Three measures, implement the "two diseases" outpatient medication guarantee to solve the people's concerns

Hypertension and diabetes (hereinafter referred to as "two diseases") are chronic diseases in residents in my country. Patients have a long treatment cycle after diagnosis, and personal medical expenses have a heavy burden. Establishing a "two diseases" drug guarantee mechanism for urban and rural residents, strengthening the health management of patients with "two diseases", it is of great significance to effectively prevent the construction of health due to illness and return to poverty due to illness.

Since 2006, Zhenjiang City, Jiangsu Province has opened a special "two diseases" outpatient clinics for medical insurance patients in the designated community health service institution in the city to achieve the "two diseases" patients. Essence In April 2021, Zhenjiang City was identified by the State Medical Insurance Bureau as a special action cities for the "two diseases" outpatient drugs for urban and rural residents, and comprehensively opened a new journey to implement the "two diseases" drug guarantee mechanism.

No payment, simplify the identification procedure

On the one hand, the medical insurance of urban and rural residents implements the first clinic of the general outpatient clinic. Based on the designated grass -roots medical institutions in the city, the cost of lowering blood pressure and blood glucose drugs that occur in the outpatient clinic in the outpatient clinic of "two diseases" will no longer set up overall planning Fund starting standards, the proportion of funds in the scope of policy is increased to 50%. For 14 chronic disease costs including high blood pressure and diabetes, the outpatient payment limit of the medical insurance fund was increased to 2,500 yuan per person during the annual annual annual, which effectively reduced the cost of medical costs for patients.

On the other hand, simplify identification procedures and extend service tentacles. For "two diseases" patients who have not been included in the scope of slow specialties in outpatient diseases, they can enjoy the "two diseases" outpatient medication guarantee policies after the medical institution confirmed and filed in accordance with the diagnosis and treatment specifications. Encourage the outpatient disease review and identification work to sink to the grass -roots designated medical institutions that meet the requirements, and implement the "one -stop" acceptance. After the grass -roots medical institutions are identified, the patient's information can be synchronized to the running institution. At the same time, the establishment of a special special window for chronic diseases, including the "two diseases", to ensure that the insured will enjoy the treatment in accordance with regulations in a timely manner. Since 2021, the medical insurance department of Zhenjiang City has set up a medical insurance score center at all medical institutions above the second level in the urban area to extend the service of the outpatient clinics for review and identification and personal account inquiry. The district -level offices, 78 medical security service centers, 269 medical security service stations, and 700 medical security service points for standardized construction are provided with "two diseases" patients with online and offline integrated online and offline integration Medical, medical, and medical insurance services have solved the needs of the medical insurance services for the people participating in the zero distance.

In addition, medical insurance departments at all levels in the city do a good job of information statistics and data maintenance of patients with "two diseases", dynamically update personnel information, and do a good job of identity identification work to ensure that patients with chronic diseases such as "two diseases" set up files to set up cards and go to the doctor. Personal, medication, and treatment can be checked. As of the end of 2021, the number of people in the city was 495,300, an increase of 63.63%year -on -year, and the total expenditure of blood pressure drug funds was 90.813 million yuan; the number of diabetes was 208,400, a year -on -year increase of 66.45%, and the total expenditure of blood glucose pharmaceutical funds was 48.962 million yuan.

Move forward to strengthen service guarantee

The first is to optimize health management services. Zhenjiang City focuses on refined management, adheres to the principles of prevention -oriented, and combining prevention and control. It strengthens the responsibility of grass -roots medical institutions and general physicians. +1 group leader+20 management objects) Signing a contractual chronic disease management model, using the "3+X" service team to do a good job of chronic disease construction files, and give full play to the role of family doctors' healthy "doorkeeper". Family doctors must provide comprehensive medical defense services for patients with "two diseases", integrate public health services such as health archives, follow -up, health education and other public health services and clinical treatment services. Services to improve the awareness rate, standardized management rate and reasonable medication rate of "two diseases" patients. Through the implementation of medical care for "two diseases" patients, we will focus on solving the needs of insured personnel in medical, medical insurance and medicine. As of the end of 2021, the medical expenses of chronic diseases managed by the city's grass -roots medical institutions decreased by 2.01%compared with the same period in 2019. Among them, high blood pressure and diabetic patients are accompanied by complications, and medical expenses decreased by 3.2%and 3.65%compared with the same period in 2019, respectively. Essence

The second is to incorporate the "two diseases" outpatient drugs into the agreement management. Continue to improve the management of designated medical insurance designated service agreements, incorporate the "two diseases" outpatient drug guarantee services into the city's designated medical institution agreement management category, and ensure that the antihypertensive drugs and hypoglycemic drugs used by "two diseases" patients can be used and used. Strengthen the "two diseases" medical supervision and assessment of the "two diseases" of designated medical institutions and physicians, improve the medical insurance doctor's drug assessment system, improve the system of medical insurance physician assessment deduction system, and prevent the case of irregular writing and insufficient targeted examination.

The third is to improve the "two diseases" medicine guarantee. On the one hand, improve the long -term prescription system for clinics. Provide patients with long -term prescription services that do not exceed 2 months, and the "two diseases" designated medical institutions and their medical insurance service physicians will specifically determine the prescription dose according to the actual needs and clinical specifications of the patient to participate in the patient. On the other hand, the unblocking policy landed "last mile". Master the "two diseases" commonly used drug needs information in the grass -roots medical institutions in time, unblock the procurement channels, and increase the supply of "two diseases" outpatient protection drug supply, especially to strengthen the supply of chronic diseases such as the "two diseases" of village clinics to ensure the rural areas to ensure the countryside Drug equipment can be available to meet the needs of the masses to take medicine nearby. Encourage the village clinics to participate in the "two diseases" primary diagnosis and treatment, medicine preparation, prescription, medicine collection and distribution services, and implement drug procurement funds of grass -roots medical institutions directly settled by medical insurance funds, while improving the management of distribution specifications. Fine management, strengthen payment method guarantee

Zhenjiang City has established a diversified "paying" management mechanism to continuously improve the medical expenses of "two diseases" patients. For outpatient cases that need to be treated with chronic diseases, special diseases, or other outpatient cases that require long -term fixed treatment and medication, they are included in the "outpatient disease group". Combine.

Taking the Dandu District Shiye Town as an example, the Zhenjiang Medical Insurance Department tried the regional "packaging" paid method in the town. 40%of the funds are used to refer to medical institutions above the second level, and 60%are packed to Shiye Town Health Center for medical expenses for residents for medical expenses. Adopt the method of overweighting and reserving the balance, the balance reserved part can be used for the health management of residents in the town. The health management projects carried out include a zero -distance contracting service for 5,900 key personnel in the town, high -risk groups of chronic diseases, and "salt reduction, oil reduction" group intervention management projects. After 3 years of "packing according to the head" and the signing management of chronic diseases, the number of hypertension in the town's hypertension, the proportion of the number of hypertension above and above has dropped from 92.7%to 43.7%; among patients with diabetes The proportion of the number of people decreased from 44.1%to 23.3%. The clinical indicators of the management object were effectively controlled, and the construction of health Zhenjiang was initially effective.

With the gradual improvement of the "two diseases" outpatient drug guarantee mechanisms of urban and rural residents' medical insurance in Zhenjiang City, the burden of medication for patients with chronic diseases has effectively reduced it. Through the integration of chronic drug medication and health management The use efficiency of medical insurance funds. In the next step, Zhenjiang City will further improve Zhenjiang City's "two diseases" drug protection in terms of improving policies, strengthening the use of drugs, improving health management, and strengthening fund supervision, and improving the comprehensive service system of "medical and defense integration" for chronic diseases, and improving it. The people's sense of gain, happiness, and security.

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