医保报销之后依旧负担沉重怎么办？可以通过大病医保再报销一次！昨天，国家发改委、卫生部等多个部门对外发布《关于开展城乡居民大病保险工作的指导意见》。国家发改委副主任、国务院医改办公室主任孙志刚称，大病保险将对一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，实际报销比例不低于50%，尽量避免“一人得大病，全家陷困境”。

After medical insurance reimbursement still burden is heavy？A serious illness can through medical insurance and submits an expense account！yesterday，The national development and reform commission、The ministry of health and other departments will be released《About urban and rural residents to carry out a serious illness insurance work guiding opinions》。The national development and reform commission deputy director、Cure of the state council office director SunZhiGang says，A serious illness insurance will be a small part of the personal burden 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，The actual expense proportion is less than 50%，Try to avoid“A man a serious illness，Family in difficulty”。

　救助目的 Rescue purpose

　　解决“因病致贫、因病返贫” solve“Become financially-difficult、Poverty due to illness”

　　《关于开展城乡居民大病保险工作的指导意见》显示，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。

《About urban and rural residents to carry out a serious illness insurance work guiding opinions》display，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。

　　孙志刚称，近年来，随着新医改的持续推进，全民医保体系初步建立，城镇居民医保、新农合参保(合)人数达到10.32亿人，政策范围内报销比例达到70%左右。“但我们也看到，目前我国城镇居民医保、新农合的保障水平还比较低，制度还不够健全，比较突出的问题是，人民群众患大病发生高额医疗费用后个人负担仍比较重，存在‘一人得大病，全家陷困境’的现象。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。”

SunZhiGang says，In recent years，With the new reform of continuous propulsion，The medical insurance system has been set up preliminarily，Medical insurance for urban residents、New farmers $ginseng(close)Number of students has reached 1.032 billion，Policy to submit an expense account within the range of about 70%。“But we also see，At present our country medical insurance for urban residents、New farmers joint safeguard level is relatively low，It is not enough to improve the system，The problem is more outstanding，People suffer from a serious illness happen after high medical expenses personal burden heavier still，exist‘A man a serious illness，Family in difficulty’phenomenon。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。”

救助标准 Salvage standard

　　实际报销比例不低于50% The actual expense proportion is less than 50%

　　据介绍，大病保险的保障对象是城镇居民医保、新农合的参保人。由于基本医保基金存有不少结余，累计结余规模较大，此次大病保险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。

According to introducing，A serious illness insurance safeguard object is medical insurance for urban residents、New farmers, ginseng protect people。Because the basic medical insurance fund entities many balance，Accumulated large scale balance，The serious illness insurance need funds from medical insurance for urban residents fund、New farmers joint funds off，No extra increasing the mass individual pay cost burden。

　　据悉，大病保险的保障范围和目标是在平均水平上，使个人不得不支出的医疗费用低于家庭灾难性医疗支出。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%。另外，极少数低收入或发生巨额医疗费用的人，可以通过救助的办法加以解决。

It is reported，A serious illness insurance coverage and target is in the average level，Make the individual had to spending medical costs less than family catastrophic medical expenditure。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%。In addition，A handful of low-income or the occurrence of major medical expenses of the people，Can through the relief way to solve。

承保机构 Underwriting institution

　　收支平衡保本微利 Balance break-even meager profit

　　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。孙志刚说，商业保险机构将按照政府的要求，为参保群众提供大病保险保障。

Urban and rural residents a serious illness insurance to take the government leading、Commercial insurance institutions undertaking way。SunZhiGang said，Commercial insurance institutions will be in accordance with the requirements of the government，To join people with serious illness insurance。

　　据介绍，承接城乡居民大病保险的商业保险机构，必须满足一定的条件。相关机构还将规范大病保险招标投标与合同管理，要求遵循收支平衡、保本微利的原则，合理控制商业保险机构盈利率。另外，商业保险机构要提供“一站式”即时结算服务，确保群众方便、及时享受大病保险待遇，发挥商业保险机构全国网络等优势，为参保人提供异地结算等服务。 J159 J205

According to introducing，To undertake urban and rural residents a serious illness insurance business insurance institutions，Must satisfy certain conditions。Relevant organizations will also regulate a serious illness insurance tender and bid and contract management，Request to follow a balance、Break-even meager profit principle，The reasonable control of commercial insurance institutions rate of return。In addition，Commercial insurance institutions to provide“one-stop”Instant settlement services，Ensure that the masses convenient、Enjoy a serious illness insurance treatment in time，Play commercial insurance institutions such as the national network advantage，To join people provide different settlement and other services。 J159 J205

马上就访 'll visit

　　记者从北京市人力社保局获悉，目前本市正在进行调研，计划完善大病医疗保障制度，建立重特大病的补充医疗办法，重点解决患恶性肿瘤、白血病、器官移植等若干重大疾病参保人员在基本医疗保险制度内医疗费用负担重的问题。

Reporters from the Beijing municipal human social security bureau learned that，At present this city is carries on the investigation and study，Plan is perfect security system of medical treatment of a serious illness，Establish and great disease of compensatory medical treatment measures，Mainly to solve with malignant tumor、leukemia、Organ transplantation of a number of major disease ginseng protect personnel in the basic medical insurance system for medical expenses in the problem of a heavy burden。

　　按照2011年的统计，参保人员在北京市三级医院的次均住院医疗费用近1.8万元，其中75%左右的费用可由医保报销，个人只需要负担25%。虽然个人负担已经大减，但是对于那些不幸罹患大病的患者来说，由于总数巨大，25%的自付部分仍旧是个不小的数字，再加上很多昂贵的检查项目以及进口药、高价药没有纳入医保目录，不能报销，医疗负担仍旧是他们“难以承受之重”。

According to 2011 statistics，Ginseng protect personnel to be in Beijing tertiary hospital second all medical treatment of be in hospital cost nearly 18000 yuan，About 75% of the cost of the medical insurance to submit an expense account，People just need to burden 25%。Although individual responsibility has big reduction，But for those suffering from a serious illness unfortunately for patients，Due to the huge total，25% of the self pay part still is a big number，Plus a lot of expensive inspection program and JinKouYao、High medicine not included in medical insurance directory，Cannot submit an expense account，Medical burden is still they“Difficult to bear the heavy”。

　　市人力社保局局长张欣庆透露，这项政策的初步设想是在参保人员已经缴存的社会保险基金中拿出一部分钱，形成一个基金，然后用这笔基金购买保险公司的商业医疗保险。患有重大疾病的参保人员医疗费用超过起付线之后，首先享受基本医疗保险的报销，减轻一部分负担之后，再通过商业医疗保险进行一个“二次报销”，这样又能减轻一部分负担。目前正在调研的重大疾病包括恶性肿瘤、肾透析、白血病、血友病等11种特殊病种。这项政策有望于明年出台。

City human social security bureau chief ZhangXinQing revealed，This policy is the initial idea in ginseng protect personnel have capture puts the social insurance funds out of part of the money，Form a fund，And then use the funds to buy insurance company of commercial medical insurance。Suffering from serious illness ginseng protect personnel to pay medical treatment charge more than up after line，First of all enjoy primary medical treatment insurance to submit an expense account，Reduce part after burden，Then through the commercial medical insurance for a“Secondary to submit an expense account”，This part and can reduce the burden。Currently research of major diseases including malignant tumor、Kidney dialysis、leukemia、Hemophilia is one of 11 kinds of special diseases。This policy is expected to be issued next year。

　　重特大病补充医疗政策出台后，将成为继医保的普惠报销、补充保险的再次报销、民政等部门的医疗救助之后，市委、市政府为参保群众撑起的第四把“保护伞”。 (记者贾中山 代丽丽)

Great disease complement medical treatment after policies，Will become the health care pratt &whitney submit an expense account、Supplementary insurance reimbursement again、The departments of civil affairs after medical treatment，Municipal party committee、The municipal government to join the masses hold up of the fourth“umbrella”。 (Reporter JiaZhongShan generation lili)