8月14日，市民在江苏太仓市人社局“大病再保险”服务窗口咨询办理结算补偿。

On August 14,，The public in jiangsu taicang people club bureau“Serious illness reinsurance”Service window consultation for settlement compensation。

　　沈 鹏摄(新华社发)

Shen peng perturbation(The xinhua news agency hair)

　　大病是一个家庭的沉重负担，不少人多年积蓄不够看病吃药。

A serious illness is a family of the heavy burden，Many people spend years savings is not enough to see a doctor to take medicine。

　　近几年来，为了解决群众因病致贫、因病返贫的问题，一些地方创新机制试点大病保障制度。从筹资来源、保障内容、经办运行等方面来看，目前各地探索的大病保障制度，大致有5种类型，其中两种类型以合同形式购买商业大病补充保险，但筹资来源不同，第三种是委托商业保险机构经办管理，第四种是政府主导型，第五种是混合型。据实际测算，试点地区群众的大病治疗费用实际报销比例提高10%以上，大大减轻了负担。

In recent years，In order to solve the masses become financially-difficult、The problem of poverty due to illness，Some local innovation mechanism pilot a serious illness security system。From the financing source、Security content、Handling operation wait for a respect to look，To explore the country at present illness security system，Generally there are five types，Two types of form in the contract to buy commercial serious illness supplementary insurance，But different financing source，The third is to entrust commercial insurance agency orgnaization of management，The fourth is the government's leading，The fifth kind is mixed。According to the actual measure，The pilot area of a serious illness treatment cost of actual reimbursement ratio increased by more than 10%，Greatly reduced burden。

　　利用基本医保基金购买大病商业保险 Use of basic medical insurance fund to buy a serious illness commercial insurance

　　广东湛江和江苏太仓的模式相似，以合同形式，利用基本医保基金购买大病商业保险，个人不需额外缴费，享受的报销比例比原来大幅提高。

Zhanjiang, guangdong and jiangsu taicang similar to the patterns，In the contract form，Use of basic medical insurance fund to buy a serious illness commercial insurance，Personal no extra pay cost，Enjoy than the original reimbursement ratio greatly increased。

　　湛江是广东的一个欠发达地区，人均收入水平只相当于我国的中西部地区。如何用有限的资金减轻城乡居民的大病负担？2009年1月，湛江将新型农村合作医疗和城镇居民基本医疗保险两项制度并轨，引入商业保险机构参与服务管理，建立全市统一的城乡居民医疗保险制度。

Zhanjiang of guangdong is one of the less developed areas，Per capita income level, only the equivalent of the western regions of our country。How to use the limited funds alleviate urban and rural residents of a serious illness burden？In January 2009，Zhanjiang will the new rural cooperative medical care and basic medical insurance for urban residents and the two system，Introducing commercial insurance agencies to participate in service management，Establish the unified medical insurance system for urban and rural residents。

　　湛江的做法是，对患重大疾病的参保人在基本医疗保险报销的基础上实施再次补助。从基本医保基金中拨出15%，购买商业大病补充保险，进行再次补助。今年再次提高标准，基本医疗年度累计支付5万元以上未超过年度最高报销限额的，个人自付部分再报销50%，超过年度最高报销限额的，个人自付部分再报销70%，全年最高报销一档25万，二档30万。商业保险机构参与城乡医保统筹管理，为全市居民提供包括基本医疗、补充医疗等咨询服务。保险公司利润率控制在3%的保本微利水平，超过部分50%划入基本医保基金中，超支部分承担50%。

Zhanjiang practice is，To those people in the ginseng of major disease insurance of primary medical treatment to submit an expense account based on the implementation of the subsidies again。From the basic medical insurance funds allocated 15%，Buy a serious illness supplementary insurance business，Again subsidies。Raise the standard again this year，Basic medical annual accumulative payment of 50000 yuan of above does not exceed the highest annual expense limit，Individual pay part from 50% to submit an expense account，More than the annual maximum limit to submit an expense account，Individual pay part from 70% to submit an expense account，The highest annual expense a 250000，Second 300000。Commercial insurance agencies to participate in medical insurance in urban and rural areas as a whole management，For the city to provide including basic medical treatment、Supplementary medical consulting services。The insurance company profit margin of 3% in the control of the break-even meager profit level，More than 50% of basic medical insurance funds into，Overspend part undertake 50%。

　　新机制使居民实际报销水平大幅提高。目前居民实际平均报销比例达到58%以上；人均住院费用报销从2008年的1405.8元提高到2011年的3490元，提高了148%。

New inhabitants to actual expense level increase。The present household actual average expense ratio above 58%；Per capita hospitalization expense from 2008 in 1405.8 yuan increased to 2011 yuan in 3490，Increased by 148%。

　　在近日召开的新闻发布会上，湛江市政府秘书长、新闻发言人黄杰介绍，商业保险机构在不增加财政投入、不增加群众负担情况下，实现了医疗保障水平大幅提高、医保管理进一步规范。

In the recently held a news conference，Zhanjiang government secretary-general、News spokesman HuangJie is introduced，Commercial insurance agencies in not increasing financial investment、Do not increase the burden cases，Realize the medical security level of increase、Medical insurance management further standardize。

　　政府引导参保(合)群众购买商业补充保险 The government guide ginseng(close)People buy commercial supplementary insurance

　　自2001年始，江苏江阴市探索引入保险机构经办农村合作医疗制度，最大限度地提高新农合资金使用效率。2010年起，江阴市鼓励参合群众在自愿基础上参加商业保险公司开办的商业补充保险。参合农民每人缴纳50元，购买商业补充大病保险，可以在新农合基础上提高保障水平10个百分点左右。同时，补充保险还可以用来支付患者在北京、上海、南京和无锡等地35个三甲医院的医疗专家会诊费用。通过新农合补充保险重大疾病专家会诊系统，居民不出城，就可以享受到省内外一些大中城市三甲医院的优质医疗资源。

Since the beginning of 2001，Jangyin exploration into insurance agency orgnaization of rural cooperative medical system，Maximize the new agriculture close the service efficiency of funds。Since 2010，Jiangyin encourage ginseng adds up to the masses on a voluntary basis to participate in commercial insurance company start business supplementary insurance。Ginseng adds up to farmers pay 50 yuan per person，Buy commercial added a serious illness insurance，Can be in the new agriculture based on close to improve security level of 10%。At the same time，Supplementary insurance can also be used to pay for patients in Beijing、Shanghai、Nanjing and wuxi, 35 3 armour hospital medical experts consultation fee。Through the new agriculture close supplementary insurance major disease experts consultation system，Residents out of the city, not，Can enjoy some inside and outside of the large and medium-sized cities of 3 armour hospital high quality medical resources。

　　2011年，江阴市实际住院补偿比例近50%，和周边同等筹资水平地区相比，保障水平高出4%，均次住院费用比无锡其他地区低1200多元。与邻近相仿地区相比，江阴财政支出的新农合经办费用约低30%—40%。

In 2011,，Jiangyin actual hospital compensation ratio nearly 50%，And surrounding the same funding level area compared，Security level higher than 4%，All times than other parts of wuxi hospitalization cost low 1200 multivariate。And adjacent similar area compared，Jiangyin financial expenditure of new agriculture close handling cost about 30% 40% lower。

　　江阴较早实现了新农合“征、管、办”相分离的管理模式，由于城镇居民也纳入其中，实现风险全社会互助共济，提高了基金的运行效率、保障水平。同时，商业保险机构开展多种形式的基金支付方式，对医疗费用的过快增长起到很大的制约作用。

Jiangyin earlier to realize the new agriculture together“sign、tube、do”Phase separation management mode，Due to the urban residents also included in the，Achieve risk society help each other in all aid，To improve the efficiency of funds、Security level。At the same time，Commercial insurance institutions to carry out various forms of fund payment，The rapid increase of the costs for medical treatment has played a significant role in the constraints。

　　云南楚雄州也采取了这种方式，在城镇居民、新农合基本医疗的基础上，分别于2009年、2010年建立了城镇居民大额补充医疗保险、新农合大额补充医疗保险制度。采取由参保人员个人缴费、自愿参保的筹资方式。

Yunnan current conditions are also take this way，In the urban residents、New farmers together on the basis of primary medical treatment，In 2009, respectively、Established in 2010 the town residents large supplementary medical insurance、New farmers joint large supplementary medical insurance system。Take by ginseng protect personnel individual capture to expend、Freewill ginseng protects the financing mode。

　　2011年，城镇居民缴费标准为每人每年50元，对超过基本医保最高支付限额(2011年为3万元)以上的部分，按照80%的比例进行报销，每年最高支付限额为6万元；农民每人每年缴费20元，新农合基本医保报销后由患者个人自付部分超过3000元(参照上年度农民纯收入)的，超过部分按照40%的比例由大额补充医疗保险进行报销。每年最高支付限额为5万元。今年起付线降低至2500元，最高支付限额提高到6万元。

In 2011,，Urban residents pay cost standards for 50 yuan per person per year，Of more than basic medical insurance highest pay limitation(In 2011 for 30000 yuan)The part above the，According to 80% proportion to submit an expense account，Every year highest pay limitation to be 60000 yuan；Farmers pay cost 20 yuan per person per year，New farmers joint basic medical insurance reimbursement by patients after individual pay part from more than 3000 yuan(Refer to previous year farmers' net income)of，More than 40% of the proportion of large amount in accordance with the supplementary medical insurance to submit an expense account。Every year highest pay limitation to be 50000 yuan。This year pay line to reduce to 2500 yuan，Highest pay limitation increased to 60000 yuan。

　　在该制度中，政府负责制定办法，商业保险机构负责具体执行，承担盈亏风险。由于是自愿参加购买大病保险制度，参保率较低。但是受益面拓宽，达到1万多人次，提高了保障水平。

In this system，The government is responsible for formulating measures，Commercial insurance institutions shall be responsible for the specific implementation，Bear the risk of profit and loss。Because is voluntarily participate in the purchase system of insurance of a serious illness，Participating insurance rate lower。But benefited range widening，More than 10000 people，To improve the security level。

　　提高基本医疗保障水平，衔接大病救助机制 Improve the basic medical insurance level，Join a serious illness relief mechanism

　　云南玉溪市北城大营村农民马玉华，今年初因为颅内出血花了8000多元，在玉溪报销了3000多元。又在昆明大医院花了87381.48元，报销了55580.43元。“我家是种地的，没有那么多钱，虽然兄弟姐妹每人给了5000元，也还是太少。要不是政府报销了那么多，也许我的命都没了。”马玉华说。

Yunnan yuxi beicheng DaYingCun MaYuHua farmers，Earlier this year for intracranial hemorrhage spent more than 8000 yuan，In yuxi to submit an expense account 3000 multivariate。In kunming and big hospitals spent 87381.48 yuan，To submit an expense account for 55580.43 yuan。“My home was a tiller of the ground，Do not have so much money，Although brothers and sisters to 5000 yuan per person，Still too little。If it weren't for the government to submit an expense account so much，Maybe my life is gone。”MaYuHua said。

　　2010年底，玉溪出台了《关于提高农民基本医疗保障和健康水平的决定》，决定在2010年全市参合农民筹资水平人均140元的基础上，2011年市财政对参合农民人均增加新农合资金100元，合计新增资金1.76亿元，个人同比增加缴费。在提高基本医疗报销水平的同时，建立面向大病患者的救助制度，完善制度设计，重点解决参合农民因病致贫、返贫问题。

By the end of 2010，Yuxi issued a《About raising farmers' basic medical insurance and health level of decision》，Decided in 2010 the ginseng adds up to farmer financing level on the basis of 140 yuan per capita，In 2011, the municipal finance to ginseng adds up to farmer per capita increase new farming joint capital of 100 yuan，Total new capital of 176 million yuan，Individual capture expends year-on-year increase。To improve the basic medical expense level at the same time，Set up facing a serious illness patient assistance system，Perfect system design，Focus on ginseng adds up to farmer become financially-difficult、Poverty problem。

　　对于大病的补偿，玉溪采取的也是基本医保先报销，大病救助再次报销的办法，只不过是政府主导参与，没有引入商业保险机构。具体办法是，当参合农民单次住院费用超过1万元时，按新农合标准报销后还需个人承担的政策范围内医疗费用，再次给予50%—60%的补助，年补助封顶线为6万元(加上新农合基本医疗报销封顶线10万元，共计16万元)。

The compensation for a serious illness，Yuxi is basic medical insurance to first submit an expense account，A serious illness salvage once again to submit an expense account，Is only the government leading to participate in，Not introduced commercial insurance institutions。Specific measure is，When ginseng adds up to farmer single hospitalization expense when more than 10000 yuan，According to the new agriculture together after standard to submit an expense account to individual to assume policy within the scope of medical expenses，Again give 50%, 60% of the subsidies，Subsidies in a top line for 60000 yuan(Add new farming together basic medical expense capped line 100000 yuan，A total of 160000 yuan)。

　　据玉溪市副市长杨洋介绍，2011年，全市大病救助7328人次，补偿金额1.57亿元，占新农合筹资总额的33.95%，大病的实际报销比例达到58%，切实减轻了参合农民的大病负担，有效缓解了因病致贫、返贫。进一步健全了农村居民医疗保障体系建设，缩小了与城镇居民医保之间的保障差距，促进了待遇公平。

According to the vice mayor of yuxi YangYang is introduced，In 2011,，The serious illness rescue 7328 person-time，The amount of compensation is 157 million yuan，New agriculture accounts for 33.95% of the total amount of financing together，A serious illness of the actual reimbursement ratio reached 58%，To reduce the burden of farmers ginseng adds up to a serious illness，Effectively relieve the become financially-difficult、poverty。Further improve the rural residents medical security system construction，Narrowed and medical insurance for urban residents of the gap between the guarantee，Promote the fair treatment。

　　此外，还有不少地方采取委托商业保险机构经办管理的方式，如河南的郑州、洛阳、新乡，其新农合基金引入商业保险机构参与经办管理。相当于把经办管理服务外包，保险机构收取管理费。引入商业保险机构经办后，洛阳的大病实际报销比例达到53%。

In addition，There are many places to take entrust commercial insurance agency orgnaization of management mode，Such as henan zhengzhou、luoyang、xinxiang，His new farm close fund into commercial insurance agency orgnaization of participate in the management。The equivalent of orgnaization of management service outsourcing，Insurance institutions charge management fee。Introducing commercial insurance institutions after handling，Luoyang big actual reimbursement ratio reached 53%。

　　还有一些地方是采用混合形式，如陕西旬邑，其筹资通过“四个一点”建立起新农合重大疾病补助基金，即新农合基金挤一点、财政拿一点、民政救助支持一点、社会各界捐助一点。目前大病基金年筹资额500万元，其中新农合基金列支200万元，财政列支专项资金200万元，民政部门从医疗救助资金中列支50万元，动员社会各界捐助50万元。

There are some places is to use mixed form，Such as shaanxi XunYi，Its financing through the“Four point”Set up the new agriculture close major disease subsidy funds，That new farming squeeze a bit close fund、Financial get a bit、Civil relief support point、The social from all walks of life a bit donations。At present a serious illness in fund raised 5 million yuan，The new agriculture close fund recovery is 2 million yuan，Financial recovery special capital of 2 million yuan，Departments of civil affairs in the row from medical assistance funds 500000 yuan，Mobilize the social from all walks of life donated 500000 yuan。

　　目前，旬邑大病基金每人每年补助资金封顶线为40万元，医药费用越高补助比例越高。据测算，实际报销比例达到70%左右。

At present，A serious illness per person per year XunYi fund subsidy funds capped line for 400000 yuan，The higher the medical expenses subsidies the higher proportion。According to the calculation，The actual reimbursement ratio reached 70%。

　　北京大学医学部主任助理、卫生经济学教授吴明认为，看一个医保制度的实施效果要从结果来看。一看补偿比，即缴费水平和报销水平的比对，二看个人自付部分占收入的比重，看能否承担得起。从目前情况来看，城乡居民医保制度已经在逐步弥合人群之间的不公平。

Beijing university, assistant director of the department of medicine、Health economics professor wu Ming think，See a medical insurance system to the implementation effect from the results to see。A look at compensation than，Namely capture expends level and submit an expense account level of comparison，Two see individual out-of-pocket part accounts for the proportion of income，See can afford。From the current situation，Urban and rural residents medical insurance system has been gradually bridge between people is not fair。