金融学院知识库

经过十多年的发展与变革，我国的医疗保障体系在不断完善，并且取得显著成果。但综合来说，我国已有的医疗体系为人们提供的保障水平还较低，特别是面对重疾的抗击能力还很弱。对于中低收入人群来说，患重疾产生的高昂的医疗费用，对于一个家庭造成的负担还是非常沉重，所以还需要进一步完善我国的医疗保障机制。大病保险这个概念是在2012年由国家六部委发布的指导意见中提出的，目的在于进一步减轻大病患者的医疗费用重担，这个是对于已经存在的基本医保的补充。随着大病保险在全国范围的开展，解决了部分人群由于患病陷入贫困的事件发生。

甘肃省在2013年4月份指定庆阳、定西、金昌三个城市为首批试点城市。由于试点城市实施效果很好，于是2014年在全省范围内推行城乡居民大病保险。根据医保局统计数据可以看出大病保险对于重病患者医疗费用的报销比例有了很大提高，这表明大病保险进一步完善了甘肃省的医疗保障体系，使得大病患者医疗费用报销比例进一步提高，自身负担的医疗费用金额减少。从2013年-2019年至今已有6年时间，大病保险具体实施过程中的存在的一些问题也值得我们关注。

本文通过对甘肃省大病保险基金进行研究，首先通过分析2013年-2019年大病保险的发展现状，主要从以下几个方面进行分析：大病保险的发展历程及基本原则、保障机制（分为参保人群、报销及筹资标准、承办主体三个部分）、基金筹集及使用情况、补偿情况；其次通过计算大病保险的人均补偿额、预测大病保险未来10年的参保人数，得出在不同的报销比例下大病保险基金的累积结余，通过上述预测分析城乡居民大病保险的可持续性，得出甘肃省大病保险基金在报销比例较高的情况下存在大额缺口。通过在上述分析基础上，从筹资机制、保障机制以及监管方面提出促进甘肃省城乡居民大病保险基金可持续发展机制完善的建议。

After a period of ten years of development , the medical security system in Gansu Province is improving and has achieved remarkable results. My country's existing medical system provides people with a relatively low level of protection, especially in the face of severe illness. For low-income groups and middle-income groups, the very high medical expenses caused by serious illnesses are heavy for a family. Therefore, it is necessary to improve my country's medical security mechanism. The concept of critical illness insurance was put forward in the guidance issued by the six national ministries and commissions in 2012. With the development of critical illness insurance nationwide, the occurrence of some people falling into poverty due to illness has been resolved.

Gansu Province designated Qingyang, Dingxi, and Jinchang as the first batch of pilot cities in April 2013. As the pilot cities have been implemented very well, they implemented major illness insurance for urban and rural residents across the province in 2014. According to the statistics of the Medical Insurance Bureau, it can be seen that the reimbursement ratio of critical illness insurance for the medical expenses of patients with severe illness has been greatly improved. This data shows that critical illness insurance has perfected the medical security system in Gansu Province. This has further increased the reimbursement ratio of medical expenses for patients with serious illnesses. The amount of medical expenses borne by severely ill patients has been reduced. The amount of medical expenses decreased. It has been 6 years from 2013 to 2019, and some problems in the implementation of critical illness insurance are also worthy of our attention.

This article conducts research on the Gansu Provincial Critical Disease Insurance Fund. First, analyzes the development status of critical illness insurance from 2013 to 2019. It analyzes the following aspects: the development process and basic principles of critical illness insurance, and the guarantee mechanism fund raising and use, compensation; secondly, by calculating the per capita compensation amount of critical illness insurance, predicting the number of people participating in critical illness insurance in the next 10 years, it is concluded that the cumulative balance of the critical illness insurance fund under the reimbursement ratio .Through the above prediction and analysis of the sustainability of the urban and rural residents’ critical illness insurance, it is concluded that there is a large gap in Gansu’s critical illness insurance fund with a high reimbursement ratio. On the basis of the above analysis, it puts forward suggestions to improve the sustainable development mechanism of Gansu's urban and rural residents' serious illness insurance fund from the aspects of financing mechanism, guarantee mechanism and supervision.