中新网8月30日电 据发改委网站消息，国家发展改革委副主任、国务院医改办公室主任孙志刚日前表示，开展大病保险，对城乡居民因患大病发生的高额医疗费用给予报销，目的是要解决群众反映强烈的“因病致贫、因病返贫”问题，使绝大部分人不会再因为疾病陷入经济困境。

Beijing on August 30, according to the development and reform commission (NDRC) news website，The national development and reform commission deputy director、Cure of the state council office director SunZhiGang has said，To carry out a serious illness insurance，To urban and rural residents suffering from serious illness happen high medical treatment charge gives to submit an expense account，Purpose is to solve the populace to reflect the strong“Become financially-difficult、Poverty due to illness”problems，Make most people won't because disease in queer street。

　　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《关于开展城乡居民大病保险工作的指导意见》8月30日正式公布。孙志刚就有关问题答记者问。

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《About urban and rural residents to carry out a serious illness insurance work guiding opinions》On August 30, officially announced。SunZhiGang relevant question answer reporters asked。

　　孙志刚表示，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。

SunZhiGang said，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。

　　在设计大病保险的保障范围和目标时，参考了世界卫生组织关于“家庭灾难性医疗支出”的定义。总的想法是，在平均水平上，使个人不得不支出的医疗费用低于家庭灾难性医疗支出的标准。

In the design of a serious illness insurance coverages and goal，The world health organization about reference“Family catastrophic medical expenditure”definition。The idea is，In the average level，Make the individual had to spending medical costs less than family catastrophic medical expenditure standard。

　　孙志刚称，经测算，各地城镇居民年人均可支配收入或农民年人均纯收入，可作为当地家庭灾难性医疗支出的标准。当参保患者个人负担的医疗费用超过这个标准时，很可能使家庭在经济上陷入困境。大病保险对这小部分人群个人负担的合规医疗费用在基本医保已经报销的基础上再次给予报销，要求实际报销比例不低于50%。这里的合规医疗费用不局限于基本医保政策范围内，但为避免浪费和过度负担，不是基本治疗所必须的项目不列入报销范围。

SunZhiGang says，According to the calculation，In all urban residents per capita disposable income or farmers per capita net income of years，Can be used as the local family catastrophic medical expenditure standard。When ginseng protect patients individual responsibility medical costs more than the standard time，Is likely to make the family in the economic mess up。A serious illness insurance to the small crowd individual responsibility compliance medical expenses in the basic medical insurance has to submit an expense account again on the basis of given to submit an expense account，Request actual expense proportion is less than 50%。Here's the compliance medical expenses is not limited to basic medical insurance policy range，But in order to avoid waste and excessive burden，The basic treatment is not necessary to submit an expense account is not included in the scope of the project。

　　孙志刚指出，当然，由于每个人家庭能够负担的医疗费用有所差异，开展大病保险，并不能完全确保每一位大病患者都不发生灾难性支出。极少数低收入或发生巨额医疗费用的人，还有可能面临困境。要切实解决这些极少数人的个性化困难，需要通过救助的办法加以解决，在医院、医保和医疗救助机构之间形成信息顺畅、快速应对的工作机制，争取做到发生一例、救助一例、解决一例。我们正在会同有关部门研究这方面的政策措施。

SunZhiGang pointed out that，Of course，Because each family can afford medical cost differences，To carry out a serious illness insurance，And cannot be completely to ensure that every a serious illness patients are not catastrophic expenses。A handful of low-income or the occurrence of major medical expenses of the people，And could face difficulties。To solve these few personalized difficult，Need through the relief way to solve，In the hospital、Health care and medical assistance mechanism formed between smooth information、The work of rapid response mechanism，Try to be a case occurred、Salvage case、Solve a case。We are in conjunction with the relevant departments to study the policy measures。

　　孙志刚说，以往，基本医保经办通常有两种形式，主要是事业单位直接经办，也有些地方委托一些专业机构提供部分环节的服务，如审核单据、稽查服务行为等。为进一步转变政府职能，创新公共服务管理，提升服务效率，新一轮医改明确提出要探索“委托具有资质的商业保险机构经办各类医疗保障管理服务”。近几年，不少地方(例如广东湛江、江苏太仓、河南洛阳等地)积极探索了政府主导与市场机制相结合的创新形式，拿出部分资金，由政府制定基本政策，进行大病保险，商业保险机构以保险合同方式承办，自负盈亏。实践证明，不仅这些地方的群众享受到更高水平的大病报销待遇，医疗保险的服务质量和水平有所提高，由于对医疗机构和医疗服务的管控更为严格，医疗服务行为也更趋合理，总体看放大了基本医保的保障效用。

SunZhiGang said，In the past，The basic medical insurance handling usually has two forms，Mainly is the institution directly handling，Also some places entrust some professional institutions to provide part of the link service，Such as audit documents、Audit service behavior, etc。For further transform government functions，Innovation public service management，Improve service efficiency，A new round of reform, clearly put forward to explore“Entrust has the qualification of commercial insurance agency orgnaization of all kinds of medical insurance management service”。In recent years，Many places(For example, zhanjiang, guangdong、Jiangsu taicang、Henan luoyang, etc)Actively explore the government leading with market mechanism combining the innovation form，Out part of the funds，The government has formulated the basic policy，For serious illness insurance，Commercial insurance institutions to insurance contract the way，Responsible for their own profits and losses。Practice has proved，Not only the local people enjoy a higher level of a serious illness to submit an expense account treatment，Medical insurance service quality and improved，The medical institutions and medical service control more strictly，Medical service behavior is more reasonable，Overall see magnifies the basic medical insurance safeguard utility。

　　孙志刚指出，在总结地方经验和反复研究论证的基础上，城乡居民大病保险采取了政府主导、商业保险机构承办的方式。相比而言，商业保险机构以保险合同形式承办大病保险，主要具有几个优势：

SunZhiGang pointed out that，At the conclusion of the local experience and repeated on the basis of research，Urban and rural residents a serious illness insurance to take the government leading、Commercial insurance institutions undertaking way。compared，Commercial insurance institutions to insurance contract form undertaking serious illness insurance，Mainly has several advantages：

　　第一，能够充分发挥商业保险机构的专业特点，加大对医疗机构和医疗费用的制约。

The first，To give full play to the commercial insurance institutions professional characteristics，Increase of medical institutions and medical cost restriction。

　　第二，可以借助商业保险机构在全国范围内统筹核算的经营特点，间接提高大病保险的统筹层次，增强抗风险能力，提高服务水平，放大保障效应。

The second，Can use commercial insurance institutions across the country as a whole accounting business characteristics，Indirect improve serious illness insurance plan as a whole level，Increase its ability to resist risks，Raises the service level，Amplification security effect。

　　第三，利用商业保险机构专业化管理优势和市场化运行机制，有利于促进提高基本医保的经办效率。此外，这也有助于促进健康保险业发展，推动构建多层次医疗保障体系。

The third，Use of commercial insurance institutions professional management advantages and market operation mechanism，To promote the improvement of the basic medical insurance orgnaization of efficiency。In addition，It also helps to promote the healthy development of the insurance industry，Push for the establishment of an multi-level medical security system。

　　孙志刚表示，大病保险的这种承办方式，是在中国特色社会主义基本理论指导下，结合中国当前国情，对公共服务管理和运行模式所作的大胆探索与创新，国际上先例并不多。采用这种方式的基本想法是，在以保公平为基础和目标的前提下，更好地发挥市场竞争在提升效率和优化资源配置方面的作用。

SunZhiGang said，A serious illness insurance for this way，In socialism with Chinese characteristics under the guidance of the basic theory，According to China's current national conditions，For the public service management and operation mode of the bold exploration and innovation，International precedent is not much。Using this kind of basic idea is，In order to protect fair as the foundation and the premise of target，Better to play the market competition in promote efficiency and optimize the allocation of resources the role。