Medical network on August 31 - yesterday, the city human social security bureau released huimin policies, clear starting from tomorrow, will increase the national drug catalogue of 477 drugs and national organization negotiations on a total of 513 36 kinds of drugs, all included in the scope of coverage in this city, and synchronous adjustment to increase outpatient diseases to 11 kinds of special disease, among them, the existing special disease outpatient service "malignant tumor radiation therapy and chemical therapy" adjustment for malignant tumor outpatient treatment, at the same time, the "multiple sclerosis" and "macular degeneration intraocular injection treatment" increase the range of special disease in clinic diseases.
This will further facilitate the medical treatment of patients and reduce the burden of medical expenses. According to statistics, the special disease policy will reduce the number of patients by 350 million yuan.
Add all new medicines to the national catalogue
In the first half of this year, the human social security department released the 2017 edition of the basic medical insurance, work-related injury insurance and maternity insurance drug catalogue, announced in July 36 countries negotiate drugs, including the treatment of lung cancer, gastric cancer, breast cancer, colorectal cancer, lymphoma, myeloma and other 15 kinds of targeted anticancer drugs, as well as chronic diseases such as diabetes, kidney disease, cardiovascular drugs.Through the negotiation of the national unity organization, the price of drugs has been greatly reduced, and the average decline has reached 40%, and the highest level has reached 70%.
Beijing morning paper reporter learned that, human social security department released the 2017 edition of drug directory to expand the basic medical insurance coverage, focus on children's drugs and drug major diseases, increased the special drugs such as occupational disease, such as a new treatment of pneumoconiosis sinomenium acutum own shell element such as drug;A total of 91 children's medicines were added.The drug or dosage form that is clearly applicable to children in the catalogue has reached 540, which increases the protection of children's medicines.It also increased support for innovative drugs.The catalogue adjustment will focus on new drugs that will be listed in 2009, and will be further skewed towards innovative drugs.Focus on major disease treatment drugs.Commonly used medicines to treat major diseases such as cancer, heavy psychosis, hemophilia, diabetes, cardiovascular and cerebrovascular diseases are generally included in the drug catalog or the scope of negotiations.
To make adjustment and ginseng protect personnel in a timely manner to the city to enjoy the national drug directory drugs negotiations for the New Deal, from September 1, will increase the national drug catalogue of 477 kinds of drugs and drugs 36 countries negotiations, a total of 513 kinds of, all included in the scope of coverage of the city.
The city bureau of manpower and social security said that the name of the new drug could be found on the official website of Beijing human social security bureau.
There were 11 outpatient diseases
All 477 new drugs and 36 national negotiating drugs will be included in the medical insurance reimbursement scope of this municipality, and the special disease policy will be adjusted.Starting from September 1, we will adjust the range of special diseases of the outpatient clinic, increase the new diseases, and further reduce the medical expenses of patients with major diseases.
According to city human social security health insurance ChangSunDeYao everywhere, since 2001, the city set up the "special disease outpatient service" system, for some need long-term outpatient treatment, patients with higher cost of a serious illness, the outpatient treatment related fees, according to the hospital and reimbursement limit reimbursement ratio, and 360 days for a starting line.
Special disease in recent years, the city constantly improve outpatient service policy, the special disease outpatient service scope expands from the initial three to nine, from September 1, the city will increase special disease outpatient service disease range, adjust the existing special disease outpatient service "the malignant tumor radiation therapy and chemical therapy" to "malignant tumor outpatient treatment", at the same time, the "multiple sclerosis" and "macular degeneration intraocular injection treatment" increase the range of special disease in clinic diseases.At this point, the disease of special diseases in the city has been extended to 11 kinds.
Malignant tumor outpatient treatment increased 42 drugs
About the special disease outpatient service "the malignant tumor radiation therapy and chemical therapy" is adjusted for "malignant tumor outpatient treatment," Sun Deyao introduce to the Beijing morning post reporter, the drugs into the scope of reimbursement of 36 kinds of negotiations, need higher cost of outpatient treatment for a long time, most of the drugs, the average annual cost of treatment is controlled in 70000 yuan to 100000 yuan, relatively heavy burden on patients generally reflect.
Adjusted, outpatient treatment of patients with malignant tumor, the existing "malignant tumor radiation therapy and chemical therapy drug reimbursement scope, on the basis of the newly added 42 kinds of drugs, including 15 kinds of targeted therapy drugs and national new varieties of drugs.New drugs have not radiotherapy and chemotherapy drugs, if not, adjust according to the original policy, these new drugs can only be carried out in accordance with the common drug reimbursement, still can't solve the burden of these patients.After adjustment, the related expenses of outpatient treatment of malignant tumor can be carried out according to the proportion of hospitalization reimbursement and reimbursement quota, which greatly alleviates the economic burden of patients.
In addition, into the special disease outpatient reimbursement scope in multiple sclerosis drug for "human recombinant interferon beta 1 b (led), macular degeneration intraocular injections into the scope of special disease outpatient reimbursement medicines for compaq heap" and "licensed".
Reduction of special disease policy adjustment will reduce the burden by about 350 million yuan
The 36 countries involved in the health care reimbursement include 15 anticancer drugs that cover a wide range of cancer, including lung cancer, liver cancer, breast cancer and kidney cancer.Sun Deyao introduction, targeted therapy drugs treatment effect is good, price is high, didn't submit an expense account, through the national negotiations, this time into the Beijing health care drugs catalog, is indeed a boon for cancer patients.Overall drug prices fell by an average of 40 per cent, up to 70 per cent, through national negotiations.
Targeted drugs to treat breast cancer "by pearl single resistance (herceptin)" as an example, the national annual negotiations before drug costs 230000 yuan, annual negotiations after drug costs about 90000, included in the special disease outpatient expenses after retiree individual responsibility is about 10000 yuan;Targeted drugs for the treatment of multiple sclerosis "" human recombinant interferon beta 1 b (led)", the national average annual drug costs nearly 150000 before negotiations, the negotiations after annual drug costs about 106000, included in the special disease outpatient expenses after retiree individual responsibility is about 12000 yuan, greatly reduced the medical burden of patients.
It is estimated that the special disease policy adjustment will reduce the cost of medical treatment for patients with major diseases by about 350 million yuan.
The special diseases of the outpatient are limited by the examination and approval of the patients
Special disease in clinic before approval process simplified, ginseng protect personnel to require attending doctors hospital and receive approval for filing, signature, ginseng protect unit seal and district health insurance agency orgnaization deals with the examination and approval, and other links, ginseng protect personnel generally reflect the procedures complex, time is long, and with special disease of ginseng protect personnel to their own physical condition, criss-crossing formalities to ginseng protect personnel to themselves and their families caused great inconvenience.
Since November last year, the government has simplified the approval process for the special diseases of the outpatient service, and has been "put on record" by "examination and approval".Ginseng protect personnel of outpatient service special illness can be directly selected the fixed-point hospital fill in return for special disease, after being signed by a physician is a social security card to the hospital medical insurance office put on record formalities, realize the declaration, for the record, treatment of query and treatment procedures such as "one-stop" completed, without having to deal with to units, agencies, to further reduce the burden of the patients and their families.
To relocated or in staff for a long time, to develop special disease when selecting different fixed-point hospital outpatient service, can be a social security card, diagnosis certificate and return to the ginseng protect area medical insurance agency orgnaization deals with put on record formalities.
Ginseng protect personnel because of illness need, such as the fixed-point hospital outpatient service special disease of change can be a social security card in the hospital after the settlement of fees to handle the cancellation procedures, the next day can be a social security card to the new selected special disease hospital surely put on record formalities.
According to statistics, so far, nearly 54,000 outpatient patients in the city have been declared in the simplified process.
The regulator's "unreasonable" prescription will stop the expense reimbursement
The municipal bureau of human social security says the health insurance will increase the cost of the health care fund.The health care department will adhere to the three doctors (health insurance, medicine, medical care) linkage, further strengthen management, standardize medical treatment, and overcome waste.
According to the medical establishment that decide a dot, use of the city's 2188 medical establishment that decide a dot to establish outpatient doctor workstation, constantly improve outpatient information standardization, standard upload data, and computer-aided audit;Five real-time monitoring indicators will be established to add suspicious labels to data that are suspected to be improperly used. The audit personnel will focus on and review the data.
In view of the ginseng protect personnel, establish personal medical information monitor early warning function, set up medical frequency, costing and monitored nine monitoring index, found that the problem timely questioning, to warning, there are violations of ginseng protect personnel to recover costs, the way such as changing the method of payment processing.
Aiming at providing health care services in the medical establishment that decide a dot of physician, through the data mining, comprehensive analysis of physician behavior of diagnosis and treatment, screening is not reasonable clinical medication cause waste list of physicians, medical insurance fund for the circumstances are serious, can stop the prescription expense reimbursement, targeted hit the "excessive", "prescription abuse", reduce the waste of medical insurance fund.
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