昨天上午，市医改办召开发布会，医改办主任韩晓芳表示，继友谊医院试点“医药分开”取得良好效果后，9月1日，朝阳医院也将启动试点。明年，本市22家市属三级医院及部分专科医院、央属医院、二级医院也将逐步推广“医药分开”。

Yesterday morning，City reform, do a conference，Do HanXiaoFang medical director said，The pilot friendship hospital“Medicine separate”After obtaining good results，On September 1,，Chaoyang hospital will also start pilot。Next year，This city and home under the tertiary hospital and some specialized subject hospital、Belong to central hospital、Secondary hospital will also be promoted step by step in China“Medicine separate”。

　　

□试点效果 - pilot effect

    友谊医院医保患者自付部分降四成     Friendship hospital medical insurance patients pay forty percent since the part

　　截至8月19日，友谊医院试点“医药分开”成果明显，出现“三降三升和三个转变”。

As of August 19,，Friendship hospital pilot“Medicine separate”Results obvious，appear“Three drop three litres and three change”。

　　

三降 Three drop

　　门诊患者次均医疗费用从439.80元下降到427.11元，减少了12.69元

Clinic patients second all medical expenses from 439.80 yuan down to 427.11 yuan，Reduce the 12.69 yuan

　　门诊患者次均药费从309.77元下降到250.65元，减少了50.12元

All expenses for medicine clinic patients time from 309.77 yuan down to 250.65 yuan，Reduce the 50.12 yuan

　　医保患者自付部分从175.78元下降到105.51元，减少了70.27元。下降近40%。

Since medical insurance patients pay part from 175.78 yuan down to 105.51 yuan，Reduce the 70.27 yuan。Down nearly 40%。

　　

三升 Three litres

　　通过加强成本和费用

By strengthening the cost and expense

　　控制，医院收益率

control，Hospital rate of return

　　明显提升。

enhanced。

　　医事服务费合理体现技术劳务价值，激发了医务人员参与改革、更好地为患者服务的动力，医务人员积极性明显提升。

Medical service reasonably reflect technology labor value，Inspired medical personnel in the reform、Better for patients service power，Medical staff enthusiasm enhanced。

　　患者满意度也有所提升，门诊满意度达81.08%、住院患者对医疗质量和服务态度的满意度达96%以上。

The degree of satisfaction of patients had increased，Outpatient service satisfaction 81.08%、Hospital patients to medical quality and service attitude of the satisfaction of more than 96%。

　　

三变 Three changes

　　医院从“卖药”转变为“卖服务”，补偿机制转变

Hospital from“Sell medicine”into“Sell service”，Compensation mechanism transformation

　　大处方、过度用药得到有效控制，医生服务行为转变

DaChuFang、Excessive medication effectively control，The doctor service behavior change

　　医事服务费发挥价格杠杆作用，患者就医习惯改变，专家号好挂了。

Medical service charge play price leverage，Patients go to a doctor habits change，ZhuanGuHao good hanged。

　　市医改办主任韩晓芳介绍，从前一阶段友谊医院试点“医药分开”运行情况看，实现了预期效果，方案符合北京实际情况。通过试点，坚定了本市“医药分开”推行的信心。韩晓芳透露，继友谊医院后，9月1日朝阳医院也将启动“医药分开”。

Medical director of the city to HanXiaoFang is introduced，Once upon a time a stage friendship hospital pilot“Medicine separate”Operation see，Achieve the anticipated effect，Plan conform to the actual situation of Beijing。Through the pilot，Firm in the city“Medicine separate”The confidence of the implementation of the。HanXiaoFang revealed，After the friendship hospital，September 1 chaoyang hospital will also start“Medicine separate”。

　　如果进展顺利，年内还将推出几家试点医院。一切平稳的话，本市明年会在市属医院这个层面上推行，目前一些央属医院也有意向参加北京这一政策，下一步将根据北京的情况逐步推进。

If all goes well，Years will also launch several pilot hospital。All smooth words，The city will next year in hospital under the plane carrying out，At present some of central hospital also have intention to participate in Beijing this policy，The next step will be based on the situation of Beijing gradually。

　　如果各界反映良好、乐观的话，明年不仅在市属医院，在二级医院都可以试点推广。

If the from all walks of life reflect good、Optimistic words，Not only in hospital under the next year，In the secondary hospital can pilot promotion。

　　对于是否有具体推广时间的问题，韩晓芳表示，一切以积极稳妥为主，没有具体的时间规定一定要在什么时间前做完，一切都看试点运行效果。针对“扩面”后，各医院试点会否完全复制友谊医院的方案，韩晓芳称，试点的意义是“在试，看问题”，可能会根据具体情况调整方案。

For if there is time to promote specific problems，HanXiaoFang said，All active and steady to give priority to，No specific time regulation must be in what time ago finish，All see the pilot operation effect。According to“Expanding surface”after，The hospital pilot will not completely copy friendship hospital scheme，HanXiaoFang says，Pilot meaning is“In the test，See a problem”，May according to the specific circumstances adjustment scheme。

　

　□试点释疑 - pilot disabuse

　　疑 doubt

　　患者花钱少了医院收入长了？

Patients spend less hospital income long？

　　昨天，友谊医院表示，试点“医药分开”后，虽然取消了药品加成，门诊次均费用、次均药费，医保患者自付部分费用同时下降，但医院的收入反而增加了。

yesterday，Friendship hospital said，pilot“Medicine separate”after，Although cancelled the drug addition，All expenses of outpatient service time、Second all expenses for medicine，Since medical insurance patients pay part of the cost down at the same time，But the hospital income increased instead。

　　答药品加成没了医事服务补了！

A drug addition didn't medical service mended！

　　就此，友谊医院院长刘建解释，取消药品加成后不仅零利润销售，药品进入医院后还有2‰—3‰的损耗成本，但医院收益没有受到影响，目前收入的医事服务费与取消的药品加成基本持平，医院实际收益还略有增加。

In this，Friendship hospital director liu explained，Cancel after drug addition not only zero profit sales，Drugs into the hospital and 2 ‰ - 3 ‰ of the loss cost，But the hospital income was not affected，At present the income of medical service charge and cancel the drug addition flat，Hospital real income also increased slightly。

　　韩晓芳介绍，北京公立医院改革的特点是综合改革，是包含医保、价格、财政的多部门政策联动，“医药分开”并不是单一的举措。

HanXiaoFang introduced，Beijing public hospital reform is characteristic of the comprehensive reform，Medical insurance is a、price、The financial sector policy linkage，“Medicine separate”Not a single move。

　

　□未来方向 / future direction

　　京 Beijing

　　

推广医药分开医保增支13亿 Promotion medicine medical insurance ZengZhi 1.3 billion separate

　　试点医药分开后，在患者须交的医事服务费中，医保基金承担了每人每次40元。医保基金补偿了取消药品加成的成本，此前市人保局静态测算，若医药分开在全市推行，医保基金可能增支13亿。

Pilot medicine after separately，The patient must pay in medical service，The medical insurance fund for each 40 yuan per person。The medical insurance fund compensated the cancel drug addition cost，After the city bureau of insurer static calculation，If the medicine separate implementation in the city，The medical insurance fund may ZengZhi 1.3 billion。

　　另外，公立医院改革试点方案中，还包括财政补偿调控机制。按此规定，试点医院基本建设、大型设备购置、重点学科发展、人才队伍建设、离退休人员费用和承担公共卫生任务等方面都能得到政府的补助。这项试点也能减轻医院运营压力。

In addition，Public hospital reform pilot scheme，Also include financial compensation regulation mechanism。According to the regulations，Pilot hospital infrastructure、Large equipment purchase、Key discipline development、The talented person troop construction、Retired personnel expense and undertake public health task, etc can receive government subsidies。The pilot can also reduce hospital operating pressure。

　

　外 outside

　　协调外地医保报医事服务费 Coordination field medical insurance quote medical service charge

　　伴随医保患者自付费用的大幅降低，非医保患者的门诊费用统计数据中并没有出现同样大幅下降的现象，试点后确实存在一些非医保患者费用增加的情况。据了解，市人力社保部门也正在同各省市沟通，协调外地患者医事服务费报销事宜。

Along with the cost of medical insurance patients self pay greatly reduced，The health care of the patients with outpatient expenses statistics data did not appear the same plunged phenomenon，After the pilot do exist some non medical expenses of patients with increased。It is understood，City human social security department is also with the provinces and cities communication，Coordinate with foreign medical service charge to submit an expense account affairs。

　

　□试点探索 - pilot exploration

　　法人治理运行机制 Corporate governance mechanism

　　现状：目前在友谊医院、朝阳医院和儿童医院试点，两医院都成立了理事会，实现决策、执行、监督相互分工、相互制衡的权力运行机制，从而避免过去院长“一支笔”决定一切的做法。

status：At present in the friendship hospital、Chaoyang hospital and children's hospital pilot，Two hospitals have set up the council，Realize decision、execution、Supervision division of each other、Checks and balances of power operation mechanism，To avoid the past dean“A pen”The practice of everything。

　　未来：医管局将建立监事会，向医院派驻监事，委任总会计师，形成医院法人治理结构。建立以公益性为核心的绩效考核制度，绩效考核结果挂钩的工资总额动态调整和薪酬分配制度、建立灵活的用人制度三方面对医院内部运行机制进行改革。

The future：Ho ital authority will establish the board of supervisors，To the hospital accredited supervisors，Appointed the chief accountant，Form the hospital corporate governance structure。Establish a public welfare as the core of performance appraisal system，The result of examination and evaluation of dynamic adjustment link total wages and salary distribution system、Establishing flexible employing system three square in the face of the hospital internal reform of the operating mechanism。

　　

医保付费调节机制 Medical insurance pay adjustment mechanism

　　现状：正在友谊、朝阳、积水潭、同仁医院试点，包括总额预付和按病种分组付费。试点工作已取得初步成效，上半年，试点医院住院次均费用同比下降8.3%、1384元（其他三级医院上升2.9%、552元）。

status：Is friendship、chaoyang、Ji shui tan、Tongren hospital pilot，The total including advance and press disease to pay packet。Pilot work has achieved initial results，In the first half of，Pilot hospital time costs are 8.3% year-on-year drop、1384 yuan（Other tertiary hospital rose by 2.9%、552 yuan）。

　　未来：有关部门正在梳理分析试点情况，在此基础上，进一步完善试点办法，同时建立健全医保基金监督考核体系，防止推诿病人、增加患者医药费负担等现象发生，充分发挥医保付费机制科学规范医疗行为、合理控制医疗费用的作用。

The future：Relevant departments are carding analysis basis of the situation，On the basis of，Further perfect pilot measures，At the same time, establish and perfect the medical insurance fund supervision and evaluation system，Prevent shuffle patients、Increase the patients medical expenses burden etc. Phenomenon occurred，Give full play to medical science pay mechanisms regulating medical behavior、The reasonable control of medical cost function。

　　

财政补偿调控机制 Financial compensation regulation mechanism

　　现状：在五家试点医院同时推进。在落实财政六项补偿政策（基本建设、大型设备、学科建设、人才队伍、离退休人员工资和公共卫生）的同时，建立了与服务量和绩效考核挂钩的财政补偿机制。

status：In the five pilot hospital at the same time promote。In the implementation of fiscal six compensation policy（Basic construction、Large equipment、Discipline construction、Talent team、Retired personnel salary and public health）At the same time，Set up and services and performance evaluation hook financial compensation mechanism。

　　未来：下一步，本市还将继续推进药品、耗材流通领域改革，探索建立联合招标和价格谈判机制，努力挤出药品不合理的价格水分，同时通过发展现代物流配送，进一步压缩医药产品在流通中产生的费用，降低药品和耗材价格。

The future：The next step，The city will continue to promote drug、Material circulation field reform，Explore a joint bidding and price negotiation mechanism，Efforts to squeeze drug is not reasonable price moisture，At the same time, through the development of modern logistics and distribution，Further compression pharmaceutical products in circulation produce cost，Lower drug prices and consumables。

　　

□第二试点 - the second pilot

    朝阳医院将警告不合理用药医生     Chaoyang hospital will warning not rational drug use the doctor

　　朝阳医院（本部和京西医院）将成为第二个试点医药分开的医院，9月1日零点起正式启动。朝阳医院是大型综合医院，2011年门急诊量323万人次，居北京地区三级医院的首位。

Chaoyang hospital（Headquarters and jingxi hospital）Will become the second pilot medical separate hospital，September 1 zero up official start。Chaoyang hospital is a large comprehensive hospital，In 2011, 3.23 million people door curves，In the Beijing area tertiary hospital first。

　　朝阳医院院长封国生介绍，目前，朝阳医院已经于去年下半年试点总额预付和DRGs（按病种分组付费），规范了医疗行为并减轻了患者负担。去年门急诊服务量、出院病人数与上年同期相比分别增长14.9%和16%，今年上半年门急诊量、出院病人数进一步增长，同比增长16.8%和10.2%。门诊患者此费用已经降至397元，住院患者单次费用降至1.6万元，远低于本市同级医院平均水平。DRGs预付费运行已经常态管理，入组病例7000余例，覆盖100多个疾病组。这些都为试点“医药分开”创造了良好条件。

Chaoyang hospital dean seal countries introduced born，At present，Chaoyang hospital has in the second half of last year the total experimental advance and DRGs（Press disease to pay packet），To standardize the medical behavior and reduce the burden of patients。Services in this last year、The third hospital compared up by 14.9% and 16% respectively，In the first half of this year the door curves、The third hospital further growth，Year-on-year growth of 16.8% and 10.2%。Clinic patients the fees have dropped to 397 yuan，Hospitalized patients with single cost down to 16000 yuan，Far below the average level in this city hospital。DRGs prepaid operation have normal management，Into the group of more than 7000 cases of cases，Covering more than 100 disease group。These are for the pilot“Medicine separate”Created good condition。

　　这次试点重点围绕加强临床合理用药管理，消除“大处方”、滥用药，减轻患者用药负担、保障患者用药安全开展。

This pilot key around to strengthen the management of clinical rational drug use，eliminate“DaChuFang”、Drug abuse，Reduce the burden for treating patients、Ensuring patients in drug safety。

　　此外，医院将设立不合理用药公示制度及警示机制。滥用药、开大处方的医生将在医院曝光公示。

In addition，The hospital will set up not rational drug use public system and the warning mechanism。Drug abuse、Open DaChuFang doctor will be in the hospital public exposure。

　　周宇

Et al