The government establishs fund of medical treatment insurance , its the charge of formal burden share with taxation privilege , worker and unit of choose and employ persons press the different scale of wage income , to the society by the month capture of insurance agency orgnaization is expended ( after the worker is retired , no longer capture is expended ) 政府建立医疗保险基金，其以税收优惠的形式负担部分费用，职工和用人单位按工资收入的不同比例，按月向社会保险经办机构缴费（职工退休后，不再缴费） 。
Abstract : the paper organizes from the practical work of medical insurance , discusses the effective method to defense the payment risk of the medical insurance fund , puts forward several countermeasures on covering more areas , increasing the income , paying in a scientific and reasonable way , confirming the payment scope and limitation , strengthening the integrative supervise administration services and so on 摘要：本文从南京市医疗保险实际工作出发，探讨防范医疗保险基金支付风险的有效途径进，就扩面增收、科学合理付费、合理确定支付范围和限额、强化综合性监督管理服务等问题提出对策。
Primary medical treatment is sure to pay policy main provision have 3 : it is to plan as a whole fund and individual account want departure government , part business accounting , as a whole fund wants balance of income and expenses , must not squeeze take individual account ; 2 it is to want to plan as a whole clearly fund and individual account pay limits severally , the requirement is made as a whole a fu biao of fund allow and highest pay limitation , individual account basically is used at outpatient service ( ailment ) medical treatment expense , as a whole fund basically is used at be in hospital ( a serious illness ) medical treatment expense ; 3 it is to want strict limit the limits of insurance medicine service mixes primary medical treatment to allow to fu biao , main content includes restriction limits of facilities of scope of the limits using drug with primary safe medical treatment , project of diagnosis and treatment and service of medical treatment life , the medical treatment cost that exceeds medicine of insurance of this primary medical treatment to serve limits is not sure to fund medium - counts pays or can pay partly only in primary medical treatment 基本医疗保险支付政策主要规定有三条：一是统筹基金和个人账户要分开治理，分别核算，统筹基金要收支平衡，不得挤占个人账户；二是要明确统筹基金和个人账户各自支付范围，要求制定统筹基金的起付标准和最高支付限额，个人账户主要用于门诊（小病）医疗费用支出，统筹基金主要用于住院（大病）医疗费用支出；三是要严格限定基本医疗保险医药服务的范围和给付标准，主要内容包括限定基本医疗保险的用药范围、诊疗项目范围和医疗生活服务设施范围，超出这个基本医疗保险医药服务范围的医疗费用不在基本医疗保险基金中支付或只能部分支付。
Following are the problems existing in our country : higher price for the medical treatment , low rate of coverage , low level of overall planning , difficult to be transferred to another hospital , low risk - resistance ability of the medical insurance premium ; low level of fund management , weak supervision , backward legislation 摘要我国医疗保险存在的问题：医疗费用高与医疗覆盖率低；统筹层次低，转诊困难与医疗保险基金抗风险能力差；基金管理水平低，监督弱化；立法滞后。
Ginseng protect a worker the charge of outpatient service medical treatment with cash settle accounts , accord with the part that primary medical treatment is sure to set and answers to pay by fund of insurance of primary medical treatment , by ginseng protect a worker to be sure by its medical treatment the concerned data such as receipt of charge of proof , id and record of outpatient service go to a doctor , medical treatment , protect clerical center to apply for to submit an expense account to designation area county doctor 参保职工以现金结算的门诊医疗费用，符合基本医疗保险规定并应由基本医疗保险基金支付的部分，由参保职工凭其医疗保险凭证、身份证以及门诊就医记录、医疗费用收据等有关资料，到指定的区县医保事务中心申请报销。
