Changji Prefecture's first batch of 46 diseases for the pilot work of "day surgery" medical insurance settlement management was included in the scope of medical insurance settlement

Changji Daily (all media reporter Ma Xiaofang) Recently, the reporter learned from the Changji Preservation Bureau that since July 1, Changji Prefecture has carried out the pilot work of "day surgery" medical insurance settlement management. The 46 "day surgery" diseases such as ureteral stones and thrombosis external hemorrhoids have been included in the scope of medical insurance payment. Insurance people can enjoy the "day surgery" medical insurance payment treatment at 7 secondary and above medical institutions in Changji Prefecture.

"Daily surgery" refers to surgery or operations that patients were admitted to and discharged within 24 hours according to the diagnosis and treatment plan (excluding outpatient surgery). Special cases of delaying hospitalization due to the need to be postponed, and the hospitalization time does not exceed 48 hours.

In order to further deepen the reform of basic medical insurance payment methods, improve the efficiency of medical insurance funds, improve the management level and service efficiency of fixed -point medical institutions, and effectively reduce the burden of insured personnel. The notice of the Finance Department and the Health and Health Committee "Notice on the Pilot Management of" Daily Surgery "Medical Insurance Settlement Management" and launched the pilot work of "day surgery" medical insurance settlement management. Changji Prefecture's "Day Surgery" medical insurance settlement pilot time is from July 1 to December 31, 2022.

During the period, the "Day Surgery" co -ordination fund's single -time payment standard was 10%of the fixed -point payment line of the fixed -point medical institution at the same level, namely: the "day surgery" starting payment line of the basic medical insurance coordination fund, in the secondary level Medical institutions for the first time were 35 yuan, second and above 30 yuan; the first third -level medical institutions in the state were 70 yuan, 60 yuan, and 50 yuan for the first time. Urban and rural residents' medical insurance overall funds "day surgery" start -up payment line, 30 yuan, second and above 20 yuan for the first time in the secondary medical institution; the first time of the third -level medical institution in the state is 50 yuan, 40 yuan, three or above 30 Yuan. "Daily surgery" medical expenses are settled by the project.

Ms. Jiang, a citizen of Changji, was 70 years old. Some time ago, she suffered from ureteral stones and performed ureteral mirror laser gravel and ureteriopathy at Changji Prefecture Traditional Chinese Medicine Hospital. Recently, after a detailed preoperative evaluation, the hospital performed the ureteroscopic uretericus stent for Ms. Jiang. Different from the last operation, Ms. Jiang was conducted in the "day surgery" diagnosis and treatment mode, which realized the hospitalization, surgery, discharge of the day, and reimbursement and settlement on the day. "I didn't expect to be hospitalized in the morning, and I could do surgery and settlement on the same day. The cost of surgery was more than 1,800 yuan. After the reimbursement, I only spent more than 60 yuan. Thank you for the good policy of the party and the country!" Ms. Jiang said.

Wang Yuan, Chief of the Fund Supervision Section of Changji Medical Security Bureau, introduced that the pilot fixed -point medical institution that undertakes the "day surgery" medical insurance settlement should be approved by the second and above and has already approved the health department. Fixed -point medical institution. For the diseased types of "day surgery" for medical insurance settlement, the notice of the "Notice of the General Office of the National Health and Health Commission on the Research Daily Surgery (2022 Edition)" (2022 Edition) (National Health Office Medical Letter [2022] No. 38) Selected. The qualified medical insurance medical institutions in Changji Prefecture may apply to the Changji Medical Security Bureau and submit relevant materials such as the "day surgery" medical insurance settlement application form. After approval, it is included in the pilot scope.

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