Dalian people pay attention!These costs can be reimbursed

From July 1st

This city will incorporate the treatment of day ward into medical insurance payment

From July 1st, Dalian will include 29 daily surgical diseases, 20 daily chemotherapy schemes, and 23 daily high -value drug injection treatment.

On June 30, the Press Office of the Dalian Municipal People's Government held a press conference on the pilot work of Dalian's pilot work on the reform of the medical insurance payment of the day ward. Deputy Director Madan reported the relevant situation.

Concept analysis: day ward treatment

"Day Ward Treatment" is a "short -flat fast" treatment mode between outpatient and ordinary hospitalization. It is suitable for diseases or surgery with mature medical technology, low surgical risk, and less postoperative complications. For example, senile cataract surgery, malignant tumor chemotherapy, colorectal polyps endoscopy, etc.

The "Notice on the Pilot Reform of the Performance of the Payment of Medical Insurance Payment of Day Ward" issued by this city refers to the treatment of patients in the treatment plan in accordance with the diagnosis and treatment plan in accordance with the diagnosis and treatment plan. Due to the special cases of delaying treatment, the ward treatment time does not exceed 48 hours. "Day Ward Treatment" will become an effective way to alleviate the problem of "difficulty in hospitalization". Patients were treated during the day and returned home at night, not only reducing the burden of medical treatment, but also the inconvenience of the patient's family members.

Surgical, chemotherapy and other day ward treatment is included in medical insurance payment

A few days ago, the Provincial Medical Insurance Bureau and the Provincial Health and Health Commission jointly issued a document to determine that Shenyang, Dalian, Dandong, Yingkou, Huludao 5 cities and provincial direct medical institutions first tried it to carry out the reform of the medical insurance payment of the day ward. The treatment of the day ward is included in the scope of medical insurance reimbursement. Since then, the Dalian Medical Security Bureau has issued the "Notice on the Pilot Reform of the Pilot Reform of the Day Ward for Medical Insurance" (hereinafter referred to as the "Notice"), and decided to carry out day ward treatment medical insurance payment in the city from July 1 this year. Reform pilot work.

According to the requirements of the "Notice", starting from July 1, 2022, 29 daily surgical diseases, 20 daily chemotherapy schemes, and 23 daily high -value drug injection therapy are included in medical insurance payment management. Patients in the day ward Treatment and medical insurance can also be reimbursed.

The types of the first batch of daily ward treatment medical insurance payment reforms mainly include three types of daily surgery, daytime chemotherapy and daytime high -value drug injection treatment.

With reference to the requirements of the national and provincial requirements for the reform of medical insurance payment for day ward, Dalian has preliminarily selected diseases with large clinical needs, mature surgical technology, clear clinical paths, and high sense of safety. The pilot disease. Including 29 daily surgery such as lower limb venous veins, senior cataracts, 20 daily chemotherapy programs involving 5 common malignant tumors, and 23 daily high -value drug injection treatment.

Among them, daytime surgery refers to surgery or operations incorporated into the daytime ward in accordance with regulations, excluding outpatient surgery and simplicity examination and review. Daily chemotherapy refers to The treatment of anti -tumor chemical drugs does not include simultaneous oral chemical drug treatment; high -value drug injection treatment during day refers to drug injection treatment required by intravenous, sheath, etc. Including high -value or ordinary drug injection that can be completed in the outpatient clinic or can be operated by patients.

Medical insurance for settlement?

These four points teach you to understand the treatment of the day ward

(1) Reimbursement scope

Daily surgery costs include: medical expenses during the treatment of day ward, outpatient examination costs directly related to surgery within 1 week before surgery, and outpatient treatment costs that necessary outpatient clinics within 1 week after surgery.

Daily chemotherapy costs include: the medical expenses of chemotherapy schemes during the treatment of the day ward, and the outpatient examination fee directly related to the daytime chemotherapy within 1 week before treatment.

Daily high -value drug injection treatment costs include: high -value drug costs and necessary examination and disposal costs during the treatment of day ward.

(2) Reimbursement standard

The daily operations that occur in the daily ward that occur in the daily ward, and the proportion of payment standards (that is, threshold fee) and medical insurance reimbursement shall be implemented in accordance with the hospitalization policy of various types;

Daily chemotherapy and daytime high -value drug injection treatment, there is no payment standard (that is, there is no threshold fee). Among them, high -value drug expenses during the day according to the province's unified high -value drug payment policy reimbursement, day high -value drug injection The medical service items involved in the treatment and the daily chemotherapy medical expenses are implemented in accordance with the proportion of hospitalization reimbursement.

(3) Reimbursement process

Insurance patients who meet the treatment standards of the day ward, if the clinic is diagnosed, the day ward is required to be treated, and the designated medical institution and it signed the consent of the treatment and go through the registration procedures. treat;

The required examination and disposal costs that meet the specified scope of treatment are temporarily paid by the patient's participating patients. When the daytime ward treatment is settled, it will be included in the scope of the medical insurance payment scope of this day ward;

After the registration procedures are not implemented for some reason, the relevant expenses are implemented in accordance with the current outpatient policy;

After the treatment of the day ward, due to complications and other accidents, the treatment standards cannot be reached within 48 hours. If they need to be transferred to a specialized ward to continue hospitalization, the relevant expenses of the daytime ward (including the implementation of and the treatment within 1 week and the treatment Directly related outpatient examination costs) and follow -up expenses of transferred to the specialized ward are implemented in accordance with the current inpatient reimbursement and settlement policy. (4) Medical in a different place

Insurance patients who handle medical treatment in different places, in the province, and inter -provincial and different places, daytime surgery and daytime chemotherapy costs are compared with hospitalization to conduct direct settlement for medical treatment;

The expenses of high -value drug injection treatment in different places in the province shall be settled in accordance with the relevant provisions of the "Administrative Measures for the Settlement Settlement Settlement of Medical Insurance in Liaoning Province (2021 Edition)";

The cross -provincial chemotherapy expenses that meet the daily chemotherapy medical insurance payment policies that are in accordance with the date of the insured place are transmitted according to the category of medical treatment in accordance with the outpatient clinic.

If you fail to settle directly for various reasons, you can reimburse manually according to the two categories of medical treatment and failure to record. Disterminers in other provinces are in charge of hospitalization for medical treatment in our city.

The list is here

7 fixed -point medical institutions first trial

At present, the city has determined that 7 fixed -point medical institutions have carried out pilot work for the medical insurance payment of the day ward.

Among them, the three types of therapeutic qualifications with daily surgery, daytime chemotherapy, and daily high -value drug injection are: the First Affiliated Hospital of Dalian Medical University, the Second Affiliated Hospital of Dalian Medical University, Dalian Central Hospital, and Zhongshan Hospital affiliated to Dalian University , Xinhua Hospital affiliated to Dalian University;

The two types of therapeutic qualifications with daily chemotherapy and daily high -value drug injection are: Ninety -Sixty -7 Hospital of the People's Liberation Army Lianqi Quality Troops and Zhuanghe City Central Hospital.

The first batch of pilot medical institutions will run until the end of December 2022. After the first batch of pilot periods expire, other targeted medical institutions that meet the above conditions and are willing to carry out day ward treatment will apply to the municipal medical insurance agency.

The specific diseases of the ward for the treatment of the ward these days are incorporated into medical insurance

The types of the first batch of daily ward treatment medical insurance payment reforms mainly include three types of daily surgery, daytime chemotherapy and daytime high -value drug injection treatment.

Specifically include: 29 daily surgical diseases, 20 daily chemotherapy schemes, and daily injection treatment costs of 23 high -value drugs.

Among them, the daily surgical diseases include 7 clinical departments including Guanpu surgery, urology, digestive department, gynecology, pediatrics, ophthalmology, otolaryngology, and otolaryngology. It involves 29 day surgical diseases including groin hernia repair, colon polyps and rectal polyps, ureteral stone crushing stone, and senile cataract ultrasound emulsification with artificial crystal implantation.

Twenty day chemotherapy schemes have been refined by breast cancer, lung cancer, bowel cancer, gastric cancer, and esophageal cancer, and the daily chemical chemotherapy is paid according to the disease.

23 types of high -value drugs that include Sicien Mipide (injection) and Nosnina sodium (injection) need to be used by intravenous, sheath, etc., and the necessary inspection and disposal expenses are included in the daily day. The scope of medical insurance reimbursement in the ward.

After receiving daytime surgery, medical insurance will be reimbursed like this

The treatment of the day ward of the pilot disease of the medical insurance payment is divided into three types: daily surgery, daytime chemotherapy, and high -value drug injection during day.

Among them, the reimbursement treatment of day surgery: day surgery costs that meet the scope of the pilot scope, the starting standard (that is, the threshold fee) and the reimbursement ratio are implemented in accordance with the hospitalization policies of various types. Two diseases of macular degeneration vitrobial drug injection do not have a standard for payment.

Take the first hospital affiliated to Dalian Medical University, one of the pilot hospitals as an example:

Preparatory patients can undergo daily surgery before surgery. For employees participating personnel, the daily surgery costs within the pilot scope of the hospital. The employee is 85%;

Retired personnel were 92.5%, of which, the standard for medical insurance for employees over the age of 70 was reduced to 600 yuan.

For adult residents in urban and rural residents' medical insurance, the standard for medical insurance payment is 1,200 yuan, and the reimbursement ratio of the expenses of expenses within the scope of medical insurance is 65%;

The standard for medical insurance for minors and college students is 300 yuan, and the reimbursement ratio of the expenses of expenses within the scope of medical insurance is 75%.

Peninsula Morning Post, 39 -degree video reporter Su Lin

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