解决看病难看病贵就要允许医生自由执业 See a doctor to see a doctor difficult to solve your will allow doctors free practice

　　2009年9月，卫生部下发《关于医师多点执业有关问题的通知》。随后，广东、海南、云南、四川、北京、江苏等地相继展开医师多点执业试点。经过两年多试运行，2011年7月，卫生部决定将试点地区扩大至全国所有省份，同时降低门槛，将申请医师的资格由副高级以上降为中级以上。国家出台多点执业政策，是希望把大医院的优质资源引到基层和社区，这得到公众的广泛支持。

In September of 2009,Issued by the ministry of health[About physicians more practice of the relevant questions of the notice].then,guangdong/hainan/yunnan/sichuan/Beijing/Jiangsu expansion physicians more professional pilot.After more than two years commissioning,In July 2011,The ministry of health decided to expand the pilot region to the national all provinces,At the same time reduce the threshold,Doctors will apply for the qualifications above by flows are reduced to intermediate above.The country has issued more practice policies,Hope is the hospital quality resources lead to a primary and community,This gets a lot of public support.

　　然而3年过去，多点执业在各地普遍遇冷，不少省份申请人数不足百人，在一些城市甚至出现“零申请”。为何医生多点执业“叫好不叫座”？近日，中国社会科学院经济所公共政策研究中心主任朱恒鹏，接受中国青年报记者专访。

But in the past three years,More practice at all in common cold,Many provinces apply for fewer than one hundred people,In some cities appear even"Zero application".Why the doctor more practice"Hurrah don't draw"?recently,The Chinese academy of social sciences, director of the center for public policy research economy ZhuHengPeng,Accept the China youth daily reporter interviews.

缺乏制度保障的政策只会成为一纸空文 The lack of system security policy will only become a dead letter

　　中国青年报：为何多点执业在各地遭遇执行难？

The China youth daily:Why do more practice in every encounter difficult to execute?

　　朱恒鹏：医生要实现多点执业，一般要通过个人申请、所在医院同意、卫生局登记注册3个步骤。在公立医院，需要院长审批的多点执业几乎等于形同虚设。因为医疗人才与技术是医院最大的竞争力，哪个院长愿意把优质资源无偿送到其他医院？况且，医生在科研、教学、学术职称评定上都由医院说了算；以后的医疗报销、退休工资等也都指望医院。拥有国有事业单位编制身份的公立医院医生，是“单位人”而非“社会人”，公开要求多点执业权利，相当于用身份保障换执业自由，多数人不敢“冒险”。

ZhuHengPeng:The doctor to achieve more practice,General to through the individual application/Hospitals agreed to/Health bureau registered three steps.In the public hospital,The need for examination and approval of the multipoint practice almost equal to exist in name only.Because the medical personnel and technology is the largest hospital competitiveness,Which President are willing to high quality resources free to other hospitals?besides,The doctor in research/teaching/Academic title evaluation are made by the hospital have the final say;After the medical expense/Retirement pay and so on also hope to hospital.Has the state-owned institutions establishment identity of public hospital doctors,is"Unit people"Rather than"Social man",Public demand more practice rights,Equivalent to use identity protection in practice free,Most people can't"adventure".

　　在政策层面，昆明市卫生局做得最好，医生多点执业只需在卫生局备案，不需要医院审批。2009年，时任云南省第二人民医院副院长兼心内科主任的李易，带领20多位医务人员以“社会人”的身份在多家医院自由执业。他们的模式十分接近多点执业的设计初衷——医生脱离对事业单位的依附关系，成为自由执业者，打破公立医院和民营医院之间的藩篱。

In the policy level,Do the best kunming pubilc health bureau,The doctor more practice only in health bureau for the record,Do not need to hospital for examination and approval.In 2009,,The second people's hospital of yunnan province vice President and director of the heart of li yi,Lead to more than 20 medical personnel"Social man"Identity in many hospitals free practice.Their model is close to the practice more the design purpose - a doctor from on institutions adhere relation,Become a free geologist,Break public hospital and private hospital barriers between.

　　但是，现在这个团队逐渐回归公立医院了，他们在实践中体会到，整个体制对自由执业权的束缚依然很多。目前，教学、科研资源集中在公立医院，更关键的是，能否获得这些资源不是取决于你是否有能力，而在于你是不是个“公家人”——自由执业的医生在圈内的影响力会下降，也评不了职称，当不了研究生导师。

but,Now the team gradually returning to the public hospital,They realized in practice,The whole system of free practice the bondage of right is still a lot of.At present,teaching/Scientific research concentrate resources in public hospital,More key is,Access to these resources is not dependent on whether you have the ability,But that you are a"GongGuRen"- free practice doctor in the circle of influence will decline,Also review the title,Moment graduate teacher.

　　更要命的是，作为自由执业者的医生退休后能拿到的养老金，可能不到国有事业体制内同行的一半。尽管前者缴纳的养老保险并不低于后者。这种不合理的养老保险制度，已成束缚医生自由执业，和妨碍社会资本办医的最大壁垒之一。

More deadly is,As a free geologist doctor can get after retirement pension,Perhaps less than a state-owned business system in the half of the counterparts.Although the former pay endowment insurance is not lower than the latter.This is not reasonable endowment insurance system,Has become a bound the doctor free practice,The medical and social capital to do the biggest one of the barriers.

　　中国青年报：比起多点执业，为什么有些医生更喜欢“走穴”(指医生到注册机构外的地点进行门诊、手术等医疗行为，并获得个人利益——编者注)？

The China youth daily:Compared with more practice,Why some doctors prefer"Money imparting knowledge to"(Refers to the doctor to the registration agency of the place to carry on the outpatient service/Surgery and medical behavior,And access to personal interests - editor's note)?

　　朱恒鹏：公开申请多点执业相当于公开宣布自己“有二心”，院长很可能认为你没把精力投入到本职工作上，以后升职、进修等都会受影响。而“走穴”尽管是事实上的多点执业，但属于私下行为，没和医院现行人事管理制度公开“叫板”，又不妨碍个人赚钱。

ZhuHengPeng:Public application more practice is equivalent to publicly declared himself"Such a",Dean probably think you didn't put energy into his own work,Later promotion/Further, etc can be affected.and"Money imparting knowledge to"Though it was in fact more practice,But belong to private behavior,No and hospital personnel management system to the public"Freed the",And do not obstruct most individuals who make money.

　　尽管新医改方案鼓励多点执业，但卫生行政部门规定多点执业的地点不能超过3个，而优秀医生“走穴”可远远不止3个点。一些医院请医生过去做台手术给3000元，听起来并不多，但是像某些手术，一个大夫一天能做五六台，这样就有了规模经济效益。

Although the new medical reform scheme to encourage more practice,But the administrative department of public health under multi-point practice site can't more than three,But good doctors"Money imparting knowledge to"But far more than three points.Some hospitals please doctor in the past do table surgery for 3000 yuan,Not many sounds,But like some surgery,A doctor one day to be able to do WuLiuTai,So have the scale economic benefit.

　　现在已形成医生价格发现机制。不同医院、不同大夫、不同手术的费用，医院之间挖医生的薪酬，都有标准的但不透明的行市价。有价就意味着有了市场，不透明不规范意味着市场不充分、不完善。医院面对的外部环境已经市场化，因此医疗服务市场也应该放开。我们可以借鉴律师行业，让医生成为自由执业人，能自主选择执业方式和机构。

Has now formed a doctor price discovery mechanism.Different hospital/Different doctor/Different the cost of the operation,Between the hospital dig the doctor's salary,There are standard but not transparent line market price.Marketable means market,Opaque is not standard means that the market is not sufficient/Not perfect.The hospital in the face of external environment has marketization,Therefore the medical service market should also let go.We can use for reference attorney the profession,Let the doctor practicing as a free man,Can independently choose practice mode and mechanism.