虽然辽宁省已初步实现人人享有医保，但重特大疾病的医保仍是突出短板。同样花费10万元的医保规定范围内的医疗费用，参保城镇职工个人只需承担1万多元，而城镇居民需要三四万，参加新农合的农民则需要个人支付四五万元，故而因病致贫、因病返贫现象时有发生。对此，农工党辽宁省委员会建议全省统一建立重特大疾病病种目录，打破城乡差别；建立三级重特大疾病补偿基金，重点向城镇居民、农民倾斜。

Although liaoning is preliminary already realize everyone enjoy medical insurance,but the great disease medical insurance is still outstanding short board.The same cost 100000 yuan of medical insurance provisions within the scope of the medical cost,Ginseng protect town worker individual need to take responsibility for up to 10000 multivariate,And urban residents need to silk,The new agriculture, farmers requires individual pay four or five ten thousand yuan,So become financially-difficult/Poverty due to illness is often happened.this,NongGongDang liaoning committee recommended the unified build great disease is planted catalog,break the differences between town and country;Establish level 3 great disease compensation fund,Key to urban residents/Farmers inclined.

医保待遇差距明显 Medical insurance treatment gap obvious

　　农工党辽宁省委员会调研后发现，我省在重特大疾病保障方面还存在着明显的不足，部分重病患者参保后个人负担仍然较重；城镇居民医保和新农合待遇明显低于城镇职工医保，家庭因病致贫的现象时有发生。

NongGongDang liaoning committee research found,Our province in the great disease protection also has the obvious deficiency,Part of the critically-ill patients after ginseng protect personal burden heavier still;Medical insurance for urban residents and new farming combined treatment was significantly lower than the medical insurance for urban workers,Family become financially-difficult phenomenon occurs frequently.

　　记者了解到，以重特大疾病患者治疗集中度最高的三级医院为例，目前我省城镇职工医保报销比例按参保年限从81%递增到90%，共付段最高支付限额为6万元。

The reporter understands,With great disease patients the highest concentration of tertiary hospital as an example,At present our province medical insurance for urban workers to submit an expense account according to the proportion of ginseng from 81% increasing to 90%,Pay period were highest pay limitation to be 60000 yuan.

　　超出的医疗费用，由超限额补充医疗保险来承担，按72元／人／年的标准购买超限额商业医疗保险，超出基本保险限额的费用最高按85%报销，封顶限额为15万元。以花费10万元的医保规定范围内的医疗费用匡算，参保职工个人需承担的部分在1.2万～1.8万元之间。

beyond medical costs,by ChaoXianE supplementary medical insurance to take,According to the 72 yuan/person/year standard purchase ChaoXianE commercial medical insurance,beyond the basic insurance limit cost reimbursement according to the highest 85%,Capped limit for 150000 yuan.To spend 100000 yuan of medical insurance provisions within the scope of the medical treatment charge density,Ginseng protect a worker individual to take part in the 12000-18000 yuan between.

　　相比之下，我省城镇居民重特大疾病医保报销比例从缴费10年以下到以上按60%～65%两个报销比例补偿，统筹基金共付段最高支付额为6万元。

Compared with,Urban residents in our province and great disease medical insurance reimbursement ratio from pay cost ten years the following to the above by 60% ~ 65% two reimbursement ratio compensation,As a whole of fund highest pay period total payments for 60000 yuan.

　　超出的医疗费用，由超限额补充医疗保险来承担，按36元／人／年的标准购买超限额商业医疗保险，超出基本保险限额的费用按60%报销，超限额补充保险共付段最高支付限额为12万元。

beyond medical costs,by ChaoXianE supplementary medical insurance to take,According to 36 yuan/person/year standard purchase ChaoXianE commercial medical insurance,beyond the basic insurance limit cost by 60% to submit an expense account,ChaoXianE supplementary insurance pay period were highest pay limitation to be 120000 yuan.

　　以花费10万元的医保规定范围内的医疗费用匡算，参保居民个人需承担的部分在3.7万～4万元之间。符合民政救助条件的人员，还会享受到医保报销范围内住院总费用的30%的报销补偿。

To spend 100000 yuan of medical insurance provisions within the scope of the medical treatment charge density,Ginseng protect resident individuals need to take part in the 37000-40000 yuan between.Conform to the civil administration the personnel of condition of relief,Will also enjoy medical insurance reimbursement to within 30% of the total cost in hospital for compensation.

　　我省新型农村合作医疗重特大疾病保障，按医院的级别和医疗总费用的不同将医疗费用分成三个段，从市级定点医院治疗的医疗费用看，0～1000元补偿比为30%；1001～10000元补偿比为55%；10000元以上补偿比为45%，共付段补偿封顶线为6万元。

The new rural cooperative medical treatment in our province and great disease security,According to the level of hospital and medical total cost of different medical cost is divided into three period,From the point of hospital medical costs look,0 ~ 1000 yuan compensation ratio is 30%;1001 ~ 10000 yuan compensation ratio is 55%;10000 yuan of above compensation ratio is 45%,Common pay period of compensation top line for 60000 yuan.

　　根据抽样调查的数据，纳入重大病种的新农合参保患者发生10万元的医保规定范围内的医疗费用，个人需承担4万元左右，未纳入重大疾病病种的患者个人承担部分在5.4万元左右。符合民政救助和红十字会医疗救助条件的另有补偿规定。

According to the sampling survey data,Major diseases in the new agriculture $ginseng protect patients and 100000 yuan of medical insurance provisions within the scope of the medical cost,People need to take responsibility for up to 40000 yuan,Did not include the major disease of disease patients individual to assume part is in 54000 yuan or so.Conform to the civil relief and the Red Cross medical treatment conditions of the compensation provisions otherwise.

呼吁建立补偿基金 Calling for compensation fund

　　对此，农工党辽宁省委员会建议全省统一建立重特大疾病病种目录，坚决摒弃部分人群按发生医疗费用的数量来界定重特大疾病的方式，综合考虑对人身健康危害性、治疗复杂程度、治疗费用、治疗周期等多方面因素，确定A、B、C三个重特大疾病等级，各市可根据本地的实际情况适当增加特殊病种。

this,NongGongDang liaoning committee recommended the unified build great disease is planted catalog,Resolutely abandoned the part according to the number of medical treatment charge happens to define the form of disease do,Comprehensive consideration of personal health harm/Treatment complexity/Treatment costs/Treatment cycle and so on various factors,Determine A/b/C three great disease level,Various cities according to local actual situation to appropriately increase the special disease.

　　同时，全省应以省、市、县(市)区财政为主，结合从医保基金中抽取的部分，建立三级重特大疾病补偿基金，重点向城镇居民、农民倾斜。在补偿办法上，可以按照一个保障年度内参保人实际住院补偿额达到最高支付限额，未纳入补偿范围的住院可补偿费用，由重大疾病补充补偿基金按一定的比例(如50%)给予报销，设置最高支付限额(如15万元)。报销的比例与最高支付额由医保部门进行科学的风险预测后设置。同时，可设置年度内个人大病累计自付支出规定额(如2万元)，超过规定额的部分按一定的比例(如70%)予以报销。设置的规定额与报销比例同样也要根据预测试运行，依据基金安全情况，逐步降低规定额，提高报销比例。此外，全省还应利用结余资金购买商业保险，放大医疗救助与慈善机构重特大疾病救助的叠加效应，合理控制医疗费用。( 时代商报 见习记者陈景华)

At the same time,The province to province should be/city/county(city)Area mainly financial,Combined with the medical insurance fund from the extraction of part,Establish level 3 great disease compensation fund,Key to urban residents/Farmers inclined.In the compensation method,Can a security in accordance with the actual NaCan applicant hospital compensation amount reach the highest pay limitation,Did not include the compensation range of hospital reimbursable expenses,The major disease supplementary compensation fund according to certain proportion(Such as 50%)reimbursed,Set the highest pay limitation(Such as 150000 yuan).The proportion of reimbursement and highest pay amount by health care providers to scientific risk prediction set after.At the same time,A serious illness can be set within the year individual cumulative out-of-pocket spending provisions amount(Such as 20000 yuan),Exceed the prescribed amount of the part according to certain proportion(Such as 70%)Shall submit an expense account.The provisions of the set amount and submit an expense account according to the proportion also predict commissioning,According to the fund safety situation,Gradually reduce the amount of provisions,Improve reimbursement ratio.In addition,The province should also use surplus funds to buy commercial insurance,Amplification medical assistance and charity and great disease aid stack effect,The reasonable control of medical cost.( Age business newspaper reporter ChenJingHua apprentice)