Since January 17, the Shanghai Municipal Medical Insurance Bureau has included 48 items such as transcatheter aortic valve replacement into medical insurance payments, further reducing the burden of medical expenses on the masses. According to the Shanghai Municipal Medical Insurance Bureau, after the 48 new projects are included in the medical insurance payment, it is expected to reduce the burden of 300 million yuan per year for insured patients in the city.
The medical service projects included in the medical insurance payment mainly include two categories: advanced cutting-edge technology, life-saving and emergency-saving projects.
The first is advanced cutting-edge technology; taking robotic X-ray stereotactic radiation therapy (radio knife) as an example, the project uses the world's latest radiosurgery equipment to treat tumors, especially intracranial tumors and cerebrovascular malformations. Before being included in medical insurance, the treatment cost of the project was relatively high, and patients with nervous system diseases needed to pay nearly 40,000 yuan for a course of treatment. After the inclusion of medical insurance reimbursement, the treatment costs of retired employees and insured persons in tertiary hospitals only need to bear 16,000 yuan, and the cost burden is reduced by 60%.
The second is life-saving and emergency-saving projects, including transcatheter aortic valve replacement (TAVR), super-selective cerebral artery intraluminal thrombosis removal, myocardial ischemia extracorporeal shockwave therapy, etc.
Among them, "transcatheter aortic valve replacement" can complete the aortic valve replacement without stopping to beat, improve the patient's symptoms, and help prolong the patient's life; while the "super-selective cerebral arterial luminal thrombosis" is a minimally invasive operation, "grasping" the thrombus with a stent and removing it, so that the blood vessels can be quickly re-opened, saving patients with acute ischemic stroke, which is conducive to reducing the fatality rate and disability rate; "myocardial ischemia extracorporeal shock wave therapy" is a non-invasive new therapy for the treatment of coronary heart disease, which is accelerated by accelerating collateral branch blood vessel regeneration , relieves symptoms of ischemia and improves functional prognosis.
CBN learned from the Shanghai Municipal Medical Insurance Bureau that the "medical insurance access of medical service projects" has initially formed a normalized management mechanism of expert review, price linkage, performance linkage and departmental coordination.
For example, in terms of price linkage, 29 of the 48 projects have simultaneously reduced the project price, an average decrease of 26%, most of which are tested projects based on reagent consumables. Jin Chunlin, director of the Shanghai Municipal Health and Health Development Research Center, said that the medical insurance department gives full play to the role of strategic purchase, and reduces the price of some projects under the premise of ensuring the labor value of medical personnel, which is conducive to standardizing the clinical development of testing projects and improving the efficiency of fund use.
For example, on the performance linkage, the septin9 gene methylation detection, the super-selective cerebral artery luminal thrombosis removal, and the beam knife were included in the medical insurance at the same time, and the performance-based payment was tried. This requires the selection of the positive detection rate, vascular recanalization success rate, mass reduction and treatment complication rate as performance appraisal indicators.
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