太原市和平医院大厅设置了“先住院后付费”的温馨提示。

Peace hospital in taiyuan city hall set up"After the first pay in hospital"Warmth tips.

　　本报记者 田国垒摄

Our reporter TianGuoLei perturbation

　　今日关注 Attention today

　　太原新农合“先住院后付费”无一例逃费 Taiyuan new farming together"After the first pay in hospital"No one escaped fee

　　全国省会城市首举 超七成参合农民患者受益 The national capital city first for ultra seventy percent patients benefit from ginseng adds up to farmer

　　本报记者 田国垒 Our reporter TianGuoLei

　　9月的一天，山西省太原市娄烦县农民张凤玲到太原市妇幼保健院做产前常规检查。车刚进太原市区，张凤玲就肚子疼。“我女儿要提前生了，当时我吓得脑袋发蒙。”张凤玲的母亲刘桂香说，当时她身上就带了几百元检查费，要是住院连交押金都不够。

September day,Taiyuan, Shanxi Province LouFanXian farmers to taiyuan city ZhangFengLing maternity and child care centers do prenatal routine inspection.The car just in taiyuan city,ZhangFengLing will have a stomachache."My daughter want to advance bore,At that time, I was scared to head get confused."ZhangFengLing mother LiuGuiXiang said,At that time her body took hundreds of yuan inspection fee,Even if hospitalization deposit is not enough.

　　两人心急火燎地赶到医院后，医生告诉刘桂香不用急，“现在农民患者住院，签个协议就行，不用交押金。”还没等刘桂香反应过来，女儿就通过“绿色通道”被送进了产房。住院几天来，医院对她女儿和刚出生的小外孙照顾得很好，一直没人催她们去缴费。“护士让我们安心住着，出院结算就行。看完病才收钱，这在过去想也不敢想。”刘桂香说。

Two people after frantic, hurried to the hospital,The doctor told LiuGuiXiang don't worry,"Now farmers patients in hospital,Just sign an agreement,Don't pay the deposit."Before LiuGuiXiang reaction to come over,Daughter was through the"Green channel"Was sent to the delivery room.Hospitalization days,The hospital to her daughter and newborn little grandson very well cared for,Haven't people push them to capture to expend."The nurse let us live at ease,Discharge settlement will do.Finish see disease to receive money,This in the past to dare not to think."LiuGuiXiang said.

　　今年8月1日起，太原在全市160余家定点医疗机构中实施了参加新型农村合作医疗农民享受“先住院后付费”的政策。在省会城市大范围实行先住院后付费的新农合服务模式，这在全国尚无先例。

August 1st,Taiyuan in the city more than 160 fixed-point medical institutions to implement the new rural cooperative medical farmers enjoy"After the first pay in hospital"policy.In the provincial capital city of big range practice in hospital first for new farm close service mode,There is no precedent for this in the country.

　　尽管太原市卫生局局长郝宝清称，“这一举措的目的是让农村急危重症、贫困患者得到及时救治，缓解医患矛盾”，但摸着石头过河的政策难免引起众人担忧：会不会刺激农民住院就医需求？如果新农合资金盘子紧张、甚至崩盘怎么办？如果出现很多赖账、逃账怎么办？出现不诚信的医院套取新农合资金怎么办？出现医院垫付资金不够、压力大怎么办？

Although taiyuan city health bureau chief HaoBaoQing says,"The move is the purpose is to let the rural the critical/Poor patients receive timely treatment,Alleviate doctor-patient contradiction",But crossing the river by groping the stone policy unavoidably cause all worries:Will stimulate farmers hospitalized demand?If the new agriculture joint venture plates nervous/Even crash?If there are many repudiate a debt/Escape accounts do?Appear dishonest hospital show the new agriculture joint capital?Appear hospital disbursements capital is insufficient/Pressure to do?

　　实践是回应担忧的最好办法。时至今日，“先住院后付费”已实施两月有余，统计数据显示：截至目前已有超过5000人次享受了“先住院后付费”，但没有出现一例逃费现象。

Practice is the best way to respond to worry.today,"After the first pay in hospital"Two months have been implemented to spare,Statistics show:So far more than 5000 people enjoy"After the first pay in hospital",But there is no one escaped fee phenomenon.

　　

农民患者“拎包入住” Farmers patients"Bag in"

　　75岁的张全发来自太原市窊流村，记者见到老张时，他正坐在山西中医学院附属医院肾病科的病床上跟护士聊天。老张患有糖尿病引发的肾病，是科里的老病号，每年都要来住几次院。和以往不同的是，最近两次住院，老张都不用交押金，他风趣地称自己是“拎包入住”，享受了贵宾待遇。

The 75 - year - old zhang from taiyuan city Wa flow village,Reporters saw old zhang,He is sitting in shanxi college of traditional Chinese medicine hospital ShenBingKe bed with nurse chat.Lao zhang diabetes caused kidney disease,Is Corey old patient,Every year to live a few times court.And the past is different,The last two times in hospital,Lao zhang all need not pay the deposit,He's funny to say he is"Bag in",Enjoy the VIP treatment.

　　患者因交不起医疗费被中止医疗的事情屡见不鲜，不用交钱就能看病的事确实很少见。让老张得以享受“贵宾待遇”的“先住院后付费”政策详细规定，凡是符合住院直补条件的参合患者，可持本人太原市新农合医疗证(卡)、身份证(或户口本)原件(复印件)等相关证件，与定点医疗机构签订《太原市参合患者“先住院后付费”住院治疗费用结算协议书》后，无需缴纳住院押金，就可直接住院治疗。患者出院时，定点医疗机构即时结报新农合补偿部分，补偿后个人应承担的费用由患者结清。

Patients can not afford to pay for medical treatment were suspended medical thing common occurance,Don't make money can see a doctor thing is really rare.Let old piece to enjoy"VIP treatment"of"After the first pay in hospital"Policy detailed regulations,Those who conform to the conditions of hospital direct subsidy ginseng to add up to patients,Can hold his new agriculture in taiyuan city close medical certificate(card)/Id card(Or registered permanent residence this getting)original(copy)And other related documents,And the medical establishment that decide a dot signing[Taiyuan city ginseng adds up to patients"After the first pay in hospital"Hospitalization cost settlement agreement]after,Need not pay the deposit in hospital,Can be directly hospitalization.When released from the hospital patients,Fixed-point medical institutions for instant "new farmers joint compensation part,After the cost of compensation for personal assume by patients settlement.

　　对于确实难以一次性结清的低保户和特困患者，此项政策规定：可持所在村(居)委会出具的低保或特困证明，经县(市、区)民政部门确认盖章后，与定点医疗机构签订“费用延期(分期)还款协议书”，然后再办理出院手续。这为农村低保、贫困人群提供了方便，让因经济困难而放弃住院治疗的新农合患者能够得到及时有效的救治。

For disposable settlement is really difficult to guarantee the door and destitute patients,This policy:Can hold the village(in)Issued by the council of guarantee or destitute proof,The county(city/area)Civil affairs departments confirmed after affix one's seal,And the medical establishment that decide a dot signing"Cost extension(installment)Repayment agreement",Then go through the discharge formalities.This for the rural residents/Poor people to provide a convenient,Let due to financial difficulties and give up hospitalization new farming together patients can get timely and effective treatment.

　　为方便参合患者更好享受此项政策，很多医院大厅开通了绿色通道，设置有“先住院后付费”温馨提示，窗口标识清楚，程序简单明了，只需持入院证在窗口签个协议就可入院。

For the convenience of ginseng adds up to patients better to enjoy this policy,Many hospitals hall opened the green channel,Settings have"After the first pay in hospital"Warm prompt,Window clearly marked,Program simple and clear,Only the admission card in the window can sign an agreement to the hospital.

　　以患者为本的政策加上贴心的就医措施，“先住院后付费”政策一经推出就深受广大农民的欢迎。

Taking patients as this policy and close the accessibility of medical care measures,"After the first pay in hospital"Policy once launched by the farmers' welcome.

　　过去农民看病都是小病扛，大病挨，攒够钱才去医院看，往往耽误了治疗。山区农民交费时，颤颤巍巍解开裤腰带，小心翼翼从内裤里往出掏钱，就怕丢了。坐在收费窗口的办公室，太原市解放军二六四医院经管科助理黄荣菊想起这些眼圈发红。她说，现在他们身体不舒服了，可以“先去看病，再慢慢筹钱，普通病症，基本上不到1万元就能解决。现在只有太原市的新农合患者，才能享受这个政策，要是能在全省普及就好了”。

In the past farmers a doctor is ailment carry,Serious illness get,Saved enough money to go to the hospital to see,Often delayed treatment.Mountain farmers when fee,Tremble wei untied belt,Be careful to pay out from their underwear,They were afraid lost.Sitting in the office of the charge window,The people's liberation army 264 hospital in taiyuan city management department assistant HuangRongJu think of these red eye.She said,Now they body uncomfortable,can"First go to the doctor,Then slowly raise money,Common disease,Basically less than 10000 yuan can solve.Now only the new agriculture in taiyuan city combined patients,Can enjoy this policy,If I can in the province the popularization".

　　截至8月9日，有712名参合患者享受到“先住院后付费”待遇。截至8月22日，有1763人受益，占同期入院人数的67%，特别是县、乡两级定点医疗机构享受“先住院后付费”人数比例分别为86%、100%。截至9月21日，有3827人享受该项服务，占新农合入院患者总数的69.66%。截至9月28日，共有7312人次参合患者住院，其中5178人次享受了“先住院后付费”，占总人次的70.8%。

As of August 9,,There are 712 ginseng adds up to patients to enjoy"After the first pay in hospital"treatment.As of August 22,,There are 1763 people benefit,The same period accounted for 67% of the number of admission,Especially county/Township level fixed-point medical institutions enjoy"After the first pay in hospital"The number of 86% and respectively/100%.By September 21,,There are 3827 people enjoy this service,New agriculture accounts for 69.66% of the total number of close to the hospital patients.By September 28,,A total of 7312 people ginseng adds up to patients in hospital,The 5178 people enjoy"After the first pay in hospital",Accounted for 70.8% of the people.

　　

有风险就不做那什么事也做不好 Have risk will not do that do nothing

　　实施“先住院后付费”后，是否会刺激农民住院就医需求，如果新农合资金盘子兜不住，甚至出现崩盘风险怎么办？

implementation"After the first pay in hospital"after,Whether can stimulate farmers hospitalized demand,If the new agriculture joint venture plates not pocket,Appear even crash risk?

　　太原市卫生局统计数据显示，实施“先住院后付费”后的首月，新农合市域内住院4669人次，市、县、乡三级分别为2224人次、2067人次、378人次。与去年同期相比，住院人次增加660人，增长14.14%。

Taiyuan city health bureau statistics data show,implementation"After the first pay in hospital"Advance after,New farmers together the be in hospital inside urban 4669 people,city/county/Township level 3 respectively for 2224 people/2067 people/378 people.Compared with the same period last year,In an increase of 660 people,Growth of 14.14%.

　　“与去年同期相比住院的人次确实有所增加，增加的原因是多方面的，也是正常的。‘先住院后付费’实施后，并未引起就医人次大幅上涨。”郝宝清说。

"Compared with the same period last year the people in hospital has actually increased,Increase the reason is various,Also is normal.‘After the first pay in hospital’After implementation,Did not cause medical people rise considerably."HaoBaoQing said.

　　在对住院人次统计时调查人员发现，实施“先住院后付费”政策后明显出现了患者就医上移的现象。

In the hospital visitors statistics when investigators found,implementation"After the first pay in hospital"The apparent policy appeared was hospitalized up phenomenon.

　　数据显示，2012年8月，太原市市、县、乡三级定点医院的人次流向比例分别是47.63%、44.27%、8.10%。与去年同期相比，市、县两级的住院人次流向比例呈现上升趋势，分别增长1.99个百分点、2.91个百分点；乡级下降比较明显，下降4.90个百分点。

Data display,In August 2012,City of taiyuan city/county/Township level 3 fixed-point hospital passengers flow ratio is 47.63% respectively/44.27%/8.10%.Compared with the same period last year,city/County two levels of hospital passengers flow ratio showed a rising trend,Growth of 1.99%, respectively/2.91%;Township obvious decline,Fell by 4.90%.

　　分析人员称：“这可能与基本药物制度实施后，乡级住院服务能力有所下降有关。”郝宝清对这一现象并不感到意外，他称，因为新农合在各级医院报销比例的不同，过一段时间后，就医上移现象会随之自动调节，“乡镇卫生院报销100%，县区医院报销80%，市区医院只能报销50%～55%，尽管是后付费，但终归还是要付费的，老百姓会自行选择合适的医疗机构就医。”

Analysts say:"This may and essential drugs system after implementation,Township hospital service capacity fell about."HaoBaoQing to this phenomenon not surprised,He says,Because the new agriculture together in hospitals at all levels in China to submit an expense account proportion of different,After a period of time,Doctor up phenomenon will then automatic adjustment,"Township health center to submit an expense account 100%,County hospital to submit an expense account 80%,Urban hospital to submit an expense account only 50% ~ 55%,Although after is pay,But after all still want to pay,People will choose appropriate medical establishment go to a doctor."

　　住院人次增加和患者就医上移都会增加新农合资金报销的数额，太原市新农合资金的块头能否抵御住呢？

People increase in hospital and patients go to a doctor up will increase new farming together the amount of funds to submit an expense account,Taiyuan city new farming joint capital bigger can resist live it?

　　据郝宝清介绍，太原市新农合资金的块头的确不大，“大概在3.3亿到3.5亿元的样子，在全市这么大的范围实行‘先住院后付费’政策，确实要冒一定程度的风险。”

According to HaoBaoQing introduced,Taiyuan city new farming joint capital bigger indeed is not big,"At roughly 330 million to 350 million yuan appearance,In the city so large range of practice‘After the first pay in hospital’policy,Do take a certain degree of risk."

　　“我是这么想的，干什么都会有一定风险，只是风险大小而已。如果说有风险我们就不去做、不去试，那我们可能什么事情也做不好，跟在别人后面做事永远做不出成绩。”郝宝清说。

"I am thinking,Do will have a certain risk,But the magnitude of risk only.If there is risk we would not have to do/Don't try,That we may do what,And behind the other people do not always do the results."HaoBaoQing said.

　　为了实时摸底以及时应对，太原市出台了“先住院后付费”日报制度。各医院每天上报农民住院数据，由太原市新型农村合作医疗管理中心进行动态监测。一旦数据有异常，特别是具有苗头性的问题，会及时研究应对方案。

In order to real time touch bottom and respond to,Taiyuan city issued a"After the first pay in hospital"Daily system.The hospital reported everyday farmers hospital data,Taiyuan city by the new rural cooperative medical management center for dynamic monitoring.Once the data is abnormal,Especially with MiaoTouXing problem,Will timely research solutions.

　　相关监测数据显示，2012年1至8月，太原市新农合统筹基金支出15726.85万元，较去年增加3960.59万元，增长33.66%；统筹基金使用率51.1%，较上年提高0.71个百分点。也就是说，实施“先住院后付费”后，“新农合补偿支出确实有所增加，但整体运行平稳可控”。

The monitoring data shows,In January 2012 to August,Taiyuan city as a whole new farming close fund of 157.2685 million yuan,Compared to last year an increase of 39.6059 million yuan,Growth of 33.66%;As a whole fund utilization rate 51.1%,Jumped 0.71% from a year earlier.That is,implementation"After the first pay in hospital"after,"New farmers joint compensation expenses has actually increased,But the overall smooth operation controlled".

　　以往新农合的报销方式是，农民住院时交钱，然后再拿着相关票据到新农合管理部门报销。而实施“先住院后付费”后，农民看病的医疗费用需要医疗机构先行垫付，这无疑将增加医院的资金压力，有人担心医疗机构会因为资金压力而运行困难。

In the past, new farming way is to submit an expense account,Farmers make money at the time of admission,Then take relevant bill to the new agriculture joint management department to submit an expense account.And the implementation"After the first pay in hospital"after,Farmers hospital medical expenses need medical institutions first disbursements,This will undoubtedly increase hospital fund pressure,There are fears that the medical institutions will because fund pressure and operation difficult.

　　为了确保服务效果，缓解因医院提前垫资而带来的资金周转问题，太原市改变了新农合资金对医疗机构的支付方式。以往是市级医院三个月支付一次，县级医院一个月支付一次。实行“先住院后付费”政策后，三个月的改为一个月，一个月的改为半个月，根据实际情况，十天也可以支付。

In order to ensure that the service effect,Ease for hospital early mat endowment brought the cash flow problems,Taiyuan city changed new farming close funds for medical institutions of payment.In the past the municipal hospital three months to pay a,The hospital at or above the county level for a month to pay a.implement"After the first pay in hospital"Policy after,Three months into a month,A month to half a month,According to the practical situation,Ten days can also pay.

　　《太原市参合患者“先住院后付费”住院治疗费用结算协议书》规定，若住院治疗费用达到或超过分段结算标准(三级医院10000元，二级医院5000元)，患者需按新农合报销比例向院方结算一次，以此来缓解医院的垫付压力及资金风险。

[Taiyuan city ginseng adds up to patients"After the first pay in hospital"Hospitalization cost settlement agreement]provisions,If hospitalization expenses, reach or exceed section settlement standard(Tertiary hospital 10000 yuan,Secondary hospital 5000 yuan),Patients should be made according to the new agriculture close to submit an expense account proportion to the hospital a settlement,In order to alleviate the hospital disbursements pressure and capital risk.

　　郝宝清认为，卫生行政部门既管理新农合经办机构，又监管着医疗机构，具有“一手托两家”的优势，通过“兼顾”和“统筹”，能够确保医疗机构正常运转和农民利益最大化。

HaoBaoQing think,The administrative department of public health management is a new agriculture joint agency orgnaization,The medical institutions and supervision,has"On hand to two"advantage,Through the"Give attention to two or morethings"and"As a whole",To ensure the normal operation of medical institutions and farmers benefit maximization.

　　

“农民不是刁民”，没人赖账 "Farmers are not DiaoMin",No one depend

　　“先住院后付费”政策实施之初，有人担心如果很多农民患者看完病就溜，出现很多赖账、逃账怎么办？

"After the first pay in hospital"At the beginning of the implementation of the policy,Some people worry that if many farmers patients finish see disease just slip,Appear many depend/Escape accounts do?

　　“这样想法的前提是把农民想象成刁民，其实农民是很质朴的。我在农村生活过，知道农村有农村的传统、规矩，如果村里的大喇叭喊哪家没补住院的钱，左邻右舍都听着呢，欠账的人会感觉很没脸面，如果不是实在拿不出钱，是不会故意拖欠着不交的。”郝宝清说。

"This idea is the premise of the farmers DiaoMin imagine,In fact farmers is very plain.I lived in the countryside,Know the traditional rural countryside/rules,If the village big horn shout which didn't fill in money,Neighbors are all listening to you,: to pay off longstanding arrears in people will feel very didn't face,If not really take no money,Is won't deliberately default not pay."HaoBaoQing said.

　　在新农合“先住院后付费”服务模式启动会上，郝宝清特别提到这么一句话：“‘先住院后付费’措施体现了卫生系统服务农民、尊重农民、信赖农民的信心和决心。”

In the new agriculture together"After the first pay in hospital"Start the meeting service mode,HaoBaoQing special mention such a few words:"‘After the first pay in hospital’Measures reflects the health system service farmers/Respect farmers/Trust farmers' confidence and determination."

　　这项政策实施两个月来的现实情况如何呢？在享受“先住院后付费”的超过5000人次中，没有出现一例逃费现象。

The policy implementation two months to the reality of the situation how?enjoy"After the first pay in hospital"More than 5000 people in,There is no one escaped fee phenomenon.

　　“这是很多人没有预料到的。我的想法是，如果医院给患者提供了一流的服务、温馨的医疗环境，农民感谢还来不及，怎么好意思赖账呢？”郝宝清认为，农民住院看病拖欠账以前也有，实施“先住院后付费”后，“不会增加坏账赖账，也不可能绝对避免，如果出现了，那就通过法律的途径去追回。”

"This was what many people hadn't expected.My idea is,If the hospital patients to provide the first-class service/Warm medical environment,Farmers thank it,How not bashful repudiate a debt?"HaoBaoQing think,Farmers hospital see a doctor before default zhang also have,implementation"After the first pay in hospital"after,"Does not increase depend on bad loans,Nor can absolutely avoid,If there was,Then through the legal way to recover."

　　为了规避风险，太原市卫生局建立了新农合就医信用系统，如果有人恶意逃费，医院可通过暂停其新农合医保、走法律程序等方法进行追查，其家属就医可能也会受到影响。

In order to avoid risk,Taiyuan city health bureau set up new farming together go to a doctor credit system,If someone malicious fled fee,The hospital can through the suspend its new farmers joint medical insurance/Go legal procedures carried out in the method of tracing,The family doctor may also be affected.

　　“先住院后付费”不仅服务了农民患者，也对医院提出了更加严格的要求。据了解，为防止医院套取新农合资金，太原市卫生局对该市的医疗机构提出严格要求，凡是住院的患者一定要符合住院标准，必须住院的才能住院，检查完能走的就不住院。对此，太原市卫生局制定了细则和标准对辖区内医院进行不定期检查。

"After the first pay in hospital"Not only the farmers service patients,Also on hospital puts forward more strict requirements.It is understood,To prevent hospital show the new agriculture joint capital,Taiyuan city health bureau to the city's medical institutions puts forward strict requirements,All patients in hospital must accord with standard of hospital,Must be in hospital to hospital,Check out can walk of is not in hospital.this,Taiyuan city health bureau has formulated the detailed rules and standards within its jurisdiction to hospital for casual inspection.

　　首先实行的就是“按床日付费”制度。将所有住院疾病分为若干类，合理确定平均住院日，经过测算，确定各类住院疾病不同床日段的床日付费标准。按日支付，费用超出部分由医疗机构承担，结余部分归医疗机构所有。为避免医院向门诊转嫁费用、不合理缩短患者住院时间以及推诿重症患者的行为，医疗服务监测评价结果，将作为新农合最终支付费用的重要依据。

First practice is"According to the bed, pay"system.Will all hospital disease is divided into several types,To reasonably determine the average day in hospital,After measuring,Sure all kinds of diseases in different bed day period of bed day pay rate.By the day to pay,Part of the expenses exceed by medical institutions to undertake,Partly to balance all medical institutions.To avoid the hospital outpatient expenses to pass on/Unreasonable shorten hospitalization time and shuffle in severe cases behavior,The medical service monitoring and evaluation results,As a new agriculture will eventually close to pay expenses is an important basis.

　　作为医疗服务的提供者，医院一方面需要直接面对病患，另一方面也受到医保基金的严格监督管理。对于医保病人，医生们要遵守“硬杠杠”，比如住院定额、药占比(山西省卫生厅要求，二级定点医疗机构使用《山西省新型农村合作医疗药品目录》内药品的费用，占使用药品总费用的比例达到90%以上，三级定点医疗机构使用目录内药品的费用，占使用药品总费用的比例达到80%以上，医疗机构非抢救生命使用药品目录以外的药品，要经过患者或家属同意并签字)、住院天数等。

As a medical service providers,On the one hand need hospital directly to patients,On the other hand is also affected by the strict supervision and management of the medical insurance fund.For health care patients,The doctors to obey"Hard underlined",Such as hospital quota/Medicine accounted for more than(Shanxi Province health department requirements,Secondary fixed-point medical institutions use[Shanxi new rural cooperative medical drug catalogue]In the cost of drugs,Use of the drug for the total cost more than 90%,Level 3 fixed-point medical institutions within the cost of drug use directories,Use of the drug for the total cost more than 80%,Medical institutions not rescue life use drug catalogue outside of the drug,To pass patient or family member to agree and sign)/Hospitalization days, etc.

　　此外，医保中心、新农合管理中心，都与定点医院签订服务协议，若医院超过次均定额的费用，省医保将全额收缴，市医保将按比例扣除，新农合将给予警告，直至取消定点医院资格。

In addition,Health care center/New farmers joint management center,With the fixed-point hospital sign service agreement,If the hospital more than the cost of the second all quota,Provincial health care will be a full collection,City medical insurance will be proportional deduction,New farmers joint will be given a warning,To cancel the fixed-point hospital qualification.

　　郝宝清认为，“先住院后付费”政策也在倒逼医疗机构提高服务水平，“因为是后交费，医院要是给患者治疗得不够好，或者过度用药过度检查了，那在交费的时候就会出现问题。”

HaoBaoQing think,"After the first pay in hospital"Policy in DaoBi medical institutions to improve the service level,"Because it is the pay after,If the hospital care to patients are not good enough,Or excessive use excessive examined,That is handing in time there will be a problem."

　　本报太原10月18日电

The taiyuan October 18 (Reuters)