Economic problems are very realistic. As a clinician fighting in the front line of the war against hepatitis B, I have a deep understanding. I once saw a patient whose liver function recovered well after transplantation. Because he could not afford ultrafiltration (a blood purification method similar to hemodialysis), he chose to leave sadly. Of course, the vast majority of patients who come to liver transplantation can still recover smoothly. You can see their colorful lives in the exchange section of Hangzhou Liver Transplantation Network.
The deceased is like a husband ... At present, the urgent problem to be solved is to let patients with end-stage liver disease and even patients waiting for liver transplantation know about the related expenses of liver transplantation and the ways to win medical insurance reimbursement. I am a poor scholar. Let me say a few words here first, so let's throw a brick to attract jade ~
Liver transplantation can be divided into cadaveric liver transplantation and parental liver transplantation according to different donor sources. Let's take cadaveric liver transplantation as an example. Expenses generally include preoperative preparation expenses, operation expenses at that time, early postoperative hospitalization expenses and follow-up expenses after discharge.
Discussion on related expenses of liver transplantation and medical insurance-1. Preoperative preparation cost
1. Preoperative preparation cost: at least 500,000.
As a major operation, preoperative examination and evaluation are very important, which directly determines whether patients can receive liver transplantation or specific surgical methods such as cadaveric liver transplantation or living donor liver transplantation, and the probability of postoperative recovery. A few years ago, a public figure had a recurrence of liver cancer after two liver transplants. I'm sure it's a pity whether it's his attending doctor or our colleague. Under the leadership of Academician Zheng, we actively improved the pre-operative evaluation system of liver transplantation and formed standardized evaluation steps. The cost of each inspection is about 0.5- 1 ten thousand.
However, due to the different severity of patients' preoperative conditions, I have also encountered that in order to save patients' lives, I have to use various expensive drugs and sophisticated treatment methods before surgery, such as artificial liver support therapy (about 6.5438+0 million yuan each time). As a result, the preoperative expenses greatly exceed the surgical expenses and postoperative expenses, and may reach several hundred thousand yuan or even more. It is true that without these high-end drugs and treatments, some critically ill patients may be life-threatening and lose the opportunity of surgery while waiting for liver transplantation. Therefore, for critically ill patients, the cost of preoperative rescue is also essential.
On the other hand, our beloved director Zhang Min has a famous saying, "Why wait until the apple is rotten?" . Yes, if the patient has indications for liver transplantation, he can make up his mind to start preoperative preparation as soon as possible. Don't wait until you are so sick that you are life-threatening that you want to ask a doctor for help. At this time, even if you spend a lot of medical expenses, the effect will definitely be much worse (compared with when your condition is relatively stable).
Pre-operative treatment of medical insurance transplantation: urban medical insurance is included in the scope of reimbursement; Rural medical insurance is reimbursed according to local regulations.
Discussion on related expenses of liver transplantation and medical insurance -2. Current operating expenses.
The cost on the day of liver transplantation is about 654.38 million yuan, which is slightly different according to the severity of the patient's condition and the hardware conditions of the local hospital. Autologous liver transplantation also needs to pay for perfusion, transportation and preservation of donor liver during ischemic period. Living donor liver transplantation needs to pay for the operation.
During the period of medical insurance transplantation:
Urban medical insurance is not included in the scope of reimbursement; Rural medical insurance is reimbursed according to local regulations. Therefore, we will suggest that urban medical insurance liver friends settle accounts before operation and handle self-funded hospitalization accounts; Rural medical insurance liver friends can go to the inpatient department to ask for a printed list and an invoice for hospitalization expenses.
Discussion on related expenses of liver transplantation and medical insurance -3. Early hospitalization expenses after operation
According to the recovery degree after liver transplantation, the general cost is about 654.38+10,000 yuan. However, if the complications are serious, they may exceed, such as preoperative hepatorenal syndrome, and postoperative renal function can not be recovered smoothly, so continuous ultrafiltration by bedside is needed.
In our center, the most economical preoperative, intraoperative and postoperative expenses of liver friends are * * * 1.3 million yuan, but there are also very few patients who exceed 500,000 yuan.
Early after medical insurance transplantation: urban medical insurance is not included in the scope of reimbursement; Rural medical insurance is reimbursed according to local regulations.
Discussion on related expenses of liver transplantation and medical insurance -4. Follow-up expenses after discharge
Follow-up expenses after discharge include outpatient adjustment and review expenses, re-hospitalization inspection and treatment expenses, etc. Because immunosuppressive agents need to be taken for a long time after liver transplantation, and the concentration should be monitored regularly, patients with hepatitis B need to insist on taking anti-hepatitis drugs such as lamivudine combined with hepatitis B immunoglobulin injection before operation to prevent hepatitis recurrence, so they need to bear certain expenses after operation, which is generally about 500-65438+million in the first year, and can be reduced year by year thereafter. If domestic immunosuppressants such as secopin, serti, serti and Thermos are used, the price is generally about 70% of the original imported drugs. At the same time, imported manufacturers have also organized transplant rehabilitation clubs such as Freshmen Club and Xiaoxi Club to improve after-sales service quality and provide some preferential measures for liver friends.
If biliary complications or serious infections happen unfortunately, the cost may rise sharply. The incidence of biliary complications in the liver transplantation center of the First Hospital of Zhejiang Medical University is in a low range in China, generally lower than 10%.
Treatment after medical insurance liver transplantation;
Urban medical insurance is included in the scope of reimbursement (except lamivudine and hepatitis B immunoglobulin, but we strongly recommend sticking to it to prevent the recurrence of hepatitis B); Rural medical insurance is reimbursed according to local regulations.
Note that most medical insurance centers stipulate that you can go through the formalities of readmission at public expense only after 7 days of discharge.
Liver friends can consult local "prescribed diseases" medical insurance, and outpatient review and hospitalization can increase the proportion of reimbursement.
Discussion on related expenses and medical insurance of liver transplantation -5. abstract
In short, the medical expenses of liver transplantation: liver transplantation is generally around 300,000 (according to the data of Hangzhou Liver Transplantation Network), and the budget of a few patients with poor postoperative recovery may exceed the standard.