生不起病，一直是普通人人生“三大怕”之一，相对于上不起学、买不起房，生不起病让人有更多的不安全感。

They can't afford to get sick，Life is always people“Three big fear of”of，Relative to can't afford to go to school、Can't afford to buy a house，They can't afford to get sick make people have more insecurity。

　　所以，当“六部门公布城乡居民大病保险政策，避免因病致贫”的消息传来，民众感到很欣慰和振奋——让那个为了给妻子做透析只好私刻医院公章的悲伤平民故事成为绝唱吧，这个社会，再也不希望看到“廖丹第二”了。

so，when“Six departments of urban and rural residents by a serious illness insurance policy，Avoid become financially-difficult”news，People feel very glad and exciting - let that in order to give his wife with dialysis have to SiKe hospital official seal of sadness civilians story become's song，The social，Don't want to see“LiaoDan second”the。

　　为了这个目标，在这个制度设计已经出台，具体实施还没推进的时候，我们第一时间采访了相关专家，希望通过拾遗补缺，为它的顺利落地增砖添瓦。

To this end，In the system design has been introduced，Specific implementation haven't promote time，We first interviewed relevant experts，Hope that through shortage make-up，For its smooth landing increase brick add tile。

　　

直接提高医保报销比例、扩大报销范围不行吗？ Directly improve medical insurance reimbursement ratio、Expand the scope to submit an expense account not？

　　为什么要引入商保？ Why want to introduce business insurance？

　　陈秋霖(北京大学国家发展研究院博士后研究员)：不管各地的改革方案将会如何制定，这都说明政府已经在制度设计上要筹措一个大病医保的项目，来补充基本医疗保障不足以抵消“巨灾疾病”负担的缺口，这是一个非常好的进步。

ChenQiuLin(Beijing university national development research institute postdoctoral researcher)：No matter around the reform plan will be how to develop，This explains the government has in the system design to raise a serious illness health project，To add basic medical insurance is not enough to offset“Catastrophe disease”Burden of the gap，This is a very good progress。

　　通过商业保险也许可以提高医保运作效率，其实不管是通过医保还是商保来投保大病保险，都是必须要先拿出一笔钱来，我个人的想法是，既然政府能拿出这笔钱，我们完全可以通过提高医保报销比例、扩大报销范围等方式，给大病患者减轻医疗费用负担，不一定非得让商保参与进来。

Through the commercial insurance may improve medical insurance operational efficiency，In fact whether through medical insurance or business is protected to cast a serious illness insurance，Is must take out a sum of money to，My personal idea is，Since the government can take out the money，We can improve the medical insurance reimbursement ratio、Expand the scope to submit an expense account, etc，Give a serious illness patients reduce medical expense burden，You don't have to let business insurance involved。

　　即便让商保参与进来，相对于政府统筹购买商业保险的太仓模式来说，允许个人使用自己的账户购买商业保险的镇江模式更好，这个选择权应该交给个人。

Even if make business insurance involved，Relative to the government as a whole to buy commercial insurance for taicang mode，Individuals are allowed to use your own account to buy commercial insurance zhenjiang mode better，This option should be handed over to the individual。

　　李慧娟(中国医师协会医疗风险管理专业委员会常委)：医保改革是一个特别复杂的问题，目前来说，我并不了解将来会推广哪个模式，或者说，我并不能判定哪个模式更加适合全国的情况。但是，我可以肯定哪种模式是不正确的，就是那种完全不考虑持续性、限制专业发展的全民免费医疗方式，那种模式肯定是一个死胡同。

LiHuiJuan(The association of professional committee of medical risk management)：Health care reform is a special complex problem，For now，I do not know the future will promote which mode，or，I'm not determine which model is more suitable for the national conditions。but，I am sure which model is not correct，That's not consider sustainability、Limit the professional development of the free medical treatment way，The model must be a dead end。

　　现在的改革方向还是要引入商业保险，我特别支持这个思路，必须有商业模式的介入，按照商业运作的规律，这种模式的医保改革方案才会有持续发展的希望。

Now the reform direction still should introduce commercial insurance，I especially support this idea，Must have a business model intervention，According to the law of commercial operation，This model of health-care reform plan will have the hope of sustainable development。

　　朱恒鹏(中国社会科学院经济所公共政策研究中心主任)：若商保不是有更大的风险池(统筹层次)，用基本医保结余购买商保补充医疗保险，并不扩大风险分散功能。如果参保人群是一样的，医保基金结余购买商业补充险并没有“保险”功能。

ZhuHengPeng(The Chinese academy of social sciences, director of the center for public policy research economy)：If business is protected not have greater risk pool(Level of overall planning)，With basic medical insurance balance the buyer the supplementary medical insurance，Does not expand risk dispersion function。If the ginseng is the same，The medical insurance fund balance to buy commercial supplementary insurance and no“insurance”function。

　　

从医保基金中划钱用作大病保险资金， From the medical insurance fund marking money used as a serious illness insurance funds，

　　会不会造成基本医保的缩水？ Would not cause basic health care shrink？

　　陈秋霖：之前的镇江模式也好，太仓模式也好，用于大病保险的钱并不是直接从医保基金里拨转的，镇江用的是个人账户里的结余资金，太仓使用的是政府从医保结余中统筹过来的资金，这些都不是直接从医保基金里切蛋糕。但是，现在出台的方案里面，允许使用部分医保基金作为大病保险资金，并允许结余不足或没有结余的地区，在城镇居民医保、新农合年度提高筹资时统筹，这跟使用医保结余，在制度上可是有本质上的差异。

ChenQiuLin：Zhenjiang mode or before，Taicang mode or，For serious illness insurance money and not directly from the medical insurance fund in the BoZhuan，Zhenjiang is account with the balance of funds，Taicang is using the government from the medical insurance balance as a whole over money，These are not directly from the medical insurance fund to cut the cake。but，Now on the introduction of the plan inside，Allows the use of part of the medical insurance fund of insurance funds as a serious illness，And allow balance is insufficient or no balance area，In medical insurance for urban residents、New farmers joint annual increase when financing plan as a whole，With the use of medical insurance balance，In the system but there is essential difference。

　　医保基金的池子是固定的，如果再分流出去一部分，去做大病保险了，是不是会挤占基本医保报销的额度？如果事后证明基本医疗报销因此缩水了，没有得到大病保险补偿的参保者，会不会产生不满？

The medical insurance fund pool is fixed，If we split out part，To do a serious illness insurance，Whether will occupy basic medical insurance reimbursement amount？If proved basic medical expense so shrunk，Don't get a serious illness insurance compensation of the beneficiaries，Will not unhappy？

　　

如何控制医疗费 How to control medical expenses

　　过度使用？ Excessive use of？

　　花不是自己兜里的钱看病，很多人都会下意识地“大方”一回，而医院更是会给能够报销的患者增加用药量，提高就诊费用。这几乎是一个人人知道的潜规则。

Flower is not his pocket money to see a doctor，A lot of people will unconsciously“generous”time，The hospital is will give can submit an expense account of the patients increase exposure leels，Improve medical expenses。It is almost a everyone know latent rules。

　　镇江一位地方医保官员就曾向媒体透露：医保(的监管措施)和公立医疗机构(不合理医疗费用产生)之间的博弈如同抗生素和细菌的关系，“吃一段时间可能就不灵了，就像抗生素一样，过一段时间就得换药”。

Zhenjiang a local health officials had revealed to the media：Medical insurance(Regulatory measures)And the public medical institutions(Unreasonable medical expenses produce)The game between the relationship between as antibiotics and bacteria，“For a period of time may be wouldn't work，Like antibiotic，Over a period of time to dressing”。

　　朱恒鹏：控费压力也巨大，这是引入医保后一个无法消除的矛盾：参保者的决策是只要个人收益超过个人支付就购买，个人掏3元就得到价值10元(医保报销70%)的服务，患者倾向于过度消费，“过度”是从社会角度看，社会成本10元的服务产生的社会收益不到10元，但个人不认为是过度，因为私人成本只有3元，私人收益超过3元。

ZhuHengPeng：Control cost pressure is huge，This is introduced after medical insurance a can't eliminate contradictions：Participants decision-making is as long as individual income more than individual pay for the purchase，Personal tao 3 yuan get value of 10 yuan(Medical insurance to submit an expense account 70%)service，Patients tend to excessive consumption，“excessive”From the social perspective，Social cost 10 yuan services have social income less than 10 yuan，But people don't think is excessive，Because private cost only 3 yuan，Private income more than 3 yuan。

　　按照现在这个趋势，数年后，各地相继会出现赤字，届时，控费和提高筹资的矛盾就会激化。

According to this trend，Years later，One after another around will appear deficit，the，Control cost and improve financing contradictions will become acute。

　　

城乡居民 Urban and rural residents

　　的医疗需求 Needs of medical treatment

　　会进一步释放？ Will further release？

　　朱恒鹏：基本医保与非基本并无明确界限，问题就在于基本的上限在哪里？按照什么标准确定基本医保？按照筹资水平定标准？按照补偿上限定标准？还是其他？

ZhuHengPeng：The basic medical insurance and the basic and no clear boundaries，The basic problem is that the upper limit in where？In what criteria are used to determine the basic medical insurance？According to the standards set forth in funding level？According to the compensation limit standard？Or other？

　　此外，基本医保的全覆盖，再伴随大病医保带来的保障水平提高，大幅度释放城乡居民的医疗需求，若医疗服务供给能力没有有效提高，越来越高的医疗需求会进一步加剧城乡居民的看病难问题，医保给城乡居民带来的实惠会大打折扣。医疗体制改革滞后还是成为缓解居民看病难和贵的最大瓶颈。

In addition，Basic medical insurance covers all，Then with a serious illness medical insurance bring safeguard level improve，Release of large urban and rural residents needs of medical treatment，If the medical service supply capacity did not improve，More and more high medical demand will further aggravate the urban and rural residents to see a doctor difficult problem，Medical insurance for urban and rural residents will bring benefit to sell at a discount greatly。Medical system reform lag or become alleviate people see a doctor difficult and expensive biggest bottleneck。

　

　补白 filler

　　商保市场份额 Business is protected market share

　　不到5% Less than 5%

　　由于我国的社保管理体制跟国外有很大不同，商业保险机构在我国医疗健康险领域的市场占有率只有5%不到。而美国、加拿大、瑞士等国商业保险机构的健康险年保费收入平均占到保险费总收入的25%至30%，与中国同处亚洲的新加坡该比例也达到了23%。

Because our country social security management system with foreign have very different，Commercial insurance institutions in our country in the field of medical health insurance market share only 5% less than。While the United States、Canada、Switzerland and other countries commercial insurance institutions in health insurance premium income accounted for an average of insurance premium income of 25% to 30%，And China with the Asian Singapore this ratio was 23%。

　　

可能导致 May lead to

　　穷人补贴富人？ The poor rich subsidies？

　　中国社会科学院经济所公共政策研究中心主任朱恒鹏认为，这样发展大病保险，很可能会出现“穷人补贴富人”现象。三四十万元的医疗费用，即便通过大病医保补偿60%甚至更多，患者自付的部分也是贫困家庭不能承受之重，因此实际享受大病保险保障的有可能是富裕人群。也许更好的做法是基本医保全部用于保基本。大病保险完全交给商业保险公司，由个人自愿购买。对贫困家庭的保护通过定向性的大病医疗救助来实现。

The Chinese academy of social sciences, director of the center for public policy research economy ZhuHengPeng think，The development of such a serious illness insurance，Are likely to emerge“The poor rich subsidies”phenomenon。40 ten thousand yuan medical costs，Even through the serious illness medical insurance compensation 60% or more，Since the pay part of patients is poor families can't bear the heavy，So the actual enjoy a serious illness insurance security may be wealthy。Maybe it is better to basic health care for all the basic。A serious illness insurance completely to commercial insurance company，By individual voluntary buying。For the protection of the poor families by directional property of a serious illness medical assistance to achieve。

　　

怎么提防 How to guard against

　　跑冒滴漏 PaoMaoDiLou

　　在很多医保制度完善的国家，保险公司的员工必须经常出入医院，检查医院在医疗费的使用上有没有“跑冒滴漏”。而在我国，保险公司监督医院是否过度治疗才刚刚开始，所以保险公司负责大病保险结算工作的员工大部分工作还只是到医院做做政策宣传。(周明杰)

In many medical insurance system perfect state，The insurance company employees must often in and out of the hospital，Check the hospital medical treatment in the use of any“PaoMaoDiLou”。While in our country，The insurance company supervision and hospital is excessive treatment has just begun，So the insurance company is responsible for serious illness insurance settlement work most employees work is only to the hospital to do policy propaganda。(ZhouMingJie)