近日，国家发展和改革委、卫生部、财政部、人社部、民政部、保险监督管理委员会等六部委《关于开展城乡居民大病保险工作的指导意见》(以下简称《意见》)发布，明确针对城镇居民医保、新农合参保(合)人大病负担重的情况，引入市场机制，建立大病保险制度，减轻城乡居民的大病负担。为此，记者采访了国家发展改革委副主任、国务院医改办公室主任孙志刚。采访人：本报记者 李红梅 解读人：国务院医改办主任 孙志刚

recently，The national development and reform committee、The ministry of health、The ministry of finance、People club department、The ministry of civil affairs、The insurance supervision and management committee and so on six ministries and commissions《About urban and rural residents to carry out a serious illness insurance work guiding opinions》(Hereinafter referred to as《opinion》)release，Clear for medical insurance for urban residents、New farmers $ginseng(close)National People's Congress disease burden situation，Introducing market mechanism，Establish a serious illness insurance system，Reduce the burden of urban and rural residents a serious illness。therefore，The reporter interviewed, deputy director of the national development and reform commission、Cure of the state council SunZhiGang office director。Interview people：Our reporter LiGongMei reading people：Cure of the state council SunZhiGang do director

　　切实减轻人民群众大病医疗费用负担 To reduce people's medical treatment of a serious illness expense burden

　　大病的医疗费用高昂。虽然当前全民医保体系初步建立，全国人民中的13亿人有了医保、新农合，政策范围内报销比例也在不断提高，但是城乡居民的个人负担仍然较重，甚至造成因病致贫、因病返贫的现象。

A serious illness medical costs high。Although the current medical insurance system has been set up preliminarily，The people of the whole country of 1.3 billion people have medical insurance、New farmers joint，Policy range to submit an expense account proportion also continuously improve，But between urban and rural residents of the personal burden heavier still，Even cause become financially-difficult、The phenomenon of poverty due to illness。

　　孙志刚说，城乡居民大病保险，是在基本医疗保障的基础上，对大病患者发生的高额医疗费用给予进一步保障的一项制度性安排，有利于切实减轻人民群众大病医疗费用负担，解决因病致贫、因病返贫问题，促进社会公平正义。

SunZhiGang said，Urban and rural residents a serious illness insurance，In the basic medical insurance is based on，In patients with serious illness to the high medical treatment charge gives further guaranteed a institutional arrangement，To earnestly alleviate people's medical treatment of a serious illness expense burden，Solve become financially-difficult、Poverty due to illness problem，Promote social fairness and justice。

　　那么，什么是大病？大病保险的保障水平有多高？孙志刚指出，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。“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。”孙志刚说。

so，What is a serious illness？A serious illness insurance safeguard level how high？SunZhiGang pointed out that，In the design of a serious illness insurance coverages and goal，The world health organization about reference“Family catastrophic medical expenditure”definition。“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。”SunZhiGang said。

　　《意见》明确，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%。也就是说，患者进行大病保险报销时，是以实际发生的医疗费用为准，报销范围更宽泛。

《opinion》clear，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%。That is，Patients with serious illness insurance when submit an expense account，Based on actual medical expenses shall prevail，To submit an expense account more broad range。

　　孙志刚说，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。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。

SunZhiGang said，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。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。

　　个人不需再缴费 People don't need to pay cost

　　大病保险是全民医保体系中新设计的一类补充保险，《意见》明确，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。

A serious illness insurance is the new design health-care system a kind of supplementary insurance，《opinion》clear，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。

　　个人不用再额外缴费，并且原则上医疗费用越高报销越多。《意见》指出，各地结合当地经济社会发展水平、医疗保险筹资能力、患大病发生高额医疗费用的情况、基本医疗保险补偿水平，以及大病保险保障水平等因素，精细测算，科学合理确定大病保险的筹资标准。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。

People don't have extra pay cost，In principle, and the higher the more medical expenses reimbursement。《opinion》Pointed out that，All combined with the local economic and social development level、Medical insurance fundraising ability、Suffer from a serious illness happen high medical costs、The basic medical insurance compensation level，And a serious illness insurance level factor，Fine measurement，Scientific and reasonable to determine a serious illness insurance financing standard。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。

　　记者注意到，关于大病保险的资金来源，《意见》提到“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、新农合年度提高筹资时统筹解决资金来源”。

Reporter noticed，About a serious illness insurance funds，《opinion》mentioned“Use balance raise serious illness insurance funds；Balance is insufficient or no balance area，In medical insurance for urban residents、New farmers joint annual increase financing plan as a whole when solving capital source”。

　　对此，孙志刚说：“大病医疗保障是全民医保体系建设当中的一块短板。与此同时，基本医保基金存有不少结余，累计结余规模较大。有必要设计专门针对大病的保险制度，解决群众的实际困难，使城乡居民人人享有大病保障。”

this，SunZhiGang said：“Medical treatment of a serious illness security is universal medical insurance system of the construction of a piece of short plate。meanwhile，The basic medical insurance fund entities many balance，Accumulated large scale balance。It is necessary to design special for serious illness insurance system，To solve the practical problems of the masses，Everyone has the right to make urban and rural residents a serious illness security。”

　　由商业机构承办 The commercial institutions undertaking

　　在开展城乡居民大病保险过程中，商业保险机构扮演了重要角色。《意见》指出，采取向商业保险机构购买大病保险的方式。政府有关部门制定大病保险的筹资、报销范围、最低补偿比例，以及就医、结算管理等基本政策要求，商业保险机构中标后以保险合同形式承办大病保险，承担经营风险，自负盈亏。

In the development process of urban and rural residents a serious illness insurance，Commercial insurance institutions play an important role。《opinion》Pointed out that，Take to commercial insurance institutions to purchase a serious illness insurance way。Relevant government departments to formulate a serious illness insurance financing、Submit an expense account range、Minimum compensation ratio，And go to a doctor、Settlement management basic policy requirements，Commercial insurance institutions after winning the bid to insurance contract form undertaking serious illness insurance，Assume business risk，Responsible for their own profits and losses。

　　为什么由商业保险机构承办？孙志刚指出，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”。

Why the commercial insurance institutions undertaking？SunZhiGang pointed out that，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”。

　　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：第一，发挥商业保险机构专业特点，加大对医疗机构和医疗费用的制约；第二，商业保险机构在全国范围内统筹核算，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；第三，专业化管理和市场化运行机制，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。

compared，Commercial insurance institutions to insurance contract form undertaking serious illness insurance，Mainly has several advantages：The first，Commercial insurance institutions play professional characteristics，Increase of medical institutions and medical cost restriction；The second，Commercial insurance institutions across the country as a whole accounting，Indirect improve serious illness insurance plan as a whole level，Increase its ability to resist risks，Raises the service level，Amplification security effect；The third，Professional management and marketization 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。

　　“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。”孙志刚说。

“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。”SunZhiGang said。

　　《意见》对商业保险机构的要求具体包括三个方面：一是制定了商业保险机构的基本准入条件；二是规范大病保险招标投标与合同管理，要求其保本微利，建立起以保障水平和参保人满意度为核心的考核办法；三是要求商业保险机构不断提升大病保险管理服务的能力和水平，为参保人提供异地结算等服务，解决大病异地报销难题。

《opinion》To commercial insurance agency requirements specific includes three aspects：A is formulated the commercial insurance agencies access to basic conditions；The second is a serious illness insurance standard tender and bid and contract management，Ask its break-even meager profit，Set up to safeguard level and ginseng protect people satisfaction assessment method as the core；Three is to require commercial insurance institutions continuously improve serious illness insurance management service ability and level，To join people provide different settlement and other services，A serious illness to solve different problems to submit an expense account。

　　孙志刚说：“城乡居民大病保险惠及全民，要把这件好事办好，加强监管尤为重要。这项工作涉及多个部门、多个环节、多方利益，要形成部门联动、全方位的监管机制。考虑到大病保险是一项创新的工作，且我国区域差异较大，各地要建立由多部门组成的大病保险工作协调推进机制，先行试点，逐步推开。”

SunZhiGang said：“Urban and rural residents a serious illness insurance benefit all the people，To put this good thing to do good，Strengthening the supervision of particularly important。The job involves many departments、Multiple link、multi-stakeholder，To form department linkage、A full range of supervision mechanism。Considering the serious illness insurance is an innovative work，And regional differences，The various localities should set up by many departments of a serious illness insurance work coordination promoting mechanism，First pilot，Gradually pushed。”

　　让城乡居民大病治疗有保障(短评) Let both urban and rural residents a serious illness treatment is guaranteed(paragraph)

　　《关于开展城乡居民大病保险工作的指导意见》出台了。这是我国进一步完善城乡居民医疗保障制度、健全多层次医疗保障体系、有效提高重特大疾病保障水平的新举措，对于减轻人民群众大病负担具有重要意义。

《About urban and rural residents to carry out a serious illness insurance work guiding opinions》Issued a。This is our country further perfecting the medical security system between urban and rural residents、Perfect multi-level medical security system、Effectively improve the level of great disease to ensure new measures，To reduce the burden of the people a serious illness is of great significance。

　　近年来，随着全民基本医保体系的初步建立，人民群众看病就医有了基本保障。目前，我国基本医疗保障已覆盖13亿人，全民基本医保制度框架初步形成。但是，由于基本医疗保障制度尚不完善，尤其是城镇居民医保、新农合的筹资水平较低、保障水平不高，城乡居民大病实际报销比例较低，因病致贫、因病返贫问题突出，大病负担仍较沉重。

In recent years，As the basic medical insurance system has been set up preliminarily，People's hospital has the basic guarantee。At present，Our country basic medical insurance has covered 1.3 billion people，The basic medical insurance system framework preliminary formation。but，Because the basic medical security system is not perfect，Especially the medical insurance for urban residents、New farmers, financing level is low、Security level is not high，Urban and rural residents a serious illness actual reimbursement ratio is low，Become financially-difficult、Poverty due to illness problems，A serious illness is still a heavy burden。

　　开展城乡居民大病保险，是全民医保制度的有力完善。这一制度拓展和延伸了基本医保的功能，基本医保、商业保险、医疗救助制度实现有效衔接，构建了多层次的全民医保体系；把结余基金利用起来，放大了基本医保的效用，使更多参保人受益，提高了保障水平；引入商业保险机构经办管理，政府责任和市场机制的基础性作用有机结合，提高了运行效率和服务水平，使基金风险得到更有效的管控，用少量的投入换来更大的收益。

Urban and rural residents to carry out a serious illness insurance，Is the powerful perfect medical insurance system。This system extension and the function of the basic medical insurance，Basic medical insurance、Commercial insurance、Medical assistance system realize effective cohesion，Constructs the multi-level universal medical insurance system；The surplus fund use up，Enlarge the basic medical insurance utility，Make more people benefit from ginseng，To improve the security level；Introducing commercial insurance agency orgnaization of management，The government responsibility and the basic role of the market mechanism organic combination，To improve the operation efficiency and service level，Make fund risk get more effective control，Use a small amount of investment for a bigger profit。

　　开展城乡居民大病保险，是社会管理制度的重大创新。这一制度强调大病保险保障水平要与经济社会发展、医疗消费水平及承受能力相适应，强化了社会互助共济的意识和作用，形成了政府、保险机构、个人共同分担大病风险的机制，推动了医保、医疗、医药互联互动，提高了医疗保障水平和质量，促进了公平正义和社会和谐。

Urban and rural residents to carry out a serious illness insurance，Is the social management system of the major innovation。This system emphasizes a serious illness insurance safeguard level to the social and economic development、Medical consumption level and affordability，Strengthening the social help each other in all aid consciousness and action，Formed the government、Insurance institutions、Individuals share the risk of a serious illness mechanism，Promote the medical insurance、medical、Medical Internet interaction，To improve the medical security level and quality，Promote the fairness and justice and social harmony。

　　开展城乡居民大病保险，是保障和改善民生的重要体现。这一制度坚持以人为本，把维护人民健康权益放在首位，以着力解决群众反映强烈的突出问题为出发点和落脚点，体现了把基本医疗卫生制度作为公共产品向全民提供的理念，是一项得民心、顺民意的重大民生工程。

Urban and rural residents to carry out a serious illness insurance，Is the guarantee and improve the livelihood of the people the important embodiment of。This system to adhere to the people-oriented，To safeguard people's health rights in the first place，To solve the populace to reflect intensely with the prominent problems as the starting point and the foothold，The reflected the basic medical and health system, as the public products to provide concept，Is a effective rabble-rousing、The major public opinion the livelihood of the people project。

　　开展城乡居民大病保险，事关13亿人的切身利益。各级政府必须高度重视，统一思想，精心谋划，周密部署。要充分考虑当地实际情况，因地制宜，稳妥推进，及时研究解决发现的问题，不断优化完善方案，确保人民群众得到实惠，让城乡居民大病有保障，逐步实现人人享有基本医疗卫生服务的目标。

Urban and rural residents to carry out a serious illness insurance，Concerning the vital interests of 1.3 billion people。Governments at all levels must attach great importance to，Unified thought，Carefully plan，Careful deployment。To give full consideration to the actual local situations，Adjust measures to local conditions，Safely ahead，Timely study and resolve the problems found，Constantly optimizing scheme，To ensure that people's benefit，Let both urban and rural residents have safeguard of a serious illness，Gradually realize everyone will have access to basic medical and health services goal。