深圳地方补充医保实施效果及其今后五年思考

The Implementing Effect of ShenZhen Supplementary Medical Insurance and Thoughts for Next Five Years

深圳地方补充医保制度建立于"十五"时期,经过"十一五""十二五"时期政策调整,制度日臻完善,颇具特色。2014年末,参加基本医保的1157.83万人全部参加了地方补充医保,最高支付限额达100万元,超过100万元的再报销50%,有效化解了重特大疾病风险和"因病致贫"。本文重点介绍了深圳地方补充医保的主要政策和做法,对实施效果进行了分析。对我国医保体系构建、职工大额医疗互助与居民大病保险的整合等社会关注的问题进行思考,期望"十三五"期间能建成助力基本医保、可有效化解重特大疾病风险和防范"因病致贫"的补充医保制度。

The local supplementary medical insurance system of Shenzhou was initiated during the period of the ＂Tenth Five-year＂, and adjusted during the period of the ＂Eleventh and Twelfth Five-year＂, which is constantly improved with its own characteristics. Since 2014, all 11.5783 million participants have supplementary insurance, with a highest payment of 1 million, and 50% reimbursement when the cost is over 1 million. As a result, it has effectively relived the burden of serious diseases and prevented the risk of poverty caused by serious diseases. We especially introduced the main policies and methods to carry out local supplementary medical insurance in Shenzhou, and analyzed the implementing effect. We also think about the construction of medical insurance system, and the social concerning problems such as the integration of large amount medical assistance for employees and serious diseases insurance for residents with a expectation to build a supplementary medical insurance system which can assist basic medical insurance and effectively relieve the burden of serious diseases and prevent the risk of poverty caused by serious diseases.