中新网10月31日电 据卫生部网站消息，卫生部办公厅日前发布关于2012年各地加强医药费用控制有关情况的通报。通报要求，建立激励约束机制，将成本和费用控制纳入医务人员绩效考核，促使医务人员自觉控费。

Beijing on October 31, according to the ministry of health news website,General office of the ministry of health has issued about 2012 strengthen medical cost control of the report.Reporting requirements,To establish incentive and restraint mechanism,Will cost and cost control into the medical staff performance evaluation,Medical personnel to consciously control fee.

——控制医药费用增长情况 - control medical cost growth

　　(一)控整体，优化医疗资源结构布局，提高医疗服务体系效率。各地在加强基层医疗卫生机构能力建设的同时，探索采取托管、建立医疗集团(联合体)、院办院管等方式，在医院与基层医疗卫生机构之间建立相对紧密的分工协作机制，逐步构建分级诊疗、双向转诊的就医格局，降低医疗费用。如江苏镇江市组建医疗集团，促进医疗资源下沉；武汉市第五医院对社区卫生服务中心进行人、财、物等统一管理和调配，建立“直管”的紧密型分工协作模式，提升区域医疗服务整体水平和绩效。

(a)Control whole,Optimize medical resource structure layout,To improve medical service system efficiency.Everywhere in strengthening basic medical and health institutions ability construction at the same time,Explore take custody/Establish the medical group(association)/Acknowledgement court tube, etc,In the hospital and basic medical and health institutions established between relative close division of Labour cooperation mechanism,Gradually build a hierarchical diagnosis and treatment/Two-way referral medical-seeking pattern,Reduce medical expenses.Such as jiangsu zhenjiang form medical group,To improve medical resources sink;The fifth wuhan city hospital to community health service center for people/wealth/Content and unified management and allocation,To establish"Straight tube"The division of close cooperation mode,Improve the overall level of regional medical service and performance.

　　(二)抓源头，降低医疗服务要素成本。一是建立健全药品和耗材集中招标采购制度。充分利用现代化物流手段，提高配送效率，降低流通环节成本。同时严肃查处医药购销领域的不正之风。二是鼓励优先使用基本药物和适宜技术。鼓励遴选国产优质药品和器材，取代进口产品，降低费用。山东省对二级以上医疗机构基本药物配备使用的范围、比例、采购配送等提出明确要求，促使公立医院优先配备使用基本药物。三是严格大型医疗设备准入和二、三类医疗技术临床应用准入管理，重点加强对高风险、高费用技术的准入管理。江苏、上海等地加强对心血管疾病介入诊疗、肿瘤治疗、关节置换等技术准入，从源头上保障质量安全，同时避免不合理使用。

(two)Catch source,To reduce the cost of medical service elements.One is to establish and perfect the medicine and consumables centralized bidding procurement system.Make full use of modern logistics means,Improve efficiency of supply,Reduce the circulation link cost.At the same time strictly investigate and prosecute pharmaceutical sales field of unhealthy tendency.The second is to encourage priority use basic drugs and appropriate technology.Encourage domestic high-quality selection of drug and equipment,Replace the imported products,To reduce cost.Shandong province more than secondary medical institutions essential drugs with the scope of use/proportion/Procurement and distribution, and other give clear requirements,Priority to public hospital equipped with use basic drugs.Three is strictly large medical equipment access and two/Three types of medical technology clinical application access management,Key strengthen the high risk/High cost technology access management.jiangsu/Shanghai to strengthen in diagnosis and treatment of cardiovascular disease/Tumor treatment/Joint replacement technology access,From the source to ensure quality and safety,At the same time avoid unreasonable use.

　　(三)管终端，控制单体医疗机构医药费用。在外部监管方面，各部门通力合作，规范诊疗行为，推动适宜技术的使用，抓好关键科室和关键环节的控费工作。一是卫生行政部门加强对医疗机构用药及控费情况的监管。通过开展抗菌药物专项整治，规范医疗机构和医务人员对抗菌药物的使用；通过对关键科室和重点病种的费用加强监测，有的放矢地控制费用。部分地区卫生行政部门还将控费情况纳入医院评审评价中，对未达到控费目标的医疗机构实行“一票否决制”。二是医保部门积极推进基本医保支付方式改革。上海、镇江等地结合医疗联合体、医疗集团的建立，推进总额预付，促进医疗机构自觉下转病人；北京市试点按疾病分组(DRGs)付费；吉林省、河南省在部分县级公立医院探索按病种付费。三是办医主体将控费工作纳入对公立医院和院长的综合目标管理、绩效考核。四是建立社会广泛参与的控费监督机制，完善医疗服务信息公示制度。

(three)Tube terminal,Control monomer medical institutions medical expenses.In the external supervision,Each department cooperation,Standard medical behavior,To promote the use of appropriate technology,Pays special attention to the key departments and key link point charge work.One is to strengthen the administrative department of public health of medical institutions and drug control cost of the supervision.Through the development of antibacterial drugs special improvement,Standard the medical institutions and medical personnel to the use of antibacterial drugs;Through the key departments and key diseases fee to strengthen monitoring,Have a definite object in view to control cost.Parts of the health administrative departments will also control fee situation into the hospital evaluation in the evaluation,Did not reach to control cost target of a medical institution"A ticket overruled make".The second is medical insurance department actively promote basic medical insurance payment reform.Shanghai/Zhenjiang, combined with medical association/The establishment of the medical group,Propulsion amount prepaid,Promote the medical institutions under the consciously turn the patient;Beijing pilot by the disease group(DRGs)pay;Jilin province/In some public hospital in henan province at or above the county level to explore press disease to pay.The third is to do medical subject will control fee work into in public hospitals and dean of comprehensive management by objectives/Performance evaluation.Four is to establish social broad participation of control cost supervision mechanism,Improve the system of public medical service information.

　　在内部管理方面，公立医院普遍加强内部管理，创新服务方式。一是通过优化服务流程、开展日间手术、建立多学科会诊中心、提供“一站式”服务等方式，在保障医疗质量安全的前提下，科学缩短平均住院日，提高服务效率。北京大学第三医院以缩短平均住院日为切入点，从内部管理挖掘潜力，平均住院日已降至6.87天；上海交通大学附属仁济医院全面推行日间手术，目前涵盖74种手术，手术数量占总手术量的25%，以甲状腺良性肿瘤手术为例，平均住院天数降低到1.35天。二是规范诊疗行为。加强临床路径管理、开展处方点评、动态监测抗菌药物使用等。三是控制运行成本。加强成本核算、预算管理等，强化医院成本控制，减少浪费，控制费用。

In the internal management,Public hospitals generally strengthen internal management,Innovation service mode.One is through the optimization service process/In ambulatory surgery/Established a multidisciplinary consultation center/provide"one-stop"Service, etc,In ensuring the quality of medical treatment under the premise of safety,Science and shorten the average day in hospital,Improve service efficiency.Peking University third hospital to shorten the day in hospital as the breakthrough point,From the internal management mining potential,The day in hospital has already dropped to 6.87 days;Shanghai jiaotong university affiliated yan chai hospital the full implementation of the ambulatory surgery,Currently covers 74 kind of surgery,The number of total surgical operation of 25%,With thyroid benign tumor surgery as an example,The average hospitalization days reduced to 1.35 days.2 it is standard medical behavior.To strengthen the management of clinical pathway/Carry out prescription comment on/Dynamic monitoring antimicrobial drug use, etc.Three is to control the operation cost.Strengthen cost accounting/Budget management, etc,Strengthening the hospital cost control,Reduce waste,Control cost.

——建立控费工作的长效机制 - to establish control fee work long-term mechanism

　　(一)加强医院内部管理，提高医院运行效率。创新服务方式，通过优化服务流程、开展日间手术、建立多学科会诊中心、延伸护理服务等，缩短平均住院日，提高服务效率，降低医药费用。优先配备、使用基本药物，广泛使用适宜技术，实行同级医疗机构检查、检验结果互认，减少患者就医成本。加强财务管理，实行成本核算与控制，减少医院运行中的“跑冒滴漏”现象，杜绝不必要的浪费。建立激励约束机制，将成本和费用控制纳入医务人员绩效考核，促使医务人员自觉控费。

(a)To strengthen hospital internal management,Improving hospital efficiency.Innovation service mode,Through the optimization service process/In ambulatory surgery/Established a multidisciplinary consultation center/Extended care services, etc,Shorten the average day in hospital,Improve service efficiency,Reduce medical expenses.Priority equipped with/Use basic drugs,Appropriate technology widely used,To check in with a medical facility at the same level/Inspection result recognition,To reduce the cost of patients go to a doctor.To strengthen the financial management,Implement cost accounting and control,The reduction of hospital operation"PaoMaoDiLou"phenomenon,To eliminate unnecessary waste.To establish incentive and restraint mechanism,Will cost and cost control into the medical staff performance evaluation,Medical personnel to consciously control fee.

　　(二)强化医院外部监管，抓好控费关键环节。加强对关键环节和费用较高病种的监测，对费用增长速度较快的疾病诊疗行为进行重点监控。及时查处不合理用药、用材和检查以及重复检查行为。完善药品和耗材集中招标采购制度，严格大型医疗设备和二、三类医疗技术临床应用准入管理，重点加强对高风险、高费用技术的准入管理。

(two)Strengthening the hospital external supervision,Pays special attention to the control fee key link.Strengthen the key link and higher cost monitoring of disease,To cost growth rate faster disease diagnosis and treatment conduct key monitoring.Timely investigate not rational drug use/Timber and check and repeated inspection behavior.Perfect drugs and consumables centralized bidding procurement system,Strict large medical equipment and two/Three types of medical technology clinical application access management,Key strengthen the high risk/High cost technology access management.

　　要继续配合有关部门，推进医保支付方式改革。建立社会广泛参与的控费监督机制，完善医疗服务信息公示制度，定期向社会公布门诊、住院平均费用变化等信息。发挥社会各方监督作用。

Will continue to coordinate with the relevant departments,Promote medical insurance payment reform.The establishment of a social broad participation of control cost supervision mechanism,Improve the system of public medical service information,Publicize regularly outpatient service/The average hospitalization cost change and other information.Giving full play to social parties supervisory role.

　　(三)以控费工作为抓手，促进公立医院体制创新和机制转换。积极探索建立促进医疗资源纵向流动的办医体制，形成公立医院与基层医疗卫生机构之间相对紧密的分工协作机制，做好疾病康复和延伸服务，逐步形成分级诊疗、双向转诊、急慢分治的就医格局，提高区域整体医疗服务效率，降低医疗费用。

(three)Take a lot of work to control as the gripper,Public hospital to promote the innovation of system and mechanism transformation.Actively explore establish promote medical resources longitudinal flow of do medical system,Formation of public hospital and basic medical and health institutions relatively close between the division of work mechanism,Do disease rehabilitation and extension services,Gradually formed hierarchical diagnosis and treatment/Two-way referral/Steep slow partition of medical pattern,Improve the overall regional medical service efficiency,Reduce medical expenses.

　　完善医院发展机制，建立现代医院管理制度。将控制医疗费用与控制医院单体规模紧密结合，引导医院转变发展模式和管理方式，通过加强内涵建设，完善以岗位管理为核心的人事管理制度，提高医院管理水平和运行效率。建立健全内部收入分配机制，提高人员经费支出占业务支出的比例，将调动医务人员的积极性转化为人民群众的健康效益，降低群众看病负担。

Perfect hospital development mechanism,The establishment of a modern hospital management system.Will control medical cost and control the hospital monomer scale closely,Guide hospital transformation development mode and management mode,By strengthening the connotation construction,Perfect to post management as the core personnel management system,To improve hospital management level and efficiency.Establish a sound internal income distribution mechanism,Improve the personnel expenditure spending accounts for the proportion of business expenses,Will mobilize the enthusiasm of the medical staff into people's health benefits,Reduce the burden to see a doctor.