日前，国家发展改革委、卫生部、财政部等六部委联合召开电视电话会议，贯彻落实《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》)。

a,The national development and reform commission/The ministry of health/The ministry of finance jointly held six ministries and commissions such as TV conference call,Implementation of the[About urban and rural residents to carry out a serious illness insurance work guiding opinions](Hereinafter referred to as[opinion]).

　　城乡居民大病保险保障的“大病”具体指的是什么？报销范围是什么？国家发展改革委副主任、国务院医改办公室主任孙志刚在会上指出，文件没有简单地按照病种区分大病，而是根据患大病发生高额医疗费用与城乡居民经济负担能力对比进行判定。大病保险报销不再局限于政策范围内，只要是大病患者在基本医保报销后仍需个人负担的合理医疗费用，就将再给予报销50%以上。

Urban and rural residents of a serious illness insurance"A serious illness"Specific mean?What is the scope to submit an expense account?The national development and reform commission deputy director/Cure of the state council office director SunZhiGang at the meeting that,Document does not simply according to the disease to distinguish between a serious illness,But according to suffer from a serious illness happen high medical cost and economic burden ability of urban and rural residents a comparison of decision.A serious illness insurance reimbursement is no longer limited to policy range,As long as it is a serious illness patients in the basic medical insurance to submit an expense account is required after the reasonable individual responsibility medical expenses,It will be given to submit an expense account more than 50%.

　　大病保险可以保哪些病 A serious illness insurance can protect what disease

　　孙志刚指出，什么是“大病”，我国的制度参考了世界卫生组织关于家庭“灾难性医疗支出”的定义，即：一个家庭强制性医疗支出大于或等于扣除基本生活费(食品支出)后家庭剩余收入的40%。如果出现家庭灾难性医疗支出，这个家庭就会因病致贫返贫。换算成国内相应统计指标，按2011年数据计算，对城镇居民而言，大体相当于城镇居民年人均可支配收入，对农民而言，大体相当于农村居民年人均纯收入的水平。

SunZhiGang pointed out that,What is"A serious illness",Our system reference the world health organization about family"Catastrophic medical expenditure"definition,namely:A family mandatory medical expenditure is equal to or greater than the basic living expenses deducted(Food expenditure)40% of the family after residual income.If a family catastrophic medical expenditure,The family will become financially-difficult poverty.Conversion into domestic corresponding statistical index,In 2011 data calculation,As for urban residents,Roughly equivalent to in urban residents per capita disposable income,For farmers in,Roughly equivalent to in rural residents per capita net income level.

　　也就是说，当城镇居民、农民当年个人负担医疗费用分别达到当地城镇居民年人均可支配收入、农民年人均纯收入时，就会发生灾难性医疗支出，就可能会导致因病致贫返贫。此时，大病保险制度发挥作用，对城乡居民的高额医疗费用进行合理的报销。

That is,When urban residents/Farmers in charge of individual responsibility medical treatment reached in local urban residents per capita disposable income/Farmers per capita net income of years when,Will be catastrophic medical expenditure,It could lead to become financially-difficult poverty.At this time,A serious illness insurance system play a role,To urban and rural residents of high medical cost reasonable to submit an expense account.

　　国务院医改办副主任徐善长在中国网访谈时提到：大病保险制度所指的大病“不是一个医学上病种的概念”。

Cure of the state council to do vice director in China XuShanChang interview mentioned:A serious illness insurance system referring to a serious illness"Not a medical concept of disease".

　　近日，卫生部宣布，今年要全面推开尿毒症等8类大病保障，在1/3左右的统筹地区将肺癌等12类大病纳入保障和救助试点。记者了解到，这里的大病是医学上的病种概念，保障的对象是新农合参合农民，不同于城乡居民大病保险制度。两个制度不冲突。

recently,The ministry of health announced,This year, we must fully opened the uremia, eight kind of serious illness security,In about one third of as a whole the area will be lung cancer etc 12 class into a serious illness protection and rescue pilot.The reporter understands,Here is a serious illness medical disease concept,The security of the object is a new agriculture $ginseng adds up to farmer,Different from a serious illness insurance system of urban and rural residents.Two system is not conflict.

　　大病保险具体能报多少 A serious illness insurance specific can offer much

　　2011年，城镇居民医保、新农合政策范围内住院费用报销比例已达到70%左右。所有统筹地区城镇居民医保、新农合统筹基金，实际最高支付限额全国平均已分别达到13万元、7.98万元。那么，在70%的基础上，大病保险制度还能报销多少？

In 2011,,Medical insurance for urban residents/New farmers joint policy range in hospital expense ratio has reached 70%.All as a whole the area medical insurance for urban residents/New farmers together as a whole fund,The actual highest pay limitation the national average has reached 130000 yuan/79800 yuan.so,On the basis of 70%,A serious illness insurance system can also how much to submit an expense account?

　　孙志刚说，大病保险的报销比例是，大病患者在基本医保报销后仍需个人负担的合理医疗费用，再给予实际报销50%以上，而且，对医疗费用实行分段制定支付比例，原则上医疗费用越高支付比例也要越高。也就是说，城镇居民医保、新农合先在政策范围内报销约70%，剩余自付费用再由大病保险实际报销最少50%。

SunZhiGang said,A serious illness insurance reimbursement ratio is,A serious illness patients in the basic medical insurance to submit an expense account is required after the reasonable individual responsibility medical expenses,To give the actual expense above 50%,and,For medical expenses implement piecewise make payment proportion,In principle, the higher proportion of medical expenses payment will is higher.That is,Medical insurance for urban residents/New farmers joint first in the policy range to submit an expense account about 70%,Residual out-of-pocket expenses again by a serious illness insurance actual reimbursement by at least 50%.

　　对具体的筹资额度或比例，文件没有作出具体规定。孙志刚指出，主要是考虑各地经济发展、居民收入和医疗费用水平差别很大，同时，根据1亿人群样本数测算，不同地方，做好城乡居民大病保障与需要的筹资标准也有很大的差距。因此，国家层面对具体筹资标准不作统一规定，由各地结合实际，进行科学测算后合理确定。

The specific amount of financing or proportions,Document does not make specific provisions.SunZhiGang pointed out that,Basically be to consider to the local economic development/Residents income and medical cost level difference is very big,At the same time,According to the 100 million people sample size calculation,Different places,Do both urban and rural residents and guarantee a serious illness need financing standard also has the very big disparity.therefore,The national level to specific financing standard not unified regulation,Around the actual,After scientific measure reasonable.

　　“这里需要强调的是，各地在测算时不能简单化。要根据前三年至少前一年大病高额医疗费用的发生情况、基本医保报销的情况、大病保险的目标水平，以及筹资能力等综合因素，进行精细测算，多方案对比，合理确定。”孙志刚说。

"Here need to be emphasized,Everywhere in estimates cannot simplification.According to the first three years at least a year before the occurrence of serious illness high medical expense situation/The basic medical insurance expense situation/A serious illness insurance target level,And financing ability, and other comprehensive factors,For fine measurement,Schemes comparison,Reasonably determine the."SunZhiGang said.

　　按照全国平均报销水平，记者大致算了一笔账。比如一个参保的城镇居民，患大病共花了10万元，假定政策范围内费用为8万元，报销了约70%，共5.6万元。剩余4.4万元，超过了当年年人均可支配收入，因此至少可以再报销50%，达到2.2万元左右，加起来共报销7.8万元，参保患者个人自付2.2万元，实际报销比例就可以达到78%。

According to the national average level to submit an expense account,Reporter roughly calculate a bill.For example a ginseng protect of urban residents,Suffer from a serious illness were spent 100000 yuan,Assume that policy range cost is 80000 yuan,To submit an expense account for about 70%,A total of 56000 yuan.Residual 44000 yuan,More than a year after year per capita disposable income,So at least 50% to submit an expense account,Up to 22000 yuan,Added up to a total of 78000 yuan to submit an expense account,Ginseng protect patients from individual pay 22000 yuan,The actual reimbursement ratio can reach 78%.

　　非政策范围内用药报销吗 The policy range medication to submit an expense account

　　大病用的很多药都是非医保目录内的，是否可以报销？

A serious illness with a lot of medicine is a medical insurance within the directory,Whether can submit an expense account?

　　孙志刚指出：“大病保险报销不再局限于政策范围内，而是大病患者在基本医保报销后仍需个人负担的合理医疗费用，再给予报销50%以上。”

SunZhiGang pointed out that:"A serious illness insurance reimbursement is no longer limited to policy range,But serious illness patients in the basic medical insurance to submit an expense account is required after the reasonable individual responsibility medical expenses,Submit an expense account to give more than 50%."

　　也就是说，非医保报销目录内的药品、治疗项目等，只要是合规的费用，都可以报销。但具体哪些是合规费用，《意见》作为指导性文件，没有作出具体规定，主要原因是各地情况差异大。徐善长说：“这次出台的大病保险文件，是一个原则性的指导文件，在许多方面没有设定全国统一的标准和比例，比如，筹资标准、合规医疗费用、高额医疗费用等的界定，都由地方政府来确定。”

That is,The medical insurance to submit an expense account within the directory of drugs/Treatment projects,As long as it is the compliance costs,Can submit an expense account.But what is the compliance costs,[opinion]As a guidance document,No, formulate specific provisions,The main reason is that local situation big difference.XuShanChang said:"This time on the introduction of the serious illness insurance documents,Is a principle guiding document,In many ways is not set the national unified standards and proportion,For example,Financing standard/Compliance medical expenses/The definition of the high cost of health expenses, etc,By the local government to make sure."

　　对于患大病的民政救助对象，民政部副部长窦玉沛表示，做好资助参保参合工作，将重特大疾病医疗救助和大病保险有机结合，最大限度提高困难群众医疗保障水平，加快推进“一站式”即时结算机制建设，力争年底前覆盖60%以上的县(市、区)。

For patients with serious illness of civil administration rescue object,Vice minister of civil affairs, DouYuPei said,Well funded ginseng protect ginseng adds up to work,Will do disease medical assistance and a serious illness insurance organic combination,To maximize the difficult medical security level of the masses,accelerate"one-stop"Instant settlement mechanism construction,Before the end of the year to cover more than 60% of the county(city/area).

　　【链接】 [link]

　　按照国务院医改办对东、中、西部1亿个样本数的统计和测算，大病发生的概率大概在千分之二到千分之四左右，按照城镇居民和新农合参保(合)人数测算，全国大概是200万—400万人左右。(李红梅)

According to cure of the state council to do to the east/in/The west 100 million a number of samples of statistics and measure,The probability of occurrence in a serious illness at about two over one thousand to four over one thousand or so,According to the town and the new agriculture $ginseng protect(close)Measure number,The national is about 2 million - about 4 million people.(LiGongMei)