让“因病致贫”远去(不吐不快)

let"Become financially-difficult"away(Don't spit unhappy)

　　白剑峰

BaiJianFeng

　　●新政策突破了过去按固定病种报销的模式，提出了按费用总额报销的模式。两种模式有机结合，是我国大病保险制度的创新

Had the new policy broke through the past according to fixed disease to submit an expense account model,Proposed according to the total cost to submit an expense account model.Two kinds of organic combination mode,China is a serious illness insurance system innovation

　　最近，我国政府出台了一项大病保险新政策：城乡居民因患大病产生高额医疗费用，可在基本医保报销的基础上，再次报销50%。这一政策的社会价值在于，可以最大限度避免城乡居民发生“家庭灾难性医疗支出”，减少因病致贫现象。

recently,Our government has offered a serious illness insurance new policy:Urban and rural residents suffering from serious illness produce high medical costs,But in the basic medical insurance on the basis of reimbursement,Submit an expense account 50% again.The policy of social value lies in,Can maximum limit avoid happened between urban and rural residents"Family catastrophic medical expenditure",Reduce become financially-difficult phenomenon.

　　“病来如山倒”，这句话既包含了疾病对人体的破坏力，也包含了疾病对家庭的破坏力。一个家庭中，如果有一个人生了大病，就如同倒了一座山、塌了半边天。相对于自然灾害来说，大病就是人间的“地震”和“海啸”。

"Disease to fall like a mountain",This sentence consists of both diseases to human body damage,Also contains a disease of the family destructive power.A family of,If there is a life a serious illness,As down a mountain/Falling down half the sky.Relative to for natural disasters,A serious illness is human"The earthquake"and"tsunami".

　　不久前，北京下岗人员廖丹为救患上尿毒症的妻子，找人刻了医院的收费章，为妻子进行“免费”透析治疗，4年间骗取医院治疗费17万余元。事发后，廖丹被检方以诈骗罪起诉。在法庭上，廖丹说：“她病成这样，我总不能掐死她，哪怕有一点钱给她治病，我何必去刻假章？”他的话充满无奈和悲凉，刺痛了社会的敏感神经。在爱心人士的资助下，他最终退回了赃款，并让妻子得到了一笔维持治疗的善款。

Not long ago,Beijing LiaoDan laid-off workers to save from uremia wife,Look for a person to the hospital fees carved chapter,For his wife to"free"Dialysis treatment,Four years cheat hospital treatment of more than 170000 yuan.After the incident,LiaoDan be prosecutors charged with fraud.In court,LiaoDan said:"She so sick,I always can't strangled her,Even if there is a little money to cure her,Why should I go to carved false chapter?"What he said is full of but and sad and dreary,Hurt social sensitive nerve.In the love for the people,He finally returned the money,And let his wife got a maintenance therapy the donation.

　　“刻章救妻”的悲剧，暴露了我国大病医保制度的“短板”。“没啥别没钱，有啥别有病”，这是老百姓最朴素的生活经验。根据世界卫生组织的定义，一个家庭在扣除基本生活费后，医疗支出超过剩余收入的40%，就属于“家庭灾难性医疗支出”。根据测算，我国的“家庭灾难性医疗支出”，大体上相当于城镇居民年人均可支配收入、农民年人均纯收入的水平。在我国，一场大病，不仅足以拖垮一个普通家庭，而且足以“消灭”一个中产家庭。虽然我国编织起世界最大的全民医保网，但就保障质量而言，仍处于较低水平。尤其是农民和城镇居民，年人均医保费只有300元左右，抵御大病风险的能力还很弱。政府提供的基本医保不足以支付大病所需，而他们自己更没有购买商业医疗保险的能力。因此，一场大病，无疑就是一场“大灾”。

"Seals save his wife"tragedy,Exposed the serious illness of the medical insurance system in our country"Short plate"."Nothing don't have no money,Have what don't be sick",This is the most simple life experience.According to the world health organization's definition,A family in deducted after basic living expenses,Medical spending more than 40% of the residual income,Belong to"Family catastrophic medical expenditure".According to the calculation,China's"Family catastrophic medical expenditure",Substantially equivalent to in urban residents per capita disposable income/Farmers per capita net income in the level.In our country,A serious illness,Not only enough to drag an ordinary family,But enough to"destroy"A middle-class family.Although our country's woven on the world's largest universal coverage network,But security for the quality,Still in lower level.Especially the farmers and urban residents,Annual per capita medical insurance fee only 300 yuan,A serious illness to resist the ability of the risk is still very weak.The government provides a basic medical insurance is not enough to pay for a serious illness,And they themselves more didn't buy the ability of commercial medical insurance.therefore,A serious illness,No doubt is a"inflicted".

　　本次出台的大病保险新政策，突破了过去按固定病种报销的模式，提出了按费用总额报销的模式。今后城乡居民无论得了什么病，只要发生了高额医疗费用，就可以得到二次报销，而且医疗费用越高，支付比例越高。此前，我国已将儿童白血病、先天性心脏病、尿毒症、肺癌等20个病种纳入重大疾病保障范围。之所以选择这些病种，不仅因为其患病人数较多，而且因为其临床路径清晰、费用可控、疗效确切。不过，这种报销方式也有局限性。因为人类的疾病有上万种，谁也无法选择得什么病。如果肺癌能报销，肠癌、胃癌就不能报销，老百姓往往难以理解，认为有失公平。但是，如果单纯按费用总额来报销，很可能诱导过度治疗，使医保为不合理费用买单。因为很多疾病缺乏统一的临床路径，治疗方式不同，费用差别很大。如果不能有效遏制过度医疗，大病保障资金投入再多，也可能被消耗殆尽。因此，将按固定病种报销和按费用总额报销两种模式有机结合，是我国大病保险制度的创新。

The new policy on the introduction of the serious illness insurance,Break through the past according to fixed disease to submit an expense account model,Proposed according to the total cost to submit an expense account model.Urban and rural residents in the future no matter get what disease,As long as happened high medical costs,Can be secondary to submit an expense account,And the higher the medical expenses,The higher pay scale.after,Our country has to childhood leukemia/Congenital heart disease/uremia/Lung cancer and 20 major disease is planted into the scope of protection.Chose these diseases,Not only because the number of people affected more,And because the clinical path needs to be clear/Cost controlled/Definite effect.but,This expense way also has limitations.Because the human disease have tens of thousands of kinds of,No one can choose what disease.If the lung cancer can submit an expense account,Bowel cancer/Gastric cancer cannot submit an expense account,People are often difficult to understand,Think is unfair.but,If press charge to apply for simple total,Probably induced excessive treatment,Make medical insurance to pay reasonable expenses.Because a lot of disease lack of unified clinical pathway,Treatment different,Cost difference is very big.If you can't effectively curb excessive medical treatment,A serious illness security funds more,Also may be consumed.therefore,The fixed disease and submit an expense account according to the total expense reimbursement two organic combination mode,China is a serious illness insurance system innovation.

　　根据这项新政策，大病保险所需资金不由政府承担，也不额外向城镇居民收取，而是从城镇居民、新农合基金中划出一定比例，主要是将沉淀的医保结余基金用于商业保险，属于“盘活存量”。相对于大病需求而言，这笔资金肯定是不足的，保障水平也是有限的。开展大病保险，并不能保证所有大病患者都不发生“家庭灾难性医疗支出”。少数低收入或发生巨额医疗费用的患者，如果通过大病保险仍不能解决实际困难，则需要通过医疗救助加以解决。因此，大病保险新政策绝不可能“包治百病”，而只是在一定程度上缓解看病贵。

According to the new policy,A serious illness insurance funds needed by the government bear,Also not extra charge to urban residents,But from the urban residents/New farmers joint funds a certain proportion,Mainly is to precipitation of medical insurance balance funds for commercial insurance,Belong to"Revitalize the stock".Compared with a serious illness in demand,The money must be insufficient,Security level is also limited.To carry out a serious illness insurance,And can not guarantee that all patients with a serious illness are not happen"Family catastrophic medical expenditure".A few low income or the occurrence of major medical expenses of the patients,If through a serious illness insurance still cannot solve the practical difficulties,It needs through the medical assistance to solve.therefore,A serious illness insurance new policy may not"cures",But only to a certain extent, ease the doctor your.

　　一个国家的文明程度，往往是以弱者的生存状况为标志的。只有当每一个家庭都不再因病致贫时，国家才更有尊严。

The civilized degree of a nation,Often is the survival condition of the weak marked.Only when every family no longer become financially-difficult when,Countries have more dignity.