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Tianjin North News: Yesterday, this newspaper reported that the city introduced the latest regulations, the future of diabetes outpatient specific diseases will be implemented brush card limit management. The reporter learned from the National Foundation for Poverty Alleviation through Health, in order to better implement the new regulations, and to protect the normal medical needs of patients with diabetes, standardize health insurance medical treatment, yesterday, the National Foundation for Poverty Alleviation through Health and the Municipal Bureau of Health once again introduced the "diabetes outpatient specific medical insurance management methods", and since February 2012 The new measures will be implemented on February 13th, 2012.
Interpretation
Limit of 10,000 enough?
For the new provisions of the credit card limit, many participants have such questions: whether the limit reduces the treatment of diabetics? Is the limit of 10,000 yuan enough? To this end, the reporter interviewed Dr. Zhang of the Shihua Renhe Institute of Traditional Chinese Medicine. Dr. Zhang introduced: "As we all know, type II diabetes accounts for 95% of diabetic patients. For this type of patients, the commonly used method of lowering sugar is mainly to use insulin and oral hypoglycemic drugs combined treatment. Based on the annual dosage, the limit of $10,000 can meet the needs of the vast majority of patients. In addition, the current diabetes medication variety, in accordance with medical advice on the basis of, do not blindly superstitious high-priced drugs high efficacy."
The reporter randomly interviewed a diabetic patient, he counted his diabetes treatment account: "I was diagnosed with type II diabetes in 2005, so far it has been six years, and now every half a month to follow-up, mainly to test blood glucose and prescribe hypoglycemic drugs. The cost of the test is about 30 yuan each time, take 'NovoRex 30' each time two, *** need 170 yuan, 'Acarbose' 3 boxes, *** need 230 yuan, so that each *** cost about 430 yuan, the year is expected to spend 10000 yuan or so."
What if I exceed the limit?
Before the introduction of the policy, the relevant departments consulted widely, especially pay attention to collect the views of diabetic patients. Many patients suggested that the 10,000 yuan limit for hypoglycemic drugs is enough under normal circumstances, but there are some special circumstances whether the policy can take into account.
The Municipal Bureau of Human Resources and Social Security said that, while making restrictions on the amount of credit card, the new policy also fully takes into account the special circumstances of diabetics, for those suffering from complications, serious conditions transferred to hospitalization and outpatient treatment due to other illnesses in the general outpatient clinic, although the cost of drugs more than 10,000 yuan, you can still network the credit card reimbursement. This not only strengthens the supervision and management, but also fully embodies the humanization of the service side of the operation.
Interpretation
New policy six strokes strict control "diabetes drug bill"
One is the implementation of outpatient specific disease access management. The insured patients diagnosed with diabetes in the hospital, if you need to apply for outpatient specific disease registration, you should hold the hospital's diagnostic medical materials to the designated 11 hospitals to do outpatient specific disease examination and identification. By the appraisal organization identified as meeting the criteria for outpatient specific diseases, the social security agency to confirm the registration, into the basic medical insurance outpatient specific disease management, registration is valid for two years. Two years need to be extended, should be re-identified within two months before the expiration of the registration period, and registration confirmation.
The second is the fixed medical treatment. Diabetic patients in the outpatient specific disease registration confirmation, in accordance with the principle of proximity and convenience, choose a tertiary hospitals, hospitals, hospitals, or designated retail pharmacies as a designated medical services, and can be selected once a year to apply for changes in the designated medical services.
Thirdly, the limit of credit card. Diabetic patients who have applied for outpatient specific disease registration confirmation, can hold social security card in the selected fixed-point medical service institutions network swipe card reimbursement. In a year the medicine cost more than 10,000 yuan part, first by my advance, advance medical expenses in accordance with the urban workers or urban and rural residents health insurance advance reimbursement procedures, the end of the year a one-time declaration of reimbursement. Those who suffer from complications, are transferred to hospitalization for serious conditions, and those who attend general outpatient clinics for other illnesses can still be reimbursed by networked credit card if the cost of medicines exceeds 10,000 yuan.
Fourth, the medical cost intelligent audit. When a physician writes a prescription for a diabetic patient, the information system provides the physician with information on the patient's use of various types of drugs over a certain period of time in the past, including the medical institution (including pharmacies), the time of consultation, the amount of medication, usage, and other information, so as to ensure the rational use of medication.
Fifth, strict medication management. Appropriately increase the proportion of out-of-pocket payments for general Category B drugs in the medical insurance drug list, and increase the proportion of out-of-pocket payments for higher-priced Category B drugs in the medical insurance drug list.
Sixth, strengthening supervision. Outpatient specific disease identification agencies should be strictly in accordance with the prescribed standards for the organization of identification. Identification agencies false identification, cancel its identification agency qualification; diabetic patients false registration, revocation of registration. Fraudulent medical insurance fund expenditure, by the medical insurance supervision department shall order the return of fraudulent medical insurance funds, and in accordance with the "Social Insurance Law" and the relevant provisions of the city to pursue legal responsibility. Reporter Hou Yan correspondent Ren Baoxuan
11 outpatient specific disease examination and identification hospital list
Serial number identification agency name scope of responsibility to make an appointment phone number
1 diabetes outpatient specific disease first identification center (Tianjin First Central Hospital) Nankai Hongqiao Hebei Xiqing Beichen 23627134
2 diabetes outpatient specific disease second Appraisal Center (Tianjin Public Security Hospital) Hexi Heping Hedong Dongli Jinnan 23142633
3 Diabetes Outpatient Specific Diseases Third Appraisal Center (Tianjin Fifth Central Hospital) Binhai New Area 25868223
4 Diabetes Outpatient Specific Diseases Fourth Appraisal Center (Tianjin Hangu District Hospital) Binhai New Area 67127168
5 Diabetes Outpatient Specific Disease Fifth Identification Center (Dagang Hospital) Binhai New Area 63109315
6 Diabetes Outpatient Specific Disease Sixth Identification Center (Tianjin Ninghe County Hospital) Ninghe 69114272
7 Diabetes Outpatient Specific Disease Seventh Identification Center (Tianjin Wuqing District People's Hospital) Wuqing 82171830
8 Diabetes Outpatient Specific Disease Eighth Identification Center (Tianjin Jinghai County Hospital) Jinghai 68924218
9 Diabetes Outpatient Specific Disease Ninth Identification Center (Tianjin Baodi District People's Hospital) Baodi 29262273
10 Diabetes Outpatient Specific Disease Tenth Identification Center (Tianjin Jixian County People's Hospital) Jixian 82852601
11 Diabetes Outpatient Specific Disease Tenth Identification Center (Tianjin Jixian County People's Hospital) Jixian 82852601
11Diabetes Outpatient Specific Diseases Eleventh Identification Center (Dagang Oilfield General Hospital) Dagang Oilfield 25925408