五、全民医疗保障体系逐步健全
V. Improvement of the National Medical Security System文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
中国大力推进医疗保障体系建设，形成以基本医疗保障为主体，其他多种形式补充保险和商业健康保险为补充的多层次、宽领域、全民覆盖的医疗保障体系，初步实现了人人享有基本医疗保障。文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
China has been vigorously improving its national medical security system. Now, a multi-layered and wide-ranging medical security system covers the whole population, mainly supported by basic medical security, and supplemented by various forms of supplementary insurance and commercial health insurance. The country has preliminarily realized basic healthcare for every citizen.文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
基本医疗保险实现全覆盖。以职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗为主体的全民医保初步实现。截至2016年底，全国基本医疗保险参保人数超过13亿人，参保覆盖率稳固在95%以上。2016年，国家正式启动城镇居民基本医疗保险和新型农村合作医疗两项制度整合，统一覆盖范围、统一筹资政策、统一保障待遇、统一医保目录、统一定点管理、统一基金管理，逐步在全国范围内建立统一的城乡居民基本医疗保险制度，实现城乡居民公平享有基本医疗保险权益。文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
Basic medical insurance covers all urban and rural residents. The whole population is now covered by medical insurance, which is mainly composed of basic medical insurance for working urban residents, basic medical insurance for non-working urban residents, and the new type of rural cooperative medical care. By the end of 2016, basic medical insurance had more than 1.3 billion recipients nationwide – a coverage of above 95 percent. In 2016, China officially integrated basic medical insurance for non-working urban residents and the new type of rural cooperative medical care, to unify insurance coverage, funding policies, insured treatment, reimbursement catalogues, management of contracted medical institutions and fund management. In this way, the system of basic medical insurance for urban and rural residents was established step by step, so that urban and rural residents now enjoy equal access to basic medical insurance.文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
基本医疗保险保障能力和可持续性进一步增强。2016年，全年职工基本医疗保险基金收入和支出分别为10274亿元和8287亿元，比2012年分别增加4212亿元和3419亿元，年均增长率分别为15.7%和15.6%；全年城镇居民基本医疗保险基金收入和支出分别为2811亿元和2480亿元，比2012年分别增加1934亿元和1805亿元。2017年，城乡居民基本医疗保险财政补助标准继续提高，各级财政人均补助标准达到每人每年450元。
Support for basic medical insurance schemes and its sustainability have been increasing. The income and expenditure of the basic medical insurance fund for working urban residents in 2016 were RMB1,027.4 billion and RMB828.7 billion respectively – RMB421.2 billion and RMB341.9 billion more than those of 2012, representing an annual increase of 15.7 percent and 15.6 percent on average. The income and expenditure of the basic medical insurance fund for non-working urban residents were RMB281.1 billion and RMB248 billion, respectively – RMB193.4 billion and RMB180.5 billion more than those of 2012. In 2017, government subsidies for basic medical insurance for non-working urban and rural residents are increased, with annual per capita subsidies at all levels reaching RMB450.
基本医疗保险待遇水平逐步提高。2016年，职工基本医疗保险和城镇居民基本医疗保险基金的最高支付限额分别达到当地职工年平均工资和当地居民年人均可支配收入的6倍，政策范围内住院费用基金支付比例分别为80%和70%左右。2017年，新型农村合作医疗门诊和住院费用的报销比例分别稳定在50%和70%左右。《国家基本医疗保险、工伤保险和生育保险药品目录（2017年版）》西药、中成药部分共收载药品2535个，比旧版目录增加339个，增幅约15%，基本涵盖了《国家基本药物目录（2012年版）》中的治疗性药品。对部分具有重大临床价值且价格高昂的专利独家药品，政府组织医保药品谈判，准入36个药品，治疗领域覆盖多种恶性肿瘤、部分罕见病及慢性病。新增部分医疗康复项目纳入基本医疗保险支付范围。
Basic medical insurance benefits have been improved. In 2016, the payment caps of the basic medical insurance for working urban residents and for non-working urban residents were six times local employees’ average salary of the year and local residents’ per capita disposable income of the year, respectively; inpatient reimbursement rates from basic medical insurance were about 80 percent and 70 percent, respectively. In 2017, outpatient and inpatient reimbursement rates from the new type of rural cooperative medical care scheme are about 50 percent and 70 percent, respectively. The National Medicine List for Basic Medical Insurance, Industrial Injury Insurance and Maternity Insurance (2017) includes 2,535 items of Western medicines and Chinese patent medicines, with 339 more medicines than those in the previous list, or an increase of 15 percent, almost including all therapeutic medicines in the National Essential Medicine List (2012). As for expensive patent medicines with high clinical value, the government organized talks on medicines covered by the insurance and added 36 items to the National Essential Medicine List (2012) for the treatment of malignant tumors, and some rare and chronic diseases. Some newly added rehabilitation treatments are now covered by basic medical insurance.
基本医疗保险支付方式改革有序推进。全国70%以上地区积极探索按病种付费、按人头付费、按疾病诊断相关分组（DRGs）付费等支付方式。加快推进基本医疗保险全国联网和异地就医直接结算工作，继续推广就医“一卡通”。截至2017年8月底，全国已基本实现参保人员统筹区域内医疗费用直接结算和省内异地就医住院费用直接结算。顺利开展跨省异地就医住院医疗费用直接结算联网接入工作，全国所有省份（含新疆生产建设兵团）、所有统筹地区已全部接入国家基本医疗保险异地就医结算系统，截至2017年8月底，开通6616家跨省异地就医住院医疗费用直接结算定点医疗机构。
Forms of reimbursements from basic medical insurance have been improved. More than 70 percent of regions in China are exploring new forms of payment from basic medical insurance, such as payment by a certain category of disease, by capitation or by Diagnosis Related Groups (DRGs). The country has been building a national network of basic medical insurance, promoting cross-province real-time reimbursement from basic medical insurance, and the use of all-purpose card. By the end of August 2017, real-time reimbursements had been realized for all areas covered by basic medical insurance across the country; real-time reimbursements for cross-region inpatient medical expenses within the same province had been basically realized in the country. A national real-time reimbursement network for cross-province inpatient expenses has been put in place, and all provinces (including Xinjiang Production and Construction Corps) have joined the national network of cross-province reimbursement of basic medical insurance. By the end of August 2017, China had a total of 6,616 designated medical institutions for real-time reimbursements of cross-province inpatient expenses.
城乡居民大病保障机制不断完善。全面实施城乡居民大病保险，以解决大额医疗费用为切入点，不断完善和提高针对重特大疾病的医疗保障制度。截至2015年底，城乡居民大病保险已覆盖所有城乡居民基本医疗保险参保人。2016年，大病保险覆盖城乡居民超过10亿人，推动各省大病保险政策规定的支付比例达到50%以上，受益人员的实际报销比例提高10－15个百分点。
Serious illness insurance for urban and rural residents has been improved. China has implemented serious illness insurance for urban and rural residents, aiming to cover large medical expenses, and improve medical security for serious illnesses. By the end of 2015, serious illness insurance for urban and rural residents covered all recipients of basic medical insurance. In 2016, serious illness insurance covered more than 1 billion urban and rural residents; according to provincial policies, the serious illness insurance reimbursement rates shall be more than 50 percent, and the actual reimbursement ratio was raised by 10 to 15 percentage points.
医疗救助机制成效显著。医疗救助政策框架基本建立，医疗救助与城乡居民大病保险有效衔接，医疗救助标准和救助水平的城乡统一逐步实现。医疗救助对象范围从过去的城乡低保对象和特困人员，逐步拓展到贫困人口、低收入家庭成员和因病致贫家庭中的重病患者。各级工会积极组织开展职工医疗互助活动，对患重大疾病的职工进行帮扶，减轻患病职工经济负担。2016年，国家共安排155亿元医疗救助补助资金（不含疾病应急救助补助资金），其中92%的资金投向中西部地区和贫困地区，累计实施医疗救助8256.5万人次，资助困难群众参加基本医疗保险5560.4万人。被救助对象在年度救助限额内住院救助的比例普遍达70%以上。医疗救助服务更加便利可及，93%的地区实现了医疗救助与医疗保险费用“一站式”结算。2013年起，国家建立疾病应急救助制度，通过设立疾病应急救助基金，对需要紧急救治但身份不明或身份明确、无力支付医疗费用的患者进行救治。截至2017年6月，累计救助患者约64万人。
Medical assistance mechanisms have made marked progress. A medical assistance policy framework has been established; medical assistance programs dovetail nicely with serious illness insurance schemes; and medical assistance criteria and capacity have become consistent in both urban and rural areas. Medical assistance recipients have been expanded from subsistence allowance recipients and people in dire poverty to the poverty-stricken population, low-income household members and critically-ill patients in illness-stricken poor families. Trade unions at all levels have been organizing employees’ mutual aid for medical expenses, to help employees with serious illnesses and reduce their financial burden. In 2016, China appropriated RMB15.5 billion in medical assistance subsidies (excluding illness emergency assistance subsidies), 92 percent of which went to central and western regions, and poverty-stricken areas, assisted 82.565 million cases, and helped 55.604 million people with financial difficulties to receive basic medical insurance. The proportion of inpatient recipients within the annual limit exceeded 70 percent. Medical assistance services have become more convenient, as 93 percent of the country has realized one-stop reimbursement from medical assistance funds and basic medical insurance. In 2013, China set up an illness emergency assistance fund to help unidentified patients who need immediate treatment, or identified patients who cannot afford the related medical expenses. By June 2017, some 640,000 patients had received help from the fund.
农村贫困人口医疗保障水平逐步提高。2016年，国家开始实施健康扶贫工程。对农村贫困人口实现城乡居民医保、大病保险全覆盖，农村贫困人口政策范围内住院费用报销比例提高5个百分点。组织动员全国80多万工作人员，对因病致贫返贫家庭，精准调查核查发病率高、费用高、严重影响生产生活能力的93种重点病种，建立起健康扶贫工作台账和数据库。组织对患有大病和慢性病的农村贫困人口进行分类救治，截至2017年5月，全国已分类救治贫困患者260多万人。实行精准的大病保险倾斜性支付政策，对农村贫困人口在起付线、报销比例、封顶线等方面给予重点倾斜。推进农村贫困人口县域内住院先诊疗后付费和“一站式”即时结算。安排全国889家三级医院承担对口帮扶任务，对所有贫困县1149家县级医院实现帮扶全覆盖。
Medical security for the rural poverty-stricken population has been improved. In 2016, China started to implement poverty relief through healthcare. Now the rural poverty-stricken population is fully covered by both basic medical insurance and serious illness insurance for urban and rural residents. The inpatient reimbursement rates for the rural poverty-stricken population have been raised by more than five percentage points. China has mobilized over 800,000 medical workers to visit illness-and-poverty-stricken families, and investigate 93 major diseases with high occurrence, high treatment costs and severe impact on work and life, thereby keeping a record and setting up a database for poverty relief through healthcare. The country provides categorized treatment to rural poverty-stricken population suffering from serious illnesses and chronic diseases. By May 2017, China had given such treatment to over 2.6 million people. The country has adopted preferential policies favoring the rural poor with respect to reimbursement from serious illness insurance. China implements a policy of treatment before payment and one-stop reimbursement for rural poverty-stricken inpatients at county-level hospitals. In addition, China has designated 889 Grade III (top-level) hospitals to assist 1,149 county-level hospitals in all poverty-stricken counties across the country.
