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，要将总额控制管理内容纳入定点服务协议，并根据总额控制管理要求调整完善协议内容。

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,To control the total contents into the designated service agreement,And according to the total amount control management requirements adjust and improve the content of the agreement.

　　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").

　　意见明确，要将总额控制管理内容纳入定点服务协议，并根据总额控制管理要求调整完善协议内容。要针对总额控制后可能出现的情况，逐步将次均费用、复诊率、住院率、人次人头比、参保人员负担水平、转诊转院率、手术率、择期手术率、重症病人比例等，纳入定点服务协议考核指标体系，并加强管理。

Opinion clear,To control the total contents into the designated service agreement,And according to the total amount control management requirements adjust and improve the content of the agreement.To control the total for the possible situation,Gradually switch all expenses/Return visit rate/Hospital admission rates/People than head/Ginseng protect personnel to burden level/Referral rate of hospital/Operation rate/Rate of elective surgical procedures/Severe patient proportion, etc,Into the designated service agreement evaluation indicator system,And strengthen management.

　　意见指出，要完善基本医疗保险基金收支预算管理制度，在认真编制基本医疗保险收入预算的基础上进一步强化支出预算，并将基金预算管理和费用结算管理相结合，加强预算的执行力度。各统筹地区要根据近年本地区医疗保险基金实际支付情况，结合参保人数、年龄结构和疾病谱变化以及政策调整和待遇水平等因素，科学编制年度基金支出预算。实现市级统筹的地区还要在建立市级基金预算管理制度基础上，根据市、区(县)两级医疗保险经办机构分级管理权限，对基金预算进行细化和分解。

Opinion pointed out that,To improve the basic medical insurance fund budget management system,In the basic medical insurance seriously prepare budget income on the basis of further strengthen spending budget,And the fund budget management and cost settlement management combined,Strengthen budget enforcement.Each plan as a whole according to region in recent years the region fund of medical treatment insurance to pay the actual situation,Combined with the number of ginseng/Age structure and disease patterns change and policy adjustment and treatment level factors,Scientific formulating annual fund spending budget.The realization of the region as a whole and in establishing municipal fund based on budget management system,According to the city/area(county)Two levels of orgnaization of agency of medical treatment insurance classification management authority,The fund budget for refining and decomposition.

　　意见进一步表示，统筹地区要按照以收定支、收支平衡、略有结余的原则，以基本医疗保险年度基金预算为基础，在扣除参保单位和个人一次性预缴保费、统筹区域外就医、离休人员就医和定点零售药店支出等费用，并综合考虑各类支出风险的情况下，统筹考虑物价水平、参保人员医疗消费水平等因素，确定医疗保险基金向统筹区域内定点医疗机构支付的年度总额控制目标。在开展总额控制的同时，要保障参保人员基本权益，控制参保人员个人负担。

Opinions further said,As a whole the area according to the set to the team/balance/Somewhat balance principle,The basic medical insurance fund in the annual budget as the foundation,After deducting ginseng protect unit and individual one-time pay insurance cost/The plan as a whole to regional medical treatment/Medical personnel retire and designated retail pharmacy spending and other fees,Considering the risks of all kinds of spending,Considering the overall price level/Ginseng protect personnel to factors such as medical consumption level,Determine the fund of medical treatment insurance to plan as a whole area designated medical institutions pay annual total amount control target.In the development of the total amount control at the same time,To guarantee the basic rights and ginseng protect personnel,Ginseng protect personnel to control individual responsibility.

　　意见指出，应细化分解总额控制指标。以近三年各定点医疗机构服务提供情况和实际医疗费用发生情况为基础，将统筹地区年度总额控制目标按照定点医疗机构不同级别、类别、定点服务范围、有效服务量以及承担的首诊、转诊任务等因素，并区分门诊、住院等费用进一步细化落实到各定点医疗机构。要按照基本医疗保险对不同类别与级别定点医疗机构的差别支付政策，注重向基层倾斜，使定点基层医疗卫生机构的指标占有合理比重，以适应分级医疗服务体系建设和基层医疗卫生机构与医院双向转诊制度的建立，支持合理有序就医格局的形成。

Opinion pointed out that,The total control indicators should be refining decomposition.The recent three years to nod medical establishment service conditions and actual medical expense as the foundation,As a whole the area will be the annual total amount control objectives, in accordance with the designated medical institutions at different levels/category/Point scope of services/Effective services and take the first diagnosis/Factors such as referral tasks,And distinguish outpatient service/Hospitalization expenses implement further refined to the designated medical institutions.According to the basic medical insurance for different categories and levels of medical institutions pay policy differences,Attention to grassroots tilt,Make point basic medical and health institutions of reasonable proportion index,To adapt to the classification of medical service system construction and basic medical and health institutions and hospitals two-way referral system establishment,Support the formation of a reasonable and orderly pattern of medical treatment.

　　意见还要求，统筹地区要遵循公开透明的原则，制定实施总额控制的程序和方法，并向社会公开。要建立医疗保险经办机构和定点医疗机构之间有效协商的机制，在分解地区总额控制目标时，应广泛征求定点医疗机构、相关行业协会和参保人员代表的意见。有条件的地区可按级别、类别将定点医疗机构分为若干组，通过定点医疗机构推举代表或发挥行业学(协)会作用等方式，进行组间和组内协商，确定各定点医疗机构具体总额控制指标，促进定点医疗机构之间公平竞争。

Opinion also requires,As a whole the area should abide by the principle of transparency,The implementation of the total amount control procedures and methods,And to the public.To establish orgnaization of agency of medical treatment insurance to nod medical establishment and between effective consultation mechanism,The total area in decomposition control goal,Should be asked for a wide range of designated medical institutions/Relevant industry associations and ginseng protect personnel representative opinions.Conditional area according to level/Class will be divided into several groups to nod medical establishment,Through the designated medical institutions held up representative or play industry study(association)Will effect, etc,In between group and group in consultation,Determine the specific amount to nod medical establishment control target,Promote fair competition between to nod medical establishment.