——基本醫(yī)療保障制度覆蓋城鄉(xiāng)居民。截至2011年,城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)、新型農(nóng)村合作醫(yī)療參保人數(shù)超過13億,覆蓋面從2008年的87%提高到2011年的95%以上,中國已構(gòu)建起世界上規(guī)模最大的基本醫(yī)療保障網(wǎng)。籌資水平和報(bào)銷比例不斷提高,新型農(nóng)村合作醫(yī)療政府補(bǔ)助標(biāo)準(zhǔn)從最初的人均20元人民幣,提高到2011年的200元人民幣,受益人次數(shù)從2008年的5.85億人次提高到2011年的13.15億人次,政策范圍內(nèi)住院費(fèi)用報(bào)銷比例提高到70%左右,保障范圍由住院延伸到門診。推行醫(yī)藥費(fèi)用即時結(jié)算報(bào)銷,居民就醫(yī)結(jié)算更為便捷。開展按人頭付費(fèi)、按病種付費(fèi)和總額預(yù)付等支付方式改革,醫(yī)保對醫(yī)療機(jī)構(gòu)的約束、控費(fèi)和促進(jìn)作用逐步顯現(xiàn)。實(shí)行新型農(nóng)村合作醫(yī)療大病保障,截至2011年,23萬患有先天性心臟病、終末期腎病、乳腺癌、宮頸癌、耐多藥肺結(jié)核、兒童白血病等疾病的患者享受到重大疾病補(bǔ)償,實(shí)際補(bǔ)償水平約65%。2012年,肺癌、食道癌、胃癌等12種大病也被納入農(nóng)村重大疾病保障試點(diǎn)范圍,費(fèi)用報(bào)銷比例最高可達(dá)90%。實(shí)施城鄉(xiāng)居民大病保險(xiǎn),從城鎮(zhèn)居民醫(yī)?;?、新型農(nóng)村合作醫(yī)療基金中劃出大病保險(xiǎn)資金,采取向商業(yè)保險(xiǎn)機(jī)構(gòu)購買大病保險(xiǎn)的方式,以力爭避免城鄉(xiāng)居民發(fā)生家庭災(zāi)難性醫(yī)療支出為目標(biāo),實(shí)施大病保險(xiǎn)補(bǔ)償政策,對基本醫(yī)療保障補(bǔ)償后需個人負(fù)擔(dān)的合規(guī)醫(yī)療費(fèi)用給予保障,實(shí)際支付比例不低于50%,有效減輕個人醫(yī)療費(fèi)用負(fù)擔(dān)。建立健全城鄉(xiāng)醫(yī)療救助制度,救助對象覆蓋城鄉(xiāng)低保對象、五保對象,并逐步擴(kuò)大到低收入重病患者、重度殘疾人、低收入家庭老年人等特殊困難群體,2011年全國城鄉(xiāng)醫(yī)療救助8090萬人次。
The basic medical care systems cover both urban and rural residents. By 2011, more than 1.3 billion people had joined the three basic medical insurance schemes that cover both urban and rural residents, i.e., the basic medical insurance for working urban residents, the basic medical insurance for non-working urban residents, and the new type of rural cooperative medical care, with their total coverage being extended from 87% in 2008 to 95% in 2011. This signaled that China has built the world's largest network of basic medical security. Medical care financing and the reimbursable ratio of medical costs have been raised, and the government subsidy standards for the new rural cooperative medical care system were increased from 20 yuan at the beginning to 200 yuan per person per year in 2011, benefiting 1.315 person/times in 2011 as against 585 person/times in 2008. The reimbursement rate for hospitalization expenses covered by relevant policies has been raised to around 70%, and the range of reimbursable expenses has been expanded to include outpatient expenses. Real-time reimbursement has been adopted for medical expenses, making it more convenient for people to have their medical costs settled. Reform has been carried out in respect of the forms of payment to include payment by person, payment by disease and total amount pre-payment, enabling medical insurance to play a better restrictive role over medical institutions as well as to control expenses and compel the medical institutions to improve their efficiency. Critical illness insurance has been included in the new type of rural cooperative medical care system. By 2011, some 230,000 patients of congenital heart disease, advanced rental diseases, breast cancer, cervical cancer, multidrug-resistant tuberculosis and childhood leukemia had been granted subsidies for major and serious diseases, with the actual subsidies accounting for 65% of their total expenses. In 2012, lung cancer, esophagus cancer, gastric cancer and eight other major diseases were included in the rural pilot program of insurance for the treatment of major diseases, and the reimbursement rate reached as high as 90%. Critical illness insurance has been introduced for both urban and rural residents, in which certain amounts of money are earmarked in the medical insurance fund for non-working urban residents and that of the new type of rural cooperative medical care to buy critical illness insurance policies from commercial insurance companies, aiming to relieve urban and rural families of the heavy burden of catastrophic medical spending. The policy of subsidy for critical illness insurance, which covers no less than 50% of the actual medical costs, provides a guarantee for the compliance costs to be shouldered by the individual after reimbursement from the basic medical insurance. This has effectively reduced the financial burden of individuals. An urban-rural medical assistance system has been established and improved, which at first covered urban and rural subsistence allowance recipients and childless and infirm rural residents who receive the so-called "five guarantees," and is now extended to cover those who are severely ill and have low comes, the severely disabled, senior citizens from low-income families, and some other groups with special difficulties. In 2011, the urban-rural medical assistance was granted to 80.90 million cases across the country.