Reimbursement Policy for Two Diseases in Chongqing

Why should the reimbursement standard for the "two diseases" policy be introduced? How to define the scope of reimbursement, including what content, depends on the interpretation of Chongqing Medical Security Bureau.

In order to further reduce the burden of medical expenses for patients with hypertension and diabetes, recently, the Chongqing Municipal Health Insurance Bureau, the Finance Bureau, the Health and Wellness Committee and the US Food and Drug Administration issued the.

1. What does "two diseases" specifically mean?

Hypertension and diabetes are the most common chronic diseases. The introduction is to further reduce the burden of drug use in outpatient clinics for "two diseases" of urban and rural residents. According to the relevant person in charge of Chongqing Medical Insurance Bureau, the "two diseases" in the middle finger refer to hypertension and diabetes that do not meet the standards of special diseases of Chongqing residents' medical insurance. Specifically, it refers to the low-risk population of primary hypertension and patients with secondary hypertension who need drug treatment.

Second, why is medical insurance only for urban and rural residents?

"It is a security policy for specific people and specific payment items." The person in charge said that the notice is mainly aimed at "two diseases" patients who participate in medical insurance for urban and rural residents. Because the medical insurance for employees adopts the mode of combining outpatient special diseases with personal accounts, the outpatient drugs for "two diseases" that are not included in special diseases can basically be solved through personal accounts, so the medical insurance for employees still implements the existing policies.

3. What is the reimbursement standard?

According to the regulations, patients with "two diseases" meet the scope of outpatient drugs in designated primary medical institutions at or below the second level, and the cost of drugs that can directly control blood pressure is paid by the overall fund. There is no reimbursement deductible line for outpatient medical expenses, and the proportional limit method is implemented. "Specifically, the reimbursement rate of secondary and below medical institutions is 60%, and the annual reimbursement limit is 500 yuan/year, disease type and person." The person in charge said.

4. How do citizens enjoy this kind of treatment?

Outpatient medication support for patients with "two diseases" shall be managed by setting standards, institutions and coverage, and reporting procedures and diagnosis management shall be implemented according to the current outpatient special disease treatment procedures.

After the patient knows his own condition, he first goes to the hospital designated by the medical insurance bureau of each district and county for diagnosis;

After being diagnosed by a specialist, the second-level hospital and the first-level hospital are selected and entered into the information system;

After entering the system, patients can settle accounts with social security cards and pay their share of the burden after doctors prescribe hypertension drugs in designated hospitals.

What is the reimbursement scope of verb (verb's abbreviation)?

The scope of reimbursement is limited to drugs that directly lower blood pressure, and non-therapeutic drugs cannot be reimbursed, such as western medicine or Chinese herbal medicines that reduce blood fat. Cardiac ultrasound and other laboratory tests are not covered by reimbursement.

6. What should I do if my condition gets worse?

The "two diseases" patients who have been included in the scope of outpatient special disease protection will continue to be implemented according to the existing policies.

Patients with "two diseases" whose condition is aggravated can be declared according to the outpatient special disease policy and included in the scope of outpatient special disease protection after being found to meet the relevant standards.