This article is from WeChat public account: A pillar column pillar (ID: yizhizhuzige), the original title: “How ordinary people fight the economic toxicity of the disease | the complete version of the column of the brothers long text”, title map from: Tencent News Valley Rain Lab

01 Life is priceless, responsibility has cost

What is the “economic risk of serious illness”?

Commonly speaking, it is because there is no money to see the disease, not to see the disease, dragging themselves and the family.

It is possible that you will think of selling a house and not selling a house. You will think of a targeted drug for 120,000 months of lung cancer. You will think of home because there is no economic pillar and income source for the whole family. You will think of it. Because the family members spend a few months with the cost of medical treatment, they don’t go to the hotel to spend money to take a bath. You will think that the family members have all the people’s calls and exhausted the last self-esteem.

I have seen my mother’s patient (early breast cancer, surgery can be cured) Husband can’t bear the two cows to change the operation fee, throwing her alone in the ward, saying, “This money can be a daughter-in-law again, for the sake of Flowers are not in the (breast) body.

I have seen my dad’s patient (rectal cancer, need to make a pocket after removing the anus), the old man is more than sixty, in the ward I am envious of the average of 25 pieces of one-time pockets that my dad is using. I don’t need to be exposed, tasteless, easy to use, I want my son to buy it, instead of a person who has to hide at the waist. Look at the disgusting transparent plastic bag. The son learned that the cost of fixing the ostomy bag every month would be about 350 yuan, and the old man would not know how to make a round.

The picture shows the skull of Squibb

I have seen more, specific, and immediate “family priceless, responsibility and cost.”

I also know that no one is a savior. I can’t help everyone. I am also one of the patients in a situation.

But I hope there is a reason that many patients can understand:

“Wild cats and wild dogs are also alive.”

“The smarter way will be a little more, and let the day of poverty test the human nature come a little later.”

02 General Principles for Reducing Economic Toxicity

During the one-year treatment period, I have more patients and families than the average patient. I understand that although everyone is paying for money, but there are many times when the information is asymmetrical. .

This country is too big, and many patients who are limited by age, cognition, and retrieval ability may not fully understand the possible ways to reduce the economic toxicity of medical treatment. Money should be spent on the cutting edge. Some money can save the province. If you don’t want to sell the house easily, I will sort out the idea of ​​alleviating the economic toxicity. I hope that the patients who need to save money can help.

Every decision to see a doctor is both about life and money.

No cry for money, not enough to talk about life.

The picture is a general map of the anti-cancer economic toxicity relief guide

After a while, I saw a young man in the early 20s posting a question about how much money to prepare for medical treatment. If you haven’t had a biopsy, you are going to borrow 200,000. If you haven’t diagnosed it, consider selling it. For the non-institutional work of the fifth-tier cities, he has no chance of five insurances and one gold. He feels that he does not purchase commercial insurance separately. If the monthly income is about 2000, the price of his own home with his parents may be 20-25. Between the million, household savings may be mostly about 100,000 yuan for marriage savings.

Once he is diagnosed, he may make two choices:

  • Selling a house 200,000+ family has a total savings of 100,000, lost their jobs, and paid for their own expenses after diagnosis. It’s easy to spend 300,000;

  • Easy to raise during the diagnosis process, in the case of a flat income level of social relations, a large probability of raising between 50,000 and 100,000, this part of the fundraising is close to 100,000 Pre-payment of family savings, follow-up treatment may still need help from relatives and friends.

I don’t want to jump out and say why he doesn’t buy commercial insurance, hundreds of millions of medical insurance, or why not go to work with employee health insurance. It’s all standing and talking, not bad, for low-end in the fifth-tier cities. For the income family, there is a general lack of insurance awareness and no extra money to fight against the risk. The biggest expenditure between the only child and the age of 20-30 is marriage.

At this time, you can think about the problem in another way:

What is the overall goal of reducing the cost of seeing a doctor?

  • Target: Overall reduction in total expenditure, increase in payers, and application for additional grants.

So we can try the following spending and payment ideas:

  • On the expense side: disk overall budget – split per stage cost – price, equivalent alternative – Capital movements, mismatches in account periods – reducing unnecessary expenses;

  • On the payment side: exhaust all possible payment entities – buy basic medical insurance (Flexible Employment Insurance)-Seeking a second reimbursement opportunity to get compensation – Applying for a poor body due to illness – Considering a commercial insurance that can be insured with a certain amount of leverage or a fee – Strengthen the family’s total risk-resistance ability to prevent worsening – Do not sell a single home easily if the current cash inflow can cover interest-bearing liabilities.

You can see that this is a step-by-step process that gradually reduces the cost of self-sufficiency.

The general principles are summarized in order: compensation, substitution, throttling, open source.

The picture shows the framework for anti-cancer economic toxicity relief

For the related matters mentioned in this article, please refer to the reference link at the end of this chapter. In view of the large differences between the regions, the operation details are only selected from Shanghai. However, the basic logic is actually similar. The local people’s bureau, civil affairs bureau, and street community affairs center can obtain relevant information.

03 Compensation principle: multi-agent reimbursement, multi-channel increase ratio, second reimbursement

The principle of compensation is a principle with regional characteristics and different applicable populations. I have summarized the following:

  • Commercial insurance self-pay part reimbursement

  • Policy-based insurance: Insured and tax-exempt insurance

  • Trade union insurance reimbursement

  • Supplemental Medical Insurance launched by the Social Security Bureau in cooperation with insurance companies

  • Additional medical insurance for the proportion of medical insurance reimbursement

  • Medical doctor’s disease clinic

  • Integration of urban workers’ medical insurance

  • Street due to sickness-type poverty-stricken life assistance” self-sufficient reimbursement

  • One-child allowance

  • Red Cross Major Diseases

First and foremost, Must buy basic health insurance. Absolutely not expensive, and absolutely necessary.

Taking Changchun City, Jilin Province as an example, the basic medical insurance premium for flexible employment is the base of contributions for the whole year. The basic medical inpatient pooling fund and the large amount of 100 yuan are paid in a proportion of 4.9%. The total amount of contributions in 2019 is 1,285.36 yuan. And a self-funded liver-enhanced CT cost is 1,400 yuan. If you go to the medical treatment price announced by the Changchun City Medical Insurance Bureau, you will find that it is very easy to see the scene, and it is easy to spend 10,000 pieces at your own expense. In the case of medical insurance, the proportion of self-sufficiency will be reduced.

Jilin Medical Insurance Bureau Medical Insurance Directory Query

Secondly, for the average person, treatment has entered a stage where the income is meager and expensive, so:

  • The top priority is income compensation, which is reimbursed for the self-sufficient/self-paying part of the medical expenses incurred. The reimbursement body can be the insurance company, the medical insurance bureau, the community street, and the civil affairs system; of course, the best income compensation is still diagnosed. Commercial insurance for critical illness insurance claims, a sum of money to solve a big problem;

  • Or to reduce the proportion of expenses incurred, that is, you can get higher medical insurance reimbursement ratio by applying for major medical insurance and additional supplementary medical insurance;

  • Or through the second reimbursement method, reduce the self-funding again, such as poverty-stricken low-income households and trade union groupsInsurance, comprehensive annual burden reduction, etc. If there are millions of medical insurance, you can completely reimburse the social security reimbursement through the scope of social insurance reimbursement.

In view of the large local differences and the details of the operation, it is recommended to directly consult the local community street affairs center, neighborhood committee, civil affairs bureau, medical insurance bureau, company union ) and so on.

In addition, if you plan to seek medical treatment in a different place, it is best to know the rhythm of treatment in the patient group in advance (in fact, the rhythm of spending money) and approximate price, In the provincial capital cities and major cities with similar medical resources, you can compare the expenditures of different medical treatment places, understand the rhythm of reimbursement according to the rhythm of spending money, and see how much working capital is needed to advance. Instead of selling the house from the beginning.

For the handling of medical insurance in different places, some provinces and cities can realize the operation of App and WeChat public number. If you can fully understand before going to the hospital for medical treatment, you can be more efficient. Taking Hunan Province as an example, I used the “Wisdom People’s Society” public number to handle the medical insurance for the local in-laws of Hunan. It is very convenient to call and confirm after submitting the information.

The picture shows the public number of Hunan Provincial People’s Social Security Bureau, which is more refined

Next, let me give an example of how to apply the compensation principle. For a low-income ordinary patient, suppose he does not have any basic social security. So what can he try to do after he is diagnosed?

The picture shows the anti-cancer economic toxicity relief guide – compensation principle

If you do not have basic medical insurance, you will immediately apply for flexible employment insurance, and at the same time, ask the medical insurance bureau whether there is supplementary medical insurance that the insurance company cooperates with the medical insurance bureau(Secondary reimbursement insurance) can be bought, For example, Zhuhai has a better medical insurance policy, and you can buy supplementary medical insurance for reimbursement at your own expense. PETT can even be reimbursed, for example, Zhejiang has better medical coverage, which is better than other regions.

In addition, some local medical insurances will adopt a matching policy in order to fill the current medical insurance deficit. For example, if my parents are in their hometown, the local medical insurance will pay more than 30,000 yuan for a higher reimbursement rate. For example, 92% of the reimbursement rate within the social security coverage during hospitalization.

Then, then, he can see if the unit has any employee medical mutual assistance for him, which may include on-the-job hospitalization, prescribed diseases and hospitalization allowances, etc. Whether there is insurance for commercial insurance group insurance, such as small reimbursement for low-cost reimbursement hospitalization yuan insurance. Taking Hangzhou City, Zhejiang Province as an example, you can apply for large-scale pathological compensation, hospitalization subsidy, and in-service employee hospitalization allowance online through the “Hanggong E Home” app. You can also apply online through the public number such as “Hangzhou Local Treasure”.

“Hanggong E Home” app applies for large pathological compensation, hospitalization subsidy,Reimbursement for staff allowances, etc.

That again, you can find out if local insurance company branches can insure tax-exempt policy insurance. This is the only medical insurance that can be taken for sickness (In addition to the innovative single-type single-species insurance), Although the insurance coverage for non-standard and past illnesses is only about 150,000, the insurance application process is more complicated, but if it can be more than 4 per year The reimbursement quota of 10,000 yuan is meaningful for reimbursement of general family social insurance and whitelisted medicines. How to insure the insurance for cancer patients, as well as my actual claims experience, will be covered in a follow-up article.

In addition, he can improve the reimbursement rate after he is diagnosed with a major illness, and he can increase the reimbursement rate. In the second year, the comprehensive reduction of urban employees will be based on the part of the previous year’s self-financed medical expenses exceeding 30% of the annual income. A certain proportion of the second reimbursement, further reduced free of charge.

Comprehensive burden reduction application flow chart

In addition, he can synchronize with the community street affairs center to understand the policies of the civil affairs, the Red Cross and other systems. If the sickness-type poverty-stricken life rescue is self-sufficient reimbursement, the family income is calculated by the family. The medical expenses of the first three months exceed the family income to apply for assistance from the civil affairs system. About the Red Cross for the serious illness The rescue of the specific regional policies is different, but at the end of each year, the list of contracted by the neighborhood committee will be used to understand the need for assistance to the families in need. The Shanghai area can also sign up for the TV station Red Cross column “Love in Action” to further raise funds.

In addition, for the only child family where the household registration is located, the child is suffering from a serious illness, and there is a certain subsidy for the parents of the family of the child with the serious illness. He can let parents go to the neighborhood committee to understand the application, and the corresponding subsidies will be concentrated at the end of the year.

This thing that can be done at the time of diagnosis can be said to apply for help in the early stage of the disease and the family has not been exhausted, and obtain the corresponding information of social assistance, in the neighborhood committee, community street, Red Cross, civil affairs, etc. Have received the corresponding attention.

04 Alternative Principle: Alternatives for Equal Functions

  • Charity donation instead of self-purchase

  • Special drug approval replaces full self-purchase purchase

  • Basic inspection in community hospitals

  • As for high-priced health products, meat and egg milk is a cheap alternative

  • The individual differences are large, depending on the actual condition

Like buying cosmetics, you can consider cheaper alternatives when the active ingredients are the same. This idea also applies if you spend money.

The picture shows the lymphoma drugs that need to be used by the pillar brother: Bendamustine, rituximab, lenalidomide; a single course of 20,000+

The disease is a long-term illness. After the initial treatment, the big head of the disease is medicines and examinations. If you can’t afford genuine imported drugs, generic drugs, Indian medicine, experimental groups, and even raw materials can be considered. It is feasible for a qualified patient to apply for a charity donation from a pharmaceutical company and apply for a medicine from a pharmaceutical factory. Of course, if you buy a special targeted drug reimbursement insurance before you get sick, it is best that hundreds of thousands of credits are slow enough for a while without sacrificing effectiveness, efficiency and opportunity cost.

The picture shows the alternative principle of anti-cancer economic toxicity soothing guidelines

In addition, for some targeted drugs that have entered the scope of medical insurance, some areas adopt the “special drug approval” mode, that is, the indication patients are applied for at the hospital and the local medical insurance bureau to obtain reimbursement. Of course, I know that for a slightly older patient, it may be because of the special drug approval procedure (Hospital Health Insurance – Medical Insurance Bureau – designated pharmacy) Span> will be more troublesome, but you can’t miss the right treatment opportunity because you are afraid of a little trouble or lose unnecessary opportunity costs because you spend unnecessary money.

During my treatment, my dad needs to use the targeted drugs to enter the medical insurance special drug approval, and can be reimbursed locally, but he feels that “running this thing is troublesome” or that “all young people run I can’t do it myself, so I didn’t apply for it. I learned that I was really angry afterwards. Part of the reason was that I was not paying attention to this matter in time. I don’t know that the local medical insurance has implemented the policy. On the other hand, I feel that he is not responsible for himself. Moral responsibility was passed on to me.

The picture shows the Jilin Province basic medical insurance special drug list

Anyway, unless you are really a todayA patient who is completely uneducated, has no autonomy, and cannot communicate at all. He must take his own illness seriously, instead of thinking that everything should be done by the family for me. I am not doing anything myself. Need to consider not to do, all the family members of the “big bag” type of patients will over-blame and affect family relationships under such pressure. The patient himself, if prematurely “fear of trouble” and “abandon it,” is extremely irresponsible to himself and his family.

Although I said that I am standing and talking and not hurting, after all, not everyone feels that running the process is a handy thing, but, Seeing a doctor is a big deal, and big things must have a big attitude and perseverance. “Do it all at once, second time tired, third time exhausted”.

As for the examination, in the case of meeting the individual treatment arrangements and the hospital approval, some basic examinations do not have to be done in the top three hospitals. The queues are amazing and the timeliness is average. In my own words, routine blood tests, B-ultrasound and I went to the community hospital for chest radiographs. Not only is it efficient, but some of the inspections are cheaper, and it also reduces the probability of my immunodeficiency patients being infected in the emergency department of the top three hospitals. During the treatment, I saw that many people have to go to the top three hospitals for a very basic examination of blood tests. I don’t think it is necessary.

Physical costs, energy costs, and even contingent risks are all based on the attitude of spending money to consider whether it is necessary and whether it needs to be saved.

With regard to supplemental nutrition, I really can’t force science popularization, and I also sincerely recommend “follow the doctor’s advice.” Except for tobacco and alcohol, I have no taboos, and I don’t want to spend a lot of money to eat Ganoderma lucidum, bird’s nest, all kinds of supplements, all of which are proteins. I don’t have the money to pay more than the actual ingredients. I also feel that it is unnecessary. I think I eat every day. It’s good to order meat and milk.

05 Open source throttling principle

Under the concept of “open source”, we can understand how to increase the inflow, what is the “source”?

I think that the investment in existing life is always open source. Whether it is to learn income through learning skills, or to invest in this family responsibility for the family, it is considered open source. Under this concept, I provide several principles for reference:

  • Active treatment is also a way to make money

  • Contributing to the family also has economic value. Housework, caring for the elderly, and counseling children are also a way to make money

  • The rights and interests of the original work: sick leave wages must be paid, and labor contract economic compensation should be terminated

  • Low-cost learning new skills: no online courses that can’t buy Baidu cloud links at a low price

  • Shanghai People’s Social Security Bureau official website subsidized vocational training

  • The concept of total cost of family

The picture shows the open source principle of anti-cancer economic toxicity relief guide

I want to introduce a concept of total cost of the family here. Many patients get sick and have a lot of pressure and gap after they are sick at home. They feel that if they don’t make money, they will cure the disease and empty the house. They will even resist negatively and no longer treat. Although I also feel that I can’t continue to work for a while, I can’t continue to be a low-level family economy. But Lao Tang often tells me that “it is to earn money by treating diseases.”

Why do you say that? The mood is depressed, the state is not good, and the treatment is not directly related. There are direct and indirect visible costs. The consumption of emotions, the advancement of confidence in the future, and the squandering of the family’s body will cause unnecessary consumption costs.

Family can be understood as the smallest economic entity in the society (except for individuals), since it is a family of common property relations, then expenditure and cost are common The main subject is the family. Similarly, the internal payment is also of economic value. Who says that doing housework, taking children, and caring for the elderly is not a way to create value and make money? I used to work together for this family.In the difficult economic period of medical treatment, everyone bears the cost together.

In addition, although the learning input during sick leave does not necessarily have visible output, it can pass the time, improve the agility of thinking, and even find something to do. A little information input mentality may be a little practical. After all, the “learning” information acquisition may be the source of “feeling” and “work hard” with the lowest cost and the most cost-effective.

If the research, postgraduate study, skill study, and reading during treatment are all converted to a certain degree of post-treatment employment, My most basic view is that people may be motivated in a difficult situation. Huge willpower, different opportunities in different situations, since it is for life and life, it is not a good eye.

When you can’t keep your job, and you don’t find a job with a high degree of matching, you can learn a new skill and find a job.

The national people’s social system is actually a big investment in vocational training. Take Shanghai as an example. There are corresponding skills training and government subsidies for the 240 categories of work in 20 categories. The employment rate is definitely better than that of college students with low academic standards. I studied yesterday. Now, a few work types are very interesting to me, and the cost of learning is only a few hundred pieces after subsidies.

Shanghai Municipal Social Security Bureau part of the vocational training subsidy program

In addition, we can also have the idea of ​​dislocation competition. Take myself as an example. I am a common financial white-collar worker. My professional skills and work experience are highly dependent on platform and platform resources. I am myself. It is a specialized screw. The education and experience in Lujiazui can only be considered ordinary, but when I use some of the skills accumulated in the investment to go to other industries, even when writing from the media, I will find that some are similar to the “bottom layer.” The cognitive approach of the operating system and the logical starting point of the origin nature make me have the advantage of misplaced competition.

There is a big person who can be unemployedWhat should the bureaucracy be?

Ask the ultimate pursuit of your work is to make money as a means of earning a living, or to pursue a career with a higher sense of value?

It’s a lot easier to make choices after you have figured this out. In order to make money, most of the work is done to a certain extent, it is the repetitive work of mental and physical strength, and the marginal effect of value is reduced (except for a few prosperous auras), a small part of the work can balance high income and high value.

If you only want to make money, then you can make a decision by considering the stability of earning money, cost-benefit efficiency, health balance, basic social security, and so on. I have observed that the urgent need of most people after illness is to retain five insurances and one gold. The working advantage in the system is great, and the care of the unit and the support of the system are relatively considerable.

But some people are still squandered. If they need more money, they will make more money. They will work for themselves. They will open a shop, do business, and start a business. Then there are still some people who are actually learning and realizing their previous skills as the main business, and more than one sideline to achieve income compensation.

On the other hand, if you feel that you need a sense of value and a sense of business for the rest of your life, then an ordinary job may not be satisfied. It is not difficult to find a career that suits your own value needs or meets the expectations of your heart. I have a breast cancer patient who I know is also a psychologically painful process after Fudan’s sister is sick. More women with breast cancer, a “Pink Angel Foundation” involved in Shanghai has helped many people. There is also the largest patient community in the lymphoma community, “the home of lymphoma”, and most of the staff are patients and their families. Helping the entire group of patients or doing something innovative also brings them great value.

As for myself, I went to the “Geriatric Service and Management” college a few years after my master’s degree, not for the psychological improvement of “educational improvement”, but to know more nursing students, understand the old-age industry, Learn how to care for the elderly.

I also participated in the training of “An Ning Healing” volunteers and actually participated in the service to do the hospice care of hospice care.

These two things are not supplemented by any income for the time being, but I have really learned more about how to get along with the elderly and even the dying elderly. I also know more about the symptoms and treatments at the end of my life. Also learn to observe the elderly at home