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class="i2i2jyu4k" id="content"> <div id="i2i2jyu4k" class="pv_box m_p ov_hi"> <div id="i2i2jyu4k" class="bw_750 fl"> <h1 class="pv_title_2"> <span id="i2i2jyu4k" class="site fr"><a href='/'>首页</a>><a href='/yl/'>要论</a>><a href='/yl/rp/'>锐评</a></span> <span id="i2i2jyu4k" class="t" id="a1"><a href="/yl/rp/">锐评</a></span> </h1> <div id="i2i2jyu4k" class="pa_0_5_0_10"> <h1 class="Content_title" id="hh"> <span id="a" style="">单靠“大病医?！辈荒苤未蟛?/span> </h1> <script>/*jQuery('#hh').width(jQuery('#a').width());*/</script> <div id="i2i2jyu4k" class="Remark"> <span>2015年08月03日 17:31 | 作者:光明网评论员 | 来源：<a target="_blank">光明网</a></span> <span id="i2i2jyu4k" class="fr">  <div id="i2i2jyu4k" class="bdsharebuttonbox"><a href="#" class="bds_more" data-cmd="more"></a><a href="#" class="bds_qzone" data-cmd="qzone" title="分享到QQ空间"></a><a href="#" class="bds_tsina" data-cmd="tsina" title="分享到新浪微博"></a><a href="#" class="bds_tqq" data-cmd="tqq" title="分享到腾讯微博"></a><a href="#" class="bds_renren" data-cmd="renren" title="分享到人人网"></a><a href="#" class="bds_weixin" data-cmd="weixin" title="分享到微信"></a></div> <script>window._bd_share_config={"common":{"bdSnsKey":{},"bdText":"","bdMini":"2","bdMiniList":false,"bdPic":"","bdStyle":"0","bdSize":"16"},"share":{}};with(document)0[(getElementsByTagName('head')[0]||body).appendChild(createElement('script')).src='http://bdimg.share.baidu.com/static/api/js/share.js?v=89860593.js?cdnversion='+~(-new Date()/36e5)];</script>  </span><span id="i2i2jyu4k" class="fr">分享到：<img src="http://www.rmzxb.com.cn/images/fx.jpg" /> </span> </div> <div id="i2i2jyu4k" class="text_box"> <p align="center"> <p> 　　光明网评论员：昨日（8月2日）新闻显示，国务院办公厅刚刚印发了《关于全面实施城乡居民大病保险的意见》，提出了拓展大病医保的路线图——</p> <p> 　　“2015年底前，大病保险覆盖所有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。”</p> <p> 　　其实，这算是个意料之中的好消息。不仅因为此前国务院医改办已经多次透漏出了改革动向，也因为大病保险全覆盖已成为医保发展的急迫诉求。如果同时考虑近些年来恶性重大疾病的发病率，和城乡居民因病致贫、因病返贫的比率，这种全覆盖虽已是紧锣密鼓试点后的结果，但来得已不算早。</p> <p> 　　也有更多的问题待解。最令人关注的是，各地报销比例差距的问题仍然会延续到全覆盖之后。虽然《意见》指出，大病医保原则上实行市级统筹，鼓励省级统筹或全省统一政策，但仍然没有改变报销比率与地方人均GDP紧密的挂钩。富裕的地方报销比例高，而贫困地区却最容易出现因病致贫现象，这种矛盾必然会削弱大病医保“托底式公平”的价值追求。</p> <p> 　　另外，大病医保虽为“大病”而设，但社会经验却显示，单靠大病医保不能治大病。对一个普通中国家庭而言，“大病”一般会成为最大的经济事件、家庭?；?、社会挫折和情感创伤，经济成本固然很大、经济以外的成本也不可计数。所以，大病医保的覆盖，也意味着基本医保、大病保险、医疗救助、疾病应急救助、商业健康保险及慈善救助等制度间的互补联动、一站式即时结算服务，也意味着医院和医疗监管部门对医疗费用的合理管控。因为，若要一个家庭弥补这些保障之间的缝隙，或问责不合理医疗费用，其成本要数倍于大病治疗本身。</p> <p> 　　如果超越“托底保障”的讨论层次，从更大的视野来看，“单靠‘大病医保’不能治大病”还意味着，应在整个医疗链条上，将疾病治疗重心前移。</p> <p> 　　上个世纪的最后几十年，无论是欧美还是日韩，都忙着治疗重症晚期病人，忙着支架、忙着透析、忙着移植、忙着放化疗。这种情况到了世纪之交开始被医学界反省。心血管界、肿瘤界、肾病界都开始认识到，将医疗重心放在治疗疾病后期、依赖各种昂贵的仪器设备和药物，不但病人、家庭和社会要付出极大的代价，而且治疗“性价比”非常低。进入新世纪，国际医学界普遍提出，必须要把疾病尤其是慢性非传染性疾病的诊断治疗前移，移到早期、移到高危人群。</p> <p> 　　在中国，已经有临床医学家提出了这个问题，并通过规模巨大的数据调查和定性定量分析，得出了高血压、心脏病、慢性肾脏病的高危人群数量、分布情况甚至治疗现状，但此类调查本身短期内仍难催动医疗力量的相应调整，仍难以对偏重“重症晚期”的治疗趋势构成反拨。充实基层医疗预防保健的力量，遏制医疗界追求门诊量和重症晚期治疗收益的惯性，和大病医保的全覆盖同样迫在眉睫。</p> <p> 　　也就是说，真要靠大病医保治大病，反而不能把所有重量都压在这最后一条紧绷的线上。</p> </div> <p class="Editor">编辑：刘文俊 </p> <div 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