently, the reporter learned from the Bureau of Jinan people's society that the medical insurance outpatient system of basic medical insurance in Ji'nan city has been adjusted, and it has been formally implemented since April 1st. In order to let the general public understand the policy adjustment details in detail, our reporter interviewed the relevant person in charge of the Ji'nan Social Security Bureau for detailed explanation.
interpretation 1: according to the characteristics of four categories of
according to the characteristics of treatment, it is understood that since the basic medical insurance of urban workers in Ji'nan was started in 2002, the type of disease of the gate was from the first 5, and has been adjusted 4 times to the present 35 kinds of 54 diseases. Among these diseases, major diseases, special diseases, chronic diseases and common diseases are very different in terms of treatment and treatment cost.
to this end, according to the principle of basic medical insurance, the basic medical insurance, based on the comprehensive consideration of the severity of the disease, the cost of medical treatment, the burden of the family and other factors, it is divided into 4 categories. Among them, 4 kinds of diseases such as dialytic treatment of uremia patients are type I, 8 diseases such as tuberculosis are type II diseases, 11 diseases such as diabetes are type III diseases, and 11 diseases such as chronic bronchitis are type IV diseases. In the future, the Municipal Bureau of human resources and social affairs will introduce corresponding management methods according to the characteristics of various diseases, treat differently, and promote the rational allocation of medical insurance funds.
Reading 2: class I, 4 kinds of disease canceling line
according to the introduction, the outpatient regulation of the onset and payment of the disease is only once in one medical year, the standard is 6% of the average salary of the employee in the last year of the city. According to the Ji'nan social and economic wage of 35436 yuan in 2011, the gate standard disease starting payment standard should be 2126 yuan. Before the adjustment of the pre hospital pay standard of Ji'nan city gate regulation hospitals, the standard set in 2005 was 400 yuan, far below the standard of starting payment. With the increase of the income of the insured and the increase of the price of drugs, the standard of that year can not play the role of guiding the patients to seek medical treatment reasonably.
according to the regulations, after the adjustment of the disease policy of the door regulations, the standard of starting payment for class I diseases will be cancelled. The responsible person in Ji'nan Social Security Bureau said that type I diseases mainly include the treatment of malignant tumor, dialysis treatment of uremia patients, anti rejection treatment of organ transplant patients, and 4 major diseases of psychosis. "These 4 diseases are expensive and the patient has a heavy burden of treatment, so this time the off payment line is cancelled, which means that seeing a doctor at a high level fixed-point medical institution will reduce the burden of treatment for the patients." Ji'nan Municipal Social Security Bureau responsible person to the reporter said.
Reading 3: Class II - IV type of disease type in accordance with the hospital level standard
Ji'nan Social Security Bureau of the relevant person in charge of the introduction, now the high level medical institutions, especially the province three medical institutions overcrowded, affected the treatment of severe patients, in some hospitals, some patients from 8 a.m. to the hospital, to the hospital, I didn't see the disease until 12 at noon. According to statistics, in the three level medical institutions, the medical expenses of the insured persons in 2012 accounted for less than 3000 yuan, accounting for 52.5%. Most of the patients are in stable condition and the rule of treatment. Low level medical institutions or community health service providers can fully meet their medical needs.
in order to guide the insured people to enter the hospital in the community and major diseases, the policy adjustment of the door regulation also adjusts the starting and paying standards of class II - IV diseases according to the hospital level. According to the requirements, in a medical year, class II - IV types of disease starting and payment standards are: the three level medical institutions in the province (Department) were raised from 400 yuan to 800 yuan, and the other three level fixed-point medical institutions were raised from 400 yuan to 600 yuan, and the two and first grade medical institutions were reduced to 30 from the original 400 yuan. 0 yuan.
reporter learned that the three level hospitals in the province of the province mainly include 8 provincial hospitals and Qilu Hospital, while other three level designated medical institutions mainly include 14 hospitals such as armed police hospitals and Ji'nan central hospitals, and two level and first level medical institutions mainly include 54 municipal and municipal second hospitals. Community health service centers mainly include 123 offices in Yanshan District, Lixia District, and community health service centers.
interpretation 4: there is no starting payment line
reporter of the fixed point community hospital of the gate regulation that, since the 2008 medical year, the community health service institutions of Ji'nan city gate regulations have implemented the exemption standards, reduced the proportion of individual burden and other preferential measures, and a considerable number of patients with portal diseases are transferred to the community medical institutions. Medical treatment saves a lot of medical expenses and reduces the personal burden of patients. According to statistics, up to now, 70 thousand and 200 people in community health service institutions, accounting for 38.6% of the total number of door rules, and 49.4% lower per capita medical costs than the three level medical institutions. In the 5 years since the implementation of the policy, the total expenditure on patient pay and personal expense has been reduced to 150 million yuan.
this policy adjustment, there is no set up standard for community health service institutions designated for disease control. At the same time, at the same time, the number of insured persons who choose the designated health care institutions in a certain medical year should be determined according to the plateau.
unscramble 5: the door regulation of disease species implements "single point" management
according to the requirements, the door regulation disease continues to carry out "single point" management, that is, in a medical year, the insured persons who have been included in the management of the gage disease type can only choose one designated medical institution (including the fixed-point community health suit with the portal disease type. " To make a diagnosis and treatment.
at the same time, in consideration of patients with some special diseases, they may have other types of gage at the same time, and the regulation of the policy is also stipulated. Among the patients with chronic viral hepatitis, liver cirrhosis, tuberculosis, and ophthalmological diseases (Huang Banlie hole, optic atrophy, glaucoma) of the type II diseases, a designated specialist hospital may be selected for the diagnosis and treatment. At the same time, at the same time, the above insured person is suffering from other types of disease, and may choose a regular medical service or a designated hospital. In a medical year, there are no more than three general hospitals selected by the insured.
, in addition, the Ji'nan Municipal Social Security Bureau of the relevant person in charge said that the medical insurance outpatient of the urban workers' basic medical insurance in 2013 medical year stipulates the patient of the medical insurance. The change of the designated medical institutions will soon be carried out in the near future.