中新网12月4日电 据人力资源和社会保障部网站消息，人力资源社会保障部、财政部、卫生部今日发布关于开展基本医疗保险付费总额控制的意见。意见指出，应建立合理适度的“结余留用、超支分担”的激励约束机制，提高定点医疗机构加强管理、控制成本和提高质量的积极性和主动性。

December 4, according to human resources and social security ministry website news,Human resources social security/The ministry of finance/The ministry of health issued today about the basic medical insurance pay in total control of opinion.Opinion pointed out that,Should establish a reasonable moderate"Balance continue to employ/Overspend share"Mechanism of incentive and constraint,To improve, strengthen the management of medical institutions/Control the cost and improve the quality of the enthusiasm and initiative.

　　当前，中国覆盖城乡居民的基本医疗保障制度初步建立，参保人数不断增加，保障水平逐步提高，按照国务院《“十二五”期间深化医药卫生体制改革规划暨实施方案》关于充分发挥全民基本医保基础性作用、重点由扩大范围转向提升质量的要求，应进一步深化医疗保险付费方式改革，结合基本医疗保险基金预算管理的全面施行，人力资源社会保障部、财政部和卫生部决定开展基本医疗保险付费总额控制(以下简称“总额控制”)。

The current,Covering both urban and rural residents in China's basic medical insurance system has been set up preliminarily,Increasing the number of ginseng,Security level gradually improve,According to the state council["1025"Deepen the medical and health system reform during the planning and implementation plan]About give full play to the basic role of the basic medical insurance/Key by extending the scope to improve quality requirements,Should further deepen the reform of the medical insurance payment methods,Combined with the basic medical insurance fund budget management and comprehensive,Human resources social security/The ministry of finance and the ministry of health decided to carry out the basic medical insurance pay total amount control(Hereinafter referred to as"Total amount control").

　　意见指出，总额控制的总体目标是，用两年左右的时间，在所有统筹地区范围内开展总额控制工作。结合医疗保险基金收支预算管理，合理确定统筹地区总额控制目标，并根据分级医疗服务体系功能划分及基层医疗卫生机构与医院双向转诊要求，将总额控制目标细化分解到各级各类定点医疗机构。逐步建立以保证质量、控制成本、规范诊疗为核心的医疗服务评价与监管体系，控制医疗费用过快增长，提升基本医疗保险保障绩效，更好地保障人民群众基本医疗权益，充分发挥基本医疗保险对公立医院改革等工作的支持和促进作用。

Opinion pointed out that,Total amount control is the overall objective of,In two years time,In all as a whole the area within the scope of work in total control.Combined with the medical insurance fund budget management,As a whole the area reasonably determine the total amount control target,And according to the classification of medical service system functional division and basic medical and health institutions and hospitals two-way referral request,The total amount control target refining decomposition at various levels to nod medical establishment.Gradually establish to ensure quality/Control cost/Standard diagnosis and treatment is the core of the medical service evaluation and supervision system,Control medical cost too fast growth,Improve the basic medical insurance security performance,Better protecting the people's basic medical rights,Give full play to the basic medical insurance in public hospital reform, as well as to support and promote the role.

　　意见指出，应建立合理适度的“结余留用、超支分担”的激励约束机制，合理确定基本医疗保险基金和定点医疗机构对结余资金与超支费用的分担办法，充分调动定点医疗机构控制医疗费用的积极性。在保证医疗数量、质量和安全并加强考核的基础上，逐步形成费用超支由定点医疗机构合理分担，结余资金由定点医疗机构合理留用的机制。超过总额指标的医疗机构，应分析原因，改进管理，有针对性地提出整改意见。医疗保险经办机构可根据基金预算执行情况，对定点医疗机构因参保人员就医数量大幅增加等形成的合理超支给予补偿。医疗保险经办机构应与定点医疗机构协商相关具体情况，并在定点服务协议中明确。

Opinion pointed out that,Should establish a reasonable moderate"Balance continue to employ/Overspend share"Mechanism of incentive and constraint,Reasonable fund of insurance of primary medical treatment and medical institutions to balance the cost of capital and overspend to share,Give full play to the designated medical institutions the enthusiasm of controlling medical expense.Ensure that medical treatment in quantity/Quality and safety and strengthen the basis of assessment,Gradually formed by cost overruns to nod medical establishment reasonable sharing,The capital of balance to nod medical establishment reasonable mechanism of continue to employ.More than the total index of the medical institution,Causes should be analyzed,Improve management,Puts forward the opinion of rectification.Orgnaization of agency of medical treatment insurance fund according to the budget implementation,To nod medical establishment go to a doctor because of ginseng protect personnel to the increase of the number of the formation of reasonable compensation overruns.Orgnaization of agency of medical treatment insurance shall be in accordance with the designated medical institutions consultation related specific conditions,And in the designated service agreement clearly.

　　意见明确，开展基本医疗保险付费总额控制，应遵循保障基本、科学合理、公开透明、激励约束、强化管理的基本原则。

Opinion clear,The basic medical insurance pay in total control,Should follow the basic guarantee/Scientific and reasonable/transparent/Incentive and constraint/Strengthen the management of the basic principles.

　　意见进一步强调，应坚持以收定支、收支平衡、略有结余，保障参保人员基本医疗需求，促进医疗卫生资源合理利用，控制医疗费用过快增长。总额控制目标要以定点医疗机构历史费用数据和医疗保险基金预算为基础，考虑医疗成本上涨以及基金和医疗服务变动等情况，科学测算，合理确定。总额控制管理程序要公开透明，总额控制管理情况要定期向社会通报。建立医疗保险经办机构与定点医疗机构的协商机制，发挥医务人员以及行业学(协)会等参与管理的作用。加强部门配合，运用综合手段，发挥医疗保险监控作用，确保总额控制实施前后医疗服务水平不降低、质量有保障。

Opinions further emphasized,Should adhere to the constant branch/balance/Somewhat balance,Ginseng protect personnel to ensure the basic medical needs,To improve medical and health resources reasonable use,Control medical cost too fast growth.Total amount control objectives to nod medical establishment historical cost data and medical insurance fund budget as the foundation,Considering the rising medical costs and fund and medical service changes, etc,Scientific measurement,Reasonably determine the.Total amount control program to transparent,Total amount control management to the society regularly to report.Establish orgnaization of agency of medical treatment insurance to nod medical establishment and the consultation mechanism,Play to the medical staff and industry study(association)Will participate in such as the role of management.Departments to strengthen cooperation,Use a combination of means,Play medical insurance monitoring function,To ensure the implementation of the total amount control and the medical service level is not reduced/Quality is guaranteed.