大病如灾，仅靠医保扛得住吗(民生视线) A serious illness, such as disaster,Only by health care carry live(The livelihood of the people line of sight)

   　一名尿毒症患者，用自制的设备维持了13年血透；10岁男孩胡镓豪，独自扛起照顾重病母亲的重任；北京男子私刻医院公章，骗取治疗费用，让尿毒症妻子进行血透……大病让人们品出了故事背后的辛酸，也引发了公众的深思。

   A uremic patients,Using home-made equipment maintenance hemodialysis for 13 years;Gallium 10-year-old boy hu hao,Shoulder the burden of taking care of sick mother alone;Beijing man SiKe hospital official seal,Diddle cost of treatment,Let the wife uremia hemodialysis...A serious illness let people to taste the bitterness behind the story,Also caused the public thought.

　　国际上对大病引发的“家庭灾难性支出”有普遍的共识，如果其支出超过家庭年收入40%，就是大病造成的灾难性支出。显然，面对大病，普通百姓尤其是年人均收入不到7000元的农民，难以负担。

International triggered a serious illness"Family catastrophic spending"There is general consensus,If its spending more than 40% of household income,The disastrous spending is a serious illness.clearly,In the face of a serious illness,Ordinary people, especially farmers' per capita income of less than RMB 7000 per year,To afford.

　　针对大病患者的高额医药费用负担，去年8月城乡居民大病保险政策推出，明确在基本医保报销后再报销50%，今年政策将陆续在各省落地。同时，新农合大病保障扩容至20种重特大疾病。大病很残酷，现实已关注，但仅靠医保撑不撑得住？医保之外，还可以借助哪些手段？记者进行了调研。

For the large medical burden of patients with serious illness,Of urban and rural residents in August last year to launch a serious illness insurance policy,Clear after the basic medical insurance reimbursement for 50% again,This policy will be in the provinces.At the same time,New farming and serious security capacity to 20 major workplace disease.A serious illness is very cruel,Reality has been focused on,But only by health care does not hold up?Outside of health care,Also can use what means?Reporter has carried on the investigation and research.

　①免费的“救命大餐” (1) free of charge"For dinner"

　　——免费救助，为江西10300名困难尿毒症患者节省约3.4亿元 - free assistance,Difficult for jiangxi 10300 uremia patients save about 340 million yuan

　　隆冬的鄱阳湖畔，天气阴冷。

Winter in poyang lake side,The weather is cold.

　　1月18日，是个普通的周五，可对于江西省新建县石埠镇竹园村尿毒症患者程细保却不一样。每周二、五下午程细保都要到县城做血透。

On January 18,,Is a regular on Friday,For the xinjian county in jiangxi province stone port town of w village uremia patients fine bao cheng is different.Every Tuesday/Five range coverage will be fine in the afternoon to the town in hemodialysis.

　　2011年，程细保在医院检查被告知患上了尿毒症，为了治病，东奔西走，当年医药费就花了3万多元。病情加重，他每周不得不上医院做血液透析。

In 2011,,Fine bao cheng in the hospital were told had uremia,In order to cure,uh,The medical expenses spent 30000 multivariate.Disease progression,He had to hospital for blood dialysis in a week.

　　由于治疗时间长，医疗费用高，尿毒症已成为一些家庭因病致贫的重要疾病。程细保说，每次血透要300多元，一年要花费近3万元的血透费，不少患者因缺钱而减少血透次数。

Due to the treatment time is long,The high cost of health care,Uremia has become an important disease of some families because of sickness poor.Fine bao cheng said,Every hemodialysis 300 multivariate,A year spent nearly 30000 yuan of hemodialysis,A lot of patients and reduce the number of hemodialysis for lack of money.

　　2012年，江西开始对尿毒症贫困患者提供免费血透救助。“每月能做8次免费血透，一年下来看病花费减少七成多。”程细保说，“现在透析不用花钱，药品费用新农合还能有报销，家里少操心，心里比以前敞亮多了！”程细保躺在床上笑着说道。

In 2012,,In jiangxi province, started providing free hemodialysis patients with uremia poverty relief."Hemodialysis can do 8 times a month,More than a year down the doctor cost reduced by seventy percent."Fine bao cheng said,"Dialysis need not spend money now,New drug cost farmers can submit an expense account,Home less to worry about,The in the mind is more clear than before!"Fine bao cheng lie on the bed said with a smile.

　　与程细保同样幸运的，还有全省其他10300名困难尿毒症患者，他们也享用到了这份免费大餐。

With fine cheng bao also lucky,And the province's 10300 other difficulties in uremia patients,They also enjoy the free meals.

　　做一次血透很贵，前几年北京通州多名尿毒症患者“抱团”血透事件，让全国人民了解了血透。血透需要设备，需要耗材，需要消毒的房间。在江西，做一次血透，三级医院400元/次、二级医院360元/次、一级医院320元/次。按照政策，困难尿毒症患者每人每周免费做2次血液透析，每年按52周计算，10300名患者最少免费3.4亿元。

Do a hemodialysis is very expensive,More than a few years ago Beijing tongzhou uremic patients"Means of"Hemodialysis events,Let the national people's understanding of the hemodialysis.Hemodialysis need equipment,Need material,Need to disinfect room.In jiangxi province,Do a hemodialysis,Tertiary hospital in 400 yuan/times/The secondary hospital 360 yuan/times/Level 1 hospital 320 yuan/times.According to the policy,Trouble free do 2 times per week per person hemodialysis uremic patients,Calculated at 52 weeks each year,10300 patients at least 340 million yuan for free.

　　谁来给“免费大餐”埋单？ Who is going to give"A free meal"Foot the bill?

　　江西省卫生厅副厅长曾传美介绍，江西主要采取“统筹卫生资源，降低医疗成本”的做法。2011年8月，江西省出台《尿毒症免费血透救治工作方案》，规定从2012年1月1日开始实施免费救助，治疗费用由医疗机构承担10%、新农合承担70%、民政医疗救助承担20%。为实施好这项工程，江西省财政安排专项资金1.35亿元，购买主要设备、耗材，并批量招标采购，市场价格20万元的血透机，采购价仅为几万元，耗材每人次也大幅下降100多元。

Jiangxi province health department was appointed deputy director-general of the who ChuanMei is introduced,Jiangxi mainly adopts"As a whole health resources,Reduce health care costs"The practice of.In August 2011,Jiangxi province has[Uremia hemodialysis treatment scheme for free],Provisions from January 1, 2012 began to implement free aid,Treatment costs borne by the medical institutions was 10%/New farmers bear the 70%/Home medical care bear 20%.Good for the implementation of the project,Jiangxi province government allocated 135 million yuan for special funds,Buy the main equipment/consumables,And batch bidding procurement,Market price of 200000 yuan of hemodialysis machine,Purchase prices of tens of thousands of yuan,Supplies each time also plunged 100 multivariate.

　　动用上亿资金，救助患者，这对于并不发达的江西来说，很不容易，即使在发达的地区也没有出现类似免费样本。事实上，江西免费救助的不仅仅是尿毒症。“光明·微笑”、城乡儿童“两病”和尿毒症“免费血透”三大重大疾病免费救治工程，让21.15万例白内障患者复明，9126例唇腭裂患者绽放笑容，440例白血病患儿和5700例先天性心脏病患儿得到免费救治，也让10300名困难尿毒症患者摆脱了经济压力。还将有4.4万名符合条件的重性精神病患者得到免费治疗。

The use of hundreds of millions of money,Rescue patients,This for is not developed in jiangxi province,It's not easy,Even in developed area also have no similar samples free of charge.In fact,,Free assistance in jiangxi province is not only a uremia."Bright smile,"/Urban and rural children"Two conditions"And uremia"Free hemodialysis"Three major disease free treatment engineering,211500 patients with cataract surgery,Smile, 9126 cases of cleft lip and palate patients,440 cases of children with leukemia and 5700 cases of children with congenital heart disease receive free treatment,Difficulty also asked 10300 uremia patients get rid of the economic pressure.There will be heavy psychosis 44000 eligible patients get free treatment.

　②大病救助不容易 (2) a serious illness is not easy to salvage

　　——疾病经济负担增长势头远高于GDP增幅，单靠医保会非常吃力 - the disease economic burden of momentum is far higher than GDP growth,Health care alone will be very hard

　　救助大病不是件容易的事。为了救治这些大病患者，江西想出了各种办法、调动起各种资源，“集中专家、集中资源、集中救治”。全省确定并公布了161家定点医疗机构、首批151名乡镇卫生院血液净化技术从业医务人员可为患者做免费血透，72家乡镇卫生院列为定点卫生院。为县、乡级定点医疗机构配置血透机、水处理机、除颤仪等主要设备。累计培训人员近2000人次。江西同时鼓励慈善机构对患者进行资助，探索建立多层次的基本医疗保障体系。

Illness is not easy.In order to treat these patients with a serious illness,Jiangxi came up with ways to/Mobilize the resources,"Centralized specialist/Pooling resources/Centralized treatment".The province shall be determined and published 161 fixed-point medical institutions/The first 151 towns and townships blood purification technology from medical personnel can do free for patients with hemodialysis,72 towns and townships as a designated hospitals.For the county/Township medical establishment that decide a dot configuration of hemodialysis machine/Water processor/Defibrillation apparatus, etc. The main equipment.Training staff nearly 2000 people.Jiangxi encourages charities to support patients at the same time,Explore to establish multi-level basic medical security system.

　　市县也在努力。为了方便尿毒症患者就医，去年新建县花200多万元在恒湖卫生院和生米卫生院各建了一个血透室，而且乡镇目录类药品报销比例达到95%。

Cities and counties are also trying to.For the convenience of uremia patients go to a doctor,New county more than 200 200 yuan last year in constant lake institutes and uncooked rice institutes built a hemodialysis room each,And the villages and towns directory class drug reimbursement ratio reached 95%.

　　除此之外，还有一系列的繁琐工作要做。据新建县人民医院副院长吴向东介绍，经过体检、抽血检查、肾功能检测，确认患者后，再确认是否要长期透析治疗。在病人身份确认中，要看户口、身份证，审核是不是当地居民，是不是贫困家庭户、低保户或低保边缘户。

In addition to this,There are a series of complicated work to do.According to the county people's hospital, vice President of the new Wu Xiangdong is introduced,After a check-up/Blood check/Renal function tests,After confirmed patients,Then decide if we need to long-term dialysis treatment.In the patient's identity,Depends on the account/Id card,Audit whether the local residents,If poor households/Low edge or low income households.

　　这是一项浩大的工程。如果全国都来对大病患者进行救助，又需要多少力量呢？

This is a huge task.If the country came to rescue the patients with serious illness,And how much power?

　　卫生部公布的第四次国家卫生服务调查主要结果显示，经推算，2008年，全国有医生明确诊断的慢性病病例数达到2.6亿。心脏病和恶性肿瘤等被我们称为“大病”的病例数每年激增。

The fourth national health services survey released by the ministry of health of mainly according to the results,By the calculation,In 2008,,Doctors across the country have a definitive diagnosis of 260 million cases chronic diseases.Heart disease and malignant tumors etc. We called"A serious illness"The number of cases surge in every year.

　　庞大的患者人群带来沉重的疾病负担。经测算，2010年我国疾病直接经济负担为2万亿元，间接负担约2.8万亿元，两者合计为4.8亿元，相对于当年GDP的12%。值得注意的是，疾病经济负担增加趋势远远大于GDP的增幅。与1993年相比，GDP增长11倍，疾病负担增加14倍。

Large patient population to bring heavy burden of disease.By measuring,Direct economic burden of disease in China in 2010 for $2 trillion,Indirect burden of about 2.8 trillion yuan,Both total is RMB 480 million,Compared to 12% of GDP.It is worth noting,Increased economic burden is greater than that of GDP growth.Compared with 1993,GDP growth of 11 times,Disease burden by a factor of 14.

　　靠谁来化解疾病负担？很多人会想到医保。比如新农合几乎全覆盖，参合8.3亿人，按年人均筹资300元计算，保费规模在2500亿元左右。然而，在卫生总费用飞速增长、并超过2万亿元的今天，医保的力量也让人堪忧。仍以新农合为例，保障水平并不算高，但每年节余很少。“公立医院的改革没完全到位，这会反过来影响资金的使用效率。”华中科技大学同济医学院教授姚岚说。这意味着，仍然存在的公立医院“以药补医”会“补”出很多不应该有的花费。医保的按项目付费方式也会刺激不合理费用的增长。

To dissolve the burden of disease by who?Many people think of health care.Such as the new farming and almost completely covered,Accounting for 830 million people,According to the calculation to raise 300 yuan per year,The premium scale in 250 billion yuan.however,Rapid growth in the total health expenses/And more than $2 trillion today,The power of the medical insurance also let a person worry.Still to new farming as an example,Security level is not high,But little savings each year."Public hospital reform is not fully in place,This will in turn affect the use of the efficiency of funds."Tongji medical college huazhong university of science and technology professor Yao Lan said.This means that,Remain in public hospitals"With medicine cure"will"fill"Spend a lot should not have.Health care according to the project payment method also stimulates the unreasonable cost growth.

　　此外，还有很多疾病治疗的成本效益不一定很好，这也是新农合选择20种疾病进行保障的原因之一。

In addition,There are a lot of the cost effectiveness of treatment is not necessarily good,This is also new farming and select 20 kinds of diseases to protect one of the reasons.

　　而且，疾病负担还不仅仅指的是看病费用。

and,The disease burden is not only refers to the treatment cost.

　　程细保和何凤桃对此深有体会。程细保去年的自费药费2000余元，而坐车和透析前营养费就达到6000元。他平常坐乡镇客运车来回要12元，如果遇上春运、重大节日和恶劣天气，车子就会随时涨价。程细保是每周二、五下午到县城做血透，1月4日星期五，那天下了大雪，他的来回车费达到30多元，春运期间，有的日子来回透析一趟还要40块钱。何凤桃是每周二、五上午血透，她每天早上5时40分坐143路车到南昌，然后坐211路车到县医院，这样做公交车来回6元钱。如果坐乡镇客运先到县城，然后坐环行车到县医院来回需要16元钱。为了每次节约10元车费，她对公交班线掌握得清清楚楚。

Cheng bao and He Fengtao have experience greatly.Range coverage out-of-pocket expenses for medicine, last year, more than 2000 yuan fine,And rode and dialysis before YingYangFei reached 6000 yuan.He usually take the villages and towns passenger transportation back and forth to 12 yuan,If meets the Spring Festival/Major holidays and bad weather,The car will be rise in price at any time.Range coverage is fine every Tuesday/Five in the afternoon to the town in hemodialysis,On January 4th, Friday,Under the heavy snow that day,His back and forth the fare up to 30 yuan,During the Spring Festival,Some days back and forth dialysis to 40 yuan.He Fengtao is every Tuesday/Five hemodialysis in the morning,She every morning at 5 40 points take bus 143 to nanchang,And then take bus 211 to county hospital,Do the bus back and forth 6 yuan.If take the villages and towns passenger go to the county town,Then sit back and forth ring road to the county hospital need 16 yuan.Every time in order to save 10 yuan fare,Her to the bus master clearly class line.

　③借社会之力做“加法” (3) through the power of social"The addition"

　　——大病如灾，应整合政府、社会、个人、慈善的力量，最大限度避免“看不起病”、“因病返贫”现象发生 - a serious illness such as disaster,Should integrate the government/social/personal/The power of charity,The maximum to avoid"Look down on disease"/"Chinese because of illness"phenomenon

　　去年8月，我国出台了开展城乡居民大病保险的指导文件。今年初，卫生部公布，新农合大病保障扩容至20种疾病，并在全国全面推开。于是，很多地方采取了“基本医保+大病保险+医疗救助”，或“新农合大病保障+大病保险+医疗救助”的大病救助模式。

In August last year,Introduced to carry out the urban and rural residents in China a serious illness insurance guidance documents.Earlier this year,The ministry of health announced,New farming and serious security capacity to 20 kinds of diseases,And implemented across the country.so,Many places adopted"The basic medical insurance, serious illness insurance and medical treatment",or"New farming and a serious illness, serious illness insurance and medical treatment"Rescue mode of a serious illness.

　　效果已初步显现。全国最早运行大病保险制度的青海省，已有500多名大病患者受益，并衔接上了基本医保、民政医疗救助制度。

Effect has been preliminarily revealed.The earliest run a serious illness insurance system of qinghai province,More than 500 patients with serious illness,And cohesion in the basic health care/Civil affairs medical assistance system.

　　中华医学会党委书记饶克勤提供了新农合大病保障的数据。截至2011年底，新农合大病保障试点全国累计救治儿童白血病、先心病、终末期肾病等重大疾病患者23万多人，2012年前三季度，有65万患者纳入重大疾病保障，获得相应补偿。儿童先心病、白血病的实际补偿比例达到77%和74%，终末期肾病等6类疾病的实际补偿比达到67%，肺癌等12个新增试点疾病的实际补偿比达到59%左右。“2013年开始，也可以先由新农合按照政策范围内不低于70%的比例进行报销，对补偿后个人自付超过城乡居民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。”

Party secretary of the Chinese medical association RaoKeQin provides new farming and serious security data.By the end of 2011,New farming and serious security pilot national treatment for childhood leukemia/Congenital heart disease/Major diseases such as end-stage renal disease in patients with more than 230000 people,2012 years ago in the third quarter,With 650000 patients included in the major disease protection,The right to obtain corresponding compensations.Congenital heart disease in children/Leukemia compensation ratio reached 77% and 77% in real terms,End-stage renal disease and diseases of the actual compensation ratio reaches 67%,12 new pilot diseases such as lung cancer the actual compensation ratio reaches 59%."Began in 2013,Can also first by new farming and carried out in accordance with the policy within the scope of not less than 70% of the expenses,To compensate pays more than the urban and rural residents of the individual after a serious illness insurance compensation standard part,Then by a serious illness insurance compensate proportion to the amount of no less than 50%."

　　世界银行高级卫生经济专家张硕说：“疾病造成的灾难性支出，具有公共产品的性质，应由社会保险来承担。与国内医保设立封顶线的做法不同，国际上通用的做法是对疾病支出设立止损点，即参保人看病的自付费用到达一定水平，如月收入，新增的费用就全部由保险来承担了。当然，我国现有的基本医保的筹资水平尚不能支撑这样的保障，因此考虑建立大病保险和大病保障，也是一种过渡办法。”据她介绍，世行农村卫生项目在陕西旬邑就开展了大病的二次补助，动用了各方面的筹资，如财政、社会慈善资金、民政医疗救助资金等，构建了大病救助资金。

World bank senior sanitation Zhang Shuo economic experts said:"Disease caused by catastrophic spending,Has the nature of public goods,Shall be borne by the social insurance.With the domestic health care to set up the top line,General international disease spending that is set up stop-loss point,The ginseng protect the patients out-of-pocket expenses reached a certain level,Such as monthly income,The new fees are all borne by the insurance,.Of course,,Existing in our country's basic health care funding level cannot support such guarantee,Therefore consider to establish a serious illness insurance and serious illness,Is also a kind of transition."According to her,The rural health project carried out a serious illness in shaanxi XunYi secondary benefits,With the aspects of financing,Such as financial/Social charities/Civil affairs medical rescue funds, etc,Build a bailout of a serious illness.

　　但这些保障制度都有前提条件，比如新农合只对20种大病保障；城乡居民大病保险也是有起付线的设置，并受制于各地筹资水平；医疗救助只面对特殊困难人群。大病救助如何更给力？

But these security system there are prerequisites,Such as the new farming and only about 20 kinds of serious illness protection;Urban and rural residents since there is a serious illness insurance pay for line setup,And subject to local funding level;Medical assistance only face special difficulties in the crowd.A serious illness how aid is more powerful?

　　长期在基层工作、接触不少低收入大病患者，吴向东认为，对于特殊病种，应该考虑去掉入院门槛线，也就是住院的报销起付线。

At the grass-roots level for a long time/Contact with many low-income patients with serious illness,Wu Xiangdong think,For a particular disease,Remove the admission threshold line should be considered,Is the hospital reimbursement starting line.

　　除了减轻看病经济负担，吴向东认为，如果有可能，当地政府可以把未列入低保对象的尿毒症患者纳入低保救助范围。因为尿毒症患者基本丧失了劳动能力，如果纳入低保的话，可以解决他们的基本生活问题。据悉，新建县现在已经取消了低保户、五保户的报销起付线费。

In addition to see a doctor to reduce the economic burden,Wu Xiangdong think,If it is possible,The local government can put the object was not included in low uremia patients included in the scope of threshold.Because uremic patients lose labor ability basically,If included in the low,Can solve the problem of their basic life.It is understood,Xinjian county has now cancelled the low-income residents/Reimbursement of infirm pay line.

　　吴向东还建议，应像“春蕾工程”一样，发动妇联、共青团、工商联，给特别困难的大病患者子女一些照顾。吴向东也联系过一个企业，但是发现单靠自身去做，能力有限，更希望全社会关注这部分困难群体。“政府、社会、个人、慈善的力量，也许应该做些加法，给予大病患者最有效的救助。”

Wu Xiangdong also suggested that,Should be like"Spring bud project"As well as,A women's federation/The communist youth league/Federation of industry and commerce,Some patients with serious illness children care for particularly difficult.Wu Xiangdong also contacted a company,But found themselves alone to do it,Ability is limited,More hope the whole society pay close attention to this part of the disadvantaged groups."The government/social/personal/The power of charity,Maybe should do addition,For patients with serious illness, the most effective relief."

　　鉴于当前的筹资水平较低，专家建议关注医保的“出水口”，着力于控制费用，推行最优的治疗方案，在保证质量的前提下，实行按病种付费等控费措施。

In view of the current funding level is low,Experts suggest that focus on health care"outlet",Focus on cost control,To implement the optimal treatment plan,On the premise of guarantee quality,Macro-reforms, etc is carried out control measures.

　　“关键是建立一个全社会的保障体系。”姚岚认为，这个保障体系，能让各种制度衔接起来，有较高的保障能力，即充足的资金和高水平的服务能力。“当然，个人也有责任，必须要参保，尽自己的责任。”(记者 吴齐强 李红梅)

"The key is to build a security system of the whole society."Yao Lan think,The security system,To link up all kinds of system,The guarantee of high ability,Sufficient funds and a high level of service ability."Of course,,The individual also has the responsibility,Must want to join,Do your duty."(Reporter Wu Ji Li Gongmei)