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The author:(作者)hpmailerpublished in(发表于) 2013/11/19 11:36:41 End of serious illness insurance programmes of urban and rural residents in Beijing are expected to introduce
Jinghua times dispatch (reporter Peng) who the Department has revealed that urban and rural residents has more than 25 provinces across the country have developed serious illness insurance pilot program. Xinhua learned from the relevant departments of the Beijing municipal, urban and rural residents in Beijing serious illness insurance programme implementation is expected to be in place before the end of.
Serious illness of residents in six ministries launched in August last year Medicare guidance documents, people Hu Xiaoyi, Vice Minister of the Ministry has revealed that currently has 25 provinces across the country have developed serious illness insurance pilot programme of urban and rural residents, 134 pilot cities have been identified, of which 59 pilot cities have already started and began to pay for treatment, other provinces and cities are under active preparation.
Reporters recently learned from the Beijing municipal authorities, the city's urban and rural residents are expected to be in place before the end of this year of serious illness insurance implementation plan, and will be implemented as soon as possible.
Beijing's new rural cooperative medical scheme (nrcms) is the responsibility of the health sector management, medical insurance of urban residents by the people responsible for management and social sector. The two departments have been established in the city urban and rural residents in serious illness insurance on individual scope of security groups, respectively, put forward their views and ideas, and reported to the municipal health care Office.
At present, relevant departments of the municipal healthcare Office is seeking views on the basis of further measurement and manpower levels, funding criteria and reimbursement data to determine various details.
It is understood that earlier this year, the Municipal Government has proposed that urban and rural residents to take some serious illness insurance medical insurance burden above, subparagraph in different proportions again claims in order to solve the problem of individual medical expense burden.
In this regard, the departments of Beijing municipality staff said that although subparagraph now is again reimbursed, or take the form of consolidated claims ratio and also not entirely sure, but in accordance with the unified arrangements in Beijing, residents in Beijing of serious illness insurance programme implementation is expected to be introduced during the year, reveal the mystery.
It is understood that the CIRC Beijing supervision Bureau has also issued a "on insurance of urban and rural residents in Beijing sickness insurance business management related issues notice", explicitly opening serious illness insurance business insurance company branch office in Beijing, in Beijing should be consistent with the health insurance special business operated continuously for more than 3 years and proven experience in the health insurance management requirements. The notice requirements, comply with the provisions of the insurance company branches, such as willingness in Beijing to conduct insurance business, shall submit a written report to the Council. This means that insurance companies have begun to urban and rural residents in Beijing will soon launch serious illness insurance competition.
Construction
Pay how to calculate only fair
At present, the annual per capita disposable income of urban residents and the per capita annual net income of rural residents to pay, in this regard, Renmin University of China Department of social security, labor and personnel Director Chou Yulin believes that this is a relatively fair approach. She describes, from the perspective of international experience, complementary medical insurance, one way is according to the disease claims, but to the definition of disease is difficult to meet all kinds of medical insurance needs, it tends to cause some controversy. In a certain amount as a payment line, ease of operation, is relatively fair. Therefore generally taken with a certain income, as the pay practices but to the relatively objective and reasonable.
Introduced diseases medical insurance of urban and rural residents was designed to address poverty resulting from sickness, but some set a cap line in the area. Capital University of Economics and business Department of labor Deputy Dean, Faculty of Economics, labour and social security Director Zhu Junsheng analysis, primarily associated with the ability to take financial and social security funds. Also set the CAP line or to save public resources to prevent the "hanging bed" resurgence in such phenomena.
But Zhu Junsheng also believes that the introduction of medical insurance of urban and rural residents, closer to the level of its workers ' health care treatment, as well as addressing poverty resulting from sickness must be positive, but it is not the decisive factor. In his view, can really address the core element of the poverty resulting from sickness, still further substantive health care reform and reduce medical fees, offset the price of medicines and medical supplies. Especially aimed at the public hospitals, but also to speed up the reform of the strength and breadth to tackle its high medical prices and gradually eliminate a lot the rational use of medicines and other ills. In this way, poverty resulting from sickness will gradually acquire a fundamental change.
Recommended
Migrants should be included in coverage
Serious illness of residents in many areas of medical insurance programmes has not come, Zhu Junsheng called for flows of foreign workers are also on the ground should be around into the scope of protection.
Zhu Junsheng says, if not these people into the scope of protection on the ground, then consider opening urban and rural residents of Medicare reimbursement of offsite function. So as to better protect the interests of floating population, promoting the mobility of these people jobs.
Zhu Junsheng also suggested that business insurance more deep involvement in China's social security system, build businesses, trade unions, Governments and insurance pillars supporting the social security system, multi-level security, you can more effectively disperse risk everyone's social security.
Chou Yulin said, is now available from large areas of medical insurance for urban and rural residents and manpower at the municipal level, the implementation of provincial level co-ordinating rarely. While national authorities had repeatedly proposed to improve the co-ordination of social security in our country, but Chou Yulin believes that low threshold is even more conducive to the rapid diffusion of new insurance products, so the initial co-ordinating level lower is the rationality and necessity.
Throughout the experience
Most paid at the high or low cost segment
Currently, Shanxi, and Henan, and Fujian, 6 provinces provides has big disease insurance funding accounted for town residents Medicare and new agricultural collection Fund years funding amount of proportion, General in 5% around; Jilin, and Hubei, and Shaanxi, and Gansu, 12 a provinces provides has specific of per capita funding lines, Supreme for Jilin, town residents Medicare and new agricultural collection respectively for per person 60 Yuan and 50 Yuan, minimum for Tibet, per person 5 Yuan. Healthcare and urban residents in most of the region to give priority to the adoption of the new rural cooperative medical fund balance or additional funding. And manpower levels, around the city (Prefectural) level co-ordinating, and imposed, Tibet, Gansu, Qinghai, Jilin provincial co-ordination.
Annual per capita disposable income of urban residents and the per capita annual net income of rural residents to pay; most provinces established according to subparagraph level payout percentage cost policy, provides for the payment of not less than 50%, costs, the higher the payout percentage is higher. Liaoning, Jilin, Gansu and other provisions do not Cap lines; 400,000 yuan of insurance in determining disease in Shanxi roof lines, called for more than 50,000 patients at his own expense and then again in accordance with 50% of the compensation. Expressly provided for urban and rural residents in Ningxia insurance payment standards and projects shall not be reimbursed.
Most of the province was taken to the commercial insurance purchased serious illness insurance contractors. In accordance with the principle of the balance of payments, capital guaranteed profit, requires proper business insurance agencies control profitability, such as Liaoning province stipulates that commercial insurers profit control in that year fundraising for serious illness insurance 3%-cent range, Inner Mongolia, Sichuan control within 5%. Some regions have established funds for risk control and regulatory mechanisms, such as Fujian requires some serious illness insurance fund balance as risk-adjusted deposit, Gansu, Guangxi, Sichuan and other provinces have identified and loss accountability mechanisms for the return of the Fund balance.
Urban and rural residents of serious illness insurance
Protection object: new rural cooperative medical insurance, urban residents of the insured.
Source of funding: from the urban residents ' health care Fund, set aside in the new rural cooperative medical Fund, additional masses are no longer personal payment burden.
Security standards: patients with high health care costs in annual terms over last year in the local annual per capita disposable income of urban residents and the per capita annual net income of rural residents as a criterion, the amount determined by the local government.
Level of protection: insurance actually paid no less than the 50%; in principle, higher medical costs, the higher the payout percentage.
Host: determining reimbursement policies of government departments, commercial insurance bodies selected through bidding to host.
(Original title: serious illness insurance of Beijing urban and rural residents are expected to end of the programme)
京华时报讯(记者赵鹏) 人社部近日透露，全国已有25个省份制定了城乡居民大病保险试点实施方案。记者从北京市有关部门获悉，京版城乡居民大病保险实施方案有望年底前出台。
六部委去年8月出台城乡居民大病医疗保险指导文件，人社部副部长胡晓义近日透露，目前全国已有25个省份制定了城乡居民大病保险试点实施方案，确定了134个试点城市，其中59个试点城市已经启动并开始支付待遇，其他省市也正在积极筹备。
记者近日从北京市有关部门获悉，今年本市有望在年底前出台城乡居民大病保险的实施方案，并将尽快实施。
北京市新型农村合作医疗(新农合)是由卫生部门负责管理，城镇居民医疗保险由人社部门负责管理。这两个部门已针对本市建立城乡居民大病保险，就各自的保障群体范围，分别提出了自己的意见和设想，并上报给了市医改办。
目前，市医改办正在征求有关部门意见的基础上，进一步测算统筹水平、筹资标准、报销比例等数据，进而确定各种细节。
据了解，今年初本市有关部门曾提议对城乡居民大病保险的参保者采取在一定负担标准之上，按不同比例分段再次报销的方式，以解决个人医药费负担重的问题。
对此，北京市有关部门工作人员表示，虽然目前是采取分段再次报销的方式，还是采取统一报销比例的方式还没有完全确定，但按照北京市的统一安排，北京市城乡居民大病保险的实施方案预计将在年内出台，揭晓谜底。
另据了解，中国保监会北京监管局近日也发布了“关于北京地区保险公司城乡居民大病保险业务资质管理有关问题的通知”，明确在京开办大病保险业务的保险公司分公司，应符合在京连续经营健康保险专项业务3年以上，具有成熟的健康保险经营管理经验等要求。该通知要求，符合规定的保险公司分公司，如有意愿在京开展大病保险业务，应向该局提交书面报告。这意味着相关保险公司已开始为北京市即将推出的城乡居民大病保险展开激烈竞争。
释疑
起付线如何计算才公平合理
目前，各地一般以城镇居民年人均可支配收入、农村居民年人均纯收入为起付线，对此，中国人民大学劳动人事学院社会保障系主任仇雨临认为，这是一种相对公平的做法。她介绍，从国际经验看，对于补充性质的医疗保险，一种方式是按病种报销，但对于病种的界定难以满足各类参保者需求，往往容易导致一些争议。以一定金额作为起付线，既便于操作，也相对公平。因此我国普遍采取的以一定收入作为起付线的做法，还属于相对客观合理的。
推出城乡居民大病医疗保险的初衷是为解决因病致贫问题，但有些地区设置了封顶线。首都经贸大学劳动经济学院副院长、劳动与社会保障系主任朱俊生分析，这主要与各地财力和社保基金承受能力有关。同时设置封顶线，也可以达到节约公共资源，防止“挂床”等现象再度抬头。
不过朱俊生也认为，城乡居民大病医疗保险的推出，对于拉近其与职工医保的待遇水平，以及解决因病致贫问题肯定具有积极意义，但却并不是决定性因素。在他看来，真正能解决因病致贫问题的核心因素，还是要进一步推行实质性的医改，降低医疗机构的收费水平，平抑药品和医用耗材的价格。尤其是针对广大公立医院，更要加快医改的力度和广度，根治其高昂的医疗价格，逐步杜绝大处方和不合理用药等痼疾。这样，因病致贫问题才会逐步获得根本性改变。
建议
将流动人口纳入保障范围
不少地区的城乡居民大病医疗保险实施方案尚未出台，朱俊生呼吁，各地应将在当地的外来流动人员也纳入保障范畴。
朱俊生表示，如果不能将这部分人纳入当地的保障范畴，那么可考虑开通城乡居民大病医疗保险的异地报销功能。这样才能更好保障流动人口的利益，促进这些人员的流动就业。
朱俊生还建议，让商业保险更加深度地介入我国社会保障体系，构建企业、职工、政府和商业保险公司多支柱支撑的社保体系，从多层次进行保障，可以更有效地分散每个人的社保风险。
仇雨临还表示，现在推出城乡居民大病医疗保险的地区多为地市一级的统筹，实行省一级统筹的还很少。虽然国家有关部门曾多次提出应提高我国社保的统筹层次，但仇雨临认为，低起点其实更利于新险种的迅速推广，因此初期统筹层次较低也是有其合理性和必要性的。
各地经验
多数地区按费用高低分段支付
目前，山西、河南、福建等6省份规定了大病保险筹资占城镇居民医保和新农合基金年筹资额的比例，一般在5%左右；吉林、湖北、陕西、甘肃等12个省份规定了具体的人均筹资额度，最高为吉林，城镇居民医保和新农合分别为每人60元和50元，最低为西藏，每人5元。多数地区要求优先通过城镇居民医保和新农合基金结余或新增资金解决。在统筹层次方面，各地以市(地)级统筹为主，吉林、西藏、甘肃、青海实行省级统筹。
各地一般以城镇居民年人均可支配收入、农村居民年人均纯收入为起付线；多数省份制定了按费用高低分段支付比例政策，规定支付比例不低于50%，费用越高支付比例越高。辽宁、吉林、甘肃等地规定不设封顶线；山西在确定的大病保险40万元封顶线外，要求对自付费用超过5万元的患者再按照50%的比例进行再次补偿。宁夏明确规定了城乡居民大病保险支付标准和不予报销的项目。
绝大多数省份采取了向商业保险机构购买大病保险的承办方式。各地按照收支平衡、保本微利的原则，要求合理控制商业保险机构的盈利率，如辽宁规定商业保险机构的盈利率控制在当年大病保险筹资额的3%—5%之间，内蒙古、四川要求控制在5%以内。一些地区建立了基金风险控制和调节机制，如福建规定将部分大病保险基金结余资金作为风险调节金，甘肃、广西、四川等省份明确了基金结余的返还和亏损的责任承担机制。
城乡居民大病保险
保障对象：城镇居民医保、新农合的参保人。
资金来源：从城镇居民医保基金、新农合基金中划出，不再额外增加群众个人缴费负担。
保障标准：患者以年度计的高额医疗费用，超过当地上一年度城镇居民年人均可支配收入、农村居民年人均纯收入为判断标准，具体金额由地方政府确定。
保障水平：保险实际支付比例不低于50%；原则上医疗费用越高支付比例越高。
承办方式：政府部门确定报销等政策，通过招标选定承办的商业保险机构。
(原标题：城乡居民大病保险京有望年底出方案)
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