2009年4月，一项民生领域的重大改革——深化医药卫生体制改革，在公众期待中“破冰起航”。3年多来，针对看病贵这一突出难题，深化医改推出了一系列政策措施：提高医疗保障水平，建立国家基本药物制度，整顿药品流通秩序，公立医院改革“试水”医药分开……这些给力举措，在一定程度上缓解了看病贵。

April 2009，A major field of people's livelihood, deepen the reform of the medical health system reform，In the public expectation“Ice set sail”。3 years，See a doctor for your this outstanding problems，Cure of the deepening launch a series of policy measures：Improve the medical security level，The establishment of a national system for basic drugs，The medicine circulation order，Public hospital reform“Try water”Medicine separate......These measures to force，In relieves your doctor。

　　但也要看到，切实减轻群众医药费用负担，任务还很艰巨。目前看病贵仍然突出，群众反映强烈，社会高度关注。解决好看病贵这一问题，关系亿万群众健康，关系万千家庭幸福，关系整个社会的和谐稳定。

But also have to see，Earnestly alleviate the burden of the medical expenses，The task is still arduous。Now you see a doctor still outstanding，The populace reflects strong，Social concern。Solve the high cost，Millions of people relationship healthy，Myriad of relationship between family happiness，The relationship between social harmony and stability。

　　◎ 看病贵到底贵在哪里 What is your money to see a doctor

　　据统计，2011年，我国医院门诊病人次均医药费用为179.8元，住院病人人均医药费用6632.2元。一次住院费接近城镇居民年人均收入的1/3，几乎相当于农民一年的人均纯收入。可见，医药费用是群众生活中一项沉重的负担，无怪乎人们看病住院时都会感慨“真的病不起”。

According to the statistics，2011 years，Our country hospital outpatient second all medical expenses is 179.8 yuan，Hospital patients per capita medical cost 6632.2 yuan。A run close to urban residents per capita income in the third，Almost as much as a year per capita net income of farmers。visible，Medical costs is the life of a heavy burden，No wonder people see a doctor was in hospital will be mixed“Really sick doesn't”。

　　2010、2011年“全国两会民生系列调查”显示：京沪穗三市居民连续两年认为“看病贵”是当前就医存在的最大问题(47.3%，44.3%)。

2010、2011 years“The people's livelihood CPPCC series survey”shows：The beijing-shanghai spike three city residents that for two years“High cost”Is the current medical treatment is the most problems(47.3%，44.3%)。

　　看病贵，到底贵在哪里？仔细分析，主要贵在以下几方面。

High cost，Where exactly is the？Careful analysis，Main is the following respects。

　　药品流通秩序混乱，导致药价贵。小小一盒药，从出厂到患者手中要经过漫长的“涨价之旅”：药企—全国总代理—省级代理—医药代表—医院—医生，各个环节层层加价，回扣现象突出。据调查，很多药品的中间利润普遍在500%以上，有的竟高达6500%！在这些流通环节中已经形成了利益共同体，直接推高了药品的价格。

Medicine circulation disorder，Drug prices lead to your。Small a box of medicine，From the factory to the patients hand after a long“Prices trip”：Medicine enterprises-the general agent-provincial agent-a medical representative-hospital-a doctor，Each link layer upon layer a premium，Kickbacks phenomenon outstanding。According to the survey，Many of the drugs among more than 500% profit in general，Some have as high as 6500%！In these circulation in the link has already formed the community of interests，Direct pushing up the price of drugs。

　　多年来，“三素一汤”(抗生素、激素、维生素和注射液)成为医院特别是基层医疗卫生机构治疗一般感染性疾病的“看家菜”，过度用药现象比较普遍。这不仅增加了患者的医疗费用，而且危害着人们的健康和生命安全。

For many years，“Three meal a soup”(antibiotics、hormone、Vitamin and injection)Be especially the hospital medical and health institutions treatment of general infectious diseases“See dishes there”，Excessive use common。This not only increase the patient's medical treatment fee，And harm people's health and life safety。

　　公立医院“以药补医”，导致过度检查和用药。长期以来，由于政府投入不足，医疗服务价格偏低，公立医院过多依赖药品加价和医疗检查收入。当前，在医院总收入中，药费和检查费收入比例一般超过60%，是医院运行发展经费、医务人员工资奖金的主要来源。在经济利益驱动下，有些医院通过开大处方、重复检查、过度检查等，增加收费项目，给患者带来不必要的支出。

Public hospital“To fill medicine medical”，Lead to excessive examination and drug use。long，Due to the lack of government's input，The medical service prices low，Public hospital relied on drugs and medical examination premium income。The current，In the hospital in revenues，Expenses for medicine and the inspection fee income proportion generally more than 60%，Is the hospital operation development funds、Medical personnel salary bonus main origin。In the economic interests under the driver，Some hospital through the open DaChuFang、Repeated inspection、Excessive examination, etc，Fee increase project，Give patients the unnecessary spending。

　　医疗保障水平低，导致个人费用负担重。我国基本医保虽然初步实现了全覆盖，但城镇居民基本医保和新农合的保障水平偏低，个人自付比例仍然较高。部分重特大疾病、一些慢性病的门诊费用、部分药品等不在报销范围之内，很多时候仍然需要自费。而城乡医疗救助制度和商业医疗保险起步较晚，覆盖人口和保障力度也不大，降低医药费用负担的作用还没有充分发挥出来。

Medical security level is low，Lead to personal cost burden。In the basic medical insurance although preliminary realized the full coverage，But urban resident basic medical insurance and new farming and safeguard level is low，Individual pays a higher proportion still。Do not part of the disease、Some of the chronic disease outpatient expenses、Part of the medicine, not submit an expense account range，Most of the time still need the expenses。And urban and rural medical assistance system and commercial medical treatment to be sure to start later，Cover the population and the security strength is small，Reduce the medical expenses of the burden function has not a full play。

　

　我国糖尿病患者逾9000万人 More than 90 million people in patients with diabetes

　　根据卫生部2010年监测数据显示，全国18岁及以上居民糖尿病患病率为9.7%，糖尿病患者人数已超过9000万，成为糖尿病第一大国。中国糖尿病治疗费用每年达1734亿元，占全国医疗总开支的13%。

According to the ministry of health monitoring data shows in 2010，The national 18 and older residents diabetes prevalence was 9.7%，The number of diabetes patients has more than 90 million，As the first country diabetes。China's diabetes treatment costs 173.4 billion yuan each year，Accounts for the medical treatment of total spending by 13%。

　　此外，随着现代医学技术快速发展，各种新药新技术不断出现，必然带来医疗费用大幅上涨。同时，人口老龄化和高血压、糖尿病等慢性病不断增加，也导致医疗卫生服务成本快速增长。部分患者盲目就医，不管大病小病都去大医院，增加了看病开销，特别是外地患者还得花上交通、吃住等费用。这些都在一定程度上加重了看病贵问题。

In addition，With the rapid development of modern medical technology，All kinds of new drug new technologies appear constantly，Must lead medical expenses are rising dramatically。At the same time，An aging population and high blood pressure、Chronic diseases, such as diabetes increased，Also lead to medical health service costs fast growth。Some people blind medical attention，Whether a serious illness ailment go to large hospital，Increased costs to see a doctor，Especially nonlocal patients take traffic、Eat live such fees。These in a certain extent, increasing the expensive to see a doctor。

　　可见，看病贵是由多种因素造成的，是医疗卫生领域诸多问题的集中反映，必须高度重视，综合施治。为此，需要开一服复方药，既要“降虚火”，切实把虚高的医药费用降下去；又要“补元气”，提高群众医保水平，更好地保障人民群众健康权益。

visible，Your doctor is by a variety of factors，Is medical health field of many problems in the concentrated reflection，Must attach great importance to，Comprehensive treats。For this，Need a take compound medicine，both“Drop XuHuo”，Make one high medical costs down；and“Vitality for”，Improve the level of medical insurance，Better protecting the people's health rights and interests。

　　

◎ 如何完善基本医保少自付 How to improve the basic medical insurance money pays less

　　“没有保障，生病硬扛；有了医保，有病就瞧。”百姓朴实的话语，道出了对基本医保的认可和欢迎。基本医保，就是利用政府、社会、个人三方力量，构建社会互助共济的医疗保障制度。这对于个人抵御疾病风险、减轻医药费用负担具有重要意义，是一把护卫公众健康的保护伞。

“No security，Ill hard to carry；Have medical insurance，Sick will look。”The people common words，The basic medical insurance for what the recognition and welcome。Basic medical insurance，Is to use the government、social、Individual tripartite power，Building social help each other in all aid health care system。This for individual resist disease risk、Reduce the medical expense burden to have the important meaning，Is a guard the umbrella of public health。

　

　深度解读 Depth interpretation

　　世界各国的主要医保模式 The main countries all over the world medical insurance mode

　　目前，虽然世界各国医保制度不尽相同，但概括起来讲主要有四种模式。①普遍医疗型：由国家承担医疗保障的绝大部分责任，以英国、瑞典为代表。②社会保险型：实施缴费和待遇相挂钩的社会医保制度，以德国、日本、韩国为代表。③市场主导型：以市场运作为主、政府仅为老人和低收入者提供基本医保的模式，美国是典型代表。④储蓄基金型：主要通过强制性储蓄积累方式，满足居民医疗保障需求，以新加坡为代表。

At present，Although the countries all over the world are not the same medical insurance system，But speak sum up there are four main mode。(1) YiLiaoXing common：The government should bear most of the medical security responsibility，In Britain、Sweden as a representative。(2) social insurance type：Implement pay cost and treatment of linked social medical insurance system，In Germany、Japan、South Korea as a representative。(3) the market leading：The operation of the market to give priority to、The government is only the old man and low-income medical insurance to provide basic pattern，The United States is a typical representative。(4) saving fund type：Mainly through the mandatory accumulated savings way，Meet residents medical security requirements，Representative in Singapore。

　　从世界范围看，有130多个国家通过建立医保制度解决居民看病问题。大多数发达国家建立了覆盖全民的医保体系。我国1998年在全国范围内进行城镇职工医疗保险制度改革，2003年和2007年，先后启动新型农村合作医疗、城镇居民基本医疗保险制度试点，并逐步推开。

From the world to see，More than 130 countries through the establishment of the medical insurance system to the doctor residents。Most developed countries have established the cover the health-care system。In 1998, China national range for urban employees' medical insurance system reform，In 2003 and 2007，Successively start new rural cooperative medical care、Urban resident basic medical insurance system pilot，And gradually push。

　　

权威声音 Authoritative voice

　　我国已初步进入全民医保国家行列 Our country has preliminary into the universal coverage country ranks

　　陈竺(卫生部部长)：一般来说，覆盖率达到90%就可以认为是全民医保，我们现在覆盖率是95%，已初步进入全民医保国家行列。现在的医保个人需要两次付费：投保的时候付保险费，治疗的时候还要自己支付一部分。将来个人付费更多是在投保的时候，看病时个人支付部分会尽可能地减少。

Chen Outlines(The health minister)：Generally speaking，Covering 90% can think is universal coverage，We now coverage rate is 95%，Preliminary already into the universal coverage country ranks。Now the health-care individual needs two pay：The insurance premium of pay insurance，The treatment even when pay their own part。Individual pay more in the future is in the insurance，When to see a doctor to pay as much as possible of individual will decrease。

　　2011年，这三项基本医保已覆盖全国95%的人口，构建起世界上最大的基本医保网，保障水平也在逐步提高。仅就新农合来说，各级财政补助标准达到200元，住院费用政策范围内报销比例提高到70%左右，全年参合农民共报销1710.2亿元，受益13.15亿人次。

2011 years，The three basic medical insurance covers the whole country has 95% of the population，Construct the world's largest basic medical insurance nets，Security level also gradually improve。Just for new farm close，At all levels for finance allowance standard to 200 yuan，Charge of be in hospital policy range reimbursement ratio increased from 70% to or so，Annual ginseng add up to 171.02 billion yuan of farmers to submit an expense account，Benefit 1.315 billion people。

　　但也要看到，当前基本医保总体水平还不高，城镇居民基本医保和新农合的筹资水平、报销水平仍然偏低，医保关系转移接续困难。为此，“十二五”医改规划指出，要充分发挥全民基本医保的基础性作用，重点由扩大范围转向提升质量，稳步提高保障水平，给群众带来更多实惠。

But also have to see，The basic medical insurance overall level is not high，Urban resident basic medical insurance and new farming, funding level、Submit an expense account level is still low，Medical insurance transferring relationship difficulties。For this，“1025”Planning points out that the cure of the，To give full play to the basic role of the basic medical insurance，Key by extending the scope to improve quality，Improved steadily security level，Give people more affordable。

　　我国基本医保覆盖率不断提高。辽宁沈阳启动在校学生基本医保制度，惠及进城务工人员子女，全市153家医保定点医院学生持卡都可就医，最高年支付限额达10万元。

In the basic medical insurance coverage enhances unceasingly。Liaoning shenyang start students the basic medical insurance system，Benefit of rural migrant workers of their children，The 153 home health care hospital surely CARDS can be medical students，In the highest pay limitation of 100000 yuan。

　　扩覆盖。目前我国基本医保还有约5%的人口没有覆盖到，由于各种原因部分人群中断参保现象也时有发生。要继续提高参保率，确保到2015年，三项基本医保参保率在2010年基础上提高3个百分点。重点做好农民工、非公有制经济组织从业人员、灵活就业人员，以及关闭破产企业退休人员和困难企业职工参保工作，并探索建立引导各类人员长期参保的机制。

Expanding coverage。At present our country basic medical insurance and about 5% of the population have no covered，Because all sorts of reasons people interrupt ginseng protect part phenomenon also happen from time to tome。To continue to improve CanBaoLv，Make sure to 2015 years，Three basic medical insurance CanBaoLv based on 2010 increased by 3%。Focusing on migrant workers、The non-public sector of the economy organization practitioners、Personnel of flexible obtain employment，And close the bankrupt enterprise retiree and difficult to those working in the staff and workers of the enterprise，Explore to establish the of all kinds of personnel and guide, join the long-term mechanism。

　　提水平。近年来，根据经济社会发展状况，我国已多次提高新农合和城镇居民基本医保政府补助标准，从最初试点时的每人每年几十元提高到2012年的240元。下一步还将继续加大中央及地方财政投入，到2015年政府补助标准将达到360元以上。同时，新农合和城镇居民基本医保门诊报销比例将提高到50%以上，三项基本医保政策范围内住院报销比例均达到75%左右，个人负担将进一步降低。

Mention level。In recent years，According to the economic and social development，China has repeatedly raise new farming and urban resident basic medical insurance and government subsidies standards，From the pilot of a few yuan per person per year increase in 2012 to 240 yuan。The next step will also continue to increase the central and local financial investment，By 2015 the government subsidies standards to will achieve 360 yuan of above。At the same time，New farming and urban resident basic medical insurance and outpatient reimbursement ratio would rise to 50%，Three basic medical insurance policy in hospital are within the scope of reimbursement ratio is around 75%，Personal burden will further reduce。

　

　深度解读 Depth interpretation

　　纳入新农合大病保障的种类 Incorporated in the new agriculture and serious illness security types

　　8类大病纳入保障范围：儿童白血病、儿童先天性心脏病、终末期肾病(尿毒症)、乳腺癌、宫颈癌、重性精神病、耐多药肺结核、艾滋病机会性感染。

8 class included in the scope of protection of a serious illness：Childhood leukemia、Of congenital heart disease in children、End-stage renal disease(uremia)、Breast cancer、Cervical cancer、Heavy nature psychiatric、Many drug resistant tuberculosis、AIDS opportunistic infection。

　　12类大病纳入保障和救助试点范围：肺癌、食道癌、胃癌、结肠癌、直肠癌、慢性粒细胞白血病、急性心肌梗塞、脑梗死、血友病、I型糖尿病、甲亢、唇腭裂。

12 kind of serious illness into the security and aid the scope：Lung cancer、Esophageal cancer、Stomach cancer、Colon cancer、Colorectal cancer、Chronic myeloid leukemia、Acute myocardial infarction、Cerebral infarction、hemophilia、Type I diabetes、hyperthyroidism、Cleft lip。

　　保大病。癌症等重特大疾病，既严重威胁生命健康，又给患者带来极为沉重的经济负担，是不少家庭因病致贫的重要原因。为此，从2010年开始，我国积极探索建立重特大疾病保障机制。2012年将在新农合中全面推开儿童白血病、儿童先天性心脏病、尿毒症等8类大病保障，并在部分地区试点，把肺癌、食道癌、胃癌等12类大病纳入保障范围，增强群众抵御大病风险的能力。

The serious illness。Cancer and great disease，Life is a serious threat to health，And to give patients bring extremely heavy economic burden，Is many families of become financially-difficult or important reasons。For this，From 2010 to，China actively explore to establish the mechanism to ensure great disease。2012 will be in new farming and full implementation of childhood leukemia、Of congenital heart disease in children、Uremia 8 items serious illness protection，And in some areas the pilot，The lung cancer、Esophageal cancer、Stomach cancer, 12 included in the scope of protection of a serious illness，Enhance the masses against the ability of the risk of a serious illness。

　　近年来，我国基本医保服务水平不断提高，截至2011年9月，90%以上统筹地区实现费用即时结算。

In recent years，In the basic medical insurance service level increases，By September 2011，More than 90% as a whole the area achieve instant settlement fee。

　　更便民。医保报销不仅要让群众报得多，还要报得方便快捷，减少“垫支”、“跑腿”的麻烦。应优化基本医保管理服务，加快推进即时结算，建立异地就医结算机制。2015年将全面实现省内医疗费用异地即时结算，初步实现跨省异地即时结算。完善医保关系转移接续政策，基本实现职工医保制度内跨区域转移接续，并推进各项基本医疗保险制度之间衔接。

More convenience for the people。Not only to let the medical insurance reimbursement for more，Also reported in convenient and quick，reduce“DianZhi”、“errands”trouble。The basic medical insurance management service should be optimized，Speed up the instant settlement，Set up different ground settlement mechanism medical treatment。In 2015, the province will fully realize medical costs beyond the instant settlement，Preliminary realize real-time spanning provinces beyond the settlement。Improve medical insurance relation in policy shift，The basic medical insurance system realize the worker in transferring across the region，And to push all the basic medical insurance system link between。

　　◎ 基本药物制度如何降药价 Money system for basic drugs how to drop prices

　　5%葡萄糖注射液，是目前输液最常用的药品。两年前，100毫升规格的注射液零售价五六元钱，今天，在很多地方已不到三元，药价足足下降了近50%。仅仅这一瓶药的降价，每年就给群众节省费用上百亿元。葡萄糖注射液价格下降的奥秘，就在于深化医改以来，我们建立并实施了国家基本药物制度。

5% glucose injection，Is the most commonly used drug infusion。Two years ago，100 ml of injection five or six yuan specifications retail price money，today，In many places has less than three yuan，For drug prices decreased by nearly 50%。Only this bottle of medicine of beans，To save costs each year the tens of billions of dollars。Glucose injection the mystery of prices to fall，It is to deepen since the cure，We establish and implement the national system for basic drugs。

　　基本药物，通俗地说，是指预防和治疗常见病所必需的药物。建立国家基本药物制度，就是对基本药物进行统筹管理，从制度上保证其价格的稳定性和可及性。这项制度，对于规范药品生产流通秩序，促进合理用药，减轻群众药费负担具有重要意义。目前已有160多个国家制定了基本药物目录，其中105个国家制定了国家基本药物政策。

Basic drugs，Popularly say，Refers to the prevention and treatment of common diseases of the necessary drugs。The establishment of a national system for basic drugs，Is the basic drugs for overall management，From the system to ensure the stability of the price and availability。The system，To regulate the medicine production and circulation order，Promoting rational drug use，Reduce the burden of expenses for medicine is important。More than 160 countries currently formulated the basic drugs directory，Of which 105 countries has formulated national basic drugs policy。

　　国家基本药物制度实施两年多来，通过药品“零差价”销售，减轻患者药费负担，受到广泛欢迎。

National system for basic drugs implementation for more than two years，Through the drug“Zero price difference”sales，Patients with ease burden of expenses for medicine，Widespread welcome。

　　2009年8月，我国正式建立国家基本药物制度。两年多来，这一制度从无到有，稳步推进，通过对基本药物实行统一招标采购、统一配送、零差率销售等方式，有效控制成本，减少中间环节，降低了基层医疗卫生机构的药价，百姓得到了实惠。下一步，应继续巩固完善这一制度，使其在降低药价方面发挥更大作用。

August 2009，China officially the establishment of a national system for basic drugs。For more than two years，This system from scratch，steadily，Through to the basic drugs unified public bidding、Unified distribution、Zero rate differential sales and other ways，Cost effective，The decrease of the intermediate links，Reduce the basic medical and health institutions drug prices，People gained。The next step，Should continue to consolidate to improve the system，In the lower drug prices to play a greater role。

　　药物目录不断完善。现在国家基本药物目录有307种药，各地也自主平均增补约210种药，但从实际使用情况来看，普遍反映还是“不够用”。应继续根据经济社会发展、群众医疗卫生需求、科学技术进步等情况，适时进行调整扩充，优化品种、类别与结构比例。目前，2012版目录已在着手制定，将适当增加慢性病和儿童用药品种，减少使用率低、重合率低的药品，保持合理的基本药物数量。

Drug directory continuously improved。Now the country's basic drugs directory has 307 kinds of medicine，Also added an average of all independent about 210 kinds of medicine，But judging from the actual use，Generally reflected or“Not enough use”。According to the economic and social development should be continued、The masses medical health needs、The progress of science and technology, etc，Timely adjust expansion，Optimization varieties、Category and structural scale。At present，2012 edition directory has set up a file in the to make，Chronic diseases and children will be appropriate increase drug varieties，Reduce low utilization rate、Coincidence rate low drugs，To maintain a reasonable number of basic drugs。

　　实施范围继续扩大。基本药物制度目前还只是在政府办基层医疗卫生机构实施，而看病贵问题却主要集中在城市和县级公立医院。为更好地发挥这一制度的作用，将进一步扩大制度实施范围，鼓励公立医院和其他医疗机构优先使用基本药物。对非政府办基层医疗卫生机构，可采取购买服务的方式将其纳入基本药物制度实施范围。同时，2012年将全面推进村卫生室实施基本药物制度。

Continue to expand the scope of implementation。The system currently basic drugs are only in the implementation of the government medical and health institutions，And the high cost of problem is concentrated in the city and county level public hospital。For better play to the function of this system，Will further expand the system implementing range，Encourage public hospital and other medical institutions prefer using basic drugs。To non-government basic-level medical health institutions，The way to buy the service into the system for basic drugs scope of implementation。At the same time，2012 will promote village clinic implement basic drugs system。

　　招标采购更加规范。“价格高不高，主要在招标”，招标采购是确保基本药物质量可靠、价格合理的关键环节。要完善以省为单位网上集中采购制度，坚持质量优先、价格合理，保障公开、公平、公正，既避免药价虚高也要防止低价恶性竞争。对独家品种、用量小且临床必需的品种，试行国家统一定价、定点生产，同时逐步将耗材、设备纳入集中招标采购范围。

The tender purchasing more regulations。“High price is not high，The main in the tender”，Public bidding is to ensure that the quality of basic drugs and reliable、The key link of reasonable price。To perfect the province as a unit with online centralized purchasing system，Insist on quality first、Reasonable price，Safeguard public、fair、justice，Not only avoid one high prices also should prevent low malignant competition。For a sole varieties、The dosage is small and clinical necessary varieties，Try out national unity pricing、Sentinel production，At the same time gradually will consumables、Equipment into the centralized bid procurement range。