突破体制限制，鼓励社会资本办儿科 Breakthrough system limit，Encourage social capital do pediatrics

　　记者对话：解决“儿科难”要有新思路(上) Reporter dialogue：solve“Pediatric difficult”To have new ideas(on)

　　新闻背景 News background

　　近年来，儿科看病难日益突出。不少家长有这样的经历，一大早带孩子去挂号，到输液结束出医院已是黄昏时分。同时，申城4家儿科专科或特色医院(儿科医院、儿童医院、儿童医学中心、新华医院)也面临空前压力，今年1月至5月门急诊总数达230多万人次，接近全市服务量1/2，同比上升了20%左右。上周一，上海市儿童医学中心门急诊实际就诊5700多人，创历史纪录，而当天挂号数超过了6000，意味着有不少患儿和家长因候诊时间太长而放弃就诊。

In recent years，Pediatric difficulties in getting increasingly。Many parents have such experience，Early in the morning to take children to register，To end the hospital is already infusion at dusk。At the same time，Shen four pediatric college or special hospital(Pediatric hospital、Children's hospital、Children's medical center、Xinhua hospital)Also facing pressure，This January to may this a total of more than 230 people，Close to half the city services，About 20% year-on-year。Last week，Shanghai children's medical center this actual clinic of more than 5700 people，"Historical records，And that registered number more than 6000，Means that there are many children and parents for the waiting time is too long and give up attendance。

　　提升儿科服务能力是医改的重要任务之一。据悉，本市一方面要求“四大儿科”内部挖潜，通过改建行政用房为病区等办法，提升服务能力20%左右；同时规划增加床位，“四大”5年内将新增1230余张床。此外，鼓励综合性医院恢复儿科病房和急诊，规定新建医院儿科床位不能低于总床位数10%，并发掘现有二级医院儿科潜力，引导病人有序就医。

Ascension pediatric service ability is one of the important tasks of cure。It is reported，This city on the one hand requirements“Four big pediatric”Internal tapping，Through the rebuilding administrative housing for the way such as ward，Increasing the service ability of about 20%；At the same time planning increase beds，“four”Five years more than 1230 new bed。In addition，Encourage general hospital in pediatric ward and restore the emergency，New hospital beds pediatrics provisions should not be below the total ChuangWeiShu 10%，And explore existing level 2 hospital pediatric potential，Guide patient orderly medical attention。

　增床位仅是救急之策 The bed is only the strategy of emergency

　　傅贤伟：现在孩子基本上都是独生子女，一旦生病家长往往带孩子去三级专科医院就诊，沪上“四大儿科”扩容，应该说很有针对性。

FuXianWei：Now the child is basically only children，Once the sick children to level 3 parents often specialized subject hospital，Shanghai“Four big pediatric”expansion，Should say very specific。

　　孙刚：此举除了满足本市儿童需求，对外地来沪就医的患儿也是个“利好”。统计显示，今年1-5月，“四大儿科”就诊中非本市居保患儿占了54%，住院开刀近80%是外地患儿。“四大”扩容，将进一步提高上海医疗服务全国尤其是长三角地区的能力。

SunGang：The move in addition to meet the demand of this city children，Foreign to Shanghai is also a doctor of children“good”。Statistics show that，1 this year-may，“Four big pediatric”The children in the city hospital central Africa accounted for 54%，Hospital operation is nearly 80% of children of the outside。“four”expansion，Will further improve Shanghai medical service national especially the ability of the Yangtze river delta region。

　　傅贤伟：不过业内专家也指出，专科医院增扩床位只是应急的治标之策。就像道路扩容赶不上车辆增速一样，市民对优质医疗资源的需求不断提高，新增床位很快就会被消化掉，所谓“水多了加面，面多了加水”，无法根本上解决儿科看病难。

FuXianWei：But industry experts also pointed out，Specialized subject hospital beds add expansion of the strategy of emergency just battles。Like road vehicles as expansion miss growth，Citizens of the high-quality medical resource demand of continuous improvement，New beds will soon be wiped out，The so-called“More water add a face，Surface much the water”，Unable to solve the difficulties in getting pediatrics。

　　孙刚：扩容床位也面临种种客观条件限制，带来新的难题。比如儿科医生本就紧缺，新增床位后医生增量从何而来？床位增加意味着门诊量进一步上升，相应的就医空间哪里去找？

SunGang：Expansion bed also confronted with various objective conditions restrictions，Brought new problems。For example the pediatrician shortage，After new beds doctor incremental come from？Beds MenZhenLiang rise further increase means，The corresponding doctor space where to find？

　　傅贤伟：集中优质资源加强少数大医院的做法，虽然短期内能一定程度上缓解供需矛盾，但从长期看却有一个根本弊端，就是形成巨大的漩涡效应，进一步压缩周边或其他综合医院儿科的发展空间。上世纪九十年代上海各大医院的儿科发展比较均衡，不少综合性医院儿科科研、人才实力不逊于专科医院，但后来专科医院越做越大，政府投入也有倾向性，以至于综合性三级医院儿科逐渐衰落，更不用提二级医院儿科了。因此专家坦言，一味给专科医院做增量，并非儿科全面均衡发展的良策。

FuXianWei：Focus on high quality resources to strengthen the practice of a few big hospital，Although short-term can get some relief, the contradiction between supply and demand，But in the long run but had a fundamental drawbacks，Is a huge circle effect，Further compression peripheral or other general hospital pediatric development space。The 1990 s Shanghai each big hospital of the pediatric relatively balanced development，Many comprehensive hospital pediatric research、Personnel strength not comparable to specialized subject hospital，But then specialized subject hospital bigger and bigger，Governments also have the inclination，That comprehensive level 3 hospital pediatric gradually decline，Not to mention of the second class hospitals pediatrics。So experts said，Blindly to specialized subject hospital do deltas，Not full of balanced development of pediatric shareholder。

　　公益事业也可民办 Public welfare undertakings can also be private

　　傅贤伟：现在本市增强儿科服务能力的措施，基本上限于公立医疗资源内部的调整布局、理顺关系，靠的是政府财政不断加大投入。

FuXianWei：Now this city pediatric service ability enhancement measures，Basically limited to public medical resources internal adjustment layout、Rational relations，By government financial constantly increasing input。

　　孙刚：当然，儿科等妇幼保健事业，公益性质不言而喻，政府和公办医疗机构责无旁贷，理应起主导地位。问题是，公益性事业一定必须政府一包到底吗？提升儿科服务能力，一定要在公立医院框架内实现吗？

SunGang：Of course，Such as pediatrics maternity and child care business，Public welfare nature is self-evident，The government and the public health agency responsibility，Should play a leading position。The problem is，Public welfare undertakings to be a pack of government to the end？Ascension pediatric service ability，Must be in public hospital framework implementations？

　　傅贤伟：现在的儿科、产科爆棚现象，与上世纪八九十年代商品供应短缺有些类似。当时，靠几家国有生产企业、国有商业企业拼尽全力，也始终难以满足市民需求。而随着改革开放不断深入，尤其是鼓励发展多种所有制企业，这个问题才真正解决，一大早就去菜场排队、通宵达旦抢购紧俏商品的景象一去不返。卫生事业是否可以借鉴经济发展的成功经验？不少专家表示，解决儿科看病难要有新思路，要跳出目前只靠财政投入、政府举办的旧框框。应创造条件，破除体制限制，鼓励引进包括外资在内的社会资本举办儿科。

FuXianWei：Now of the pediatric、Maternity befriending phenomenon，And s commodity supply shortages some similar。At that time，By several state-owned production enterprise、Desperate to state-owned commercial enterprise，Always hard to meet demand and citizens。And with the opening and reform deepening，Especially encourages the development of diversified forms of ownership enterprise，That this problem was really solve，Early in the morning to go to CaiChang line up、Early hours surfing snapping up hot product picture of the quest。Whether health can draw lessons from the successful experience of economic development？Many experts say，Solve the pediatric difficulties in getting calls for new ideas，About to jump out at present only by the financial investment、The government JiuKuangKuang held。Shall create conditions，Break system limit，Encourages the introduction of foreign capital, including the social capital of the pediatric held。

　　孙刚：目前人们认识中的社会办医，要么是部分高端或外籍人士的特需服务，要么是美容、眼科、牙科等，且是违规经营、过度医疗、乱收费的“重灾区”。而如果放眼国际可以发现，社会资本办医与公立医院是其医疗服务体系中的平等组成部分，具有公益性质的基本医疗包括妇幼保健事业，有很大比例是由非国有的社会医疗机构承担的。从理论上讲，社会事业由全社会举办，不分公立民营，也是题中应有之义。将儿科认为只能由政府举办，也只有公立医院才愿意举办，实在是个大大的误区，是自我设限。

SunGang：At present people know the social do cures，Or is part of the high-end or foreign nationals of the special consultation service，Or is beauty、eye、Dental etc，And is illegal business、Excessive medical、Fees of“hard-hit”。And if scan widely international can be found，Social capital to do medical and public hospital is the medical service system in the equal part，Nonprofit nature including basic medical maternity and child care business，A large proportion of the social medical treatment is non-state-owned institution shall bear。In theory，Social cause by the society hold，Regardless of public private，Also is the subject should be contained in righteousness。Will that can only be held by the government pediatrics，Also only public hospital to hold，It's a greatly error，Is self-handicapping。

　　傅贤伟：从大背景来说，正是依靠不断改革开放，不断破除旧体制的瓶颈与束缚，激发全社会的资源和活力，才使得我国近几十年来经济社会取得了举世瞩目的重大成就。医疗卫生领域也应如此。

FuXianWei：The background from it，Is to rely on continuously reform and opening up，Continuously break the bottleneck of the old system and bondage，Arouse all social resources and energy，That made our country economic society in recent decades have achieved remarkable great achievements。Medical health field should be like this。

　　开放市场是根本之策 Open the market is the basic strategy

　　傅贤伟：近年来，鼓励社会办医的政策不断出台。2010年5月，国务院颁布了“关于鼓励和引导民间投资健康发展的若干意见”(“新36条”)，明确指出：“鼓励民间资本参与发展医疗事业。支持民间资本兴办各类医院、社区卫生服务机构、疗养院、门诊部、诊所、卫生所(室)等医疗机构……支持民营医疗机构承担公共卫生服务、基本医疗服务和医疗保险定点服务。 ”2010年底，国家发改委、卫生部等5部门联合发布《关于进一步鼓励和引导社会资本举办医疗机构的意见》，提出改善社会资本办医的执业环境，包括放宽对社会资本办医的准入，符合条件的民营医院将纳入医保定点范围，享受和公立医疗机构一样的税收和价格政策等。

FuXianWei：In recent years，Encourage social do medical policies introduced gradually。May 2010，The state council issued“About encourage and guide the healthy development of the private investment in some opinions”(“Article 36 the new”)，Explicitly pointed out that：“Encourage private capital participating in the development of medical cause。Support folk capital by all kinds of the hospital、Community health service agencies、Nursing homes、clinic、clinic、Health center(room)Medical institutions such as......Support the private medical institution shall bear the public health service、Basic medical care and medical insurance designated service。 ”By the end of 2010，The national development and reform commission、Ministry of health and other 5 departments jointly issued《On further encourage and guide the social capital held the opinions of the medical institution》，Puts forward to improve social capital to do the practice of medical environment，Including to relax the social capital of the access to medical，Meet the conditions of the civilian battalion hospital medical insurance will put into the designated area，Enjoy and public medical institutions of the same tax and price policy and so on。

　　孙刚：今年3月出台的国务院医改 “十二五”规划，对社会办医提出了明确的量化指标，即到2015年，实现非公立医疗机构床位数和服务量分别达到医疗机构总数和服务总量的20%左右。此外，卫生部部长陈竺在多个场合演讲时强调，公立医疗机构不能再负债搞建设、盲目扩张，要为民间资本、社会资本进入卫生行业、满足不同层次的需求留出空间。

SunGang：In march this year on the introduction of the cure of the state council “1025”planning，To do the medical society put forward the quantitative index，That is 2015 years，Realize the public health care institutions and services to the total number of medical institutions are about 20% of the total amount and service。In addition，Health minister Chen middle&small on many occasions when the speech emphasized，Public medical institutions can't liabilities to construction、Blind expansion，For private capital、Social capital into the health care industry、Meet different demand of white space。

　　傅贤伟：可以说，引入社会资本举办儿科，在政策上已经没有障碍。根据国外经验，社会资本办医自己解决场地、开办资金、工作人员，还分担了政府的基本医疗功能，何乐不为？而从市民角度看，之所以非大医院不去，是因为周边地区要么没有儿科，要么对其水平不放心。如果有资质过硬、口碑良好的儿科医生在社区开业，市民遇到孩子感冒发烧拉肚子等小病，就不会舍近求远，起到了真正的分流作用。

FuXianWei：Can say，Introducing social capital held in pediatrics，In the policy has no obstacle。According to foreign experience，Social capital to solve medical field、Open capital、staff，Also Shared the government's basic medical function，He le？From the perspective of citizens，Are the big hospital not to go，Because the surrounding areas or no pediatrics，Either the level is not assured。If there is a high qualification、Public praise good pediatrician in community practice，People meet children cold fever have loose bowels etc ailment，Won't SheJinQiuYuan，A real split role。

　　孙刚：除了社区举办诊所合理分流患儿，还可引入有实力的社会资本开办儿童专科医院，以其明晰的产权定位、灵活的经营方式，与现有公立医院儿科开展良性竞争，以鲇鱼效应“倒逼”公立机构改善服务、提高质量。总之，打破固有框框，敞开市场大门，引进社会资本，使其成为公立医院儿科的有力补充，能有效缓解政府财力不足局面，尽快增强儿科整体服务能力，从根本上缓解儿科看病难。(记者 傅贤伟 孙刚)

SunGang：In addition to the community clinic children held reasonable divergence，Still can bring in the strength of the social capital open specialist children's hospital，With its clear property rights positioning、Flexible mode of operation，And the existing public hospital in pediatrics benign competition，With the catfish effect“DaoBi”Public institutions to improve service、Improve quality。In short，Break inherent frame，Open the market of，Introduction of social capital，Make it a public hospital of pediatrics powerful added，Can effectively relieve the government insufficient financial situation，Enhance the overall service ability pediatrics as soon as possible，Fundamentally relieve difficulties in getting pediatrics。(Reporter FuXianWei SunGang)