官方详解大病保险：解决因病致贫、因病返贫问题

The official explanation a serious illness insurance：Solve become financially-difficult、Poverty due to illness problem

　　中新网8月30日电 据国家发展和改革委员会网站消息，国家发展和改革委员会等六部委今日发布《关于开展城乡居民大病保险工作的指导意见》。意见提出，要以力争避免城乡居民发生家庭灾难性医疗支出为目标，合理确定大病保险补偿政策，实际支付比例不低于50%。

Beijing, aug. 30, according to the national development and reform commission website news，The national development and reform commission and so on six ministries and commissions released today《About urban and rural residents to carry out a serious illness insurance work guiding opinions》。Opinions put forward，To strive to avoid catastrophic happened between urban and rural residents family medical expenditure as the goal，Reasonable serious illness insurance compensation policy，The actual payment proportion is less than 50%。

　　今日，国家发展和改革委员会、卫生部、财政部、人力资源和社会保障部、民政部、保险监督管理委员会正式公布《关于开展城乡居民大病保险工作的指导意见》。

today，The national development and reform commission、The ministry of health、The ministry of finance、Human resources and social security、The ministry of civil affairs、The insurance supervision and management committee officially announced《About urban and rural residents to carry out a serious illness insurance work guiding opinions》。

　　意见在提到城乡居民大病保险的保障范围时指出，大病保险的保障范围要与城镇居民医保、新农合相衔接。城镇居民医保、新农合应按政策规定提供基本医疗保障。在此基础上，大病保险主要在参保(合)人患大病发生高额医疗费用的情况下，对城镇居民医保、新农合补偿后需个人负担的合规医疗费用给予保障。

Opinion when it comes to urban and rural residents a serious illness insurance coverage out，A serious illness insurance coverage and medical insurance for urban residents、New farmers conjunction cohesion。Medical insurance for urban residents、New farmers should be combined by policy provisions to provide basic medical insurance。On the basis of，A serious illness insurance mainly in the ginseng protect(close)People suffer from a serious illness happen under the condition of high medical costs，For medical insurance for urban residents、New farmers joint compensation should be personal burden compliance medical treatment charge gives security。

　　意见指出，高额医疗费用，可以个人年度累计负担的合规医疗费用超过当地统计部门公布的上一年度城镇居民年人均可支配收入、农村居民年人均纯收入为判定标准，具体金额由地方政府确定。合规医疗费用，指实际发生的、合理的医疗费用(可规定不予支付的事项)，具体由地方政府确定。各地也可以从个人负担较重的疾病病种起步开展大病保险。

Opinion pointed out that，High medical costs，Can individual annual accumulated burden compliance medical costs more than the local statistics released by the department of previous year in urban residents per capita disposable income、Rural residents per capita net income of years for decision criteria，The specific amount to determine by the local government。Compliance medical expenses，Refers to the actual、Reasonable medical expenses(But regulation does not grant to pay the matters)，By the local government to determine specific。All can also from personal burden heavier disease disease started to carry out a serious illness insurance。

　　在保障水平方面，意见称，以力争避免城乡居民发生家庭灾难性医疗支出为目标，合理确定大病保险补偿政策，实际支付比例不低于50%；按医疗费用高低分段制定支付比例，原则上医疗费用越高支付比例越高。随着筹资、管理和保障水平的不断提高，逐步提高大病报销比例，最大限度地减轻个人医疗费用负担。

In the security levels，Suggestions that，To strive to avoid catastrophic happened between urban and rural residents family medical expenditure as the goal，Reasonable serious illness insurance compensation policy，The actual payment proportion is less than 50%；According to the medical treatment charge high and low section make payment proportion，In principle, the higher proportion of medical expenses paid higher。Along with the financing、Management and the unceasing improvement of the level of security，Gradually improve reimbursement ratio of a serious illness，Maximize reduce personal medical expense burden。

　　意见指出，要做好基本医疗保险、大病保险与重特大疾病医疗救助的衔接，建立大病信息通报制度，及时掌握大病患者医保支付情况，强化政策联动，切实避免因病致贫、因病返贫问题。城乡医疗救助的定点医疗机构、用药和诊疗范围分别参照基本医疗保险、大病保险的有关政策规定执行。

Opinion pointed out that，To do the basic medical insurance、A serious illness insurance and medical treatment of the disease and great cohesion，Establish a serious illness information reporting system，Master in time the medical insurance payment for the patients with a serious illness，Strengthening policy linkage，To avoid become financially-difficult、Poverty due to illness problem。Urban and rural medical assistance to nod medical establishment、Medicine and diagnosis and treatment respectively reference range of basic medical insurance、A serious illness insurance policy provisions。