本报讯(记者 汪丹) 近日，一则“许多医院医保额度用完，患者看病须自费”的微博现身网上，引起网友热议。市人力社保局回应，北京定点医疗机构执行总额管理指标是为了控制过度医疗，医院超标部分医保基金仍将予以支付，患者合理就医不会受到任何影响。如医院以医保额度用完为由推诿病人，市民可向医保部门或拨打96102投诉。

Report from our correspondent(Reporter WangDan) recently,a"Many hospital medical insurance line run out,Patients must be a doctor at one's own expense"Micro bo appeared online,Cause net friend of hot debate.City human response to social security bureau,Beijing fixed-point medical institutions the total execution management index is to control the excessive medical treatment,Hospital overweight part of the medical insurance fund will still be pay,Reasonable medical patients not be affected.If the hospital medical insurance amount to use up for evasiveness patients,Public can call 96102 to medical insurance department or complaints.

　　8日晚，新浪网友“@耳鼻喉科张医生”发微博称：“北京很多医院的医保额度用完了，想用医保看病的患者要遭殃了，如何解决？在医院医保额度用完的情况下，医生无法给医保病人治疗，要么患者全自费无法走医保报销，要么医生自掏腰包负担患者的医疗费用。”此微博一出，立刻被几百人转载、评论。不少网友一头雾水，纷纷求解：“没看懂”、“医保有额度限制？”另一些网友则表示有同感，“@傻傻的老蚂蚁”说：“是的，医保没钱了，不管是慢性病的高血压还是糖尿病，每个患者在医院只能开少于380元/月，否则要不患者自费，要不医生自己贴钱。”

8 late,Sina net friend"@ otolaryngology doctor zhang"FaWei bo said:"Beijing many hospital medical insurance amount used up,Want to see a doctor with health care to patients with calamity,How to solve the?In the hospital medical insurance line out of,The doctor couldn't give medical treatment of patients,All patients with either can't walk at one's own expenses medical insurance to submit an expense account,Or doctors own burden of the patients with medical costs."The micro bo a,Hundreds of people were immediately transfer/comments.Not a few net friend heads or tails,Have to solve:"Did not understand"/"Medical insurance have quotas?"Some net friend, said on the same wavelength,"@ silly old ants"said:"yes,Health broke,Whether chronic hypertension (high blood pressure or diabetes,Each patient in the hospital can only open less than 380 yuan/month,Otherwise or patients at one's own expense,Or doctors TieQian himself."

　　医院有医保额度吗？为此，记者采访了市人力社保局。市人力社保局医疗保险处有关负责人介绍，根据国家医改规定以及人社部下发的《关于进一步推进医疗保险付费方式改革的意见》，本市于去年7月对医保基金实行预算管理，对各定点医疗机构下达了总额管理指标。具体来说，总额管理是以本市当年医疗保险基金收入为基础，按照“以收定支、收支平衡”的原则，根据不同定点医疗机构的级别、承担的服务量等因素，分级确定总额管理指标，控制医保费用不合理增长，防止过度医疗。“目前，上海、天津、杭州等城市都已实行医保基金总额控制管理，这也是各国通用的管理手段。”

Hospitals have medical insurance line?therefore,The reporter interviewed the city human social security bureau.City human social security bureau medical BaoXianChu relevant controller introduces,According to the state provisions of medical reform and the club department issued[On further promoting medical insurance payment reform opinions],This city in July last year to medical insurance fund executes budget management,The medical establishment that decide a dot to total management index.specifically,The city is in total management of medical insurance fund income as the foundation,According to the"To receive a fixed/balance"principle,According to the different levels of medical establishment that decide a dot/Take such factors as services,To determine total classification management index,To control the medical insurance cost is not reasonable growth,Prevent excessive medical."At present,Shanghai/tianjin/Hangzhou and other cities have a total medical insurance fund control management,This is also countries general management method."

　　当然，不可回避的是总额管理的确出现了一些问题。此前有媒体报道，上海一市民由于总额预付的问题，被多家医院拒收。究其原因，就是医院会根据总额管理给各科室定指标，当实际费用接近总额、服务人次达标后，不排除有的医院会推诿患者，尤其是重症患者。

Of course,The total is inevitable management do appear some problems.There have been media reports,Shanghai a citizen due to the problem of the total advance,By many hospitals rejected.Investigate its reason,Is the hospital total according to management to all departments set index,When the actual cost was close amount/After the service people,Don't exclude some hospital will shuffle patients,Especially in severe cases.

　　对此，市人力社保局表示，总额管理是对医院使用医保基金的一种管理方式，不会影响个人就医及其医疗待遇。超过总额管理指标的部分，医保基金仍会支付，但对于超指标医院会加强监管。

this,City human social security bureau said,Total management is the hospital medical insurance fund use a kind of management mode,Will not affect individual go to a doctor and medical treatment.More than the total management index of the part,The medical insurance fund will still pay,But for super index hospital will strengthen supervision.

　　释疑

disabuse

　　市人保局回应三大疑问

City bureau of insurer respond to three questions

　　疑问一：有医院以“医保限额即将用完”为由不给病人看病，如何解决？

Doubt a:A hospital to"Medical insurance limit will run out"For not to give the patient to see a doctor,How to solve the?

　　医保总额管理的对象是医疗机构，而非参保患者。总额管理不会改变对医疗机构的结算方式，更不会影响个人就医及其医疗待遇。

The total medical insurance management object is a medical institution,Instead of ginseng protect patients.Total management of medical institutions will not change the settlement way,More will not affect individual go to a doctor and medical treatment.

　　在总额管理的执行过程中，医疗机构应规范医疗行为，减少不合理医疗费用的支出和浪费。对于简单地向科室医生下达指标而导致推诿病人的现象，市人力社保局制定了一套综合管理考核指标。如参保人员遇到这种情况，可向医疗机构所在区县人力社保局医保部门或拨打96102进行投诉。一经核实，将对医疗机构进行处罚，确保医疗质量，满足参保人员的就医需求。

In the management of the total in the implementation process,A medical institution shall regulating medical behavior,Reduce unreasonable medical expenditures and waste.To simply to department doctor give index and lead to shuffle the patient's phenomenon,City human social security bureau has developed a set of comprehensive management assessment index.Such as ginseng protect personnel to meet this situation,But to the medical institution area county human social security bureau medical insurance department or the number is 96102 complaints.Once verify,For medical institutions will be punished,To ensure the quality of medical treatment,Ginseng protect personnel to meet the medical needs.

　　疑问二：医院用完了指标额度，医保是否就不能报销，需要医院自付？

Question 2:Hospital finished index line,Whether medical insurance cannot submit an expense account,Need hospital pays?

　　本市医疗机构发生的医保应支付项目，由医保基金支付。实行总额管理后，结算方式并无改变。医院发生的超过总额管理指标的部分，仍由医保基金支付。但对于超指标医疗机构会加强监管，年终不予考核奖励。

This city happens medical institutions of medical insurance should pay project,The medical insurance fund pays.Implement total after management,Settlement way and no change.Hospital happened more than part of the total management index,Still by the medical insurance fund payment.But for super index medical institutions will strengthen supervision,Year-end not reward assessment.

　　疑问三：本市每年的诊疗人次在增长，总额管理指标会否相应增长？

Question three:Every year the city of diagnosis and treatment in the growth of people,Total management index will be no corresponding growth?

　　各定点医疗机构的总额管理指标，以该院上一年的医保基金支付金额为基数，并综合考虑基金支付能力、门诊(住院)量以及医疗机构的次均费用等因素确定。因此，各医院的总额管理指标是有增有减，根据实际需求动态变化的。

The total amount of the medical establishment that decide a dot management index,The previous year to the hospital the medical insurance fund the amount to be paid base,And comprehensive consideration of the fund ability to pay/Outpatient service(hospital)Quantity and medical institutions are the time cost to determine factors.therefore,The total amount of the hospital management index is increased a minus,According to the actual demand of dynamic change.