2024-07-09 18:52:12
Research helps monitor changes
After the diagnosis of diabetes mellitus is established, it is important for the patient to monitor the effectiveness of the measures and treatment applied to him.
In order to determine the effectiveness of the treatment, patients’ pancreas compensates the glycosylated hemoglobin test 4 times a year and once a year the albumin-to-creatinine ratio test in a single morning urine, which helps to notice the beginning changes in kidney function. They are prescribed by a family doctor.
30 different medicines are reimbursed
For people with diabetes, the health insurance funds pay for the necessary medicines and medical aids. Currently, 30 different active ingredients or combinations of drugs are reimbursed for the treatment of diabetes.
According to the data of the State Sick Fund, almost 155,000 people received treatment for diabetes last year with compensable drugs and compensable medical aids. patients.
More than 43 million was needed to compensate the costs of treating these patients with drugs and medical aids. EUR 10 million of Mandatory Health Insurance Fund (PSDF) funds. euros more than in 2022. This is more than 8 percent. all expenses of the fund for compensatory drugs and medical aids.
Health fund specialists remind that patients accumulate a basket of premiums every time they purchase reimbursable drugs with the lowest premium. When the accumulated amount reaches 48.33 euros, then the costs of patients buying the cheapest drugs are covered from the state budget until the end of the year.
What medical aids are reimbursed?
For patients with type 1 diabetes up to 24 years of age, up to 1,800 diagnostic strips for glucose determination can be paid, for persons over 24 years of age – up to 1,200 diagnostic strips per year; for children with type 2 diabetes and persons up to 24 years of age who use insulin – up to 900 strips per year; Up to 600 strips per year can be reimbursed for type 2 diabetes 24 years and older who take insulin.
Also, diagnostic glucose strips are reimbursed for pregnant women, people with gestational diabetes, people with type 2 diabetes and taking blood glucose-lowering drugs (except insulin), and people with other specified diabetes, unspecified diabetes or hypoinsulinemia that occurred after the procedure. You should ask the treating doctor or nurse what amount of strips can be compensated in each of the listed cases.
For adult patients with type 1 or type 2 diabetes who use a special pen to inject insulin, 1 insulin needle per day is also reimbursed. Children with type 1 diabetes are compensated for up to 2 insulin injections per day.
It’s good to know that nurses can refill and write prescriptions for replacement strips and insulin pen needles for patients with any type of diabetes if they’ve already been prescribed by a doctor.
Patients with type 1 diabetes can be prescribed continuous glucose monitoring systems from PSDF, if no other method of glucose measurement is financed. This monitoring system can be prescribed by an endocrinologist, pediatric endocrinologist, internal medicine physician, pediatrics or family physician.
Rental of insulin pumps is paid for
For children with type 1 diabetes, adults, pregnant women and women planning to become pregnant for up to one year, when the diabetes is uncontrolled, the council of doctors of the tertiary care institution can prescribe insulin pumps and a set of disposable replacement parts for subcutaneous insulin injection, paid for by the PSDF.
Patients who are prescribed such treatment should contact a company that has a contract with the health fund for the reimbursement of insulin pump rental costs and sign a contract for the issuance of the device, warranty and ongoing maintenance, and the supply of replacement parts. The entire list of companies can be found on the website of the health insurance funds.
Two pairs of orthopedic footwear per year
Diabetes often causes problems with feet, ankles, leg swelling, and foot ulcers, so foot inserts and complex orthopedic footwear can be compensated every six months. The base price of the first pair of footwear is compensated by 100% from the PSDF funds, and the base price of the second pair produced in the same year is compensated by 70%. Foot inserts are compensated by 100 or 80 percent. base prices depending on the social group. Orthopedic footwear and foot insoles can be prescribed by an orthopedic traumatologist, surgeon, physical medicine and rehabilitation doctor, and repeatedly by an endocrinologist. In case of complex complications, shin prostheses with a silicone sleeve and ankle foot braces are compensated.
For patients with foot problems, a therapeutic pedicure is also paid for 4 times a year. A person can get this service with a referral from a family doctor or an endocrinologist. In the case of diabetic foot, patients who have a referral are covered by the health fund for up to 24 diabetic foot care services per year.
Vision screening and eyeglass lenses
If diabetes affects the eyes, the patient may be prescribed an assessment of visual acuity, retinopathy, and the cost of spectacle lenses reimbursed by PSDF funds.
Currently, the compensable amount for simple spectacle lenses amounts to 95 euros, for complex ones – 148 euros.
What do you need to know about medical rehabilitation?
For people with diabetes, a physical medicine and rehabilitation doctor, after assessing the patient’s condition, can prescribe initial, outpatient or inpatient rehabilitation services paid for by the PSDF. According to the indications, individual medical rehabilitation services are prescribed, for example: physiotherapy, occupational therapy, physiotherapy, massage, and consultations of a medical psychologist or social worker may also be prescribed in an inpatient setting.
Medical rehabilitation may also be prescribed for certain diabetes-related complications, such as inpatient rehabilitation following inpatient treatment if orthopedic devices are required.
A patient with a referral for rehabilitation can choose both a doctor and a treatment facility where he will receive rehabilitation services. It is important to apply to health care institutions that have signed a contract with territorial health insurance funds for the provision of these services.
After the doctor prescribes rehabilitation treatment, the patient does not need to worry about the certificates, he only needs to contact the selected rehabilitation institution by phone and coordinate the arrival date. A list of institutions with contracts for rehabilitation services with health insurance funds can be found here.
Klaipėda Territorial Sick Fund information
2024-07-09 18:52:12