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The author:(作者)归海一刀
published in(发表于) 2014/2/1 2:08:43
Guangzhou Health Bureau： bird flu cure included Medicare reimbursement

Dai Yu people infected South reporter Wang Daobin correspondents H7N9 avian influenza in Guangzhou, Guangdong Province, as well as the whole country is gradually increasing. As of January 29, local infections have occurred in Guangzhou area in 5 cases, 1 death cases. As an early treatment of the disease which can cure---of oseltamivir (Tamiflu), the price expensive, unfortunate infection in medical expenses will increase the pressure.

Yesterday, Guangzhou Medicare Council emergency introduced corresponding initiatives: according to 29th emergency publishing of Guangdong Province human resources and Social Security Office on further do h 7N 9 avian influenza patients medical insurance work of emergency notification under file spirit, introduced has for parameter insurance personnel patient h 7N 9 avian influenza of medical guarantees Huimin initiatives, treatment h 7N 9 avian influenza of AO Division he Merriam-drug (that up Philip) can using Medicare accounted claims. At present, the city's more than 9 million Medicare insured h 7N 9 once the risk of human infection of bird flu, when you use the potent drugs, reference can be made out-patient claims to specific projects.

　Three categories of insured 9 million people can enjoy

It is reported that Guangzhou health insurance are divided into the urban workers ' basic medical insurance (insured 5.08 million), urban residents ' health insurance (the insured 2.08 million) and the new type of rural cooperative medical insurance (insured 2.11 million) of three species, total insured over 9 million people.

According to provinces, municipalities, including Dr Zhong Nanshan, academician of avian influenza prevention and control of medical specialists group of specialists, which should make h 7N 9 against human infection of avian influenza early use of potent drugs, oseltamivir (Tamiflu) for treatment. To reduce the patient's medical expense, the Huimin initiative introduced at the right time, oseltamivir treating h 7N 9 avian influenza medication (Tamiflu), outpatient claims for a particular project, Medicare Billing claims.

According to the City Health Department regulations, a definitive diagnosis for insured h 7N 9 suspected cases of bird flu, in fixed-point medical institutions of basic medical insurance clinics (positioning, limit not subject to Medicare outpatient) oseltamivir (including capsules and granules) treatment for drugs, by Group b paid into Medicare funds range, reference out-project-specific grant to pay for the treatment. This means that the patient pays 5% for drugs after, remaining 95% and Medicare funds to pay for the drugs into individual phases.

　　Tamiflu medicine scattered claims settled

According to the policy setting, as an outpatient disease claims a particular project, types of medical insurance funds paid by the insured person, paid hospital level proportion of total pay. To workers ' basic medical insurance, for example, entered the stage of individuals, the Fund has paid 95% in drug costs, incumbents can claim 80%, retiree reimbursement 86%. After all the calculations, the incumbent Tamiflu use, can claim the 76% (95%x80%); retirees can claim 81.7% (95%x86%).

It is reported that the price of Tamiflu (domestic) about 190 Yuan per box.

Oseltamivir drug outpatient billing settlement, an insured person or members of their families can possible h 7N 9 certificates of diagnosis of avian flu or outpatient medical records, statements, invoices, proof of social medical insurance information such as copies of positive and negative, sporadic claims to Medicare secondary agencies to apply; oseltamivir medicine that is not accounted, according to sporadic sporadic reimbursement applications for reimbursement of the relevant provisions.

Guangzhou health insurance-related charge, has the above initiatives emergency notification to the designated medical institutions and require care fixed-point medical institutions admitted to h 7N 9 confirmed or suspected Bird flu in Guangzhou when insured health care agencies reported, announced emergency measures at the national h 7N 9 above terminates execution after the bird flu outbreak is lifted.

(Original title: integration of Guangzhou Health Bureau of emergency communications bird flu cure for Medicare reimbursement)

　　南都讯 记者王道斌 通讯员戴雨 人感染H7N9禽流感病例在广州、广东乃至全国都在逐渐增加。截至1月29日，广州地区已发生本地感染病例5例，其中死亡1例。而作为早期治疗该疾病的特效药物———奥司他韦(达菲)，其单价昂贵，将增大不幸感染患者的医疗费用支出压力。

　　昨日，广州市医保局紧急出台相应举措：根据29日紧急发布的《广东省人力资源和社会保障厅关于进一步做好H 7N 9禽流感患者医疗保险工作的紧急通知》文件精神，出台了针对参保人员患H 7N 9禽流感的医疗保障惠民举措，治疗H 7N 9禽流感的奥司他韦药品(即达菲)可使用医保记账报销。目前，全市900多万医疗保险参保人一旦患上人感染H 7N 9禽流感，使用特效药时，可参照门诊特定项目进行报销。

　　三类参保900万人可享受

　　据悉，目前广州市医疗保险分为城镇职工基本医疗保险(参保人508万)、城镇居民医疗保险(参保人208万)和新型农村合作医疗保险(参保人211万)三个种类，合计参保人超900万人。

　　根据包括钟南山院士在内的省、市禽流感防控治疗专家组专家，均提出应针对人感染H 7N 9禽流感病例及早使用特效药物奥司他韦(达菲)进行治疗。为减少患者的医药费用支出，该局适时出台惠民举措，将治疗H 7N 9禽流感的奥司他韦药品(即达菲)，按门诊特定项目的报销项目，进行医保记账报销。

　　按照市卫生部门的规定，明确诊断为H 7N 9禽流感疑似病例的参保人员，在基本医疗保险定点医疗机构门诊(不受医保门诊选点限制)使用奥司他韦(含硬胶囊和颗粒剂)治疗的药费，按乙类纳入医保基金支付范围，参照门诊特定项目待遇给予支付。这意味着患者在自付5%的药费后，剩余95%的药费进入个人和医保基金共同支付的阶段。

　　已结算的达菲药费可零星报销

　　根据政策设置，作为门诊特定项目报销的病种，医保基金支付比例按参保人员险种，医院级别共付段比例支付。以职工基本医疗保险为例，进入个人、基金共付阶段的95%药品费用中，在职人员可报销80%，退休人员报销其中的86%。折算后，在职人员使用达菲，可报销76%(95%×80%)；退休人员可报销81.7%(95%×86%)。

　　据悉，目前达菲的售价(国产)约为190元每盒。

　　已门诊记账结算的奥司他韦药费，参保人或家属可凭疑似H 7N 9禽流感的诊断证明书或门诊病历、结算单、发票、社会医疗保险凭证正、反面复印件等资料，到各医保二级经办机构申请零星报销；未记账的奥司他韦药费，按零星报销相关规定申请零星报销。

　　广州市医保局相关负责人介绍，已经将以上举措紧急通知到了各定点医疗机构，并要求各定点医疗机构在收治到确诊或疑似H 7N 9禽流感参保人员时及时向广州市医保经办机构报备，以上应急措施在国家宣布H 7N 9禽流感疫情解除后终止执行。

（原标题：广州市医保局紧急发文 禽流感特效药纳入医保报销）

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