人社部：大病保险要先行试点逐步推开，起付标准由各地参照居民年人均收入确定 People club department:A serious illness insurance to first pilot gradually push away,Fu biao all residents by reference to determine in per capita income

　　大病保险不设最高支付限额 A serious illness insurance do not set highest pay limitation

　　记者从人社部了解到，大病保险将先行试点逐步推开，原则上不设最高支付限额。

Reporters from one club department to know,A serious illness insurance will be gradually opened the first pilot,In principle, do not set highest pay limitation.

　支付项目限定在医保内 Payment items in limited within the medical insurance

　　人社部17日召开大病保险和医保付费总额控制座谈会，人社部副部长胡晓义介绍，城乡居民大病保险作为完善医保体系、创新公共服务的探索，是一个新生事物。各地将结合实际，先行试点，进行阶段性评估，总结经验，然后逐步推开。

People club department 17th of serious illness insurance and medical insurance pay total amount control symposium,People club vice minister HuXiaoYi is introduced,Urban and rural residents a serious illness insurance as improve medical insurance system/The exploration of innovation public service,Is a new thing.Cities will be based on the actual,First pilot,Periodically evaluation,To sum up experience,Then gradually pushed.

　　胡晓义介绍，开展城乡居民大病保险，各地可参照当地城镇居民年人均可支配收入或农村居民年人均纯收入，确定大病保险起付标准。大病保险支付的药品、诊疗项目等，原则上限定在基本医保政策范围内。试点地区可以根据实际适当增加支付弹性。大病保险实际支付比例不低于50%，原则上不设最高支付限额。

HuXiaoYi introduced,Urban and rural residents to carry out a serious illness insurance,All we can refer to the local urban residents per capita disposable income or in rural residents per capita net income of years,Determine a serious illness insurance fu biao.A serious illness insurance pay for drugs/Diagnosis and treatment projects, etc,In principle limit in the basic medical insurance policy range.Pilot areas may, according to actual appropriately increase pay elastic.A serious illness insurance actual payment proportion is less than 50%,In principle, do not set highest pay limitation.

　将出商业机构考核办法 Will the commercial organizations examination methods

　　胡晓义介绍，对于大病医保引入的商业保险机构，将建立以保障水平和参保人满意度为核心的考核办法，合理控制商业保险机构盈利率。

HuXiaoYi introduced,For serious illness medical insurance into commercial insurance institutions,Will establish a security level and ginseng protect people satisfaction assessment method as the core,The reasonable control of commercial insurance institutions rate of return.

　　在具体操作中，将统筹考虑基本医保和商业保险，在参保、缴费、资金划拨、基金财务管理、支付结算、费用审核等各个环节进行衔接。

In the concrete operation of,The basic medical insurance and considering the overall commercial insurance,In the ginseng/Capture to expend/Funds transfer/Fund financial management/Payments and settlement/Cost audit and so on each link to be linked.

　　胡晓义曾强调，尽管引入商业保险机构，但是大病医保政策仍是政府的一项公共政策，只是依托市场资源，请商业保险公司来具体经办，其资金来源是从城镇居民医疗保险、新农合的结余资金里拨出的。

HuXiaoYi ever emphasized,Although into commercial insurance institutions,But serious illness medical insurance policy is still one of the government public policy,Just depends on the market resources,Please commercial insurance company to specific handling,Its source of funds from urban residents medical treatment insurance/New farmers, balance in the capital of the dial out.

　　- 相关新闻

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　医保付费将全面推行总额控制 The full implementation of the medical insurance payment will total amount control

　　 人社部17日召开大病医保和医保总额控制座谈会，人社部副部长胡晓义介绍，在此前推行的基础上，医保将全面推行付费总额控制。

People club department 17th of serious illness medical insurance and medical insurance amount control symposium,People club vice minister HuXiaoYi is introduced,On the basis of carrying out before,Medical insurance will pay the full implementation of the total amount control.

　　据了解，按照医改规划，医保付费进行改革，推行按病种、按人头、总额预付三种付费方式。其中，总额预付就是在总额控制基础上，测算医疗机构的费用总量，预付定额费用，以此控制医保费用的支出。

It is understood,According to medical planning,Pay for health care reform,Implement press disease to/According to the head/The total advance three kind of payment.the,The total advance is based on the total amount control,Estimates the cost of medical institutions total amount,Advance a fixed fee,To control the medical insurance cost of expenditure.

　　胡晓义介绍，医保付费要全面推行总额控制。具体操作时，与医保基金预算衔接，合理确定总额控制目标。

HuXiaoYi introduced,Medical insurance pay to the full implementation of the total amount control.Specific operation,And the medical insurance fund budget cohesion,To reasonably determine the total amount control target.

　　医保总额控制将建立激励约束机制。即在按照总额控制的目标，出现的结余或者超支资金，确定医保基金和定点医疗机构的分担比例，以此调动医疗机构控制医疗费用的积极性和主动性。

Medical insurance amount control will establish incentive and restraint mechanism.That is in accordance with the goal of total amount control,Appear balance or overspending funds,Determine the medical insurance fund and the medical establishment that decide a dot the allocation proportion,To mobilize medical institutions of controlling medical expense enthusiasm and initiative.

　　总额控制在前期各地试点中，曾出现了负面效应。一些医院为了完成总额控制的目标，出现了降低诊疗服务质量、推诿病人的情况。胡晓义介绍，我国将建立以参保人满意度为核心、同行评议为补充的医疗服务行为评价体系。完善医保信息系统，加强实时监控，建立部门联动机制，加大对违约、违规行为的查处力度，坚决杜绝推诿拒收病人情况的发生。(记者韩宇明)

The total amount control in all of the pilot,There were negative effect.Some hospitals in order to complete the goal of total amount control,Appeared to reduce the quality of medical services/Shuffle the patient's condition.HuXiaoYi introduced,China will establish a ginseng protect people satisfaction as the core/Peer review for supplementary medical service behavior evaluation system.Improve medical insurance information system,Strengthen the real-time monitoring,Establish department linkage mechanism,Intensify the breach of contract/Illegal behavior investigation dynamics,Resolutely put an end to shuffle rejected the patient the happening of the circumstance.(Reporter HanYuMing)