撕掉“以药养医”标签： 医改迈出难得一步 tear“To raise the medical medicine”label： Taking a rare medical step

　　据新华社7月22日报道，今年7月以来，北京、深圳两地公立医院陆续取消药品加成收费，同时设立阶梯定价的医事服务费等，北京试点医院友谊医院超过1500种药品实施“零加成”，半个多月来，医保患者次均药费比照上半年次均下降了100.44元，降幅接近三成。深圳在公立医院全面取消药品加成，涉及2962种医保目录药品，药价是以前的“八五折”甚至是“七五折”。京深两地这些医改举措引起了社会各界的广泛关注。卫生部部长陈竺近日在北京友谊医院调研时表示，医改撕掉了“以药养医”的标签，取得了初步成效，下一步将适度扩大改革范围。

On July 22, according to xinhua news agency reported，Since July this year，Beijing、Shenzhen public hospitals have cancelled drug charge bonus，While establishing a ladder of medical service charge and pricing，Beijing friendship hospital more than 1500 pilot hospital of drugs enforcement“Zero bonus”，Half a month to，Health care patients second all expenses first half second all down, mutatis mutandis, 100.44 yuan，By close to thirty percent。Shenzhen public hospital in comprehensive drug bonus cancelled，Involving 2962 kind of medical insurance directory drugs，Is the drug prices before“Get a discount of”even“discount”。The two deep caused the cure of the measures of social concern。Health minister Chen middle&small recently in the Beijing friendship hospital research said，Tore down the cure of the“To raise the medical medicine”label，Acquired preliminary achievements，The next step will be moderately expand scope of reform。

　　作为解决“看病难、看病贵”的制度设计之一，医院取消药品加成收费的改革今年7月在一些地方、一些医院正式开始实施，从一些试点医院反馈的统计数据看，医药费降低效应明显，说明改革的目标和思路清晰，方向正确。“处方现在‘瘦身’了”，“药价降下来” ，试点医院一些患者的回应也在一定程度上说明了这一点，这无疑是一个令人欣喜的好的起点。

As the solution to“Difficulties in getting、High cost”One of the design of the system，Hospital reform of the bonus cancelled drug charge this year July in some places、Some hospital formally implement，Some of the feedback from the pilot hospital statistical data to see，Medical expenses reduce effects，Explain the goal and clear thinking，Right direction。“Prescription now‘Thin body’the”，“Drug prices come down” ，Some of the patients with hospital pilot have responded to a certain extent showed this point，This is undoubtedly a pleasurable good starting point。

　　总结上述医改取得的正效应，有几个方面是值得肯定的。一是医药费与医疗行为分开，实现了一些患者到大医院想看好医生不想买贵药的愿望，以前到医院看医生被绑架购买高价药的现象得到了纠正；二是药事费提高后，医生的收入与医术实现了正相关，改变了过去不管医术如何只要卖药多就能获取高收入的本末倒置现象；其三，医药分开后，一直被患者诟病的医生和医药代表之间的商业贿赂行为得到了有效遏制，患者期盼医院管好医生手中那支笔有了相对公开且可监督的制度保证。当然，好处还不止这些。

Summarize the cure of the positive effect achieved，There are several aspects is worth for sure。One is the medical expenses and medical behavior apart，Implements some patients to big hospital doctors don't want to buy expensive to value the desire of the medicine，Previously to the hospital to see the doctor kidnapped the phenomenon of medicine to buy high prices got the correct；2 it is drug fee increase，The doctor's medical income and realized the positive correlation，No matter how to change the past medical sell more medicine as long as can get high income is putting the cart before the horse phenomenon；thirdly，Separated medicine，Has been for patients with doctors and medical representatives of between commercial bribery got effectively，Looking forward to the hospital after the doctor hands with the pen with relatively open and the supervision system guarantee。Of course，Benefits not stop there。

　　好的开始是成功的一半。目前取消药品加成的医改正效应还只是初步的，只是医改大局的一小步。这一小步走得是否扎实，关系到未来的医改大局。因此，必须及时总结经验，巩固成果。从公众的回应看，在肯定成效的同时，还有一些担忧。如“大处方审核”机制能否有效预警；出现医生和医药代表勾连行为，医院能否坚决处理；药事费、挂号费是否存在部分病种的一律上限加高；医院会不会“拆东墙补西墙”延续惯性的获利冲动，将药费损失通过其他方式实行平移，最终“羊毛出在羊身上”等等。

A good beginning is half of success。At present the correct bonus cancelled drugs medical effects are just preliminary，The big picture is a giant leap cure。This is one small step for man walked solid，Relationship into the future of cure of the overall situation。so，To summarize the experience，Consolidate results。From the public response to see，At the same time in sure effect，And some concerns about。if“DaChuFang audit”The effectiveness of the early warning mechanism；Doctors and medical representative appear link behavior，The hospital can firmly processing；Pharmacy fee、The registration fee whether there are part of the disease are heightening the upper limit；Hospital will not“Robbing Peter to pay Paul”Continue the inertia profit impulse，The expenses for medicine loss through other means of translation，finally“The wool in the sheep”, etc。

　　患者的关切是有道理的，应该引起有关方面关注，并将这些可能导致改革迟滞的因素通过更加有操作性的方式逐一解决。破解“以药养医”的改革举措只是医改大局的“冰山一角”，要解决“看病难、看病贵”，还需要内容更周全、措施更得力、监督更有力的大动作。

The concerns of the patients is reasonable，Should arouse the attention，And these may lead to reform the hysteresis factor through the more operational way addressing。crack“To raise the medical medicine”Reform measures just overall medical“The tip of the iceberg”，To solve“Difficulties in getting、High cost”，Need more complete content、More effective measures、Supervision and more powerful big action。

　　比如，大医院挂号难一直是老大难问题，现在尽管实现了网上挂号，但一些医院3个月内的号基本挂完，患者无法快速挂号，尤其对于外地患者更是无奈；医生服务态度恶劣问题，在屡屡发生的医患纠纷中，一些医生的态度冷漠和不负责任是一个重要原因，能否彻底更改，需要制度跟进；医药费用不细化，小病大费用的现象在一些地方还比较普遍，怎样进行病种费用封顶，也在考验医疗改革的国民福利性；医事活动不公开、医疗责任主体不明确等问题也都亟待有效化解。

For example，Big hospital has been registered difficult long-standing problem，Now although realize the online registration，But some hospitals 3 months, the basic hang out，Patients cannot quickly registered，Especially for the nonlocal patients is helpless；The doctor service attitude bad problems，In the ongoing medical disputes，Some doctors attitude indifference and irresponsible is an important reason，Can completely change the，Need to follow up the system；The medical expenses not refined，The phenomenon of cost in large ailment some places are more common，How disease to seal a top cost，Also in the reform of medical test national welfare；The medical activities not public、Health main responsibility unclear to effectively solve problems as well。

　　上述问题解决得好坏，直接关系到医改的成效。医改措施的设计需要付出极大心力，需要更多的经验辅助。朝着患者的利益至上，急患者所急、想患者所想，减轻患者负担这个大方向走下去，迈出一步，夯实一步，我们离成功的医改目标才会越来越近。(郭振纲)

The above problem solving the quality，Directly related to the cure of the results。The design of the cure of the measures need to pay a great heart，Need more experience of AIDS。In the interests of the patients first，Urgent patients are worried、Want to patients want，Reduce burden the general patients go down，step，Ramming step，We were successful cure of the goal can be more and more close。(GuoZhenGang)