Staff long-term care insurance to solve life lost self-care ability of long-term care security as the key point, based on grassroots medical institutions and aged care facilities, establish overall staff long-term care insurance system, further improve the sustainable social security system more fair, ginseng protect patients family transactional and to reduce the economic burden,We will continue to increase the people's sense of gain and happiness from joint efforts and shared development, and promote social harmony and stability.
Jinming Yu Hospital is a designated institution of long-term care insurance in Linshu County, which is specialized in medical care, institutional nursing and home nursing.At present, the long-term care insurance work of Jinming Yu Hospital, especially the home door-to-door service, is very down-to-earth, and has been highly praised by the elderly and the relevant functional departments.
The worker nurses safeguard for a long time what kind of job is, how to deal with?What are the policies and regulations?Recently, we interviewed Xu Minfu, vice president of Jinming Yu Hospital.
Reporter: can you tell me what is long term care, long term care, long term care insurance, long term care security?
President Xu: OK.Long-term care, as the name suggests, is the care of a disabled person for a long time.As an institutional system, it includes the security system of long-term care, the service system, the handling management and the supervision system.
The concept of a long-term care system is defined differently by different countries and different organizations.Our country is officially called long-term care insurance for employees.
The World Health Organization (WHO) defines long-term care as:"Long-term care is by informal care providers (family, friends and neighbors), formal care providers (health, social and other professionals and volunteers system of nursing care activities in place to ensure that those who do not have full capacity for self care, can continue to get their personal likes and higher quality of life,To achieve the greatest possible degree of independence, autonomy, participation, personal satisfaction, and personal dignity ".
This definition has such several meanings: one is the object of care, that is, the person to be taken care of.The term "disabled" refers to people who have lost the ability to care for themselves "due to physical, mental and cognitive impairments."The second is the care service provider, that is, the caregiver.There are three types of people: informal care providers (family, friends or neighbours), formal care providers (health, social and other professionals), and volunteers.
Third, the content of care services.Here did not expand the expression, only summarized as "nursing care", is obviously should include life care.The fourth is the purpose or goal of care.So that the disabled person "continues to enjoy his or her personal preference and a high quality of life, achieving the greatest possible degree of independence, autonomy, participation, personal satisfaction and personal dignity".The expression of some around the mouth, but revealed the essence of care services, here every phrase has its own unique meaning, and our traditional understanding of care, care are very different (not passive care, but in care, mobilizing the positive factors of being caregivers themselves, as far as possible to get independent sense, engagement, satisfaction, and personal dignity,A higher quality of life).The meaning of "long term" here.Long-term care is different from emergency clinical care, or short-term care, refers to the object of care has basically no possibility to restore the ability to take care of themselves, need long-term care.In many countries, the long-term disability period is defined as 6 months. After 6 months, people who cannot take care of themselves can apply for long-term care treatment.
In short, long-term care insurance for employees is a brand new social insurance system, aimed at the employees and retirees who participate in the basic medical insurance and long-term care insurance for employees,Insured workers who need long-term care due to age, disease or disability and loss of daily living capacity shall be provided with basic life care and medical care services closely related to basic life.
Reporter: what is the basic principle of employee long-term care insurance?
President Xu: Adhere to the people-oriented, strive to solve the long-term disability of the insured workers in the state of daily life care and closely related to the basic life of medical care problems, improve the insured workers' quality of life and humanistic care level;We will continue to set expenditures based on income, maintain a balance between revenues and expenditures, and set appropriate levels of basic benefits and benefits in light of the level of local economic development and the affordability of various sectors.Adhere to the diversification of financing channels, through the government, society, individuals and other parties to raise employee long-term care insurance funds;We will continue to make overall planning and coordination, coordinate the functions of various social security systems, and jointly promote the development of the health industry and the service system.The establishment entrusts the third party to handle the management mode.
Reporter: what does worker long - term care insurance GINSENG protect scope to have?
President Xu: All employees and retirees who participate in the basic medical insurance of Linshu County shall be covered by long-term care insurance.The worker that enjoys treatment of insurance of worker basic medical treatment to participate in to protect normally, after passing assessment accord with a condition, enjoy long-term care insurance treatment since the day of approval.Long-term care insurance focuses on the long-term protection of workers who lose their ability to take care of themselves.
Reporter: What are the ways of long-term care insurance for employees?
President Xu: Employees who are disabled due to old age, disease, disability and other reasons and meet the prescribed conditions can apply for long-term care insurance treatment, which can be divided into special medical care, institutional care, and home care.Medical treatment only protects is to point to the agreement fixed point medical establishment to open medical treatment only protects ward, to accord with medical treatment only protects the GINSEN of admitment condition provides 24 hours medical treatment to nurse a service.Institutional nursing refers to the agreed designated nursing institution, which provides 24 hours in hospital care service for the insured workers who meet the conditions of institutional nursing access.Home nursing is an agreement to appoint medical treatment or nurse regularly designated medical institutions, to meet the family to nurse admitment conditions of the GINSENS protect workers regularly provide long-term care and care services.Reporter: What does long-term care insurance cover for employees?
President Xu: In order to enable disabled people to enjoy more standardized nursing services, our city has specially issued the "Linyi City Employee Long Term Care Insurance Medical Care Service Project" and "Linyi City Employee Long Term Care Insurance Life Care Service Project".Disability patients can enjoy up to 30 medical care services such as vital signs monitoring, blood glucose monitoring and oxygen inhalation guidance, and can enjoy 12 required services such as bath, head and face cleaning and combing, hair washing, and at least 3 other life care services according to the nursing needs of patients or their families.
Undertake medical treatment to protect specially with the agreement that the institution nurses the medical institution that fixed point, should according to GINGINI the condition that protect worker and actual demand make nursing plan, provide necessary, appropriate and moderate nursing service.
The services of Jinming Yu Hospital include but are not limited to the following items: 1.Regular inspection, observation of the condition, monitoring of blood pressure and blood sugar, according to the doctor's advice to carry out oral, injection and other ways of drug administration.2.Basic nursing, specialized nursing and special nursing should be carried out according to the nursing grade, and disinfection and isolation measures should be strictly standardized.3.Dispose and care for urinary tube, gastric tube, fistula tube and other pipes, guide and implement ostomy care, sputum suction care, pressure ulcer prevention and care, dressing, bladder irrigation, as well as the implementation of oral care, perineal irrigation, bed washing, urine and stool treatment and other general special care.4.Collect and submit specimens for inspection.5.Instruct the use of oxygen inhaler and ventilator.6.Deal with patients with major changes in their condition in time and assist in referral if necessary.7.On the basis of nursing evaluation, nutritional guidance, psychological consultation, rehabilitation treatment and health education for patients, health education and rehabilitation guidance for patients and their families, psychological intervention.8.Hospice care for terminally ill patients, through care and symptomatic treatment, to alleviate pain and maintain the dignity of life.9.Assisted feeding, turning over, bathing and other life care content.
Reporter: What are the application procedures and evaluation criteria of long-term care insurance for employees?
President Xu: To apply for long term insurance benefits, insured employees should bring copies of medical records (stamped with the official seal of the hospital), ID card, and the ID card of the client, and apply to the health care institutions in the county or window No.43 (0539-6212969) of China Life Linshu Company on the third floor of the government hall at the intersection of Zhenxing North Road and Zhenglu Road.Evaluate after passing public show, the applicant has the qualification that enjoys long to protect insurance pay, from the day that deals with build a bed to register formalities to enjoy long to protect insurance pay.
Attend long-term nursing insurance condition is ginseng protect a worker because old, disease, disabled wait for to bring about personal certain function to lose completely or part, lie in bed all year 6 months or anticipate 6 months of above, the life cannot manage by oneself, the illness is basically stable.Less than 55 points (excluding 55 points) according to the Daily Living Ability Rating Scale.
For those who enjoy special medical care, one of the following conditions should be met: (1) Because of the condition, external drainage tubes such as tracheal cannula, biliary tract, fistula, deep vein catheterization, nasal feeding tube and urethral catheter should be retained for a long time, and the wound should be treated regularly;(2) those who need to rely on ventilator to maintain vital signs for a long time;(3) coma, general paralysis, hemiplegia, paraplegia, lower limb muscle strength or unilateral upper and lower limb muscle strength are 0-Ⅱ grade or severe impairment of limb coordination function due to nervous system disease, bone and joint disease, trauma, etc., requiring medical care;(4) hip fracture without operation, lower limb bone non-union (except fibula), chronic osteomyelitis, need medical care;(5) because of other postoperative still need long-term hospital maintenance treatment.
To enjoy the treatment of institutional care and home care, one of the following conditions should also be met: (1) To meet the application conditions of special medical care;(2) with the following chronic disease, cerebral apoplexy sequelae (at least on one side of the lower limb muscle strength grade 0 - Ⅲ or moderate body coordination function, and Parkinson's disease (smi), severe rheumatoid arthritis late (more severe joint deformation) or other serious chronic joint disease influence the content and walk, vegetative, end-stage cancer (the cachexia status);(3) The gastric tube, urinary tube, tracheal cannula, biliary external drainage tube, fistula tube, deep vein tube and other tubes need to be retained for a long time;(4) elderly patients with long-term fracture nonunion, complicated with other chronic diseases;Suffers from other serious chronic diseases, trauma and other causes of paralysis, paraplegia.
The process of applying for long-term care insurance treatment of the worker is the worker who accords with the above conditions through assessment, needs to carry the ID card of photocopy of medical records, ID card, client, put forward an application to the hospital of Jin Ming of fixed medical institution, and fill in "application form of long-term care insurance treatment of the worker".After receiving the application, the undertaking organization will conduct the preliminary examination, and the medical experts who meet the conditions for the preliminary examination will be organized to conduct the on-site evaluation. The applicant will begin to enjoy the treatment the next month after passing the evaluation.The scope of nursing insurance treatment will be included in the next month after the examination and approval of the undertaker.
Reporter: Would you please introduce the sources of funds and individual payment standards of employee long-term care insurance?
Colombia rich:Qualified disability, accept medical care, body care, home care, conform to the basic medical insurance drug catalogue, and medical diagnosis and directory services range as well as the long-term care medical care services, basic life care services scope of nursing cost, standard into worker long-term care insurance by the regulation pay limits.
The employee long-term care insurance fund is raised annually through the employee basic medical insurance pooling fund, individual contributions and financial subsidies.Raising money standard is decided tentatively every person every year 100 yuan, among them, worker basic medical treatment is sure to plan as a whole fund transfers according to every person every year 55 yuan, same class financial subsidy (contain lucky lottery public welfare fund) every year 15 yuan, individual undertakes 30 yuan (one-time transfers from fund of individual account of insurance of worker medical treatment by medical insurance agency organization;If no personal account has been established, it shall be paid by the individual).
Reporter: Attend a worker how to settle accounts for a long time to nurse insurance pay?
President Xu: the long - term care insurance cost of the insured staff does not set up the payment line.The proportion of medical service payment for designated medical institutions under the agreement shall be 80% for special medical care, 85% for institutional care, and the remaining expenses shall be borne by the individual.
Fee settlement management to implement the "quota payment, overspend is not made up" method.One, two, three fixed point medical care institutions provide medical treatment to protect specially, every bed day pay standard (contain standard of living care to protect standard) respectively for one class 140 yuan, two class 170 yuan, three class 200 yuan;The standard payment for each bed day (including the standard payment for life care) is 60 yuan;Accepting home care for each bed day to pay a standard quota of 40 yuan.Life care service items according to the standard of 15 yuan per person per day to implement the fixed payment.The implementation of home care by the standard payment of quota subsidies.To undertake long-term care insurance agency and the medical establishment that decide a dot per month shall be carried out in accordance with the standard quota settlement settlement and payment, by the end of each year to undertake long-term care insurance agency will be implemented to the medical establishment that decide a dot care insurance policy and service quality evaluation and customer satisfaction to the service object, substandard to deduct the amount as appropriate.
The medical institutions designated by the agreement shall upload the details of all medical expenses of the insured workers in bed in time according to the regulations.To the ginseng that is in the bed for a long time protect a worker to be able to deal with midway settle accounts;The insured staff should go through the procedures of removing the bed, and the medical institutions designated by the agreement should timely handle the network settlement of medical expenses, and print the long-term care insurance fee settlement statement and the detailed list of expenses. The settlement statement must be signed by the insured staff or their families to confirm.GINSENG protects the cost of in-hospital medical treatment that the hospital that the agreement decides a point to produce because of illness during the bed, settle accounts about the regulation by primary medical treatment insurance, enjoy long-term nursing insurance treatment no longer during be in hospital.
Reporter: What is not covered by employee long-term care insurance?
President Xu: During the period when the insured employees enjoy special medical care and institutional care, they will no longer enjoy related benefits such as hospitalization and outpatient treatment for chronic diseases, which should be paid by the pooling fund of basic medical insurance.GINseng protects a worker to enjoy during home nursing treatment, can enjoy outpatient disease to plan as a whole treatment at the same time.
Ginseng protect a worker to be enjoy treatment of insurance of nursing period, by inductrial injury insurance, birth insurance payment or third-party payment related medical expenses, and shall be paid by the existing system and has been incorporated into security, military disability pension for the disabled, mental disease control and prevention, and other countries and the scope of laws and regulations of nursing project cost, long-term care insurance funds no longer gives pay.
Reporter: I county worker long - term care insurance to undertake and a few appointed institutions?
President Xu: Our county contractor is China Life Insurance Linshu County Branch Company.Linshu Jinming Yu Hospital, the first batch of medical special nursing, institutional nursing, home nursing designated institutions;County Hospital of Traditional Chinese Medicine, Linshu Huimin Hospital, the first batch of medical care, institutional nursing designated institutions;Linshu Street Health Hospital is the first batch of designated medical care institutions.
Reporter: Thank you, President Xu.
President Xu: We welcome qualified employees to participate in the long-term care insurance of Jinming Yu Hospital. We will do our best to serve you well.
