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　　[ 对于如何界定“大病”的“合规”，国家发展改革委副主任、国务院医改办公室主任孙志刚指出，文件没有简单地按照病种区分大病，而是根据患大病发生高额医疗费用与城乡居民经济负担能力对比进行判定 ] [for how to define"A serious illness"of"compliance",The national development and reform commission deputy director/Cure of the state council office director SunZhiGang pointed out,Document does not simply according to the disease to distinguish between a serious illness,But according to suffer from a serious illness happen high medical cost and economic burden ability of urban and rural residents a comparison of decision]

　　六部委贯彻落实《关于开展城乡居民大病保险工作的指导意见》，各地方的大病医保政策细则呼之欲出。

Implementation of the six ministries and commissions[About urban and rural residents to carry out a serious illness insurance work guiding opinions],Local serious illness medical insurance policy rules be vividly portrayed.

　　对于城镇居民医保和新农合的参保人来说，大病保险将提高这部分人大病保险的上限，提高的幅度在25%以上。而大病医保虽然由商业保险公司承办，但是专家指出，政府定制的大病医保类似于“交强险”保障基本需求，而个人的个性化需求还是可以通过购买商业医保来满足。

For medical insurance for urban residents and the new agriculture, ginseng protect people,A serious illness insurance will improve this part of the National People's Congress disease insurance limit,In the range of the increased more than 25%.A serious illness and medical insurance although by commercial insurance company to undertake,But experts point out that,The government of the medical insurance is similar to customize a serious illness"comprehensive"Safeguard basic demand,And the personalized needs of individuals or by buying commercial medical insurance to meet.

　　主要保障城镇居民和新农合参保人 The main safeguard town and the new agriculture $ginseng protect people

　　近来，国家发展改革委、卫生部、财政部等六部委联合召开电视电话会议，贯彻落实《关于开展城乡居民大病保险工作的指导意见》（下称《指导意见》）。

recently,The national development and reform commission/The ministry of health/The ministry of finance jointly held six ministries and commissions such as TV conference call,Implementation of the[About urban and rural residents to carry out a serious illness insurance work guiding opinions](said[Guiding opinions]).

　　《指导意见》明确指出，大病保险的保障对象是城镇居民医保、新农合的参保人，所需要的资金从城镇居民医保基金、新农合基金中划出，不再额外增加群众个人缴费负担。

[Guiding opinions]Explicitly pointed out,A serious illness insurance safeguard object is medical insurance for urban residents/New farmers, ginseng protect people,The funds required to urban residents from the medical insurance fund/New farmers joint funds off,No extra increasing the mass individual pay cost burden.

　　目前我国医保体系大致包括三个部分：城镇在业职工享受的城镇职工医疗保险，城镇非在业职工的城镇居民医保基金和农村目前实施的新农合基金。

At present our country medical insurance system generally consists of three parts:Town in the worker enjoy medical insurance for urban workers,Not in the town of the worker medical insurance for urban residents fund and rural at present of the implementation of the new farmers joint fund.

　　与1998年建立的城镇职工医保不同，2003年建立的新农合医保和2007年建立的城镇居民医保都未附加大病补充保险。新农合和城镇居民医保的给付标准较低，另外，“封顶”的报销模式实则难以解决城乡居民“因病致贫、因病返贫”问题。

And in 1998 the establishment of medical insurance for urban workers different,Established in 2003 new farmers joint medical insurance in 2007 and the establishment of medical insurance for urban residents are not additional serious illness supplementary insurance.New farmers joint and medical insurance for urban residents of the payment standard is low,In addition,"capped"Submit an expense account model actually difficult to solve the urban and rural residents"Become financially-difficult/Poverty due to illness"problems.

　　中国社会科学院社会政策研究中心秘书长、研究员唐钧告诉第一财经日报《财商》：“城镇职工这一块的报销比例已经达到80%～90%，而城镇居民医保和新农合的报销比例大致占到医疗费用的40%～50%，相比起城镇职工医保是比较低的。这部分人在自费部分之后利用大病保险还能再报销至少50%。也就是说大病的报销上限提高到了75%以上。”

The Chinese academy of social sciences social policy research center secretary general/The researchers TangJun told the first financial daily[Money business]:"Town worker this one to submit an expense account proportion has reached 80% ~ 90%,And medical insurance for urban residents and the new agriculture, submit an expense account to medical expense proportion approximately accounts for 40% ~ 50%,Compared with the medical insurance for urban workers is relatively low.This part of the people in part at one's own expenses after use of a serious illness insurance can submit an expense account again at least 50%.That is a serious illness to submit an expense account of upper limit increased to more than 75%."

　　目前城镇职工医保的报销比例较高，而城镇居民和新农合参保人的保障比例则相对较低，《指导意见》并未提及城镇职工的保障，而是明确提出针对城镇居民和新农合参保人的保障。

At present medical insurance for urban workers of higher percentage to submit an expense account,And the town and the new agriculture $ginseng protect people's security ratio is relatively low,[Guiding opinions]Did not mention the security of urban workers,But clearly puts forward the town and the new agriculture $ginseng protect people's security.

　　唐钧告诉记者：“根据《指导意见》大病医保的保费不用个人另行付钱。而是用城镇居民和新农合保障内结余的基金来做。”

TangJun told reporters:"According to[Guiding opinions]A serious illness of the medical insurance premium shall be separately pay not personal.But with the town and the new agriculture joint security inside balance fund to do."

　　当然也有学者担忧，虽然目前城镇居民和新农合保障都尚有结余，不过目前的结余并不代表未来的结余，如何可持续运作还得看政策进一步落实。

Of course, there are also some scholars concern,Although at present the town and the new agriculture joint security are still balance,But the current balance does not represent the future of balance,How to sustainable operation still have to see policy further implement.

　　另外，从字面上看，未来大病保险将实施事后报销的赔付方式，有学者担忧，一些过于困难的群体将由于没有办法负担医疗费用而在实际情况下不能享受大病医保。

In addition,literally,The future of a serious illness insurance will be implemented after the compensation way to submit an expense account,Some scholars concern,Some too difficult group will have no way to burden due to medical costs and in actual situation cannot enjoy medical insurance of a serious illness.

　　中国社科院卫生经济研究专家朱恒鹏教授在微博中也提到，大病医保同时会把稀缺的医保资金花费在一些成本-效益比很差的病种上。比如，富裕的晚期肿瘤患者花费50万～100万。而由于穷人往往付不起自付费用而放弃治疗以及中国特殊的一些国情，大病医保在执行中，可能产生大量的逆向选择，即将普通民众的医保费用剥离出来，却补贴给了治疗意义不大、费用高昂的富裕人群。

The Chinese academy of health economic research experts ZhuHengPeng professor in micro bo also mentioned,A serious illness medical insurance at the same time will be scarce medical insurance funds spent on some cost - benefit than poor on the disease.For example,Rich terminal cancer patients spend 500000 ~ 1 million.And because the poor often can't afford out-of-pocket cost and give up treatment and Chinese special some conditions,A serious illness medical insurance in the course of execution,May produce a lot of adverse selection,The general public health care coverage stripping out,But subsidies to the treatment of meaning is not big/The high cost of wealthy crowd.

　　提高大病报销上限 Improve serious illness to submit an expense account upper limit

　　本次大病保险的主要受益人群是患大病、需要大笔医疗费用，并且超出个人支付能力的人群。

The main benefit from a serious illness insurance crowd is a serious illness/Need large medical expenses,And beyond the individual ability to pay.

　　《指导意见》指出若参保人患大病发生高额医疗费用，对两大医保体系补偿后需个人负担的合规医疗费用给予保障。

[Guiding opinions]Pointed out that if people suffer from a serious illness happen ginseng high medical costs,The two big health-care system after compensation to individual responsibility compliance medical treatment charge gives security.

　　对于如何界定“大病”的“合规”，国家发展改革委副主任、国务院医改办公室主任孙志刚指出，文件没有简单地按照病种区分大病，而是根据患大病发生高额医疗费用与城乡居民经济负担能力对比进行判定。大病保险报销不再局限于政策范围内，只要是大病患者在基本医保报销后仍需个人负担的合理医疗费用，就将再给予报销50%以上。

For how to define"A serious illness"of"compliance",The national development and reform commission deputy director/Cure of the state council office director SunZhiGang pointed out,Document does not simply according to the disease to distinguish between a serious illness,But according to suffer from a serious illness happen high medical cost and economic burden ability of urban and rural residents a comparison of decision.A serious illness insurance reimbursement is no longer limited to policy range,As long as it is a serious illness patients in the basic medical insurance to submit an expense account is required after the reasonable individual responsibility medical expenses,It will be given to submit an expense account more than 50%.

　　“大病保险报销的范围是自费部分超出上一年的人均收入，这意味着，只有非常严重的疾病才在报销范围内。”一位商业保险产品设计人士告诉记者。

"A serious illness insurance reimbursement range is part at one's own expenses beyond the previous year's per capita income,This means that,Only very serious diseases to submit an expense account in range."A commercial insurance product design sources told reporters.

　　按照国务院医改办对东、中、西部1亿个样本数的统计和测算，大病发生的概率在千分之二到千分之四左右，按照城镇居民和新农合参保（合）人数测算，全国是200万～400万人左右。

According to cure of the state council to do to the east/in/The west 100 million a number of samples of statistics and measure,The probability of occurrence in a serious illness in the two over one thousand to four over one thousand or so,According to the town and the new agriculture $ginseng protect(close)Measure number,The national is 2 million ~ 4 million or so.

　　对于报销是否覆盖非医保报销目录内的药物，《指导意见》的精神是非医保报销目录内的药品、治疗项目等，只要是合规的费用，都可以报销。但具体哪些是合规费用，《指导意见》作为指导性文件，没有作出具体规定，主要原因是各地情况差异大。

Whether to submit an expense account to medical insurance cover not submit an expense account within the directory drug,[Guiding opinions]And the spirit of the medical insurance to submit an expense account within the directory drug/Treatment projects,As long as it is the compliance costs,Can submit an expense account.But what is the compliance costs,[Guiding opinions]As a guidance document,No, formulate specific provisions,The main reason is that local situation big difference.

　　大病保险的实质作用是提高了弱势群体的大病医疗报销上限。

The essence of a serious illness insurance role is to improve the disadvantaged groups of the medical treatment of a serious illness to submit an expense account upper limit.

　　孙志刚说，大病保险的报销比例是，大病患者在基本医保报销后仍需个人负担的合理医疗费用，再给予实际报销50%以上，而且，对医疗费用实行分段制定支付比例，原则上医疗费用越高支付比例也要越高。也就是说，城镇居民医保、新农合先在政策范围内报销约70%，剩余自付费用再由大病保险实际报销最少50%。

SunZhiGang said,A serious illness insurance reimbursement ratio is,A serious illness patients in the basic medical insurance to submit an expense account is required after the reasonable individual responsibility medical expenses,To give the actual expense above 50%,and,For medical expenses implement piecewise make payment proportion,In principle, the higher proportion of medical expenses payment will is higher.That is,Medical insurance for urban residents/New farmers joint first in the policy range to submit an expense account about 70%,Residual out-of-pocket expenses again by a serious illness insurance actual reimbursement by at least 50%.

　　国务院医改办副主任徐善长指出，关于报销方式，文件要求大病保险要加强与城镇居民医保、新农合经办服务的衔接，提供“一站式”即时结算服务。也就是说，虽然报销是先报销基本医保，再报销大病医保，这只是概念上的两个层次报销，实际上对于公众就是在医院看病的费用通过刷卡等方式就可以即时结算，而不需要基本医保报销完了以后二次到商业保险公司进行报销。

Cure of the state council to do vice director XuShanChang pointed out,On the way to submit an expense account,Documents require the serious illness insurance should strengthen and medical insurance for urban residents/New farmers orgnaization of service of the close connection,provide"one-stop"Instant settlement services.That is,Although to submit an expense account is to submit an expense account basic medical insurance,Submit an expense account to medical insurance of a serious illness,This is the concept of two levels to submit an expense account,In fact for the public is in hospital cost through the credit card, etc can immediate settlement,Without the need for basic medical insurance to submit an expense account after secondary to commercial insurance company to submit an expense account.

　　仍需要商业保险补充 Still need to commercial insurance added

　　大病保险出台后，是否还需要购买商业医疗保险，是很多人关心的话题。

After a serious illness insurance issued,Whether also need to buy commercial medical insurance,Is a lot of people are concerned about the topic.

　　《指导意见》指出，大病保险采取政府委托办理、购买服务等办法，由商业保险机构承办大病保险，并在全国范围推广。

[Guiding opinions]Pointed out that,A serious illness insurance to take government entrust to handle/To buy services, etc,The commercial insurance institutions undertaking serious illness insurance,And wildly used in the whole country.

　　中央财经大学保险学院院长郝演苏告诉记者：“之前大病保险的试点是局部地区，之后大病保险将由商业保险公司承办，由有关部门向商业保险公司进行统一采购，此时应该会制定标准化的产品形式，这类似于此前的交强险。”

Central university of finance and insurance, dean of the college of hao play Sue told reporters:"A serious illness insurance before the pilot is local,After a serious illness insurance is to be covered by commercial insurance company to undertake,By the relevant departments to commercial insurance company for unified purchasing,At this time should formulate standardized product form,This is similar to previous insurance."

　　不过，郝演苏提到，这种情况下商业保险与大病医保仍然是相互补充：“大病医保是政府统一采购的标准化产品，而商业保险则可以满足个人的个性化需求。大病医保不可能给患者以合规医疗之外的报销，比如一些患者要享受单人病房，或者去一些昂贵的私立医院，大病医保不会给予报销，但是商业医疗保险可以满足他们的需求。”

but,Hao play Sue mentioned,This kind of circumstance commercial insurance and serious illness medical insurance is still complement each other:"A serious illness medical insurance is the government unified purchase the standardization of products,And commercial insurance, can meet the personalized needs of the individual.A serious illness medical insurance may not give patients compliance with outside of the medical expense,For example some patients to enjoy a single ward,Or to some expensive private hospital,A serious illness medical insurance will not give to submit an expense account,But the commercial medical insurance can meet their needs."

　　目前国内市场上可以买到的商业医疗保险大致可以分为两种形式：一种是一次性给付的商业大病险，还有一种是事后报销医疗费用的医疗费用保险。虽然前者可以作为主险销售，但是由于该险种的保费收入并不高，所以保险公司推广力度有限。在大多数情况下，这两个险种都是作为终身人寿险等主险的附加险销售。

In the current domestic market can buy commercial medical insurance can be roughly divided into two forms:One is a one-time payment business big seepage path,Still another kind is a medical expenses after reimbursement of medical expenses insurance.Although the former can be as the main risks sales,But because the insurance premium income is not high,So the insurance company limited to popularize strength.In most cases,These two categories are as a lifelong life insurance and main risks additional risk sales.

　　“目前看来大病保险主要针对城镇居民医保和新农合参保者，保障的是医疗费用特别高的一些疾病。但是商业医疗保险的购买人群和报销范围则非常宽泛，一些小额医疗费用的疾病不能通过大病保险进行报销，却是目前商业医疗保险的赔付范围。”一位保险产品设计人士告诉记者。摄影记者/高育文

"At present looks like a serious illness insurance is aimed at medical insurance for urban residents and the new agriculture joint beneficiaries,Security is particularly high medical costs of some diseases.But commercial medical treatment to be sure to purchase the crowd and submit an expense account range is very broad,Some small medical expenses disease cannot through a serious illness insurance to submit an expense account,It is the commercial medical insurance compensation range."An insurance product design sources told reporters.Photographers/high drives