“医药分开”开门红的启示 “Medicine separate”Make a revelation

　　近日，据北京市卫生局有关负责人透露，该市自公立医院改革以来，医保患者次均药品费用下降约30%；在部分医院实施的付费制度改革，也使住院例均费用减少1384元，下降8.3%。

recently，According to the Beijing health bureau chief discloses about，Since the city's public hospitals since the reform，Health care patients second all drug costs down about 30%；In part of the implementation of the hospital pay system reform，And in both cases in hospital costs reduced 1384 yuan，Down 8.3%。

　　这对勇啃“硬骨头”的北京市医改而言，无疑是一个开门红。

The yong chew“Hard stuff”Beijing for the cure，It is a perfect start。

　　公立医院是医改的主战场。其最为困难的所在，是长期以来公立医院在政府补贴不足的情况下，不得不依靠药品、检查等收入维持自身运行。在这种政策惯性中，医院多把医生收入与所开处方、所列检查等挂钩，致使“大处方”、“大检查”愈演愈烈，进而酿成备受诟病的“看病难、看病贵”。

Public hospital is the cure of the Internet。Its most difficult place，For a long time in a public hospital is the lack of government subsidies，Had to rely on drugs、Check for sustained operation income。In this policy of inertia，Hospital doctor income and have more than a prescription、Check the link listed etc，cause“DaChuFang”、“examination”intensified，And then for a much“Difficulties in getting、High cost”。

　　北京市宣布，从7月1日开始，北京友谊医院在全国率先试点公立医院改革的重要目标——“医药分开”。其内容是，自7月1日开始，北京友谊医院终止药品加成15%的成规，提高医疗服务价格、医疗服务收费，以图理顺医疗价格体系。

Beijing announced，From on July 1，Beijing friendship hospital in the national pilot takes the lead in public hospital reform important target--“Medicine separate”。Its content is，Since on July 1，Beijing friendship hospital terminated drugs established rules of 15% bonus，Improve the medical service prices、Medical service charge，In an effort to straighten out of medical price system。

　　目前看来，北京友谊医院的“一升一降”，基本达到了医院、患者双满意的效果。据北京市卫生局负责人介绍，从医院而言，实施医事服务费可为医院带来1.5亿元的年收益，而该院2011年的药品加成收入为1.26亿元，两者基本持平，达到平移的目的；而医保患者每人次医药费用从449.97元降至381.51元，减少68.46元，下降了15.21%；次均药品费用从344.42元降至241.02元，减少103.4元，下降了30.02%。

Now it looks，Beijing friendship hospital“A liter of a drop”，Basic to the hospital、The effect of the patients with double satisfaction。According to the Beijing health bureau chief introduction，For from the hospital，Implementation of the medical service charge can bring $150 million for the hospital in income，And the 2011 years of drugs for 126 million yuan bonus income，Both flat，To achieve the purpose of translation；And each time health care patients medical costs fell to 381.51 from 449.97 yuan RMB，Reduce 68.46 yuan，Down 15.21%；Second all drug cost 344.42 yuan from dropped to 241.02 yuan，Reduce 103.4 yuan，Down 30.02%。

　　不过，距离真正理顺医疗价格体系，北京市的改革还只是刚刚起步。比如，北京友谊医院以往的普通挂号费是5元，这次提高到42元，涨幅颇大，但其真正的价值应该是多少，恐怕还很难说。而中国医生提供的医疗服务价格，则是长期被严重低估的。据笔者了解，三甲医院一位副主任医师的挂号费只有9元，而请理发店小工洗头一般需要10元；一级护理的收费约30元/天，而足浴按摩则多需50元/小时。显然，体现医生知识、技能的医生人力“不值钱”，反倒是药品、器械等的辅助物件“值钱”，这种医疗服务价格体系的“混乱”，还需较长时间的调整。

but，Distance of medical price system to straighten out the real，Beijing's reform was only just beginning。For example，Beijing friendship hospital past ordinary registration fee is 5 yuan，This increased to $42，Or a big，But its real value should be what it is，I'm afraid it is hard to say。And the Chinese doctors of medical services provide price，Is long been underestimated badly。According to the author know，3 armour hospital of doctor of vice director of one of the registration fee only nine yuan，And please barbershop coolies shampoo generally need to 10 yuan；Level 1 nursing fee about 30 dollars/day，And the foot bath massage is 50 RMB/hour to。obviously，Reflect the doctor knowledge、Skills doctor human“Not worth”，But is medicine、Equipment and other auxiliary objects“worth”，This medical service price system“chaos”，Also the need for a long time of adjustment。

　　此外也要看到，取消药品加成15%，还不是真正意义上的“医药分开”，也很难彻底斩断医、药之间的灰色利益链条。从国际经验和地方实践来看，公立医院改革必须得到充足的资金保障，北京市医改提出的医事服务费，能不能足额弥补取消药品加成15%后的损失，补贴资金的规模估计有多大，财政有没有能力承担等问题，仍横亘在前。

In addition also want to see，Cancel the drug addition 15%，Also are not real“Medicine separate”，Also it is difficult to complete medical lift off、Medicine of interests between grey chain。From the international experience and local practice，Public hospital reform must get adequate funding，Beijing put forward by the cure of the medical service charge，Can make up 15% of full specified amount bonus cancelled after the loss of the drug，The scale of the subsidies estimated how much，Financial problems have ability to bear，Still exists in the first。

　　而在当前公立医院改革多瞄准内部的情况下，笔者认为，需要考虑同时启动来自公立医院外部的改革，即以引入社会资本办医等手段，通过外在力量的倒逼，促使公立医院改革走向深远。(文/张冉燃)

And in the current reform of public hospitals aim more internal，The author thinks that，Need to consider and starting from the reform of public hospital outside，That is introducing social capital do medicine as means，Through the DaoBi outside forces，Prompted public hospitals to profound reform。(Wen/zhang Ran burning)