破茧之道 The way of cocoon——关于医药分开的对话 - about medicine separate dialogue

　　医改，是“世界性难题”，尤其在中国这样一个人口众多、国情复杂的国家，更是难上加难。“看病难、看病贵”，像被厚厚的茧重重包裹着。改变，期待着破茧重生。

medical,is"Worldwide difficult problem",Especially in China's such a large population/The complex conditions of the country,Is brutally hard."See a doctor difficult/The doctor your",As the thick cocoon heavy parcel.change,Looking forward to the broken cocoon rebirth.

　　以药养医被认为是“看病难、看病贵”的主要原因。针对这一症结，2012年7月1日起，北京市和广东省深圳市开始试水医药分开改革，旨在让公立医院回归公益性。北京市公立医院医药分开改革分别在友谊医院与朝阳医院实施试点，即取消15%药品加成、增收42元、60元、80元不等的医事服务费。深圳市则取消该市所有公立医院约2962种医保目录药品15%至25%的加成。

To raise the medical medicine is considered"See a doctor difficult/The doctor your"The main reason of the.In view of this a sticking point,July 1st, 2012,Beijing and guangdong province shenzhen began to test the waters medicine separate reform,Designed to allow public hospital regression public welfare.Beijing public hospital reform medical separated respectively in friendship hospital and chaoyang hospital implementation of the pilot,Namely cancel 15% drug addition/42 yuan income/60 yuan/Differ 80 yuan medical service charge.Shenzhen city is cancelled all public hospital about 2962 kinds of medical insurance directory drug 15% to 25% of the addition.

　　这样一项重大改革举措，能否解决“以药养医”痼疾，破解“看病贵”难题？医药分开改革怎样改变了医院，百姓看病随之发生了怎样的变化，对于公立医院改革又意味着什么？针对相关话题，记者近期采访了试点医院的患者、医务人员、院方负责人、医管方以及相关专家。

Such a major reform measures,Can solve"To raise the medical medicine"Chronic illness,crack"The doctor your"problem?Medicine separate reform of the hospital how to change,People see a doctor ensue how to change,For public hospital reform and what does that mean?According to the related topics,Reporter recently interviewed pilot hospital patients/Medical personnel/The hospital chief/Medical tube side and relevant experts.

　　在公立医院改革的道路上，一条破茧大道正在铺开。

In the public hospital reform on the road,A broken cocoon avenue are spread out.

对话患者：“药费降了，专家门诊挂号容易了” Dialogue patients:"Expenses for medicine down,Expert outpatient service registered easy"

　　“我和老伴每个月都要到医院拿二十几盒治疗高血压、糖尿病的药，医改后我们对着药单仔细算了算，相同数量的药，药费比以前便宜了300多元，自付费便宜100多元吧。”常到北京市朝阳医院西院区拿药的李老伯说。

"I and his wife to the hospital every month to take more than 20 box treat high blood pressure/Diabetes medicine,After the reform, we to the medicine single carefully calculated to calculate,The same number of medicine,Expenses for medicine than before cheap 300 multivariate,Since the pay cheap 100 multivariate it."Often to the Beijing chaoyang hospital finish the west may or may not prescribe medicine for LiLaoBo said.

　　70多岁的李老伯和老伴因为患有心脏病、糖尿病等几种慢性疾病，每个月到医院拿药的花费不少于1000多元，而医改为他们看病带来了明显实惠。“取消药品加成，药价降低；增收的医事服务费里医保可以报销40元，挂普通号只要2元，而且药价降了，我们看病总的花费便宜了不少，改革对我们来说是好事。”李老伯说。

More than 70 years old LiLaoBo and his wife because suffer from heart disease/Several chronic diseases such as diabetes,Every month to the hospital medicine cost of not less than 1000 yuan,And for their medical doctor brought obvious benefits."Cancel the drug addition,Lower drug prices;Increasing the income of medical service fery medical insurance can submit an expense account 40 yuan,Hang ordinary number as long as 2 yuan,And prices down,We see a doctor total cost a lot cheaper,Reform is good for us."LiLaoBo said.

　　除了药费便宜了，一些患者还发现挂专家号比以前方便了。陪老伴到友谊医院看病的冉兰芝告诉记者，以前陪家人到友谊医院看病，早晨4点到医院排队也不一定能挂上专家号。医改后，为了避免患者看病挂号高峰期，友谊医院推出24小时预约挂号、挂号时间提前等惠民措施。

In addition to medicine cheap,Some patients also found hanging ZhuanGuHao than before convenient.Accompany her to friendship hospital of RanLanZhi told reporters,Before friendship with my family to hospital,At 4 a.m. to hospital queue also not necessarily can hang ZhuanGuHao.After reform,,In order to avoid patients registered peak to see a doctor,Friendship hospital introduced 24 hours make an appointment/Registered time in advance we measures.

　　“我们早上7点到，排队等5分钟左右就挂上了专家号，实话实说，有的专家号确实比以前好挂了。”冉兰芝说。

"Our morning 7 o 'clock to,Waiting in line 5 minutes or so hung up the ZhuanGuHao,Call a spade a spade,Some ZhuanGuHao did more than before the hanging."RanLanZhi said.

　　医药分开改革试点以来，记者在北京市友谊医院与朝阳医院的蹲点采访中了解到，医保患者感受到看病费用降低了，医生的态度比以前有好转。朝阳医院的一份数据显示，截至9月30日，朝阳医院9月份试点数据与上半年月均值相比，门诊次均费用从393.9元下降到354.3元，下降10.05%；医保患者次均药费从277.4元下降到204.4元，下降26.32%；医保患者次均自付费用从185.1元下降到106.7元，下降42.36%。

Since the pilot reform of medical separate,Reporter in Beijing friendship hospital and chaoyang hospital CunDian interview to understand,Medical insurance patients feel the doctor cost reduced,The doctor's attitude is better than before.Chaoyang hospital a data display,By September 30,,Chaoyang hospital September pilot data and compared in the first half month average,All expenses of outpatient service time from 393.9 yuan down to 354.3 yuan,Fell by 10.05%;Medical insurance patients second all expenses for medicine from 277.4 yuan down to 204.4 yuan,Fell by 26.32%;Medical insurance patients second all out-of-pocket expenses from 185.1 yuan down to 106.7 yuan,Fell by 42.36%.

对话医务人员：“工作量增加了，压力也大了” Dialogue medical personnel:"Workload increases the,Pressure is big"

　　医务人员作为医药分开改革的实践者，对于医药分开改革后有哪些感受？

Medical personnel as medicine separate reform practitioners,For medical separate what feeling after reform?

　　北京市友谊医院门诊服务中心负责大厅服务调度工作的王晶告诉记者：“医改后，门诊就诊人数明显增多，现在医院就诊的患者每天8000左右的门诊量，看病的以老年人居多，有大部分患者对医改新政不了解，需要我们一遍遍细致的讲解，刚开始改革时，就诊的患者中咨询医改新政的人占了门诊量的一半，一天下来嗓子哑得都说不出话来，工作压力明显比以前大。”

Beijing friendship hospital outpatient service center is responsible for the service scheduling of jing wang told reporters:"After reform,,Clinic on a significant increase in the number,Now the hospital every day about 8000 patients MenZhenLiang,The doctor is in the majority with old people,Most of the patients have to reform, the New Deal don't understand,We need to carefully explain again,Just started when reform,See a doctor in patients with medical consultation New Deal people accounted for half of the MenZhenLiang,One day down his throat dumb all could not say words,Working pressure obviously big than before."

　　医药分开改革后，由于医院利益机制发生变化，各医院也根据自身特点改变了医院运营机制与管理机制，把管理重点放在患者满意度、遏制医务人员过度用药等方面。

Medicine apart after the reform,Due to the hospital benefit mechanism changes,The hospital also according to their own characteristics change the hospital operation mechanism and management mechanism,The management focus on patient satisfaction/Curb excessive use medical personnel, etc.

　　在北京市友谊医院挂号处工作的付大喜曾告诉记者，医院进行改革试点后，医院运行机制作出了相应调整，其中，挂号处提前开放4个挂号窗口，时间也由原来早晨6:30分提前至5:30分，增加了24小时预约挂号窗口。“医改后工作量增加了，压力自然也增大很多，不过看着挂号人多的情况有所缓解，忙一点也没什么。”

In Beijing friendship hospital registration office work big pay told reporters,After the pilot reform of hospital,The hospital operation mechanism has made the corresponding adjustment,the,Registration office early open four registered window,Time also by original at 6:30 in the morning ahead of points between points,Added 24 hours make an appointment window."After the reform, the workload increases,Pressure nature also increase a lot,But look at registered person many of the situation to ease,Busy is nothing."

　　“改革之前上班时，一进门就焦虑，很多时候看病患者等号挂号的队伍都排到医院外马路上，有的患者等了大半天好不容易排到号也挂满了，看着很多患者急躁情绪，我们其实也很难受，干着急没办法。”闫瑞东说，医改之后，医院一些便民措施跟着变化，现在医院早上排长队等候挂号的现象没有了，一般几分钟就可挂上号。

"Before the reform at work,A door anxiety,Most of the time the doctor patients equal sign registered team exhaust to the hospital on the road outside,Some of the patient and the best part of a very not easy row to number also hung,Looking at many patients with impatience,We in fact also very uncomfortable,Worried can't."闫瑞东 said,After reform,,Some measures for the convenience of the hospital with change,Now in the morning hospital of long queues waiting for registered phenomenon have no,General a few minutes to hang number.

　　北京市朝阳医院医务处处长、泌尿外科医生闫勇告诉记者：“医药分开改革已开始作用于医院管理的各个层面，医院更重视患者的满意度，若满意度较低或暴露了较为明显的服务缺陷，科室所有医务人员和科主任都会受到处罚。而且增收医事服务费后，患者合理分流，看专家也不再盲目，专家们也可以花更多的时间为患者看病，医药分开改革为医院提高服务质量提供了契机。”

Beijing chaoyang hospital medical department director/Urinary surgeons 闫勇 told reporters:"The medicine has begun to separate reform effect on hospital management of all levels,Hospital pay more attention to the satisfaction of patients,If the degree of satisfaction is relatively low or exposed the obvious service defect,All department medical staff and section head will be punished.And increasing medical service charge after,Patients reasonable shunt,See experts also no longer blind,Experts also can spend more time for patient to see a doctor,Medicine separate for hospital reform to improve the quality of service provided an excellent opportunity."