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根据国务院要求,建立城镇职工基本医疗保险制度工作从1999年初开始启动,年底基本完成。目前,各地都在紧锣密鼓地制定医改实施方案,以确保医改工作的顺利推进。现就医改实施方案制定中的几个问题,谈点粗浅认识。一、起付标准(起付线) 通常按照门诊、住院划分个人账户和统筹基金支付范围时,为防止小病大治、医院分解住院等不合理费用的发生,对多次住院者,宜多次设立起付钱;同时考虑到患者的承受能力,起付线应逐次降低,幅度可掌握在20%左右。为有利于引导病人合理分流,起付线应按不同等级的医院分别设立。
According to the requirements of the State Council, the establishment of the basic medical insurance system for urban workers began at the beginning of 1999 and was basically completed at the end of the year. At present, all localities are working hard to formulate medical reform implementation plans to ensure the smooth progress of medical reform. Now I will discuss some issues in the formulation of medical reform implementation programs and talk about some superficial understandings. First, the payment criteria (payoff line) Generally, according to the outpatient and in-patient division of individual accounts and the overall fund disbursement range, in order to prevent the occurrence of unreasonable expenses such as minor illnesses and major diseases, hospital decomposition and hospitalization, multiple hospitalizations should be repeated several times. Set up and pay for the money; taking into account the patient’s ability to bear, the payoff line should be reduced gradually, the magnitude can be controlled at about 20%. To help guide the reasonable diversion of patients, the payoff line should be established separately for different grades of hospitals.