The new framework contract for the provision of medical services was approved in the government meeting on Friday, placing more emphasis on the early detection of diseases and increasing the number of preventive consultations that can be settled, according to the head of the National Health Insurance House (CNAS ) who described the document as “a true reform of the system”.
“These regulations do not represent a simple update of the normative acts in the field of social health insurance, but a true reform to reorient the system and make efficient use of the Single National Fund for Social Health Insurance. (…) The measures adopted by this act normative will essentially contribute to improving the health of the population by reversing the “pyramid” of medical services from treating late-discovered serious cases to early detection and treatment of diseases in their early stages,” said Adela Cojan, president of CNAS, according to News.ro.
Analyzes for the prevention of major impact diseases
The institution presented in a press release the main news, in the fields of medical assistance, which are to be detailed in the application rules.
“In primary health care, the legal framework is created that allows the early detection of diseases with a major impact on the health of the population, and new tools are introduced in order to carry out preventive consultations for people between the ages of 40 and 60 (riskograms for the early detection of the possibility of developing diseases cardio-vascular, cerebro-vascular, oncological, diabetes, chronic kidney disease, as well as for the assessment of mental and reproductive health) and for people over 60 years of age (assessment of behaviors with global impact on health, fatal risk cardiovascular, oncological, osteoporosis, urinary incontinence, mental health assessment, dementia and depression risk)”, announces CNAS.
According to the institution, adults between the ages of 18 and 39 will benefit annually from preventive consultations.
Also in order to strengthen prevention, family doctors will recommend a wider range of paraclinical investigations that the insured can benefit from free of charge.
“The financing mechanism in primary healthcare was modified, so that by changing the weight of payment per capita and per service, from 50%-50% to 35%-65%, the possibility was created to introduce new prevention services that will benefit more insured persons, from more numerous age groups than at present”, the press release states.
Incentives for rural family doctors
Also, the new Framework Contract regulates for the first time performance-based payment, family medicine being the first segment of healthcare for which an amount is allocated for this purpose.
The framework contract also aims to stimulate rural family doctors.
“New measures are being introduced in order to reduce the disparities between rural and urban areas in terms of access to medical services, by creating incentives in order to attract family doctors in rural areas poorly covered/not covered by primary medical care. Thus, the doctor who will choose to carry out his activity in a rural locality will have a bonus of 50% compared to the incomes he could obtain in a similar way in the urban environment, or 100% if there is no other family doctor in the locality /point of work”, the CNAS press release states.
Outpatient rehabilitation services
In ambulatory medical assistance, diagnostic and therapeutic service packages are expanding, by introducing new services.
According to CNAS, the legal framework was created to increase the access of the insured to outpatient physical medicine and rehabilitation services, with each provider having the obligation to ensure an activity program of 7 hours per day, respectively 35 hours per week.
“In ambulatory paraclinical medical assistance, the package of analyzes and investigations is significantly expanded and the possibility of suppliers to conclude a contract with the health insurance company for mobile collection points is introduced. The possibility of settling over the value contracted by the laboratories with the insurance companies is regulated of health both of the analyzes recommended by family doctors, as a result of preventive consultations given to insured persons over 40 years of age, as well as of those for monitoring the evolution of the pregnancy”, the CNAS also transmitted.
The laboratories will be able to send the results of the analyzes and paraclinical investigations to the attending physician by e-mail.
New services in hospitals
In hospital medical assistance, the list of medical services that can be provided in day hospitalization regime is expanded with over 100 new services and the condition is introduced that the units ensure a day hospitalization program of at least 5 days a week and 7 hours a day day covered by the presence of at least one specialist doctor.
The counter value of the accommodation services requested for the persons insured by the sanitary units with beds will not be able to exceed 300 lei per day.
For medical and palliative care at home, the possibility of providing them at the location declared by the insured person is regulated, regardless of the health insurance company at which it is taken into account.
“Also, new services are introduced and the period during which insured persons under the age of 18 can benefit from medical and palliative care at home is increased from 90 to 180 days”, CNAS also transmitted.
For compensated medicines, new regulations are introduced regarding the prescription of biosimilars, both at the initiation of treatment and at its continuation, as well as the obligation of health insurance companies to monitor the prescription of biological products every six months.
The basic package includes new medical devices intended for the recovery of organic or functional deficiencies in the ambulatory, including compression sleeves for insured women who have undergone oncological surgery, the active wheelchair, the cough assist device or the cranial orthosis.
The new provisions apply from July 1.
Editor : D.R.
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