新华视点：药品“暗加价”，是无奈还是难防？ Xinhua viewpoint:drugs"Dark tariffs",Is helpless or difficult to defend?

　　今年下半年以来，全国部分县市试点取消15%的药品价格加成，这一医改试点引起了社会各界的广泛关注。

Since the second half of this year,Some counties of the national pilot cancel 15% of drug price addition,The pilot reform caused wide attention of all social sectors.

　　业内人士指出，除了医院公开的药品加成外，还有一些不公开的药品加价，比如进院费、勾标费、统方费等，也涉及广大患者的切身利益，有待于通过医改进一步加以解决。

The personage inside course of study points out that,In addition to the hospital public drug addition outside,And some don't open drug tariffs,Such as into the courtyard fee/GouBiao fee/System party fee, etc,Also involves the vital interests of the majority of patients,Needs to be solved through further reform.

　　“明加价”易改，“暗加价”难防 "Ming tariffs"Easy to change,"Dark tariffs"Difficult to control

　　9月19日，国家发改委、卫生部和人社部发布《关于推进县级公立医院医药价格改革工作的通知》，要求311个县(市)公立医院试点破除“以药补医”机制，取消15%的“药品加成”政策。

On September 19,The national development and reform commission/The ministry of health and people club department issued[At or above the county level on promoting the public hospital medicine price reform work of the notice],For the 311 counties(city)Public hospital pilot break"In medicine for medical"mechanism,Cancel 15%"Drug addition"policy.

　　在此之前，北京、深圳等地部分医院率先实施了“零加成”，超过2000种药品入列，药价降到以前的85%甚至更低。仅北京友谊医院，医保患者半个多月的次均药费比上半年次均药费下降了100.44元，降幅接近三成。

Before this,Beijing/Shenzhen city, part of the hospital took the lead in the implementation"Zero addition",More than 2000 kinds of drugs fall in,Prices dropped to 85% before or even lower.Beijing friendship hospital only,Patients with medical insurance for more than half a month of time all expenses for medicine than the first half second all expenses for medicine down 100.44 yuan,By close to thirty percent.

　　北京市医改办主任韩晓芳说，取消药品加成后，医生与医药代表之间若再有勾连，也容易暴露出来，便于院方监督检查。

Beijing medical director do HanXiaoFang said,Cancel after drug addition,Doctors and medicine representative if between link again,Also easy to exposed,Facilitate the supervision and inspection.

　　可是，国家有关部门调查发现，除了批零环节的药品加价之外，一些不公开的药品加价也需要进行清理。例如，某种药品进入一些医院，需要支付“进院费”，就像一些商品进入超市需要支付“入场费”，只有支付了这笔费用，才有可能进入一些医院销售。

but,Survey found that the relevant departments of the state,In addition to zero link drugs beyond tariffs,Some private drug tariffs also need to clean up.For example,Some drugs into some hospitals,Need to pay"Into court fee",As some goods into the supermarket need to pay"admission",Only pay the expenses,Can be in some hospitals sales.

　　内蒙古包头市检察院日前批捕了一起医药回扣案件的当事人，发现该案医药代表在向某家医院推销药品时，按照销售药品总量给予开药大夫5元到25元不等的回扣。据初步查明，收受金额最多的达70多万元。

Baotou, Inner Mongolia region procuratorate has the necessity together medicine rebate case of the parties,Find the case medicine representative in a hospital to sell drugs,According to the sales amount drugs to prescribe the doctor 5 yuan to 25 dollars rebate.According to preliminary find out,Receive the most amount of more than 70 yuan.

　　与此同时，在医保部门确定中标药品名单之后，一些医院并不是照单全收的，而要进行再一次选择，由医院领导和药房主任对中标药品中“打钩”。为了确保自家药品能够选上，药企方面还要支付一笔费用，名曰“钩标费”。

meanwhile,In the health care providers to determine the bid after drug list,Some hospitals and not accept according to the order of,But must carry on the choice again,The hospital leadership and pharmacy chief for the drugs"off".In order to ensure their drugs can be selected,Medicine enterprises aspects will pay a fee,yue"Hook scale fee".

　　在包头这起案件中，一些医院药房工作人员还要统计每种药品的销售清单。医药代表根据这一统计，以每盒三到五毛钱的标准向药房支付一笔费用，同时还要向医生返还一笔费用，内部人分别称之为“统方费”和“处方费”。

In the case of baotou,Some hospital pharmacy staff also statistics each drug sales list.Medicine representative according to the statistics,The magazine in three to five hair moneys standard to pharmacy pay a fee,At the same time also to the doctor returned a fee,Insiders were called"System party fee"and"Prescription fee".

　　2011年媒体曝光的克林霉素磷酸酯注射液价格案也印证了“暗加价”现象。出厂价0.6元一支的注射液，中标价为11元，大大超过出厂价。业内人士指出，这一中间差价分别被医药代表、医院和医生等蚕食。

2011 the media exposure of clindamycin phosphate injection price case is also proved"Dark tariffs"phenomenon.Ex-factory price 0.6 yuan a of the injection,Price for 11 yuan,Greatly more than ex-factory price.The personage inside course of study points out that,The middle price difference were medicine representative/Hospitals and doctors, encroach on.

　　长期致力于医改研究的国务院研究室社会发展司原司长朱幼棣认为，药品“暗加价”不仅会损害患者利益，而且容易腐蚀医务人员，不利于缓解“看病难”“看病贵”问题。

Long-term commitment to reform the social development research study under the state council the original priests ZhuYouDi think,drugs"Dark tariffs"Not only can damage the interests of patients,And easy corrosion medical staff,To ease"See a doctor difficult""The doctor your"problems.

　　一边是门诊，一边是药房 Side is outpatient service,Side is pharmacy

　　在北京大学第一医院，记者看到这里的好几个门诊楼层都有药品结算窗口。正在这里看病的傅先生告诉记者，每次来这里，都要开五六百块钱的药，看一次医生就得买一次药。“有些药不敢吃完，就丢到了一边。”

In the first hospital, Beijing university,The reporter sees the several outpatient floor have drug settlement window.Is there a doctor's Mr. Fu told reporters,Every time I come here,All want to open after yuan medicine,See a doctor would have to buy a medicine."Some drugs can't finish eating,Put to one side."

　　另一位陈女士对记者说，孩子拉肚子到北京某儿童医院看病，医生没看五分钟，就开出了五种药。“我对药房说能否少拿两种，对方表示，必须全部拿走。”她一气之下什么药都没拿就回家了，第二天孩子自然好了。

Another ms. Chen told reporters,Children have loose bowels to Beijing to a children's hospital,The doctor didn't watch five minutes,Just open the five kinds of medicine."I said it would take to pharmacy less two,Each other said,Must all take."She in a pet what medicine didn't take went home,The next day the child nature.

　　药品销售是医院收入的重要来源。中国医药企业管理协会会长于明德说，目前医院的药品加成率达42%，药品收入占到总收入的50%以上。

Drug sales are an important source of income of hospital.Chinese medicine enterprise management association YuMingDe said,At present the hospital drug addition rate was 42%,Drug income account for the 50% above of gross income.

　　为了增加药品销售，药厂往往以回扣来敲开医院之门，鼓励医生多开药。武汉人福医药集团董事长王学海介绍，这种现象在外资药企更为普遍。不久前辉瑞公司被查出向多家中方医院进行商业贿赂，回扣率在30%左右。

In order to increase drug sales,Pharmaceutical factory takes a rebate to open the door of the hospital,Encourage doctors to prescribe more.Wuhan people f medicine group chairman of the board WangXueHai is introduced,This kind of phenomenon in foreign medicine is more common enterprises.Not long ago Pfizer was found to several Chinese hospital for commercial bribery,HuiKouLv at around 30%.

　　一位患者对记者表示，“如果医生一边开方、一边计算着自己的提成，那么如何维系其职业道德？”

One patient told reporters,"If the doctor side root/Side calculation with his commission,So how to sustain its ethics?"

　　不过也有医务人员向记者吐诉：“我们从事的是高风险职业，然而并没有得到相应的技术回报，医疗服务价格偏低，收入更多依赖于药品提成。”

But there are medical personnel TuSu to reporters:"We work in the high-risk profession,However and didn't get corresponding technical returns,The medical service price is low,Income more dependent on drug commission."

　　面对药品“暗加价”现象，一些医院等单位似乎“视而不见”，并不公开回应这一问题。

In the face of the drug"Dark tariffs"phenomenon,Some hospitals and other units seems to be"Turn a blind eye to",Not public response to this problem.

　　卫生部负责人曾经指出，我国公立医院的建设、发展及医务人员的收入，很大程度上依靠药品加成解决，这在世界范围内都是独有的。“以药补医”容易滋生“以药腐医”问题。

Person in charge once pointed out that the ministry of health,The construction of the public hospitals in our country/Development and medical personnel income,To a large extent depend on drug addition to solve,This worldwide are unique."In medicine for medical"Tend to produce"In medicine rot medical"problems.

　　破解“暗扣”顽疾 医改如何动“刀”？ crack"hidden-interlocking"How to cure ill still"knife"?

　　如今在发达国家大多是药店负责卖药，医生只负责看病。而我国由于历史形成的“以药养医”格局，导致了医院与药企之间的利益关系。“医药分开”成了医改无法回避的问题。

Now in the developed countries are mostly pharmacy is responsible for selling drugs,The doctor is responsible only for the doctor.And our country due to the history of the formation"To raise the medical medicine"pattern,Led to the hospital and drug benefit relationship between the enterprises."Medicine separate"Become unable to avoid medical problems.

　　“‘暗加价’现象很多人了解，但没有一家医院承认。” 朱幼棣说，医院方面也有自己的难处，不加价难以维持，职工奖金也难以兑现，加价又增加患者负担。这既是现状又是改革难点。

"‘Dark tariffs’Many people understand the phenomenon,But not a hospital admit." ZhuYouDi said,Hospital also has its own difficulties,No alteration is difficult to maintain,Premium also difficult to cash,Tariffs and increase patients burden.This is not only the reform situation is difficult.

　　“本轮取消药品加成改革之初，我们就认为这是一个需要多方面联动的改革，尤其需要政府拨款补贴差额。”按计划取消“明加成”的上海东方医院副院长李钦传分析认为。

"This cancel drug addition at the beginning of the reform,We think this is a need to various linkage reform,Especially needs the government appropriation subsidies balance."According to plan to cancel"Ming addition"Shanghai eastern hospital, vice President of the LiQinChuan analysis think.

　　专家指出，取消医院对药品“15%明加价”，只是新医改一小步。当前，医院面临的最大问题是，在增加政府投入的同时，对医疗体制、机制进行改革。

Experts point out that,To cancel the hospital drug"Ming tariffs by 15%",Just a small step the new medical reform.The current,The hospital is the biggest problems facing the,In the increasing government investment at the same time,For medical system/Mechanism reform.

　　北京市门头沟区医院两年前与民营的凤凰医疗集团合作，通过引进7500万元资金和管理技术等，探索“管办分开”的医改新路，被称为在卫生行政部门下成立“医管局”或组建相应“国资委”之外的“第三路径”。

Beijing mentougou district hospital two years ago of the phoenix and private medical group cooperation,Through the introduction of 75 million yuan capital and management technology, etc,exploration"Pipe run separate"Reform of new,Known as the administrative department of public health in established under"formed"Or set up corresponding"sasac"Outside of the"The third path".

　　于明德说，门头沟区医院医改是在不改变公立医院性质的情况下，对医疗体制、机制进行一系列调整与变动，这是一种较为平稳的改革方式，各方面都能接受，有利于改革推进，具有全国借鉴意义。(记者徐海波、许晓青)

YuMingDe said,Mentougou district hospital reform is not changing the public hospital nature,For medical system/Mechanism of a series of adjustment and change,This is a kind of relatively smooth reform mode,Various aspects can accept,To reform,Has the reference significance.(Reporter XuHaiBo/XuXiaoQing)