■ At present, 40 elderly people in the community are equipped with specialized family medical staff.
■ 70% of the expenses were paid by the town cooperative medical system, which solved the problem of reimbursement for medical insurance outpatient service.
Family sickbed, in short, is to "move the hospital into the home".
As an important part of community health service, Xiaolan family sickbed provides different ideas for alleviating the difficulty and expensive medical treatment. For those elderly patients and patients with chronic diseases who are inconvenient to move, if they go to different medical institutions and receive treatment from different doctors during outpatient service, hospitalization and rehabilitation, it will inevitably lead to a waste of time and money because doctors are familiar with the disease again. From the practice of Xiaolan, family sickbed is an effective way to make full use of community medical and health equipment, obtain continuous medical services and reduce medical expenses.
The family sickbed implemented in Xiaolan Town was piloted in a community in Lexi for half a year last year, and 13 family sickbeds were set up. After the pilot, it will be promoted in some qualified communities this year. In just two and a half months, the number of beds built reached 40.
Liang, deputy director of Xiaolan Town Insurance Institute, said that family beds are mainly aimed at patients with chronic diseases or convalescence who need frequent medical treatment and medicine, are inconvenient to move and are not suitable for hospitalization. Residents of Xiaolan Town who meet the conditions for setting up family beds can apply for building beds to qualified community health service stations nearby by themselves or their families, and the health service stations will report to the town cooperative medical office for examination and approval.
Aunt Liang of Shengfeng Community established a family bed in June 65438+1October 65438+July. Aunt Liang is 53 years old this year. She/kloc-suffered from laryngeal cancer 0/5 years ago and hypertension 7 years ago. Because of the spread of cancer cells, she developed neuropathy, hearing loss, slurred speech, loss of walking ability and more and more limited upper limb activities.
Shengfeng Community Health Service Station established a family bed for Aunt Liang, and also equipped her with special family doctors and nurses. The reporter saw from the medical records that the date of bed construction was 65438+ 10/7 in 2008, while the nursing records of doctors and nurses occurred at 65438+ 10/7, 20, 24, 27, 3 1 0. In less than two months, the number of home visits by family doctors and nurses reached 10, with an average of at least one bed visit per week.
Zhong Xiaoqing is a nurse invited by Aunt Liang's son to her mother. She has been with the elderly for more than four years. She told reporters: "In the past, the old man had a high fever almost every night, and I had to get up every two hours to wait on him. Moreover, the elderly have high blood pressure and poor sleep and diet. I push the old man to the hospital in a wheelchair every three to five days. I feel particularly tired when the old man suffers. "
"It's very different now. Because of the doctor's home care, the old man's body is no longer hot and cold. Eat well, sleep well, and be much more relaxed. After more than four years, the old man won't let me go at all, and he can't even go home for the New Year. " Zhong Xiaoqing said, "In fact, I think the biggest change for the elderly now is in spirit. I used to run to the hospital, and the old man's face was always gloomy. She thought she was waiting to die, and kept pestering the doctor to ask her how long she could live. Now, the old man's face is rosy, and he still talks and laughs from time to time, and he never says the word' death' that he used to say. "
Uncle Liu of a community in Lexi stood up trembling and moved slowly: one step, two steps, ... slowly, he walked almost 20 meters away! Uncle Liu's wife said excitedly, "Thanks to the family sickbed service in a community health service station in Tiexi, it helped my husband get back on his feet and greatly reduced the financial burden of my family."
Who can believe that more than half a year ago, Uncle Liu was still a hemiplegic patient. Uncle Liu is 80 years old. In May last year, he was hospitalized in ICU ward of a hospital for cerebral hemorrhage in brain stem, left basal ganglia and internal capsule hindlimb. After discharge, there are still symptoms such as cough, expectoration and slurred speech. His right limb is hemiplegic, and he has multiple bedsores on his back, lower back and buttocks. The patient's family has few financial resources and life is relatively difficult. When a community health service station in Lexi learned of this situation, it immediately reported the situation to the town prevention and protection office. After approval, a family sickbed was set up in Tiexi No.1 community health service station, and a detailed treatment plan was formulated according to Uncle Liu's condition, which was taken care of by a special person, with regular home treatment and rehabilitation guidance, supplemented by careful psychological counseling.
Half a month after the bed was built, Uncle Liu's bedsore basically healed and his right limb muscle strength was obviously enhanced. On this basis, doctors instruct patients' families to help patients with functional rehabilitation. Now, Uncle Liu's condition has obviously improved.
Characteristics of sickbed
Systematic treatment and nursing plan.
After reading the introduction of this family bed, readers may feel deja vu: "Isn't this the previous house?"
Xiao Shangbin, the stationmaster of Shengfeng Community Health Service Station, disagrees with this view. He said: "Compared with family visits, family beds have at least the following advantages: family visits are an emergency, which can be said to be a headache, and family beds have a systematic and complete treatment and nursing plan; Visits are one-off, and family beds have a system of regular bed inspection; Seeing a doctor is an individual's behavior, and the family sickbed is supported by experts from big hospitals and professionally cared by nurses. More importantly, family sickbed service can provide systematic and professional guidance, and family members or caregivers can provide targeted care for patients. "
Shengfeng Community Health Service Station has established a family sickbed file, which records the patient's condition, diagnosis and treatment and the doctor's visit time in detail, and another file also contains the patient's detailed rehabilitation plan and schedule.
Although community medical staff and equipment are still insufficient at present, family beds increase the workload of health stations, but they also bring many benefits to health service stations. "Experts from big hospitals come to give guidance at least once a week, which provides a good learning opportunity for doctors in the station. The establishment of family beds is also conducive to building a harmonious relationship between doctors and patients. Doctors often go to patients' homes, which can not only effectively solve patients' pain, but also establish a good doctor-patient relationship, and then gain patients' recognition of health service stations. "
According to Xiao Shangbin, when doctors check beds, they often give them some routine examinations at the request of patients' neighbors and family members. Therefore, patients or patients' families often pull the bed-checking doctor back and want to stay for dinner. "Because of discipline, our doctor will politely refuse."
Cost problem
70% paid by urban cooperative medical care
According to Liang, deputy director of Xiaolan Town Prevention and Protection Institute, all eligible residents in Xiaolan Town can apply to a qualified community health service station by themselves or their families to build a bed nearby, and the health service station will report it to the town cooperative medical office for examination and approval.
Liang said that family beds make up for a gap in medical insurance in Xiaolan Town: outpatient reimbursement. According to the regulations of the town government, 70% of the medical expenses incurred by the approved family beds are paid by the town cooperative medical system, and patients only need to pay 30%. This effectively reduces the family burden of patients, and to some extent relieves the problems of difficult and expensive medical treatment. According to the pilot situation of a community health service station in Lixi last year, three family beds were built at that time, and the average daily cost was 14.7 yuan, of which medical expenses accounted for 60.3%, which was basically the same as the cost of going to the health station.
As a livelihood project, family sickbed service in Xiaolan Town is being gradually popularized in the whole town.
Liang said: "Before the scale of family sickbed service was formed, low prices and expensive manpower and time investment brought some pressure to the daily operation of health stations, but in the long run, its social benefits should not be underestimated. In order to encourage health service stations to actively do a good job in community health service, the town government allocates funds according to the standard of 20 yuan per registered population, and evaluates and scores according to the work of community health service stations every year. Those who get full marks will get the funds from 20 yuan, and those who are insufficient will be deducted in proportion. "
Even if we don't consider the convenience brought to patients, only from the overall economic benefits, family beds have certain merits. Liang analysis: "Regular examination and nursing can make patients get continuous and standardized treatment, and their condition is more stable, which can reduce the chances of patients being hospitalized again and save medical resources for the society."
Xiaolan Town, Zhongshan City comprehensively promotes outpatient medical insurance for urban and rural residents.
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In order to build a harmonious society and alleviate the practical problems of farmers' difficulty and high cost of medical treatment, Xiaolan Town has carried out urban and rural outpatient medical insurance on the basis of urban-rural cooperative medical care. This work has been fully implemented since May 20, 2009. By June 10, there were 13 1909 people in the whole town, and the participation rate exceeded 80%.
In carrying out this work, Xiaolan Town always adheres to the following principles: 1. The principle of combining individual contributions, collective support and government subsidies; 2. The principle of balance of payments; 3. The principle that the obligations of the insured correspond to the rights; 4. Focus on solving the principle of outpatient medical expenses for common diseases, frequently-occurring diseases and chronic diseases of the insured; 5. According to the principle of gradual construction of village (community) medical institutions. In order to let the community residents enjoy this policy of benefiting the people better and faster, the staff of the government, community and other units guide and help the insured to fill in and handle the relevant insurance information regardless of holidays, and submit the application materials to the town social security branch in time. According to the procedure, the town labor and social security bureau collates and proofreads the insured information submitted by various communities, inputs the identification of the designated community medical institutions of the insured, and makes medical insurance cards for the newly insured. From August 1 day, the insured person can submit an outpatient reimbursement at the designated community health service station and hospital with the medical insurance card.
The way to participate in outpatient medical insurance for urban and rural residents is: the community neighborhood Committee is the unified registration unit, and all eligible members in the same household registration book are registered and paid. The payment standard is 2 yuan per month for individuals, 3 yuan per month for municipal and town financial subsidies, and 8 yuan per person per month. The accumulative maximum payment limit of the insured person for outpatient service in each social security year is 400 yuan. From August this year 1, residents who have successfully registered for payment can go to the designated community health service station for medical treatment. Within the scope of reimbursement of medical expenses, the overall fund pays 80%, and the individual pays 20%. To the town hospital for medical treatment, the fund pays 20% and the individual pays 80%.
According to statistics, as of June 10, the participation rate of Xiaolan Town has reached 82.43%, and the participation rates of Baofeng, Shengfeng, Lianfeng, Liexiyi, Dongyi and Donger communities have all exceeded 98%, among which Baofeng community has the highest participation rate, reaching 99.26%.
The basic outpatient medical insurance for urban and rural residents is another important measure to improve the social medical security system in Xiaolan Town. Establishing the basic medical insurance system for residents' outpatient service will further improve the medical security level of registered residents, make residents more convenient to seek medical treatment nearby on the basis of basic hospitalization security and cooperative medical insurance, realize the goal of benefiting the people without leaving the community, and promote the construction of a harmonious socialist society.
According to Xiaolan Town Labor and Social Security Branch, from September this year, registered residents in this town can participate in the basic medical insurance for urban and rural residents in Zhongshan City. This is also a concrete measure for Xiaolan Town to improve people's livelihood, comprehensively promote the basic medical insurance for urban and rural residents, improve the level of social insurance participation, and let everyone have two medical insurances.
There are three kinds of existing social medical insurance, namely comprehensive medical insurance, basic medical insurance for employees and basic medical insurance for urban and rural residents, of which the first two are mainly for employees of enterprises and institutions, while hospitalization medical insurance for urban and rural residents is mainly for urban and rural residents. At present, 95% of Xiaolan residents have participated in the cooperative medical system, and more than 40,000 people have participated in the medical insurance for urban workers.
According to Chen, director of the Labor and Social Security Branch of Xiaolan Town, since the comprehensive medical insurance and basic hospitalization medical insurance are mainly insured by employees of enterprises, farmers and residents who have not worked in enterprises have not been insured. Therefore, in accordance with the relevant provisions of the Measures for Basic Hospitalization Medical Insurance for Urban and Rural Residents in Zhongshan City, Xiaolan Town plans to comprehensively promote the basic hospitalization medical insurance for urban and rural residents in September. The basic medical insurance for urban and rural residents is a basic medical insurance system based on hospitalization, which is coordinated by the municipal level. The insured objects are rural residents who have participated in the basic old-age insurance, urban residents who have not participated in the basic medical insurance for urban workers, and family members of five-guarantee households and low-guarantee households.
In Xiaolan Town, all registered residents who have not participated in comprehensive medical insurance and basic medical insurance for employees can participate in hospitalization medical insurance for urban and rural residents, but residents who participate in cooperative medical care are not affected. The principle of voluntary insurance for residents will be adopted, but all the people who meet the insurance conditions in the same household registration book must be insured. The insurance premium is paid by the residents themselves, regardless of age, per person per month 18 yuan.
According to the statistics of relevant departments in Xiaolan Town, residents holding two medical insurances can basically reimburse all medical expenses except the self-funded part.