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12-09-2022

The health insurance funds will reimburse modern prosthesis

Iliustracija

Compulsory Health Insurance Council approved the reimbursement of thigh prosthesis with microprocessor-controlled knee joint from the Compulsory Health Insurance Fund (CHIF) funds. The new modern prosthesis will enable the patients to live an active life, offering complete safety and freedom of movement.

‘We are glad to inform that the list of reimbursed orthopaedic technical devices will soon be extended with the long-awaited prosthesis. This device is a smart prosthetic system, compensating the function of the missing limb and enabling to perform movements that are as close to those of a healthy limb as possible. A microprocessor-controlled knee joint significantly contributes to the patient safety, improving the efficiency of their walking, mobility and daily functions thus increasing their life quality and social engagement.’ says Giedrius Baranauskas, Head of the Division of Medical Devices Reimbursement of the National Health Insurance Fund (NHIF) under the Ministry of Health.

The prosthesis with a microprocessor is the most expensive limb prosthesis, reimbursed by NHIF to this day. Its basic price amounts to more than 44 thousand Eur. The new prostheses will be reimbursed to CHI-covered patients up to 100 per cent.

The thigh prosthesis with microprocessor-controlled knee joint will be prescribed to CHI-covered adult patients, diagnosed with category 5 mobility level due to congenital or acquired limb loss. The smart prosthesis can only be prescribed by a council of doctors of an institution providing tertiary health care services, which must include at least one physical medicine and rehabilitation expert and at least one orthopaedic traumatologist. The production and application of these prostheses will only be entrusted with orthopaedic companies, whose orthopaedic traumatologist holds a certificate of competence and is trained on production and adaptation of these prostheses.

NHIF expects that thigh prosthesis with microprocessor-controlled knee joint could be produced and adapted to 22 patients with category 5 mobility level every year. According to calculations, the annual NHIF costs for the reimbursement of the production and adaptation of this prosthesis, will constitute approximately 793 thousand Eur.

According to NHIF expert, CHIF funds are used only for high-quality limb prostheses, prescribed for patients based on clinical indications, thus, patients should be trained on using these prostheses. This would improve their social lives, psycho-emotional state and enable them to work. Thus, thigh prosthesis with microprocessor-controlled knee joint should be produced and adapted to adult patients during the first stage of medical rehabilitation. The rehabilitation institution will have to ensure services of a qualified orthopaedic technologist, who will produce the said prosthesis.

The reimbursement of the new smart prostheses will be launched as soon as the Minister of Health signs an order regarding the inclusion of the said prosthesis into the List of Orthopaedic Technical Devices and Medical Devices, Reimbursed by the NHIF Funds and Their Basic Prices.

The health insurance funds are constantly improving the accessibility to orthopaedic technical devices to people with disabilities, including new modern and much-needed limb prostheses into the reimbursement list. For example, new myoelectric forearm prostheses began to be reimbursed for CHI-covered patients last year.

4.5 million Eur of CHIF funds were allocated for reimbursement of limb prosthesis this year. The Fund procures prosthetic devices for approximately 1,200 patients every year.

(ottobock.com photo)

The NHIF invites you:

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

Last updated: 16-01-2023

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