| | |
| Opinions of the General Office of the State Council on Comprehensively Implementing Critical Illness Insurance for Urban and Rural Residents | | 国务院办公厅关于全面实施城乡居民大病保险的意见 |
| (No. 57 [2015] of the General Office of the State Council) | | （国办发〔2015〕57号） |
| The people's governments of all provinces, autonomous regions, and municipalities directly under the Central Government; all ministries and commissions of the State Council; and all institutions directly under the State Council: | | 各省、自治区、直辖市人民政府，国务院各部委、各直属机构： |
| Critical illness insurance for urban and rural residents (hereinafter referred to as critical illness insurance) is an expansion and extension of the basic medical security system and a new systematic arrangement that gives a further guarantee to residents if large amount of medical expenses are incurred from their critical illness. Since its beginning, the pilot program of critical illness insurance has advanced the coordinated reform of medical insurance, medical treatment and medicine, promoted the combination of government leadership and allowing market mechanism to play its role, improved the management and operation efficiency of the basic medical security and effectively eased the problem of poverty caused by illness and return to poverty caused by illness. For purposes of accelerating the advancement of the development of the critical illness insurance system, consolidating the bottom line of the national basic medical security and allowing more people to benefit, with the approval of the State Council, the following opinions are hereby offered: | | 城乡居民大病保险（以下简称大病保险）是基本医疗保障制度的拓展和延伸，是对大病患者发生的高额医疗费用给予进一步保障的一项新的制度性安排。大病保险试点以来，推动了医保、医疗、医药联动改革，促进了政府主导与发挥市场机制作用相结合，提高了基本医疗保障管理水平和运行效率，有力缓解了因病致贫、因病返贫问题。为加快推进大病保险制度建设，筑牢全民基本医疗保障网底，让更多的人民群众受益，经国务院同意，现提出以下意见。 |
| I. Basic principles and objectives | | 一、基本原则和目标 |
| (1) Basic principles | | （一）基本原则。 |
| 1. Adhering to people-oriented security for critical illness. A critical illness insurance system shall be established and improved, the level and accessibility of services of critical illness security shall be improved, the health rights and interests of the people shall be protected in particular and the fact that the people become impoverished or return to poverty resulting from illness shall be effectively avoided. | | 1.坚持以人为本、保障大病。建立完善大病保险制度，不断提高大病保障水平和服务可及性，着力维护人民群众健康权益，切实避免人民群众因病致贫、因病返贫。 |
| 2. Adhering to overall coordination and coordinated policies. The connection between basic medical insurance, critical illness insurance, medical aid, illness emergency aid, commercial health insurance, charitable aid and other systems shall be enhanced to play the role in coordination and mutual complementation, output sufficient security momentum and form joint security force. | | 2.坚持统筹协调、政策联动。加强基本医保、大病保险、医疗救助、疾病应急救助、商业健康保险和慈善救助等制度的衔接，发挥协同互补作用，输出充沛的保障动能，形成保障合力。 |
| 3. Adhering to government leadership and professional undertaking. While the functions of the government in policy making, organization and coordination, supervision and management and other aspects are strengthened, the mode of commercial insurance institutions undertaking critical illness insurance shall be adopted and the role of market mechanism and the professional advantage of commercial insurance institutions shall be made use of, to improve the efficiency, services and quality of the critical illness insurance. | | 3.坚持政府主导、专业承办。强化政府在制定政策、组织协调、监督管理等方面职责的同时，采取商业保险机构承办大病保险的方式，发挥市场机制作用和商业保险机构专业优势，提高大病保险运行效率、服务水平和质量。 |
| 4. Adhering to steady and gradual advancement and constant implementation. The level of critical illness insurance security shall adapt to social and economic development, medical consumption level and burden tolerance of society, among others. Social mutual aid shall be strengthened and a mechanism where government, individuals and insurance institutions share critical illness risks shall be created. The adoption of measures suitable to local conditions and regulated operation shall be adhered to, to achieve the steady and sound operation and sustainable development of critical illness insurance. | | 4.坚持稳步推进、持续实施。大病保险保障水平要与经济社会发展、医疗消费水平和社会负担能力等相适应。强化社会互助共济，形成政府、个人和保险机构共同分担大病风险的机制。坚持因地制宜、规范运作，实现大病保险稳健运行和可持续发展。 |
| (2) Major objectives | | （二）主要目标。 |
| Prior to the end of 2015, the critical illness insurance shall cover all insured persons of the basic medical insurance for urban residents and new-type rural cooperative medical insurance (hereinafter collectively referred to as basic medical insurance for urban and rural residents) and effectively ease the burden of medical treatment on residents with critical illness. By 2017, a relatively complete critical illness insurance system shall be established to closely connect medical aid and other systems to jointly play the role of security floor, effectively prevent catastrophic family medical expenditure and significantly improve the equality of medical security for urban and rural residents. | | 2015年底前，大病保险覆盖所有城镇居民基本医疗保险、新型农村合作医疗（以下统称城乡居民基本医保）参保人群，大病患者看病就医负担有效减轻。到2017年，建立起比较完善的大病保险制度，与医疗救助等制度紧密衔接，共同发挥托底保障功能，有效防止发生家庭灾难性医疗支出，城乡居民医疗保障的公平性得到显著提升。 |
| II. Improving the fund-raising mechanism for critical illness insurance | | 二、完善大病保险筹资机制 |
| (1) Scientifically calculating the fund-raising standards All regions shall scientifically, meticulously and effectively calculate funds based on the social and economic development, high medical costs incurred by critical illness and fund-raising ability and payment level of the basic medical insurance as well as the guarantee level of critical illness insurance and other factors, and reasonably determine the fund-raising standards of critical illness insurance. | | （一）科学测算筹资标准。各地结合当地经济社会发展水平、患大病发生的高额医疗费用情况、基本医保筹资能力和支付水平，以及大病保险保障水平等因素，科学细致做好资金测算，合理确定大病保险的筹资标准。 |
| (2) Stabilizing fund sources. A certain proportion or amount shall be allocated from the basic medical insurance funds for urban and rural residents as the funds of critical illness insurance. Regions with a surplus of basic medical insurance funds for urban and rural residents shall make use of the surplus to raise funds of critical illness insurance; regions with an insufficient surplus or without a surplus shall make arrangement with the funds raised annually. The mechanism of multiple-channel fund raising for basic medical insurance for urban and rural residents shall be improved to ensure the sustainable development of the system. | | （二）稳定资金来源。从城乡居民基本医保基金中划出一定比例或额度作为大病保险资金。城乡居民基本医保基金有结余的地区，利用结余筹集大病保险资金；结余不足或没有结余的地区，在年度筹集的基金中予以安排。完善城乡居民基本医保的多渠道筹资机制，保证制度的可持续发展。 |
| (3) Raising overall arrangements and plans. The critical illness insurance shall be subject to city-level (prefecture-level) overall arrangements and plans and provincial-level overall arrangements and plans or uniform policy and uniform organization and implementation in the whole province (autonomous region or municipality directly under the Central Government) shall be encouraged, to improve the ability to resist risks. | | （三）提高统筹层次。大病保险原则上实行市（地）级统筹，鼓励省级统筹或全省（区、市）统一政策、统一组织实施，提高抗风险能力。 |
| III. Improving critical illness insurance guarantee | | 三、提高大病保险保障水平 |
| ．．．．．． | | ．．．．．． |
Dear visitor,you are attempting to view a subscription-based section of lawinfochina.com. If you are already a subscriber, please login to enjoy access to our databases . If you are not a subscriber, please subscribe . Should you have any questions, please contact us at:
+86 (10) 8268-9699 or +86 (10) 8266-8266 (ext. 153)
Mobile: +86 133-1157-0713
Fax: +86 (10) 8266-8268
database@chinalawinfo.com
| |
您好：您现在要进入的是北大法律英文网会员专区，如您是我们英文用户可直接 登录，进入会员专区查询您所需要的信息；如您还不是我们 的英文用户，请注册并交纳相应费用成为我们的英文会员 。如有问题请来电咨询；
Tel: +86 (10) 82689699, +86 (10) 82668266 ext. 153
Mobile: +86 13311570713
Fax: +86 (10) 82668268
E-mail: database@chinalawinfo.com
|
| | | |
| | | |