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因病致贫问题影响着我国农村地区的稳定。农村居民因病致贫的主要原因有两个:就医保障水平下降和就医经济风险急增。因此,解决农村居民因病致贫的基本思路为,控制医疗费用过快增长以降低农村居民的就医经济风险,建立和完善医疗保障体制以增加农村居民的抗就医经济风险的能力。在医疗费用得以控制的前提下,“大病统筹”保险是目前及今后一段时期内增加农村居民抗就医风险能力的可行和适宜方案。如何让基层决策者理解因病致贫问题的解决和医保(或合作医疗)紧密相连,是医保(或合作医疗)推行的现实条件。在宏观政策到位,其他条件具备情况下,也就是说一地拟实施农村居民大病统筹医疗保险时,研制科学、合理和可操作的大病统筹医疗保险方案是能否达到解决因病致贫问题的关键。其中农村居民就医经济风险分析、风险临界线界定、保险给付比测算和保险费率厘定等,是农村医疗保险方案研制中迫切需要解决的关键技术,这些技术的缺乏是我国农村医疗保险或合作医疗流于形式的技术原因。本课题组拟以上述难点和空白点作为研究重点,理论结合实际,探索研制大病统筹医疗保险方案中的关键技术和技术操作步骤。
The problem of poverty due to illness affects the stability of rural areas of our country. There are two main reasons why rural residents are poor because of illness: the level of medical care is reduced and the economic risk of medical treatment is increased sharply. Therefore, the basic idea of solving the problem of poverty caused by rural residents is to control the excessive growth of medical expenses so as to reduce the economic risks of medical treatment for rural residents, and to establish and improve the medical insurance system so as to increase the rural residents’ anti-medical economic risks. Under the premise of controlling the medical costs, the “serious illness co-ordination” insurance is feasible and appropriate for increasing the anti-medical risk ability of rural residents at present and for some time to come. How to let grass-roots decision-makers understand that the solution to the problem of poverty caused by illness is closely linked with the medical insurance (or cooperative medical care) is the actual condition for the implementation of medical insurance (or cooperative medical care). When macroeconomic policies are in place and other conditions are met, that is to say, when it is planned to implement comprehensive medical insurance for rural residents with serious illnesses, it is of great significance to develop a scientific, rational and operable comprehensive medical insurance plan that can solve the problem of poverty caused by disease The essential. Among them, the rural residents medical risk analysis, the definition of the risk threshold, the insurance cost ratio calculation and the determination of premium rates are the key technologies that need to be addressed urgently in the development of rural medical insurance schemes. The lack of these technologies is the key to our rural medical insurance or cooperative medical system Fall in the form of technical reasons. The task force to be the above difficulties and gaps as the research focus, theory and practice, explore the development of serious illness integrated health insurance program in the key technologies and technical steps.