卫生部收回去年新增三级医院牌照 The ministry of health back last year new tertiary hospital licence

　　医院评级制度：废止还是再造 Hospital rating system:Abolished or reconstruction

　　一石激起千层浪。近日，卫生部发出通知，收回2011年新增三级医院的牌照，并要求各地规范医院评审工作，防止出现医院争级上等，搞形式主义。然而，舆论借机将之演变为医院评审“存废”之争。不少人认为，不是评审过程出了问题，而是这种评审本身就不该有。

A stone arouses thousand layer wave.recently,The ministry of health issued a circular,Back in 2011 the newly added tertiary hospital licence,And requires all standard hospital evaluation work,Prevent hospital for superior level,formalism.however,Public opinion will be looking to the evolution for hospital evaluation"Save waste"struggle.Many people think,Not review process out of the question,But this review itself should not have.

　　那么，医院评级究竟从何处而来，又将走向哪里？

so,Hospital ratings from where on earth to,And going to go?

　　

前世今生 All men are mortal

　　卫生部医政司前司长、医院评级制度的主要奠定者于宗河告诉中国青年报记者，中国医院评审萌生于20世纪70年代末。最早由辽宁省丹东市开展“文明医院评比”活动拉开序幕。1987年11月，卫生部召开全国“文明医院”建设研讨会，将丹东经验推而广之，并引向医院评审。半年后，经过反复讨论，“医院分级管理”和“医院评审标准”的框架和原则被确定下来。

The ministry of health YiZhengSi former priests/Hospital rating system lays the main person in ZongHe told China youth daily reporter,China hospital evaluation initiation in the 1970 s.The earliest dandong city in liaoning province to carry out by"Civilization hospital appraisal"Activities began.In November 1987,The ministry of health held the national"Civilization hospital"Construction seminar,Will dandong might experience,And to hospital evaluation.After six months,After repeated discussions,"Hospital grading management"and"Hospital evaluation standard"Framework and principles are decided.

　　按照这些框架和原则，医院依据功能、任务的不同划分为一、二、三级；各级医院经过评审，按照《医院分级管理标准》确定为甲、乙、丙三等，三级医院增设特等，共三级10等。一级医院是直接为一定人口的社区提供预防、治疗、保健、康复服务的基层医院、卫生院。一级甲、乙、丙等医院由地(市)卫生局审批。二级医院是向多个社区提供综合医疗服务和承担一定教学、科研任务的地区性医院。二级甲、乙、丙医院等医院由省、自治区、直辖市卫生厅(局)审批。三级医院是向几个地区提供高水平专科性医疗卫生服务和执行高等教学、科研任务的区域性以上的医院。三级甲、乙、丙等医院由省、自治区、直辖市卫生厅(局)审批；三级特等医院，由卫生部审批。企业事业单位及集体、个体举办的医院的级别，也比照划定。为了防止出现医疗事故，保证患者的安全、合理治疗，规定极少数药品及麻醉剂，只允许医疗设备和医疗技术较高的地区性和区域性以上的医院使用。

According to the framework and principle,Hospital according to the function/The task for a different division of/two/Level 3;At all levels of hospital after review,According to the[Hospital grading management standard]Identified as a/b/c,Tertiary hospital additional card,Common level 3 10, etc.Level 1 hospital is directly for the certain population community to provide prevention/treatment/Health care/Rehabilitation services basic-level hospitals/Health center.Level 1 armor/b/C etc hospital by the way(city)Health bureau for examination and approval.Secondary hospital is more than to the community to provide comprehensive medical services and assume a certain teaching/The scientific research task regional hospital.Level 2 methyl/b/C hospitals by the provincial hospital/Autonomous region/Municipality directly under the provincial health bureau(bureau)Examination and approval.Tertiary hospital is to a few areas, which are provided for high level ZhuanKeXing medical and health services and implement higher teaching/Scientific research tasks more than regional hospital.Level 3 armour/b/C, etc by the provincial hospital/Autonomous region/Municipality directly under the provincial health bureau(bureau)Examination and approval;Level 3 special grade hospital,The examination and approval by the ministry of public health.Enterprises, institutions and collective/The level of the individual at the hospital,Also defined by applying mutatis mutandis the.In order to prevent medical accidents,Ensure the safety of patients/Reasonable treatment,A few regulations drugs and narcotics,Only allow medical equipment and medical technology higher regional and regional above hospital use.

　　1989年11月，卫生部发布了卫医字(89)第25号《关于实施医院分级管理的通知》、《综合医院分级管理标准〈试行草案〉》。医院评级正式走进中国人视野。自那以后，中国开展了世界上数目最多的医院评审。从1989年到1998年，17708家医院被归类审定，其中三级医院558所、二级医院3100所、一级医院14050所，占1998年底我国医院总数的26.4%。

In November 1989,The ministry of health issued a health medical word(89)No. 25[Concerning the implementation of hospital grading management notice]/[General hospital grading management standard (trial draft >].Hospital rating formal into Chinese view.Since then,China to the world's number to be most hospital evaluation.From 1989 to 1998,17708 hospitals were classified examination and approval,The tertiary hospital 558/Secondary hospital 3100/Level 1 hospital 14050,By the end of 1998 China accounted for 26.4% of the total number of hospital.

　　这个过程被认为使中国的医院面貌一新。1997年11月，时任卫生部部长的陈敏章说，在实行评级制度之前，中国医院最大的弊病是缺乏完善的标准体系，而只有十几项统计指标。这就造成了医院设置、建立和发展的盲目性很大，资源配置不合理，医疗质量也难以稳定提高，对其执业更是很难实行监督。实行评级制度以后，这种境况发生了根本的改变。

This process is considered to make China a new look in the hospital.In November 1997,The ministry of health minister said Geoffrey,The implementation of the rating system before,China hospital the biggest disease is the lack of perfect standard system,And only a dozen items in a statistical index.This creates a hospital Settings/Establishment and development of the great blindness,Irrational allocation of resources,Medical quality is also difficult to improve stability,The practice is hard to implement supervision.After a rating system,This situation has been given birth to essential change.

　　他还引述一份对医院评审工作的问卷调查(调查对象包括卫生厅、局长，医政处长，医院院长，医科大学校长，医院职能科室负责人，科主任，医生，护士)说，百分之九十以上的调查对象对这项工作充分肯定，得到了多数医院管理者和广大医务人员的普遍欢迎，医院评审使医院管理达到历史较好水平。

He also cited a hospital evaluation work of the questionnaire survey(Subjects include health department/chief,Medical administration division chief,Hospital dean,Medical university President,Hospital function department person in charge,Of director of division of,The doctor,The nurse)said,More than ninety percent of the respondents to the work full affirmation,Get the most hospital administrators and the medical staff the universal welcome,Hospital evaluation to hospital management history to better level.

　　卫生部还推出唐山市工人医院、同济医科大学附属同济医院和北京医院等典型。据说，在医院评审试点过程中，唐山市工人医院将评审标准七大方面100多条款，细化分解成了700多个名目，落实到全院每个职工身上，“全院上下齐心协力，凝聚力非常好，为了考核达标都具有了吃苦耐劳的奉献精神，许多护士为了练好基本技能，把输液瓶带回家利用休息时间在自己手上反复训练，在亲人身上练扎针”。

The ministry also launch tangshan hospital workers/Tongji medical university affiliated tongji hospital and Beijing hospital and other typical.It is said that,In the hospital evaluation in the process of pilot,Tangshan worker hospital will review standard seven aspects of more than 100 terms,Refining decomposition became more than 700 items,To carry out partial on every worker,"Partial fluctuation concerted effort,Cohesion is very good,In order to assessment standards are the bear hardships and stand hard work dedication,Many nurses in order to practice basic skills,The transfusion bottle home use the break time in our own hands repeated training,In family practice on needle".

　　

扭曲乱象 Distorted the mess

　　医院评级制度始终面临着质疑。这种质疑在现实的乱象下更趋严厉，以至于演变为今天的存废之争。

Hospital rating system is faced with question.This kind of question in real mess down more hasten is severe,That evolved into today's save waste rivalry.

　　事实上，作为该制度主要的设定者，于宗河在最初即对可能发生的问题有所担忧。正因为如此，1989年发布的《关于实施医院分级管理的通知》特别强调，要“防止和克服盲目攀比，不顾全局的局部观念。切实防止借分级管理之机盲目扩大医院规模和发展不适宜技术的现象发生”，要“防止和克服不顾基础质量，单纯片面追求扩大规模和高技术设备的不正确导向”。

In fact,As the system of the main set,In ZongHe in the original namely for possible problems have concerns.Because of this,Published in 1989[Concerning the implementation of hospital grading management notice]Special emphasis on,to"Prevent and overcome the blind bandwagon,In spite of global local concept.To prevent borrow classification management of machine blindly expand hospital scale and development is not suitable for technology of the phenomenon",to"Prevent or overcome regardless of basic quality,Simple one-sided pursuit of expanded scale and high technology equipment is not correct guide".

　　然而，现实有自己的逻辑，并非“通知”所能防止。由于等级高低不仅关乎医院的面子，而且直接决定医院的发展，争级上等自然成为主流。

however,The reality has its own logic,Is not"notice"Can prevent.Due to the high and low level not only for the hospital's face,But also directly decide the development of the hospital,For level superior natural become mainstream.

　　有业内人士指出，医院评审标准和指标中对基础条件的规定成为被评审医院盲目争级上等的主要诱因。在分等标准中，医院规模、医疗设备都是看得见、摸得着的硬标准，通过增加床位、扩建用房和购置大型医疗设备，短时间内都能够产生显著的突击效应。卫生部医院评审课题研究小组的调查显示，尤为突出的是：为盲目增收而争购高档医疗设备，并且突击效应失效后的医院管理工作也开始出现滑坡。

The personage inside course of study points out,Hospital evaluation standards and indicators of the provisions of the basic conditions to be review hospital blind for the main causes of quality level.In the classification standard,Hospital scale/Medical equipment are visible/The real hard standard,By increasing the beds/Expansion occupancy and purchase of large medical equipment,A short time to be able to produce significant shock effect.The ministry of health hospital evaluation subject research group's survey,Especially:For blind 'income and 争购 high-grade medical equipment,And assault effect after the failure of the hospital management work also begins to appear landslide.

　　在最疯狂的时候，一些县市医院为了评上三甲医院，竟然从国外购买了已被淘汰的二手CT机。当时新的CT机的价格为400万元左右，而二手CT机每台100来万元。一夜之间，几乎所有的县市医院都有了CT机。

In the most crazy time,Some counties hospital in order to judge on 3 armour hospital,Actually bought from abroad has been eliminated second-hand CT machine.When new CT machine price for 4 million yuan,While second-hand CT machine per 100 to ten thousand yuan.overnight,Almost all the counties hospital has the CT machine.

　　有人把医院评审比作一场运动。在达标上等的过程中，医院一般都会上下动员，全面整治，修正规章制度，提高医护水平等，但是评审后，医院未能坚持下去，如一阵大风刮过。评审中建立的标准化、规范化管理名存实亡。虽然有的地区开展过突击复查，但是对医院工作质量的持续改进并没有长期的监管机制。

Someone put the hospital evaluation compared to a movement.In the process of quality standard,Hospitals usually fluctuation mobilization,Comprehensive improvement,Fixed rules and regulations,Improve the medical level, etc,But after the review,The hospital failed to hold on,Such as a gust of wind to blow through.Review the establishment of standardization/Standardization management exist in name only.Although some areas to develop a assault review,But for hospital the sustained improvement in quality and no long-term supervision mechanism.

　　有的医院在评审中甚至规定“处罚到人”。江西抚州市一位院长明言，如因科室工作不到位影响“二甲”评审，该科室所有人员年终应受到相应的经济处罚。科室负责人不能评先、评优。如果在评审工作中因被查到各种技能、岗位职责、规章制度、三基知识考核不及格而扣分的，对于个人给予××元的经济处罚，是聘用人员的直接解聘。

Some hospitals in the review even provisions"Punishment to the people".Fuzhou city in jiangxi province a dean protest,If because of the desk work does not reach the designated position influence"dimethyl"review,This department all personnel year-end should be under corresponding economic punishment.Department person in charge can't PingXian/recommendation.If the evaluation work for was found to all kinds of skills/responsibilities/Rules and regulations/Three basic level knowledge failed the examination and the point deduction,For individual to xx yuan economic punishment,Is to hire personnel's direct discharge.

　　在这种情况下，即便是力主推行的陈敏章也不得不承认，全国评审工作进展极不平衡，评审标准掌握严宽不一，评审质量差距较大，评审队伍过于庞大，工作效率较低，一些医院重“硬”轻“软”，盲目攀比，扩大规模，争购设备，短期行为，弄虚作假，评审后滑坡等等。虽然这些问题与所取得的成绩、经验相比，是支流、局部的问题，但是，它已经给社会和整个评审工作带来了很不利的影响。

In this case,Even if it is argued that the implementation of Geoffrey also have to admit that,The national review work the uneven progress,Review standard master YanKuan differ,Review quality difference is bigger,Review team too large,Work efficiency is low,Some hospitals heavy"hard"light"soft",Blind bandwagon,expansion,争购 equipment,Short-term behavior,fraud,After the landslide, etc.Although these problems and achievements/Than experience,Is tributary/Local problem,but,It has to the society and the whole evaluation work brought very adverse effects.

　　在于宗河看来，“经是好经，就是念歪了”。他说，医院分级管理的目的是调整与健全三级医疗预防体系，以增强其整体功能，充分合理地利用我国有限的卫生资源，提高医院管理水平和医疗质量，更好地为人民健康服务。可是，随着商业化的侵袭，这种愿景成为不可能的镜花水月。

Lies in ZongHe seems,"The good is the,Is read slanting".He said,Hospital grading management purpose is to adjust and perfect level 3 medical prevention system,In order to enhance its overall function,Fully and reasonably make use of limited health resources in our country,To improve hospital management level and the quality of medical treatment,Better for the people's health to serve.but,With the commercialization of the invasion,This vision become impossible an illusion.

　　另外，由于评审过程缺乏透明和约束，寻租腐败的滋生也败坏、蛀蚀了制度的基础。

In addition,Due to the lack of transparency and constraint review process,Rent-seeking of corruption and corrupt/Decay the system foundation.

　　

何去何从 What course to follow

　　1998年后，医院评审工作走走停停，波折不断。卫生部曾试图通过调整评审权重、方式等办法避免乱象却屡遭挫折。在刚刚结束的2011年评审中，全国晋升三级的240多家医院中，一半左右为县级医院，有的10万人口的县就配置一家“三甲”医院，甚至乡镇卫生院也挂上“三甲”的牌子。这让卫生部无法容忍，于是有了收回牌照之举。

1998 years later,Hospital evaluation work for a walk off,Twists and turns continuously.The ministry of health have been trying to by adjusting the weight of evaluation/Methods to avoid the mess but never had setbacks.At the recently ended 2011 years in the review,The national promotion level 3 more than 240 in the hospital,About half at or above the county level for hospital,Some 100000 population county is a configuration"top"hospital,Even township health center also hung up"top"brand.It makes the ministry of health can't stand,Then a back an licence.

　　对达不到标准的医院实行“收牌”，这得到了应有的嘉许。可是，此事却引起了更深的思考。有评论指出，需要“收牌”的其实不止那些不合标准的医院，而是医院评级制度。卫生部作为医疗服务管理部门，不能以行政手段把医院划分为三六九等，应该考虑医疗资源分配的公平合理，避免医院陷入逐利的冲动。

For can not reach the standard of the hospital"Charge card",This gets due recognition.but,Matter but caused the deeper thinking.Critics say,need"Charge card"It not only that substandard hospital,But the hospital rating system.The ministry of health for medical service management department,Not to administrative means the hospital is divided into 369, etc,Should consider the medical resources in allocation of fair and reasonable,Avoid in the hospital by the impulse.

　　首都医科大学教授崔小波对中国青年报记者说，给医院评级并非中国独有，这一制度的实质，是按照现代医院管理的原理，遵照医疗卫生服务工作的规律与特点，实行医院标准化管理和目标管理，因此，断言废除确实过于激进，也不符合现阶段中国国情。不过，现实中的种种问题也不能视而不见，因此，改进当是必由之路。他建议，医院评审应本着功能到位、淡化等级观念的原则，依据医院的功能、任务定位进行评审，结合医院实际运行和社会认同来确定功能任务。目前，我国的医院评审主要是围绕组织结构，强调综合管理、规章制度和硬件建设方面，忽略了医院作为公共卫生服务机构的社会属性，作为服务人群的评价指标较少。

The capital university of medical sciences, CuiXiaoBo professor of China youth daily reporter said,To the hospital rating is not unique in China,The essence of this system,According to the principle of modern hospital management,Follow the medical and health service work of regulation and characteristics,A hospital standardization management and a target management,therefore,Assertion abolished really too radical,It also doesn't conform to the present China's national conditions.but,The reality of a variety of problems also cannot turn a blind eye,therefore,The only way to improve belong to.He suggested that,Hospital evaluation should be in line with the function in place/The principle of desalination level concept,According to the function of the hospital/The task for review,Based on the actual operation and social identity to determine the functional task.At present,Our hospital evaluation is mainly around the organization structure,Emphasize comprehensive management/Rules and regulations and hardware construction,Ignore the hospital as a public health service agencies of social attribute,As a service to the crowd evaluation index is less.

　　解放军总医院原院长朱士俊也持相似观点。他说，国外现有的一些评审标准是以持续改善患者安全和医疗服务质量为中心，我国不妨借鉴一些。“评审应提高患者意见的权重，注重过程的更加公开、公正，(这些方面)都是大可改进的。”

The people's liberation army general hospital of the former director ZhuShiJun also have similar ideas.He said,Foreign some existing evaluation standard is continuously improve patient safety and medical service quality as the center,Our country might as well some reference."This review shall improve the opinions of patients with weight,Pay attention to process more open/justice,(These aspects)Are all can be improved."

　　北京大学政府管理学院教授顾昕告诉中国青年报记者，如果仅以认证以及与认证有关的评级而论，它是一种服务。其服务内容是告诉消费者(或埋单者)，哪些服务提供者达到了哪一级的服务水平。这种服务不必也不能仅由政府提供。

Beijing university professor of school of government GuXin told China youth daily reporter,If only to the authentication and certification related the ratings,It is a kind of service.The service content is to tell the consumer(Or buried single person),What service provider reached the level to which the level of service.This service don't have also not only provided by the government.

　　“我相信，消费者更加需要的是多样化的服务认证或评级，例如眼科哪家医疗机构是哪一级？生孩子如何等等？当然，对综合医院，笼统地来一个一二三级也未尝不可。教育领域就是如此。美国有很多教育认证和评级机构，几乎没有公立的。作为一个消费者，我认同某几个机构的认证和评级，它们的认证和评级告诉我，作为综合大学，哈佛大学基本上是最好的，但是作为经济学专业，芝加哥大学是最好的。就是这么简单。在医疗领域，也应该是同样的道理。”他说。

"I believe that,Consumers more need is diversified service authentication or rating,For example an eye which medical institutions is which one class?Children how to and so on?Of course,To comprehensive hospital,General to a two level 3 also have not cannot.Education field is so.In the United States, there are a lot of education the authentication and rating agencies,Almost no public.As a consumer,I agree with certain mechanism of authentication and rating,Their authentication and rating told me,As a comprehensive university,Harvard University basically is the best,But as economics specialty,University of Chicago is the best.Is so simple.In the medical field,Should also be the same way."He said.

　　顾昕认为，如果认证和评级走向多样化、竞争化、专业化而不是行政化，对于医疗服务质量的改善是有好处的，但这同医疗资源配置问题不大相干。只有在评级体系和资源配置都行政化的情况下，两者才相干。

GuXin think,If the authentication and rating for diversification/competitive/Specialization and not security administration,For the improvement of the medical service quality is good,But with the medical resources allocation problem is coherent.Only in the rating system and the allocation of resources under the condition of all security administration,Both to coherent.

　　不过，更为悲观的论调指出，只要政府主导的威权存在，第三方机构的介入就必定在官方支配之下，那势必失去独立性。而拥有行政级别的医院天然具有在卫生系统更强的话语权和支配权，获取级别的优势仍然不会变化。没有独立性的第三方机构也无法监督，甚至本身也会被权力寻租所异化。记者 董伟

but,More pessimistic view points out,As long as the government leading power existence,The third party institution intervention will surely be in the official under control,That certainly will lose independence.And have administrative levels of hospital with natural in health system more strong voice and eminent domain,For the advantages of level still won't change.No independent third party agencies also is unable to supervise,Even itself will also be power rent-seeking have alienation.Reporter DongWei