2009年3月新一轮医改启动以来，各地认真贯彻落实中央决策部署，统筹推进基本医疗保障制度建设、建立国家基本药物制度、健全基层医疗卫生服务体系、促进基本公共卫生服务逐步均等化、公立医院改革试点等五项重点改革。三年多来的医改起步稳健、进展顺利，人民群众得到了实惠，近70%的居民对医改总体情况表示满意，84%的居民认为医疗卫生服务比医改前有明显改善，国际社会也给予了积极评价。

In March 2009, a new round of reform since the launch,All conscientiously implement the central decision deployment,As a whole propulsion basic medical insurance system construction/The establishment of a national system for basic drugs/We will improve grassroots medical and health service system/Promote equal access to basic public health services gradually/Trial reform of public hospitals and so on five key reform.More than three years of reform, to start steady/Goes well,People gained,Nearly 70% of residents medical reform to the overall situation satisfied,84% of the people think that medical and health service reform has obviously improved than before,The international community has also given a positive assessment.

　　总体看，新一轮医改的成果还是初步的、阶段性的，与中央的要求和人民群众的期待还存在差距。老龄化进程加速，慢性病负担带来严峻挑战，卫生需求矛盾仍将十分突出；进一步深化改革更多涉及体制机制问题，涉及诸多利益调整问题，任务仍将十分艰巨。下一步医改工作要全面贯彻党的十八大精神，落实国务院“十二五”医改规划和卫生事业发展“十二五”规划，着力破解体制机制性矛盾和问题，在提高重特大疾病保障水平、加快推进公立医院改革、控制医药费用、创新卫生人才培养和使用制度、调动医务人员积极性、加强乡村医生队伍建设、营造有利于卫生改革与发展环境等重点、难点问题上取得新突破，在完善国民健康政策上取得新进展，努力实现党的十八大报告中提出的提高人民健康水平，人人享有基本医疗卫生服务的目标。

On the whole,A new round of reform achievements or preliminary/gradual,And the central requirements and people's looking forward to also has the disparity.Accelerated aging process,Chronic disease burden has brought serious challenges,Health demand contradictions will still is very outstanding;To further deepen the reform more involved in system mechanism,Involved in many interest adjustment problems,The task will be very difficult.The next step reform work to fully implement the party's eighteen great spirit,Implement the state council"1025"Health reform, planning and career development"1025"planning,Focus on the crack system mechanism continuity contradictions and problems,To improve the level of security and great disease/Accelerate the reform of public hospitals/Control medical expenses/Innovation health personnel training and use system/Mobilize medical staff enthusiasm/To strengthen the team construction of rural doctors/Construction is beneficial to the health reform and development environment, such as key/Difficult problem to make new breakthrough,To improve the national health policy have made new progress,Efforts to achieve the party's eighteen big report put forward improving people's health level,Everyone will have access to basic medical and health service goals.

一、关注民生，提高重特大疾病保障水平 a/Attention livelihood of the people,Improve the security level and great disease

　　近年来，随着全民医保体系的初步建立，人民群众看病就医有了基本保障。但是建立在一般性普惠报销水平上的保障制度难以有效地解决人民群众重特大疾病的医疗保障问题，因重特大疾病致贫、返贫问题依然突出。加快推进重特大疾病保障机制对于完善基本医疗保障制度、减轻大病患者家庭经济负担，提高患者救治质量，维护人民群众健康权益，提升医疗机构服务和管理水平具有重要意义。

In recent years,Along with all the people of the medical insurance system has been set up preliminarily,People's hospital is the basic guarantee.But based on general pratt &whitney submit an expense account level of security system is difficult to effectively solve the people do the medical security problems of disease,Because of the poor and great disease/Poverty problems still outstanding.Accelerate the great disease safeguard mechanism to improve the basic medical security system/Reduce the serious illness patients family economic burden,To improve the treatment of patients with quality,Maintain the health of the people rights,Improve medical service and management level to have the important meaning.

　　(一)加快健全全民医保体系，满足群众基本医疗保障需求

(a)To speed up improvement of the national health care system,To meet the basic medical insurance demand

　　当前和今后一段时期，全民基本医保重点要从扩大范围向提升质量转变。一是巩固扩大基本医保覆盖面。职工医保、城镇居民医保和新农合三项基本医疗保险参保率在“十二五”期末达到98%左右。二是提高保障水平。探索建立稳定增长的筹资机制，提高报销比例，基本医保政策范围内住院费用支付比例均达到75%左右。三是发挥商业保险作用。依托信息化等手段加快推进异地即时结算，推进委托商业保险机构承办新农合经办管理的具体业务工作。四是提高统筹层次。积极稳妥地将县级统筹提高到地市级统筹，具备条件的省份也可提高到省级统筹。五是充分发挥卫生部门统筹管理医疗保障和医疗服务的优势。推动建立医保、医疗和医药“三医联动”的新机制，形成对医疗行为内控和外控相结合的新治理机制。

The current and future a period,The basic medical insurance from the key point is to expand the scope to improve quality transformation.One is to consolidate the basic medical insurance coverage to expand.Worker health/Medical insurance for urban residents and new farming together three basic medical insurance in participating insurance rate"1025"The final 98% or so.The second is to improve the security level.Explore to establish stable growth of financing mechanism,Improve reimbursement ratio,The basic medical insurance policy within the scope of hospital cost payment ratio reached 75%.Three is to play to the role of commercial insurance.Relying on the information, and other means to accelerate the different immediate settlement,Promote entrust commercial insurance agency orgnaization of the new farmers joint management of the specific business.Four is to improve the overall level.Actively and steadily at or above the county level will improve as a whole to prefecture-level as a whole,Qualified provinces can also improve the provincial as a whole.Five is give full play to the health departments of health care and medical service advantages.Promote the establishment of medical insurance/Medical and pharmaceutical"Three medical linkage"New mechanism of,The formation of medical behavior internal control and external control combination of new governance mechanism.

　　(二)积极稳妥开展重特大疾病医疗保障工作，推动建立城乡居民大病保险制度

(two)The active and steady development and great disease medical security work,Promote the establishment of a serious illness insurance system of urban and rural residents

　　自2010年以来，卫生部会同民政部、财政部启动了提高儿童两病(儿童先天性心脏病、急性白血病)医疗保障水平试点工作。2011年以省为单位全面推开农村儿童两病试点，并在全国范围内推广终末期肾病、妇女乳腺癌等6类重大疾病医疗保障工作。2012年，又将肺癌、食道癌等12类疾病纳入重大疾病保障试点范围。截至2012年上半年，全国累计救治上述20种重大疾病患者88万多人次。近日，发展改革委、卫生部等国务院6部门印发了《关于开展城乡居民大病保险工作的指导意见》，在城乡居民大病保险的筹资机制、保障内容和承办方式等方面做出了明确规定。

Since 2010,The ministry of public health and the ministry of civil affairs/The ministry of finance started raising children two disease(Congenital heart disease in children/Acute leukemia)Medical security level of trial work.2011 province as a unit to full implementation of rural children two disease pilot,And in the nationwide promotion end-stage renal disease/Women such as breast cancer and kind of major disease medical security work.In 2012,,And lung cancer/Esophageal cancer etc 12 diseases into major disease protection scope.By the first half of 2012,The total treatment and kind of major disease patients more than 880000 people.recently,Development and reform commission/The ministry of health issued by the state council and the department of the[About urban and rural residents to carry out a serious illness insurance work direction],In both urban and rural residents a serious illness insurance fund-raising mechanism/Security content and the way of made specific provision.

　　从卫生部门职责出发，下一步工作重点要从两方面加快推进20种重大疾病医疗保障工作。一是实现新农合重大疾病保障和城乡居民大病保险的衔接。2013年基本推开20种重大疾病保障，新农合基金按照不低于70%的比例进行补偿。在已经开展城乡居民大病保险试点的地区，优先将20种重大疾病纳入大病保险，在新农合补偿70%后，个人负担费用超过大病保险补偿标准的部分，再由大病保险按照不低于50%的比例给予补偿，力争避免居民发生家庭灾难性卫生支出。二是提高医疗服务能力。基本完成县级医疗机构标准化建设，优先支持其配备救治设备。加强县级医疗机构的学科和人才队伍建设，增强重大疾病救治能力。实行重大疾病分级医疗制度，引导各级定点医疗机构间建立分工协作和双向转诊机制，形成分级诊疗格局，使大部分大病在县级医院得到救治。

From the department of health on duty,The next step work the key point is to accelerate the from two aspects of twenty kinds of major disease medical security work.One is to realize the new agriculture close major disease protection and urban and rural residents a serious illness insurance cohesion.2013 basic push away twenty kinds of major disease security,New farmers joint fund according to not less than 70% of the compensation.In the urban and rural residents have been conducted a serious illness insurance pilot area,Priority will be twenty kinds of major disease insurance into a serious illness,In the new agriculture joint compensation after 70%,Individual responsibility cost more than a serious illness insurance compensation standard part,Again by a serious illness insurance according to not less than 50% of the compensation,Strive to avoid residents had a family catastrophic health spending.The second is to improve medical service capacity.Basically completed the construction of the standardization of medical institutions at or above the county level,Priority support its equipped with treatment equipment.Medical institutions at or above the county level shall strengthen the discipline and the talent team construction,Enhance ability of major disease treatment.The major disease classification system of medical treatment,Guide to nod medical institutions at all levels to establish cooperation and division of labor between two-way referral system,Formation classification pattern of diagnosis and treatment,Most of the serious illness in the hospital for treatment.

　　(三)推进支付方式改革，提升基本医保运行效率

(three)Advance payment reform,Improve the basic medical insurance operation efficiency

　　改变现行按项目支付的方式，从制度上避免“大处方”、“大检查”现象，控制医药费用不合理上涨。要认真总结一些地区实行新的支付方式改革试点的成效与经验，继续扩大改革试点范围。一是实现统筹区域内机构、病种全覆盖，逐步对统筹区域内所有定点医疗机构和所有病种全面实行支付方式改革。二是实行不同支付方式。在现有技术管理水平下，可考虑在对费用实行总控的基础上，推行按病种付费、按服务单元付费、总额预付等支付方式。三是统筹兼顾多方利益。以收定支，根据基金承受能力合理确定基金支付水平。科学确定参合人员的费用分担比例。坚持激励与约束并重，建立新农合经办机构与定点医疗机构的谈判协商机制。四是强化质量监管。发挥卫生等部门对医疗服务的协同监管作用，运用行政、经济、管理等多种手段，确保实施支付方式改革后医疗机构服务内容不减少，服务水平不降低，实现保证服务质量和控制费用不合理上涨的双重目标，切实维护参合人员利益。

Change the current item paid,From the system to avoid"DaChuFang"/"examination"phenomenon,Control medical cost rise is not reasonable.Carefully summarize some areas new payment reform pilot results and experience,Continue to expand the scope of the pilot reform.One is a balanced mechanism in the region/Diseases covered all,To plan as a whole area gradually all to nod medical establishment and implement all disease payment reform.The second is a different payment method.In the current technical management level,Can consider to cost in the total control of the basis,Implementation of the press disease to pay/According to the service unit pay/The total advance payment, etc.The third is balanced various interests.To receive a set,According to the foundation bearing capacity reasonably determine the level of fund pays.In order to determine the cost of ginseng add up to staff the allocation proportion.Adhere to the incentive and constraint and,New farmers joint agency orgnaization to nod medical establishment and negotiation and consultation mechanism.Four is to strengthen the quality supervision.Play to health and other departments of medical service cooperative supervision role,Use of administrative/economic/Management and so on many kinds of means,To ensure implementation of payment after the reform of the medical institutions will not reduce the service content,Service level is not reduced,Realize that the service quality and cost control unreasonable rising double purpose,Safeguarding the interests of ginseng add up to personnel.