2, cerebral hemorrhage and cerebral infarction recovery, rheumatoid arthritis
3, chronic active hepatitis, chronic obstructive emphysema and pulmonary heart disease.
4, epilepsy, mental illness
5. Hepatolenticular degeneration and decompensated cirrhosis
6. Diabetes and systemic lupus erythematosus with ineffective diet control.
7. Parkinson's syndrome and myasthenia gravis
The State Council requested to expand the scope of reimbursement for chronic drugs used by the elderly and reduce their drug burden. The specific provisions are to improve the basic medical insurance policy, gradually realize the direct settlement of outpatient expenses across provinces, expand the scope of reimbursement for chronic diseases of the elderly, bring more chronic diseases into centralized procurement, and reduce the drug burden of the elderly.
First, the handling process:
1, review the household registration book and medical books; bank card
2. Review medical records or disease certificates to determine whether the disease is within the scope of reimbursement;
3, review medical records and laboratory tests, as well as invoices, determine the total reimbursement;
4. Input the information of chronic diseases in the compensation management of chronic diseases in the integrated medical system.
5. Improve the files of patients with chronic diseases;
6. Apply for the monthly report of chronic diseases and submit it to the competent leader for signature; And put bank cards according to people; Combined with the copy of the diagnosis and the household registration book, the reimbursement list and invoice of the system are filed and submitted to the county medical insurance bureau.
Second, the policy background
Recently, the State Council issued the "14th Five-Year Plan for the Development of the Cause for the Aged and the Plan for the Old-age Service System", which clearly stated that the coverage of basic old-age insurance should be continuously expanded. Realize the national overall planning of basic old-age insurance for enterprise employees as soon as possible; Gradually postpone the legal retirement age; Implement the reasonable adjustment mechanism of basic pension, and require timely and moderate adjustment of basic pension standards for urban and rural residents; Vigorously develop enterprise annuities and occupational annuities, improve the coverage rate of enterprise annuities, promote and standardize the development of the third pillar pension insurance, and promote the development of individual pensions. Improve the basic medical insurance policy, gradually realize the direct settlement of outpatient expenses across provinces, expand the scope of reimbursement for chronic diseases of the elderly, include more chronic diseases in centralized procurement, and reduce the drug burden of the elderly.
The main goal of the plan: the supply of old-age services continues to expand. Family pension capacity has been effectively enhanced, the underlying pension services have been improved, and the resources of inclusive pension services have continued to expand; The health security system for the elderly is more perfect. The supply of health service resources for the elderly is increasing, and family medical services such as family beds and home visits are actively carried out; Serve the elderly and innovate and develop in multiple formats. Services such as education and training for the elderly, cultural tourism, fitness and leisure, financial support, etc. have been continuously enriched, the elderly products industry has been growing, and the ability of scientific and technological innovation has been significantly enhanced; The ability to support factors has been continuously enhanced. The comprehensive supervision of old-age care services and the long-term care insurance system are more perfect; The social environment is more suitable for the elderly and livable. The construction of elderly-friendly demonstration communities in China has been comprehensively promoted, and the difficulties encountered by the elderly in using intelligent technology have been effectively solved.
Legal basis:
Notice of the State Council municipality directly under the Central Government on printing and distributing the national development plan for the cause and service system for the aged during the 14th Five-Year Plan period.
Sixth, improve the health support system for the elderly.
(thirteen) to strengthen health education and preventive health care for the elderly.
Improve health education and health management. Develop popular science textbooks for health education for the elderly, and use various media to popularize health knowledge and healthy lifestyle through various activities such as the health promotion week for the elderly, so as to improve the health literacy of the elderly. Implement the basic public health service of the elderly health management project, and do a good job in signing up family doctors for the elderly. Strengthen the early screening and intervention of major infectious diseases in the elderly population, and encourage places where conditions permit to carry out early screening and health guidance for neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease.
Implement the health promotion project for the elderly. Strengthen the early screening, intervention and classified guidance of key chronic diseases in the elderly population, and carry out oral health, nutrition improvement, dementia prevention and psychological care actions for the elderly. Promote the transformation of scientific research achievements in the field of elderly health, select and promote a number of appropriate technologies for elderly health, and improve the ability of grassroots elderly health services. Give full play to the advantages and functions of traditional Chinese medicine in the prevention and treatment of senile diseases and chronic diseases.
(fourteen) the development of medical care, rehabilitation care and hospice care services for the elderly.
Enhance the ability of medical and health institutions to serve the elderly. Strengthen the construction of national geriatric centers and lay out several regional geriatric centers. Strengthen the construction of geriatrics department in general hospitals. Support areas rich in medical resources to transform some public medical institutions into nursing homes and rehabilitation hospitals. Promote medical and health institutions to carry out the management of senile syndrome, and promote the transformation of elderly medical services from single-disease mode to multi-disease treatment mode. Accelerate the construction of elderly-friendly medical institutions to facilitate the elderly to see a doctor.
Promote the extension of medical services to family communities. Support qualified medical and health institutions to provide home medical services such as family beds and home visits for disabled, chronically ill, elderly and disabled elderly people. Public medical institutions provide on-site medical services for the elderly, and charge by means of "medical service price+on-site service fee". The medical services, drugs and medical consumables provided are subject to the medical price policy implemented by medical institutions, and the on-site service fee can be determined by public medical institutions independently. Encourage social forces to set up community nursing stations. Actively carry out community and family TCM health services.
Carry out hospice care services. Promote medical and health institutions to carry out hospice care services in accordance with the principle of "fully informed and voluntary choice". We will steadily expand the pilot program of hospice care and promote the standardization of hospice care institutions. Support the development of community and home hospice care services, and establish a hospice care service mechanism linked by institutions, communities and homes. Strengthen public life education.