前天，记者从两会上获悉，今年本市拟建立医保药品耗材集中招标采购机制，以制约过度医疗和高值医用药品耗材浪费。同时，今年有望将医保总额预付试点范围扩大。通过实施这一系列惠民措施，本市群众的医疗费用负担有望减轻。

The day before yesterday,Reporters learned from the two meetings,This year the city intends to establish medical insurance drugs consumables centralized bid procurement mechanism,To restrict excessive medical treatment and high value medical pharmaceutical waste materials.At the same time,This year is expected to total health care will advance the scope to expand.Through the implementation of a series of measures that we,The city of the medical expense burden is expected to reduce.

　　记者从人社部门获悉，本市去年通过医保付费方式改革，将医保总额预付试点由4家医院扩大到33家中央、市属和军队医院。今年，这一数字将飙升至全部199家二三级医院，试点范围也将扩大到本市全部三级和二级医院。

Reporters from one club administration authority,This city last year through the medical insurance payment reform,The total advance medical insurance pilot from 4 hospitals to expand to 33 home central/City and military hospital.This year,This number will soar to all 199 second tertiary hospital,The scope will also be extended to the whole tertiary and secondary hospital.

　　医保总额预付即根据上年度基金使用情况，加上一个合理的增长率，作为医院一年的报销总盘子，超支部分由医院自己承担，以此控制医保花费，从而防止医院过度医疗。

The total health care in advance according to previous year fund use,Plus a reasonable growth,As a hospital reimbursement total plate,Overrun by oneself bear part of the hospital,To control the medical insurance cost,So as to prevent hospital excessive medical treatment.

　　今年，本市会把门诊和住院指标分别测算，相关医院的医保总额预付额各不相同，例如一家三甲大医院每年核定的医保费用总额会超过亿元，而一些二级医院，每年核定的医保费用总额则在千万元。

This year,The city will be in hospital outpatient service and measuring index respectively,Related to the hospital medical insurance amount prepaid amount each are not identical,Such as a large hospital top every year approved health care coverage of more than one hundred million yuan,And some secondary hospital,Every year the total approved medical insurance cost is in ten million yuan.

　□重点 - key

　　加强监管 Strengthening the supervision of

　　病人遭推诿可投诉 The patient was shuffle can complain

　　如果患者确实遇有推诿，可向医疗机构所在区县人社局医保部门或拨打96102热线投诉。

If patients really in case of evasiveness,But to the medical institution area county bureau of people club medical insurance department or dial 96102 hotline complaints.

　　人社部此前透露，曾发现有的医院以医保限额即将用完为由不给病人看病，相互推诿的现象。对此，市人社局表示，为避免医院为实现管理成效，简单地向医生下达指标而导致推诿病人的现象，对于医院总额管理的考核，市人社局制定了一套内部综合管理考核指标，对其加以制约。

People club department previously revealed,Have found some hospitals in medical insurance limit will be finished by not to give patients a doctor,Mutual shuffle phenomenon.this,City people club bureau said,In order to avoid the hospital to realize management performance,Simply to the doctor to the patient to index shuffle phenomenon,For the total hospital management evaluation,City people club bureau has developed a set of internal comprehensive management assessment indicators,Restrict them.

　　如果患者确实遭遇推诿，可向医疗机构所在区县人社局医保部门或拨打96102热线投诉。如果发现医疗机构推诿病人的情况，人社部门将会对医疗机构做进一步处罚，以确保医疗质量，满足参保人员的就医需求。

If patients really encounter shuffle,But to the medical institution area county bureau of people club medical insurance department or dial 96102 hotline complaints.If it is found that a medical institution shuffle the patient's condition,People club department of medical institutions will be further punishment,To ensure the quality of medical treatment,Ginseng protect personnel to meet the medical needs.

　防止骗保 Prevent cheat the

　　人社、医院间互通信息 People club/Share information among hospitals

　　相关人员通过电脑系统可了解参保人员近30天内在全市定点医疗机构的全部就诊信息。

Relevant personnel through the computer system can understand ginseng protect personnel to nearly 30 days to nod medical establishment within the city all the medical information.

　　近日外地媒体曝出，有些地区由于将医保总额预付的额度简单地逐级下达指标，导致患者每次住院费用不得超过一定金额。一旦面临超额，医院可能采取让病人出院再重新住院来“扩大”额度的违规方式。

Recently the foreign media exposure,In some areas, because the total amount of the advance medical insurance will simply step issued index,Every time result in patients hospitalized costs may not exceed a certain amount.When faced with excess,The hospital could take to the hospital patient again to hospital"expand"The amount of illegal way.

　　本市人社部门就此透露，人社部所称“住院率”等指标基本都已被纳入本市定点服务协议考核指标体系中。今年，本市会采取“健全制度”和“强化管理”双管齐下的方式，来加强对医保基金的监管。

The city people club department said this,People club department""Hospital admission rates"The basic parameters such as have been incorporated into this city designated service agreement evaluation indicator system.This year,This city will take"Sound system"and"Strengthen management"The way of work,To strengthen the supervision of the medical insurance fund.

　　据介绍，实现医院间信息互联互通将是一项重要举措，它可以使相关人员通过电脑系统了解到参保人员近30天内在全市定点医疗机构的全部就诊信息，减少参保人员因不合理就医行为而产生的医保基金浪费。最终，一些医保违规和骗取医保基金的行为，都将得到有效遏制。

According to introducing,To realize the inter-communication between hospital information will be an important measure,It can make relevant personnel through the computer system to ginseng protect personnel to understand the past thirty days to nod medical establishment within the city all the medical information,Ginseng protect personnel to reduce because of unreasonable medical behavior from the waste of medical insurance fund.finally,Some of the medical insurance of medical insurance fund and cheat behavior,All will be effectively.

□对话 / dialogue

　　医保总额控制不影响个人就医 Medical insurance amount control does not affect individual go to a doctor

　　记者：医保付费总额控制会影响到参保者医保费用的报销吗？

reporter:Medical insurance pay total amount control will affect participants medical insurance reimbursement of expenses?

　　市人社局：医疗保险的总额管理对象是医疗机构，而不是医保病人。不能完成管理指标的定点医疗机构，不能纳入年终的医疗机构的评比。因此，总额管理不涉及医疗费用结算方式的调整，不会影响医疗机构的结算，更不会影响个人的就医和医疗待遇。

City people club bureau:The total amount of the medical insurance management object is a medical institution,Instead of medical insurance patients.Can't complete the management indicators to nod medical establishment,Not into the year-end of the medical institutions comparison.so,Total management does not involve medical cost settlement way adjustment,Will not affect the settlement of medical institutions,More will not affect personal medical treatment and medical treatment.

　　记者：今年本市将在二三级医院实行医保付费总额控制，那对于一级的医疗机构，有何管控手段吗？

reporter:This year the city will be on two tertiary hospital medical insurance pay the total amount control,For the level of medical institutions,What controls?

　　市人社局：今年在一级和一级以下定点医疗机构，本市会实行医保费用总量管理，完善配套政策，实现“年初预算、按月拨付、过程监控、年终清算”的全过程管理控制。

City people club bureau:This year in level and the level of medical institutions,The city will implement total medical insurance cost management,Perfect supporting policies,realize"Budget at the beginning of/Allocated by the month/Process monitoring/Year-end settlement"The whole process of management control.

　　记者：北京市每年的诊疗人次都在增长，这个管理指标是否是动态的、是否已考虑了增长幅度？

reporter:The annual medical people are in growth,The management index is dynamic/Is considered the increase?

　　市人社局：可以肯定地说，北京市的这个管理指标就是动态的，而且也考虑了增长幅度等相关因素。因此，北京市对各定点医疗机构所下达的总额控制目标其实都是有所区别的，而且每年都会适当地进行动态调整。

City people club bureau:We can say with certainty,The management of Beijing index is dynamic,But also considers the factors related to increase.so,Beijing to the designated medical institutions of the issued amount control target is distinct,And every year on the appropriate dynamic adjustment.

　　记者：那么本市目前和今后的总额控制目标都有哪些变化？

reporter:So this city at present and future amount control objectives what are the changes?

　　市人社局：2012年本市已经细化了各定点医疗机构在服务量等方面指标的区分。2013年，本市还会对各定点医疗机构的门诊、住院等费用进一步细化。如三甲等大医院会更侧重于管理其住院方面的费用，而其他中小定点医疗机构则会侧重于管理其门诊方面的费用。

City people club bureau:In 2012, the city has detailed the appointed medical institution in the aspects of the distinction between services index.In 2013,,The city will also to nod medical establishment to the clinic/The charge such as hospital further refinement.Such as three grade a big hospital will be more focus on the management of the cost of the hospital,And other small and medium-sized medical institutions will focus on the management of the cost of the clinic.

　□新闻背景 - news background

　　医保参保者高居各项社保之首 Medical insurance beneficiaries of social security at all

　　今年预计再增30万参保者 This year it is forecast to increase to 300000 participants

　　2012年本市已彻底打破劳动者“身份、户籍、地域”界限，基本实现“人人享有社会保障”的目标。全市医疗保险参保人数达到1272.6万人，这也是本市各项社会保险中，参保人数最高的一项保险。

In 2012, the city has broken laborer"identity/Census register/regional"limit,Basic realization"Everyone has the right to social security"goal.The medical insurance ginseng protect a number of students has reached 12.726 million,This is also the various social insurance,The highest number of ginseng protect a insurance.

　　今年，本市要以“增强公平性、适应流动性、保证可持续性”为主线，按照“全覆盖、保基本、多层次、可持续”的方针，加快建成“城乡一体化、水平多样化、服务均等化、管理精细化”的社会保障体系。

This year,This city to"Enhance fairness/Adapt to the liquidity/Guarantee sustainable"As the main line,According to the"Full cover/The basic/multi-level/sustainable"policy,Built to speed up the"The integration of urban and rural areas/Horizontal diversification/Equal access to services/Fine management"The social security system.

　　据预计，今年全市医疗保险参保人数有望再新增30万人，参保率达到97%以上。(记者赵鹏)

It is expected,This year the number of medical treatment insurance ginseng is expected to add 300000 people,Participating insurance rate above 97%.(Reporter ZhaoPeng)