【本周聚焦】六问大病保险 [This week focusing]Six asked a serious illness insurance

　　

编者按 Editor's note

　　2012年8月30日，国家发改委、卫生部、财政部、人社部、民政部、保险监督管理委员会正式公布《关于开展城乡居民大病保险工作的指导意见》。

On August 30, 2012,The national development and reform commission/The ministry of health/The ministry of finance/People club department/The ministry of civil affairs/The insurance supervision and management committee officially announced[About urban and rural residents to carry out a serious illness insurance work guiding opinions].

　　根据《意见》，大病保险保障对象为城镇居民医保、新农合的参保(合)人。根据发改委网站数据，这部分人数达10.32亿人，政策范围内报销比例达70%左右。

According to[opinion],A serious illness insurance object for medical insurance for urban residents/New farmers, ginseng protect(close)people.According to the development and reform commission website data,This part of the toll to 1.032 billion,Policy range to submit an expense account rate of 70%.

　　大病保险能否堵住全民医保的“短板”，如何确保其平稳落地，可持续发展？如何惠及更多民众？都是各界关注焦点。

A serious illness insurance can obstruct the universal coverage"Short plate",How to ensure that its smooth landing,Sustainable development?How to benefit more people?Is attention from all walks of life.

　　1 《意见》没规定“大病保险”中“大病”范畴。对“大病”范畴应如何界定？

1 [opinion]No provisions"Serious illness insurance"in"A serious illness"category.to"A serious illness"Category should be how to define?

　　2 《意见》中规定，大病保险资金从城镇居民医保基金、新农合基金中划出一定比例或额度，个人不增加缴费。在人口老龄化加剧情况下，如何保证大病保险资金来源的稳定性和持续性？

2 [opinion]Specified in the,A serious illness insurance funds from medical insurance for urban residents fund/New farmers joint funds a certain proportional or limit,Individual does not increase the pay cost.In an aging population increased cases,How to guarantee a serious illness insurance capital source stability and sustainability?

　　3 如何保证大病保险惠及更多人群？“收支平衡、保本微利”原则能否调动商业保险机构参与热情？

3 how to guarantee a serious illness insurance benefit more people?"balance/Break-even meager profit"Principle can mobilize commercial insurance agency participation enthusiasm?

　　4 对于大病保险全国范围跨地区转移支付，目前实施条件是否成熟？

4 for a serious illness insurance nationwide cross-regional transfer payment,At present the conditions is mature or not?

　　5 大病保险如何平稳“落地”，可持续发展？未来应如何更好的完善？

5 a serious illness insurance how to smooth"landing",Sustainable development?The future should be how to better improve?

　　6 在推进新医改过程中，此次大病保险的价值和意义何在？(记者 王瑜 实习生 尹晓鹏)

6 in promoting the new medical reform process,The serious illness insurance value and significance?(Reporter WangYu interns YinXiaoPeng)

　　

【专访】筹资能力可持续发展是核心 [interview]Financing ability of sustainable development is the core

　　

北京大学人民医院院长 王杉 The people's hospital of Beijing university WangSha dean

　　大病保险可持续发展的核心是筹资能力的可持续发展。国家需营造商业健康险公司生存的政策条件，一方面建立全民个人健康档案，规避逆选择风险；另一方面建立防止道德风险的监督机制。实现跨地区转移支付会否影响筹资水平较低的医保系统，值得研究。

A serious illness insurance for the sustainable development of the core is the financing ability of sustainable development.Countries need to build commercial health insurance company survival policy conditions,On the one hand to establish the personal health records,Avoid adverse selection risk;On the other hand build prevent moral hazard of the supervision mechanism.Achieve cross-regional transfer payment will affect financing the low level of medical insurance system,Is worth studying.

　　1.您对“大病”范畴的界定如何理解？

1. You"A serious illness"How to understand the definition of the category?

　　答：大病的概念是相对的，比如阑尾炎的症状，具体操作中有些人若有并发症可能需要花的费用会更多。因此，我理解大病保险主要是根据国家基本医疗保险外，还有能力多支付的那部分钱。这部分钱应与筹资能力和水平直接相关。因此，大病的范畴不固定，可能随着筹资能力的变化和时间推移而变化。

a:The concept of a serious illness is relative,Such as a sign of appendicitis,Concrete operation of some people if there are complications may need to spend more cost.therefore,I understand a serious illness insurance is mainly according to the national basic medical insurance outside,Have the ability to pay more for that part of the money.The money should be and financing ability and is directly related to the level.therefore,The category of a serious illness not fixed,May with the financing ability of change and time and change.

　　2.未来，在人口老龄化加剧情况下，不少民众担心大病保险资金来源的稳定性和持续性，您如何看待？

2. The future,In an aging population increased cases,Many people worry that a serious illness insurance capital source stability and sustainability,How do you think?

　　答：毫无疑问，政府推行大病保险的政策基调和方向是正确的。不过有些情况还需认真考虑。比如目前城镇居民基本医保和新农合医保的筹资水平怎样？各地城镇居民医保基金、新农合基金中有多少结余能投入大病保险，都需严格测算。因为有些地区连基本医保筹资都不一定能保证，若再加上大病医保将会更有负担。无论是基本医保还是大病保险，主要涉及民众医疗保障，而保障问题的核心仍是筹资问题，应根据筹资能力和水平确定保险范围和比例，确保将来的可持续发展。

a:There is no doubt that,Government to promote serious illness insurance policy the tone and the direction is right.But in some cases still need to seriously consider.Such as the currently urban resident basic medical insurance and the new agriculture joint health care financing level?Urban residents around the medical insurance fund/New farmers joint fund how many balance can be brought into a serious illness insurance,Must be strictly calculation.Because some areas even basic health care financing is not necessarily can guarantee,If coupled with a serious illness medical insurance will have more burden.Whether basic medical insurance or serious illness insurance,Mainly involves the public health care,And the core of the security is still financing problems,Should be based on financing ability and to determine the level of insurance coverage and proportion,To ensure the sustainable development of the future.

　　3.如何保证大病保险惠及尽可能多的需要的人群？“收支平衡、保本微利”原则能否调动商业保险机构参与热情？

3. How to guarantee a serious illness insurance benefit as much as possible the crowd of need?"balance/Break-even meager profit"Principle can mobilize commercial insurance agency participation enthusiasm?

　　答：在城镇居民医保基金和新农合基金的总量没有增量前提下，如果将大病保险交给商业保险来做，可能基于以下两方面考虑：

a:In medical insurance for urban residents fund and the new agriculture close to the amount of funds no incremental premise,If will be a serious illness insurance to commercial insurance to do,Can be based on the following two aspects:

　　一方面，商业保险可能更规范。从筹资角度来说，能从管理中再节省一些。但能结余多少，还需精算。长远看，仅靠商业保险管理自身能节省的钱，毕竟还是少部分。

On the one hand,Commercial insurance may be more standard.From financing point of view,From management to save some.But how can balance,Still need to actuarial.The long run,Only on commercial insurance management itself can save money,After all, or a few.

　　另一方面，政府可能考虑发挥金融优势筹资。但从目前看，若缺乏相应政策，筹资水平和结果将会受金融市场影响较大。目前多数商业健康保险公司主要靠其他金融业务来维持健康险保本运转，而其自身运转多处于亏本状态。

On the other hand,The government may consider play financial advantage financing.But see from the current,If the lack of corresponding policies,Funding level and results will be greatly influenced by the financial markets.At present most of the commercial health insurance company mainly rely on other financial business to maintain health insurance break-even operation,And its own operation more at a loss in the state.

　　因此，如何使得商业健康险通过自身运作来保本盈利，才是问题的关键。目前我国商业健康险本身还存在道德风险和逆选择风险。道德风险主要指“医保串保”问题。加之我国目前尚未建立完整的个人健康档案，投保时，保险机构无法判断投保人真实健康情况，因此存在逆选择风险。

therefore,How to make commercial health insurance through their own operation to break-even profit,Is the key to the problem.At present our country commercial health insurance itself is the moral hazard and adverse selection risk.Moral risk refers to"Medical insurance series protect"problems.And China is not yet the establishment of a complete personal health records,Cast when protecting,Insurance institutions can't judge policy-holder real health,Therefore there are adverse selection risk.

　　总之，归根结底还是筹资问题，要构建可持续发展的筹资方式和模式。而要使商业健康险获得良性发展，国家尚需营造健康险公司生存的政策条件，既要建立配套的全民个人健康档案，规避逆选择风险；又要建立一整套防止道德风险的可执行的政策和防控监督机制。

In a word,In the final analysis or financing problems,To construct the sustainable development of the financing mode and mode.And to make the commercial health insurance for benign development,Countries still need to build health insurance company survival policy conditions,Should a set of matching the personal health records,Avoid adverse selection risk;And to establish a complete set of prevent moral hazard executable policies and prevention and control supervision mechanism.

　　4.大病保险跨地区转移支付条件是否成熟？

4. A serious illness insurance cross-regional transfer payment condition are mature?

　　答：实现跨地区转移支付是好事，但会否影响筹资水平比较低的医保系统，值得研究。因为各地医保起付水平不一样，医疗服务价格有差异。同样的病在当地看病花费比较低，而在中心城市花费可能远高于当地水平。报销时应按当地价格水平还是按中心城市价格水平，都需要考虑。

a:Achieve cross-regional transfer payment is a good thing,But will affect financing level is low medical insurance system,Is worth studying.Because all the medical insurance pay level is not the same,The medical service price difference.The same disease in local low cost to see a doctor,And in the center city spending may be far higher than the local level.Should submit an expense account according to the local price level or by the center city price level,All need to consider.

　　目前过渡阶段，看病方便和看病贵的问题很难在短期内同步解决。即使通过全国联网解决了方便的问题，却可能同时造成一部分人看病更贵了。比如本来在当地看病就感觉不便宜，若按中心城市价格和百分比来负担，就会造成用相对落后地区的筹资水平去支付物价高的地区的价格水平，加剧落后地区医保部门筹资负担。

At present the transition stage,The doctor convenient and the doctor expensive problem is difficult in the short term synchronous solution.Even through the national network solved the problem of convenience,But may also cause some people more expensive to see a doctor.Such as originally in the local doctor had a feeling not cheap,If according to the center city price and the percentage of burden,Can cause with relative backward area of funding level to pay for price high areas of the price level,Aggravate backward area health care providers financing burden.

　　5.大病保险如何更平稳“落地”？

5. A serious illness insurance how to more smoothly"landing"?

　　答：大病保险平稳“落地”的背后是可持续运转，而能可持续运转的根本问题还是筹资的问题，即解决好钱从哪里来的问题。同时还应注意根据当地筹资水平来确定大病医保的最高数额。

a:Serious illness insurance smooth"landing"Is behind the sustainable operation,But can the sustainable operation of the fundamental problem or financing problems,That is where the money came from, solve the problem.At the same time should also pay attention to the according to local financing level to determine the highest amount of medical insurance of a serious illness.

　　6.从新医改的推进来看，大病保险的价值和意义何在？

6. The advancement of the new medical reform to see,A serious illness insurance value and significance?

　　答： 从新医改的推进来看，大病保险是一个进步，方向正确，但要保证其可持续发展。而这一问题核心是筹资能力的可持续发展。其中政府持续投入是最保险的，同时若能从政策和制度层面对商业健康险进一步支持，使其尽可能不依赖其他金融领域，仅靠经办大病保险本身，就能保本盈利，那么这一政策就能可持续发展下去。(本报记者王瑜采写)

a: The advancement of the new medical reform to see,A serious illness insurance is a progress,In the right direction,But to ensure its sustainable development.And this one problem core is financing ability of sustainable development.The government continued investment is the most insurance,At the same time, if can the policy and system level in commercial health insurance further support,Make it as far as possible do not rely on other financial fields,Only on handling serious illness insurance itself,Can break even earnings,So the policy can sustainable development.(Our reporter WangYu collection &composition)