8月24日，国务院医改办主任孙志刚一行来我省调研，当日下午专赴太仓市实地考察。据权威人士透露，这一安排，与本月底即将出台《关于开展城乡居民大病保险的指导意见》密切关联。

On August 24,，Cure of the state council SunZhiGang director to do a line to research in our province，Only that day afternoon to taicang on-the-spot investigation。According to authoritative sources，The arrangement，And is about to come the end of the month《About urban and rural residents to carry out a serious illness insurance's instruction opinion》Close association。

　　据了解，将由国务院办公厅转发的《意见》首次明确规定，“开展城乡居民大病保险，可以利用基本医疗保险基金购买大病保险，对大病患者发生的高额医疗费用，给予更大范围和更高比例的报销。”因此，它被视为今后进一步减轻大病患者负担的医改重要新政。更值得关注的是，“大病再保险”的顶层设计来源于江苏的“太仓模式”。

It is understood，By the general office of the state council will be transmitted《opinion》Expressly for the first time，“Urban and rural residents to carry out a serious illness insurance，Can use fund of insurance of primary medical treatment of a serious illness to buy insurance，In patients with serious illness to the high medical costs，Giving greater range and a higher proportion of submit an expense account。”therefore，It is regarded as a serious illness in the future to further reduce the burden of patients with medical reform important New Deal。The more notable is，“Serious illness reinsurance”From the top of the design of jiangsu“Taicang mode”。

向商业保险机构购买大病保险 To commercial insurance institutions to purchase a serious illness insurance

　　国务院医改小组人士说，此次大病保险的保障范围与城镇居民医保和新农合相衔接，即在参保人患大病发生高额医疗费用情况下，对城镇居民医保和新农合补偿后需要个人负担的合规医疗费用给予保障。

Cure of the state council changes a group people said，The serious illness insurance coverage and medical insurance for urban residents and the new agriculture conjunction cohesion，Namely in the ginseng protect people suffer from a serious illness happen high medical cost cases，For medical insurance for urban residents and the new agriculture joint compensation needs after individual responsibility compliance medical treatment charge gives security。

　　根据《意见》，以避免城乡居民发生家庭灾难性医疗支出为目标，大病保险补偿实际支付比例将不低于50%，并将按照医疗费用高低分段制定支付比例，即医疗费用越高，支付比例越高。

According to《opinion》，In order to avoid disastrous happened between urban and rural residents family medical expenditure as the goal，A serious illness insurance compensation actual payment ratio will not be less than 50%，According to the medical expenses and high and low section make payment proportion，That is the higher medical costs，The higher pay scale。

　　对于大病保险的资金来源，《意见》明确规定可从城镇居民医保基金、新农合基金中划出一定比例或额度，作为大病保险资金。按当年收支平衡的原则，基金有结余的地区利用结余筹集大病保险资金；结余不足或没有结余的地区，在城镇居民医保和新农合年度筹资时解决，逐步完善筹资机制。

For serious illness insurance funds，《opinion》Specific provision from the medical insurance for urban residents fund、New farmers joint funds a certain proportional or limit，As a serious illness insurance funds。According to the principle of balance of payment，The fund has balance districts to use balance raise serious illness insurance funds；Balance is insufficient or no balance area，In medical insurance for urban residents and new farming together when the annual funding to solve，Gradually improve financing mechanism。

　　此次开展城乡大病保险依然遵循“政府主导、专业运作”原则。即由政府负责基本政策的制定、组织协调、筹资管理并监管指导，同时，支持商业保险机构承办大病保险，即，“由地方政府卫生、人力资源与社会保障、财政、发展改革等部门制定大病保险的筹资、报销范围、最低补偿比例等基本政策要求，通过政府招标选定商业保险机构。

The urban and rural areas to carry out a serious illness insurance still follow“The government leading、Professional operation”principle。The government is responsible for the basic policy formulation、Organization and coordination、The financing management supervision and guidance，At the same time，Support business insurance institutions undertaking serious illness insurance，namely，“By the local government health、Human resources and social security、financial、Development and reform departments formulate serious illness insurance financing、Submit an expense account range、Minimum compensation ratio, and other basic policy requirements，Through the government tender selected commercial insurance institutions。

　　今日太仓，大病报销可超过80% Taicang today，A serious illness to submit an expense account can be more than 80%

　　昨天孙志刚在调研中强调，江苏医改许多工作走在全国前列。知情人士透露，这里就包括大病保险的“太仓模式”。

Yesterday in the research SunZhiGang stress，Jiangsu cure many work to walk in the national front row。insider，Here including a serious illness insurance“Taicang mode”。

　　2011年7月，太仓市人社局通过公开招标方式，与中国人保健康苏州中心支公司签订“太仓大病再保险”项目，在不增加参保人员缴费前提下，对享受基本医保报销后剩余的住院个人付费部分，给予“二次补偿”。太仓市医保中心按职工每人每年50元、居民每人每年20元的保费标准，向人保健康一次性缴纳购买大病保险。大病保险项目的资金来源则为社会医疗保险基金的结余，基金不足时由财政补齐。

In July 2011，Taicang people club innings through the public bidding mode，And China health insurer suzhou central sub-branch of the sign“Taicang serious illness reinsurance”project，Without any increase in ginseng protect personnel to pay cost premise，The basic medical insurance to submit an expense account to enjoy the rest of the hospital after individual pay part，give“Secondary compensation”。Taicang health care center according to worker 50 yuan per person per year、Residents of the 20 yuan per person per year premium standard，People can keep a one-off health to buy a serious illness insurance。A serious illness insurance project funds is the social medical insurance fund balance，Lack of funds from financial polishing。

　　在太仓，大病保险报销实行分级累进补偿。即参保群众医疗费用经过基本医保报销后，由大病保险按53-82%的比例分段报销，费用越高、报销比例越高，上不封顶。通过一年实践，太仓试点取得良好效果，百姓医疗费用实际报销比例明显提高。

In taicang，A serious illness insurance reimbursement grading progressive compensation。Is ginseng protect the masses medical expenses after basic medical insurance after submit an expense account，According to the serious illness insurance 53-82% of the proportion section to submit an expense account，The higher cost、The higher the reimbursement ratio，Not capped。Through one year practice，Taicang pilot good effectiveness has been obtained，The people medical expenses actual reimbursement ratio obviously improved。

　　58岁的太仓职工沈九荣，患癌症，单次住院医疗费用47.8万元。医保政策范围报销32.2万元，实际报销比例为67%，享受补充保险后又报了10.4万余元，实际报销比例达到89%。

At the age of 58 taicang worker shen ninth glory，cancer，Single medical treatment of be in hospital cost 478000 yuan。Medical insurance policy range to submit an expense account is 322000 yuan，The actual reimbursement ratio is 67%，Enjoy after supplementary insurance and announce more than 104000 yuan，The actual reimbursement ratio reached 89%。

　　37岁的城市居民顾莉芬，丈夫打工，因儿子患肾病花费了几十万元，成为低保家庭，本人又患脑溢血，医疗费32.8万元。医保政策范围报销21万元，实际报销比例为63%，享受补充保险后又报了8万元，实际报销比例达到88%.

37 GuLiFen city residents，Husband work，The son had kidney disease spent hundreds of thousands of yuan，Become low income families，I also suffer from cerebral apoplexy，Medical treatment cost 328000 yuan。Medical insurance policy range to submit an expense account is 210000 yuan，The actual reimbursement ratio is 63%，Enjoy the supplementary insurance and called the 80000 yuan，The actual reimbursement ratio reached 88%.

　　据太仓市人社局局长陆俊介绍，2011年医保资金使用年度，太仓有2604名住院的大病患者拿到了大病保险补偿，占当地医保参保人员的千分之四。受益最多的一位患者，拿到了10.4万元的保险补偿。

According to taicang people club secretary for LiuJun is introduced，2011 medical insurance fund use year，Taicang 2604 hospitalized patients with a serious illness got a serious illness insurance compensation，Accounts for four over one thousand of the local medical insurance ginseng protect personnel。The most benefit from a patient，Got 104000 yuan of insurance compensation。

　　陆俊提供的另一组数据是，2011年医保资金使用年度，太仓市住院费用超过15万元的有207人，由于实行了大病保险制度，这些大病患者的报销比例几乎都在80%以上。而在此前，由于不少大病所需的药物都属自费项目，患者报销比例只有50%，甚至低于当地医疗费用报销的平均水平。

LiuJun provide another group of data is，2011 medical insurance fund use year，Taicang hospitalization costs more than 150000 yuan in 207，Because of the serious illness insurance system，These serious illness patients almost all reimbursement ratio in more than 80%。And in previous，Because many serious illness required drug belong to the project at one's own expenses，Patients reimbursement ratio is only 50%，Even lower than the local medical expense of the average level。

　　在陆俊看来，通过大病保险提高大病患者的报销比例，意味着医保要在普惠基础上实现特惠，向大病患者倾斜，减少他们因病致贫的风险。

In LiuJun seems，Through a serious illness insurance improve serious illness patients proportion to submit an expense account，Medical insurance means in pratt &whitney basis to realize preference，Patients with a serious illness to tilt，Reduce their become financially-difficult risk。

　　不用多花钱，医保水平大提高 Don't spend more money，Medical insurance level greatly increase

　　江苏省医改办钱晓兰处长对记者分析说，“大病再保险”是基本医保基础上的一种补充保险，不能简单理解为“政府去购买商业保险推出的一个医疗保险产品”，而是政府建立的“基本+补充”的大病医保机制，并通过市场竞争，引入商业保险，实行政府主导、商业保险承办的运作方式。

Jiangsu province QianXiaoLan do medical director told reporters said analysis，“Serious illness reinsurance”On the basis of the basic medical insurance is a kind of supplementary insurance，Can understand simple for“The government to buy commercial insurance launched a medical insurance products”，But the government was established“Basic + complement”A serious illness of the medical insurance system，And through the market competition，Into commercial insurance，A government leading、Commercial insurance undertake works。

　　“政府、老百姓以及商业机构都没有增加投入，却通过商业运作使老百姓得到了实惠。”钱晓兰进一步解释说，以目前大部分地区的医保资金结余额来看，老百姓和政府无需再投入，靠医保结余的统筹完全可以覆盖大病保险所需金额，太仓模式完全可以复制。

“The government、Common people and business organizations did not increase investment，But through the commercial operation make people gained。”QianXiaoLan further explained，At present most regions of the medical insurance fund "balance to see，Common people and government need not investment，By medical insurance balance as a whole can cover a serious illness insurance amount required，Taicang mode can completely copy。

　　据了解，2011年太仓市全年用于支付保费的资金约为上年医保基金结余的3%左右，“仅用基金的利息收入即可实现支付。”

It is understood，In 2011 the taicang used for the payment of the premium fund about last year about 3% of the medical insurance fund balance，“Only use fund interest income pay can be realized。”

　　南京大学政府管理学院教授、博士生导师顾海说，在社会保障体系建设中，发挥商业保险的作用，有利于降低社会管理成本，提高社会保障水平。运用现代金融保险工具，发挥“经济杠杆”效用，可以做到政府不多花一分钱、老百姓不多出一分钱，但保障水平大幅提高。

Nanjing university professor of school of government、Doctoral tutor GuHai said，In the social security system construction，Play the role of the commercial insurance，To lower the society management cost，To improve the level of social security。The use of modern financial insurance tool，play“Economic lever”utility，The government can do not spend a penny、Few people a penny，But security level increase。

　　本报记者 沈峥嵘

Our reporter ShenZhengRong