“北京2012年度医保总额，很多医院已用完。医保病人必须自费，甚至必须拿处方去药店买药，建议各位生病必须前九个月，看病要月初。”昨天，一条微博在网上被疯狂转发，引发网友的恐慌。

"Beijing 2012 annual total health care,Many hospitals has run out.Health care the patient must be at one's own expense,Even must take prescription to a drug store to buy medicine,Suggest you get sick must first nine months,Early to see a doctor."yesterday,A micro bo on the Internet is crazy forward,Cause net friend panic.

　　市人力社保局昨晚回应称，即使医院用光了管理指标，也不存在医保就一律不能报销的问题。医院发生的超过总额管理指标的部分，医保基金仍给予支付，公众不用担心。

City human social security bureau responded that last night,Even ran out of hospital management index,There is no medical insurance will all cannot submit an expense account problem.Hospital happened more than part of the total management index,The medical insurance fund still give payment,Public don't have to worry about.

为什么要实施总额管理？ Why should carry out total management?

　　所谓总额管理，是指社保部门根据医院一段时间内的就诊人次、次均接诊费用等因素，测算出这家医院下一年将发生的医保费用总量，对这笔费用定期预拨，包干使用。

The so-called amount management,Refers to the social security department according to the hospital a period of time inside of medical people/Second all accepts factors such as cost,Work out the hospital next year will take place of the total amount of the medical insurance cost,For this cost with regularly,Lump sum use.

　　市人力社保局介绍，北京市于2011年7月对医保基金实行预算管理，对各个定点医疗机构下达了总额管理指标。总额管理的目的，是通过建立医疗保险基金管理新的激励约束机制，进一步调动医疗机构加强内部管理的积极性，规范医疗行为，控制医疗费用的不合理支出和不合理增长，减少过度服务，进一步提高医疗保险基金的使用效率。

City human social security bureau is introduced,Beijing in 2011 to July medical insurance fund executes budget management,For each fixed-point medical institutions issued amount management index.The purpose of total management,Is through the establishment of medical insurance fund management new incentive and restraint mechanism,To further mobilize medical agencies to strengthen internal management's enthusiasm,Regulating medical behavior,Control the cost of medical treatment is not reasonable expenditure and unreasonable growth,Reduce excessive service,Further improve the efficiency in the use of fund of medical treatment insurance.

　　各定点医疗机构的总额管理指标不是固定不变的，而是以本医院上一年的医保基金支付金额为基数，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管理指标确定。

The total amount of the medical establishment that decide a dot management index is not fixed,But in the last year of the hospital medical insurance fund the amount to be paid base,Comprehensive consideration of the fund ability to pay/Outpatient service(hospital)Quantity and medical institutions are the time cost management index confirmation.

医院超标了影响个人就医吗？ Hospital exceed bid affect individual go to a doctor?

　　市人力社保局相关负责人表示，医疗保险的总额管理是医保基金的一种管理手段，管理的对象是医疗机构，而不是医保病人。

City human social security bureau officials say,The total amount of the medical insurance management of medical insurance fund is a kind of management method,Management of the object is a medical institution,Instead of medical insurance patients.

　　即使医院用光了管理指标，也不存在医保就一律不能报销的问题。北京市的基本医疗保险实行按项目结算，即医疗机构发生的医保应支付项目，由医保基金给予支付。实行总额管理后，结算方法没有改变，医院发生的超过总额管理指标的部分，医保基金仍给予支付。因此，总额管理不涉及医疗费用结算方式的调整，不会影响对医疗机构的结算，更不会影响个人的就医和医疗待遇。但对于超指标医疗机构，会加强监管，年终不予考核奖励。

Even ran out of hospital management index,There is no medical insurance will all cannot submit an expense account problem.Beijing's primary medical treatment is sure to execute according to project settlement,That is a medical institution happen medical insurance should pay project,The medical insurance fund to pay.Implement total after management,Settlement method has not changed,Hospital happened more than part of the total management index,The medical insurance fund still give payment.therefore,Total management does not involve medical pattern of settle accounts of expense of adjustment,Does not affect medical institutions and settlement,More will not affect individual go to a doctor and medical treatment.But for super index medical institutions,Will strengthen supervision,Year-end not reward assessment.

遇到医院推诿病人怎么办？ Meet hospital shuffle the patient how to do?

　　有网友发微博称，“实行总额预付的医院，每个医生每月有总费用，超额后医生再开药做检查，社保局不承担费用，由医生承担。为自保，总额月初用完后，医生将只接受自费病人，医保病人如不愿自费，将无医生愿看。如需住院，更得排几个月队。”

Have net friend FaWei bo said,"The total advance hospital,Each doctor monthly have total cost,Excess the doctor to prescribe medicine do check again,Social security bureau does not bear the costs,By the doctor take.For holding,Early total after using,The doctor will only accept patients at one's own expenses,Health care for patients would not at one's own expense,There will be a doctor may see.If you need hospital,A row of a few months team."

　　对此，市人力社保局相关负责人说，为避免医疗机构为实现管理成效，简单地向科室医生下达指标而导致出现推诿病人的现象，北京市人力社保局对医院总额管理的考核制定了一套综合管理考核指标。如果参保人员遇有推诿病人的情况出现，可向医疗机构所在区县人力资源社会保障局医保部门或拨打96102投诉。(代丽丽)

this,City human social security bureau the relevant person in charge said,To avoid medical institutions to achieve management performance,Simply to department doctor give index and lead to shuffle the patient's phenomenon,Beijing human social security bureau to total hospital management evaluation has developed a set of comprehensive management assessment index.If ginseng protect personnel in case of shuffle the patient's situation,But to the medical institution area county human resources social security bureau medical insurance department or dial 96102 complaints.(Generation of lily)