今年7月，友谊医院试点医改后，市民可随时了解药价（资料图片）。本报实习记者赵恩泽摄 July,Friendship hospital after reform pilot,Public can understand prices(Material picture).Our internship reporter ZhaoEnZe perturbation

　　医改，在北京，难上加难。去年，北京三级医院门诊总人次6000万，其中来自全国各地的患者就达3000万人次，占了一半。积淀了太久的问题，像是被厚厚的茧重重包裹着，期待着破茧重生。

medical,In Beijing,Extremely difficult.Last year,Beijing tertiary hospital outpatient service 60 million total people,The patients from all over the country reached 30 million person-time,Accounted for half.Accumulated a too long problem,Like be thick cocoon heavy parcel,Looking forward to the broken cocoon rebirth.

　　管办分开、医药分开，在公立医院改革的道路上，北京在全国率先试水，探索一条破茧而出之路，并且取得了初步胜利。

Pipe run separate/Medicine separate,In the public hospital reform on the road,Beijing is in the lead in test the waters,Explore a broken cocoon road,And achieved initial success.

　　□第一步：探索 - the first step:exploration

　　中央领导亲定试点 The central leadership close fixed pilot

　　2011年4月25日，中共中央政治局常委、分管医改工作的国务院副总理李克强带领国务院医改办、卫生部、财政部、人社部、中宣部等各部委，来到北京友谊医院，实地考察调研北京市医改工作。

On April 25, 2011,The standing committee of CCCPC political bureau/In charge of the work of the state council reform, vice premier li keqiang lead to cure of the state council/The ministry of health/The ministry of finance/People club department/The publicity and so on various ministries and commissions,Came to Beijing friendship hospital,On-the-spot investigation research work of Beijing medical reform.

　　从预约挂号怎么取号、方不方便，到医保卡怎么实现实时结算，领导们一路看得认真，问得仔细，不仅听院方介绍，也问患者们的亲身感受。李克强还观看了患者在自助服务区怎么自己打印检查结果。

Make an appointment from how take number/Party does not convenient,To cure to keep card how to realize real-time settlement,All the leaders see more seriously,Ask more carefully,Not only listen to the hospital is introduced,Also asked patients' experience.Li keqiang also watched the patients in self-service area how oneself print the result.

　　从门诊楼出来，考察调研的队伍又来到了心内科病房。心血管中心护士刘酉华今天当班，李克强仔细询问了她的工作和收入情况。“李克强副总理的关心让我受到特别大的鼓舞，我相信，先做出努力的一定会获得更多关注。”谈起这份关心，刘酉华至今依然很激动。

Come out from the outpatient service building,Investigation research team and came to the heart ward.Cardiovascular center LiuYou China nurse on duty today,Li keqiang carefully asked her job and income situation."Vice premier li keqiang care let I was particularly big boost,I believe that,The first efforts will get more attention."About the care,LiuYou China still very excited.

　　随后，李克强与北京友谊医院的医护人员进行了座谈，他细致询问，医生、护士畅所欲言，原定10分钟的交流时间延长到了40分钟。

then,Li keqiang and Beijing friendship hospital medical personnel for a further discussion,He careful inquiry,The doctor/The nurse can,Original 10 minutes of communication time extension to 40 minutes.

　　就是在这次座谈会上，李克强亲自确定北京为第17个公立医院改革试点城市，这就是后来被媒体所称的公立医院改革“16+1”模式。

Is in this symposium,Li keqiang personally sure Beijing as a 17 trial reform of public hospitals city,It is then referred to by the media of public hospital reform"16 + 1"mode.

　　医改明确三个方面 Three aspects of reform, clear

　　李克强说，公立医院改革是整个医改的重点和难点，要从三方面做好这篇文章。一要逐步缓解人民群众看病难、看病贵问题。破除以药养医、药价虚高现象，减轻患者就医负担。二要使医护人员的价值和地位得到应有体现。注重医德医技，倡导尊医重卫，理顺分配机制，发挥好医务人员改革主力军作用。三要建立有利于医疗卫生持续发展的体制机制。制度创新、管理创新、服务创新潜力很大。要加快推进投入、补偿和人事分配、绩效考核等方面的机制建设，走出公立医院发展的新路子。

Li keqiang said,Public hospital reform is the key point and the difficulty of the reform,From three aspects to do this article.A will gradually ease people see a doctor difficult/Expensive to see a doctor.Break to raise medical medicine/Prices virtual high phenomenon,Reduce the burden of patients go to a doctor.Secondly, to make the value of medical staff and status should be reflected.Pay attention to medical ethics medical,Advocate and medical heavy guard,Rationalize distribution mechanism,Play good medical personnel reform main force action.Third, we need to establish the system of medical and health sustainable development mechanism.System innovation/Management innovation/Service innovation potential is very great.To accelerate the investment/Compensation and personnel distribution/Performance assessment mechanism construction,Out of the public hospital development new way.

　　友谊医院院长刘建坦言，“以药养医大大挫伤了医务人员的积极性，我们的社会形象也受到影响。我们希望通过改革尽快撕掉灰色标签，变成‘以医养医’。我们愿意大胆探索。”

Friendship hospital director liu said,"In medicine have YiDa big dampened the enthusiasm of the medical staff,Our social image have also been affected.We hope that through reform as soon as possible tear grey label,into‘To raise the medical medical’.We are willing to the bold exploration."

　　来自党中央、国务院的关心和指导不仅让北京医改的决策者和执行者坚定了信心，也温暖了一线医务人员的心。

From the party central committee/The state council's care and guidance of the reform, not only let Beijing policymakers and executor strengthened confidence,Also a line warm the heart of the medical staff.

　　友谊医院肝病中心主任贾继东对于李克强谈到的“使医护人员的价值和地位得到应有体现”这句话感触颇深：“我希望医药分开后，医生能通过自己的劳动得到社会的认可，这才是一个良性循环。”

Friendship hospital liver disease, director of the center for li keqiang JiaJiDong talked about"Make the value of medical staff and status should be reflected"This sentence is quite deep feelings:"I hope the medicine after separately,The doctor can through own labor get recognized by the society,This is a benign cycle."

　　此后，李克强先后十几次对北京的医改举措作出批示，要求国家有关部门关注北京医改，支持北京医改。

Since then,Li keqiang has more than ten times of Beijing medical reform measures to make instructions,The relevant departments of the state for medical attention to Beijing,Support Beijing medical.

　　今年7月1日，北京开始试水医药分开，友谊医院从这天起取消药品加成，收取医事服务费。针对这样一项重大改革举措，李克强马上指示国家医改办，追踪了解，及时总结分析有关情况，并对北京市给予必要支持。

On July 1 this year,Beijing began to test the waters medicine apart,Friendship hospital from this day cancel drug addition,Collect medical service charge.According to such a major reform measures,Li keqiang instructions immediately cure country do,To track,Summarize the analysis about it,In Beijing and provide necessary support.

　　思路、理念是改革之本。在北京医改的每一个重要的阶段性时刻，都得到了来自国家层面的指引与肯定，这也使北京的医改步伐更加坚定有力。没有李克强副总理的调研指示，北京医改难以突破。

ideas/Philosophy is the reform.Reform in Beijing every important periodic moment,Got from the national level guidance and affirmation,It also make Beijing more strong pace of reform.No vice premier li keqiang research indication,Beijing medical reform is difficult to break through.

　　□第二步：行动 - the second step:action

　　量身定做医改方案 Customize reform scheme

　　方向有了，但没有具体经验可以借鉴，破茧谈何容易？

Direction have,But there is no specific experience can use for reference,Broken cocoon easier said than done?

　　北京，必须要在国家医改方案的大框架下，在很短的时间内给医改开出一张符合北京实际、可操作性强且见效快的特效“药方”。

Beijing,Must be in the state of medical reform scheme framework,In a short time to open a reform with Beijing actual/The maneuverability is strong and quick result effects"prescription".

　　“改革管理体制、建立运行机制、创新服务模式”，北京确定了公立医院改革的三驾马车。

"Reform the management system/Establish the operation mechanism/Innovation service mode",Beijing determined the public hospital reform troika.

　　2011年7月28日，北京114查号台，在纷繁的查询中人们听到了一种新的声音：“您好，请问有什么能帮您的？”“我要预约友谊医院心内科的号。”“友谊医院，心内科是吗？好的，已经帮您预约成功，8月2日上午9点至10点……”这是北京市在全国率先启动的全市预约挂号统一平台，从这一天起，百姓拨打114或登录统一预约挂号网站www.bjguahao.gov.cn即可预约所有上线医院的普通号、专科号和专家号号源。

On July 28, 2011,Beijing 114 information directory desk,In the numerous and complicated in the people heard a new sounds:"How do you do,What can I help you?""I want to make an appointment friendship hospital heart number.""Friendship hospital,Heart is??good,Have you an appointment for success,On August 2, 9 to 10 point..."This is in the lead in Beijing launched the make an appointment unified platform,From this day,People call 114 or login unified make an appointment website www.bjguahao.gov.cn can make an appointment all on-line hospital of ordinary number/Junior number and ZhuanGuHao number source.

　　预约挂号从表面上看是挂号方式的调整，而实际上是北京公立医院改革一个具象的切入点，是就医制度新模式的探索。预约挂号、双休日门诊、优质护理服务、主诊医师负责制、优化就诊流程，北京的公立医院改革，以创新医疗服务模式为切入点，下大气力解决当前患者反映最强烈的问题。但北京的公立医院改革远不止于此。

Make an appointment on the surface is registered way adjustment,But in fact is Beijing public hospital reform a concrete the breakthrough point,Medical treatment system is a new mode of exploration.Make an appointment/Double cease day outpatient service/High quality nursing service/The attending physician responsibility system/Optimization medical process,Beijing public hospital reform,Innovation of medical service mode as the breakthrough point,Makes great efforts to solve the current problems of the most strongly reflects the patients.But Beijing's public hospital reform is far more than that.

　　确定16字医改目标 Determine 16 word reform goals

　　2011年7月，市医院管理局挂牌，在“管办分离”上迈出了实质性步伐。

In July 2011,The city hospital administration listed,in"Tube do separation"Made substantive steps.

　　建立医管局是改革管理体制的第一步，此后北京又推出了一个新事物——医院理事会。理事会制度不是让医院更加市场化，而是更加公益化，因为参与医院决策的人中有了患者理事。

To establish hospital authority is the first step in the reform of the management system,Then Beijing and launched a new things - hospital council.The council system not to have the hospital more marketization,But more public change,For their part in the hospital decision among patients with the director.

　　而建立新的运行机制则是要破除延续了几十年的以药养医的顽疾。2012年7月1日，北京友谊医院成为第一个“吃螃蟹的人”，试点医药分开。

And set up new operation mechanism is to do away with all fetishes lasted for decades to a persistent ailment of the medical medicine.On July 1, 2012,Beijing friendship hospital became the first"Eat crab people",Pilot medical separate.

　　推进发展、提高效率、减轻负担、促进健康——这是北京医改的16字目标，而用更通俗的话来说，就是解决社区“看不好病”、低收入者“看不起病”、大医院“看不上病”三大难题。

Push forward the development/Improve efficiency/Reduce the burden/To promote health, this is Beijing 16 word medical goal,And with more popular words,Is solve community"See bad disease"/low-income"Look down on disease"/Large hospital"Despises disease"Three major problems.

　　前两个难题通过建立一张覆盖全市城乡的社区卫生服务网络和打造一个覆盖全人群的医疗保障系统，已经基本完成。而大医院“看不上病”的问题随着日益推进的公立医院改革也正在缓解。

The first two difficult problem by establishing a covering the whole city urban and rural community health service network and build a cover the whole crowd of medical security system,Has been basically completed.And big hospital"Despises disease"Problems with the increasingly more propulsion of public hospital reform is also ease.

　　至此，一个思路清晰、制度设计完整的北京医改方案展现在公众面前，并且完成了从纸上到现实的一跃。

So far,A clear thinking/System design complete Beijing medical scheme up front and in public,And completed from paper to realistic leap.

　　□第三步：成效 - the third step:results

　　药费降了服务提升 Expenses for medicine down to serve ascension

　　不久前，市民黄女士因为感冒、咳嗽到友谊医院就诊，挂到了呼吸内科25号。

Not long ago,Citizens ms wong because of the flu/Cough to friendship hospital,Hang the respiratory medicine 25.

　　接诊的刘大夫认真地给黄女士问诊、听诊、看嗓子，最后诊断为上呼吸道感染。他给黄女士开了一盒痰咳净、一盒感冒清热颗粒，药费一共是22.24元。“就这么点药么，要不您再给我开点板蓝根，或者开点治咳嗽的糖浆？”黄女士说。“您现在不用喝糖浆，颗粒类的药物也只吃一种就可以，已经给您开了3天的药量，够了。”刘大夫解释说。“真没想到20多元就搞定了，以前到医院看感冒，怎么也得花两三百元。”黄女士说。

LiuDaFu became seriously to ms wong inquiry/auscultation/Look at his throat,Final diagnosis of upper respiratory tract infection.He gave ms wong opened a box of expectorant/A box of cold heat particle,Expenses for medicine altogether is 22.24 yuan."So point medicine yao,Don't you give me open point radix isatidis,Or open point to cough syrup?"Ms wong said."Now you don't drink syrup,Grain type of drug also eat only a can,Has given you open for three days and dosages of the vaccine,enough."LiuDaFu explained."I didn't know that 20 multivariate then it's done,Ago to the hospital to see a cold,How also have to spend 2300 yuan."Ms wong said.

　　友谊医院试点实行医药分开后，医院要求医生控制患者次均费用，这不仅给患者省钱，还减少了药品的浪费。

Friendship hospital pilot practice medicine after separately,The hospital asked the doctor to control patients second all expenses,This not only give patients money,Reduced the waste of drugs.

　　两个月后的9月1日，北京朝阳医院成为第二家医药分开试点医院。两家医院试点后的统计数据都呈现三升三降，医药分开试点取得初步成功。所谓三降，门诊次均费用、次均药费、医保自付费用三下降。而三升说的则是百姓满意度、服务质量、医院收益三提升。医管局的问卷调查结果，对医生服务的总体满意率为90.2%，88.4%的患者认为专家门诊的交流和解释时间比以前增加了。

Two months later, on September 1,Beijing chaoyang hospital become the second home medicine separate pilot hospital.Two hospitals after the pilot statistical data are present 3 litres three drop,Medicine separate pilot achieved initial success.The so-called three drop,All expenses of outpatient service time/Second all expenses for medicine/Since the pay medical insurance cost three down.And three litres said is the people satisfaction/Service quality/Hospital income three ascension.The questionnaire investigation of the hospital authority,The overall satisfaction rate of doctor service for 90.2%,88.4% of the patients think expert outpatient service of communication and explain time increased than before.

　　“在全国17个公立医院改革试点城市中，北京是动了真格的。”多年一直持续关注医改的北京大学中国经济研究中心副主任李玲对北京公立医院医改，尤其是医药分开评价颇高。

"In the national 17 trial reform of public hospitals in the city,Beijing is moving the true."Years of continued focus on the reform of the China center for economic research at Peking University, deputy director of Beijing LiLing public hospital reform,Especially medicine separate evaluation quite high.

　　医改不可能一蹴而就，必须坚持一个阶段、一个阶段去突破难点，破冰前行。下一步北京要在21家市属三级医院继续推广医药分开试点，要调整医疗机构，建立医疗、康复、护理相衔接的医疗服务链，要继续推进大医院带社区，让市民更信任社区，还要鼓励社会办医，吸引国际顶级医疗资源到北京。

Reform can't accomplish in one move,Must insist on a stage/A stage to break through the difficulty,Ice forward.The next step to Beijing in the 21st home under the tertiary hospital continue to promote medical separate pilot,To adjust the medical institutions,Establish the medical/rehabilitation/Nursing the coherent medical service chain,To continue to push forward the large hospital with community,Let people believe more in the community,Also be encouraged to do medical society,To attract top international medical resources to Beijing.

　　漫漫医改路，北京刚刚迈出第一步。我们期待它破茧成蝶。

Cure long road,Beijing just take the first step.We are looking forward to it broken cocoon into a butterfly.