慢病有序管理的实现路径

The Approach in Achieving Sequential Management of Chronic Diseases

建立专业化的评审队伍、规范化的评审流程、病情资料评审与现场体检评审相结合的评审方式,是准确界定慢病的重要前提;实行治疗定点、费用定额、支付定项、用药定量的"四定"管理,对参保人员享受门诊慢病待遇的资格实行年年申报、年年评审制度,形成"能进能出、进出有序"的管理运行机制,是制度可持续的要求。

The establishment of a professional assessment team, a standardized procedure of assessment, and the combinative assessment of illness condition and checkup condition, is the prerequisite to accurately define chronic diseases. The implementation of “ four determination”, such as treating in appointed institutions, expenditure limitation, payment specification, drug use quantification; the qualification of the insured to enjoy chronic disease treated at outpatient department to be applied and evaluated annually, therefore to form a mechanism of“allowing entering or exiting, entering or exiting in order”, are the requirement of sustainability of the system.