国家医疗保障局待遇保障司司长樊卫东在国家医保局举行的国务院政策例行吹风会上透露，全国政策范围内住院医疗费用基金支付比例达到70%左右，基金的年度最高支付限额能够达到当地居民年人均可支配收入的6倍左右。这一政策的实施，有效减轻了参保居民的医疗费用负担，保障了基本医疗需求。
樊卫东介绍，居民医保一直坚持权责对等原则，城乡居民只要按规定缴费参加居民医保，就可以享受相应的待遇。居民医保实行市地级统筹，各地的具体保障政策因各地经济发展水平、基金承受能力有所差异。但总体来看，全国政策范围内住院医疗费用基金支付比例达到70%左右，基金的年度最高支付限额能够达到当地居民年人均可支配收入的6倍左右，有效保障了居民的住院医疗需求。
在保门诊方面，居民医保也提供了全面的保障。普通门诊、门诊慢性病、特殊疾病以及高血压糖尿病门诊用药均可保障。各地普遍把治疗周期长、对健康损害大、费用负担重的慢性病、特殊疾病门诊费用纳入基金支付范围，同时开展普通门诊统筹，保障了参保人在定点医疗机构发生的普通门诊费用。
此外，居民医保还保大病，无需另行缴费即可享受城乡居民大病保险待遇。参保人患病住院后发生的高额医疗费支出，通过基本医疗保险报销后，个人自付费用还可以通过大病保险进一步保障。大病患者报销水平在基本医保报销基础上再提高至少15个百分点，大大减轻了参保患者的费用负担。
最后，居民医保还保生育，保障了参保人生育分娩后可按照相关流程进行报销。国家医保局坚决贯彻落实党中央、国务院积极生育支持政策，指导各地持续加强生育医疗费用保障，保障水平也在稳步提升。
这一系列措施，不仅有效保障了居民的医疗需求，也减轻了居民的医疗费用负担，是社会保障体系的重要组成部分。随着政策的不断完善和实施，居民医保将更好地服务于民，保障人民群众的健康生活。
英语如下：
News Title: “New Health Insurance Policy: 70% Coverage for Hospitalization Costs”
Keywords: Health Insurance, Reimbursement, Ratio
News Content: At a regular press conference for the implementation of the National Health Insurance Administration’s policies, Director Fan Weidong of the Department of Treatment Security of the National Medical Insurance Administration disclosed that the proportion of hospitalization medical expenses within the scope of national policies that are covered by the insurance fund has reached approximately 70%, with the annual maximum payment limit for the fund being around 6 times the local residents’ annual per capita disposable income. This policy has effectively reduced the financial burden of medical expenses for insured residents and ensured their basic medical needs.
Fan Weidong explained that resident health insurance has always adhered to the principle of equitable rights and responsibilities. Urban and rural residents who comply with the regulations and pay the fees can enjoy the corresponding benefits. Resident health insurance is implemented at the municipal and county levels, with specific policy differences due to local economic development levels and fund bearing capacity. However, overall, the proportion of hospitalization medical expenses within the scope of national policies that are covered by the insurance fund has reached approximately 70%, with the annual maximum payment limit being around 6 times the local residents’ annual per capita disposable income, effectively ensuring the medical needs of residents during hospital stays.
Regarding outpatient care, resident health insurance also provides comprehensive coverage. Regular outpatient care, chronic illness outpatient care, special disease care, as well as the medication for hypertension and diabetes can all be covered. Localities generally include long-term treatment diseases, chronic illnesses, and special diseases with significant health damage and heavy financial burden in the fund’s payment range, and also carry out regular outpatient care pooling to ensure the outpatient expenses incurred by insured individuals at designated medical institutions.
Moreover, resident health insurance also covers major illnesses, with no additional fees required for residents to enjoy the benefits of major illness insurance in urban and rural areas. After a resident suffers from a major illness and is hospitalized, the high medical expenses incurred can be reimbursed by the basic health insurance, with further protection through major illness insurance for the individual’s self-paid expenses. The reimbursement level for patients with major illnesses is at least 15 percentage points higher than that of basic health insurance, significantly reducing the financial burden on insured patients.
Finally, resident health insurance also covers maternity, ensuring that insured individuals can be reimbursed after giving birth according to the relevant procedures. The National Medical Insurance Administration has resolutely implemented the proactive support policies for childbirth issued by the Central Committee of the Communist Party of China and the State Council, guiding localities to continuously strengthen the medical expenses guarantee for childbirth, with the level of protection steadily improving.
These measures not only effectively ensure the medical needs of residents but also reduce their financial burden, making them an important part of the social security system. As the policy continues to be perfected and implemented, resident health insurance will serve the people better and ensure a healthy life for the people.
【来源】http://www.chinanews.com/life/2024/08-01/10261653.shtml
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