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Aiding incontinent patients: reimbursement offered by the health insurance funds

Date

2022 06 28

Rating
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At the end of June, joining the World Continence Week campaign with the rest of the world, the National Health Insurance Fund under the Ministry of Health (NHIF) is raising the public awareness of the issue of incontinence. NHIF experts are kindly reminding of the measures that can be reimbursed from the Compulsory Health Insurance Fund (CHIF).

The amount of medical aid measures (MAM) for patients, diagnosed with incontinence, has been increased since July 2021. Upon making amendments to the list of MAM, patients, diagnosed with severe incontinence are currently reimbursed for 60 diapers per month for CHIF funds.

According to calculations, last year, the reimbursable measures for urinary and faecal incontinence in Lithuania were used by 66.5 thousand patients. That is 8 thousand more than last year. These measures alone required nearly 11 million Eur from CHIF funds. That is 1.6 million Eur more than in 2020.

Another 4.9 million Eur from the state budget last year was allocated to cover patient payments for incontinence measures. This means that as many as 78 per cent of all patients, using reimbursable incontinence measures had their payments for the needed MAM covered.

According to NHIF experts, patients should first of all direct their request for reimbursable pads and diapers to their general practitioner. The practitioner will diagnose a disorder and issue a prescription for reimbursable MAM upon considering the risk factors of urine or faecal incontinence. In case of a need for a more detailed examination, a general practitioner can send the patient to a specialising doctor (gynaecologist or urologist) to confirm the diagnosis.

If the physician determines a urinary and (or) faecal incontinence, the number of the measures, reimbursed from the CHIF funds, per month is as follows:

Who?   When?  What?
CHILDREN  Urinary incontinence in case of a disability    60 diapers, pads or disposable sheets
  Faecal incontinence    45 diapers
ADULTS  Average urinary incontinence 60 pads with >300 ml absorbency
   Severe urinary incontinence 60 diapers or pads and disposable sheets
  Faecal incontinence only 45 diapers
  Faecal and urinary incontinence  90 diapers

NHIF experts are kindly reminding that the first prescription for reimbursable MAM must be issued by a physician, as it is the physician, who diagnoses the disorder, which may make the patient eligible for reimbursable measures. Later these prescriptions may be issued by nurses.

According to NHIF, the number of prescriptions for MAM, issued due to incontinence was 252 thousand. That is 9 per cent more than in 2020.

(Piktochart pict.)

The NHIF invites you:

Your questions are welcome by email [email protected] or phone: local (8 5) 232 2222, international +370 5 232 222