摘要：2009年新医改大病医保作为一项新举措进入公众视线。但大病医保蕴藏着无立法保障、缺乏稳定基金、承办方式有风险等制度缺陷，财政投入不足、患病人群缺公平、公立医院丢公益也为制度的保障埋下了隐患，制度主体的道德风险和逆向选择也使制度利益无法最大化。必须通过完善立法、加大财政投入、推进公立医院改革、引入社会力量、与大病保障相衔接等措施来完善它。

关键词：大病医保；新医改；立法；社会力量；大病保障

Abstract: A serious illness medical insurance as a new move into the public eye in the new health care reform of 2009. Through exploration of the system, I think that a serious illness medical insurance has   no legislation to guarantee stable, lack of funds, the way to undertake is risky and another system defects.Insufficient financial input, population lack of fairness, public hospital public lost welfare will make system security,has a hidden trap.Finally the moral hazard and adverse selection of system main body are also makes the system unable to maximize interests. So we needs to perfect the legislation, increase financial investment, promote the reform of public hospitals, introduce social strength,link with a serious illness guarantee and another measures to improve it.

Keywords: serious illness medical insurance; the new health reform; legislation; social forces; guarantee of a serious illness

　　城乡居民大病保险，是基本医疗保障制度的拓展和延伸，是对基本医疗保障的有益补充，是以基本医疗保障为基础，对大病患者发生的高额医疗费用给予进一步制度保障，可进一步放大保障效用，符合党十八大报告中要坚持全覆盖、保基本、多层次、可持续方针，以增强公平性、适应流动性、保证可持续性为重点，全面建成覆盖城乡居民的社会保障体系的要求。

开展这项工作，是减轻人民群众大病医疗费用负担，解决因病致贫、因病返贫问题的迫切需要；是建立健全多层次医疗保障体系，推进全民医保制度建设的内在要求；是推动医保、医疗、医药互联互动，并促进政府主导与市场机制作用相结合，提高基本医疗保障水平和质量的有效途径；是进一步体现互助共济，促进社会公平正义的重要举措。