从昨天开始，广州市人大常委会的年底集中视察拉开了帷幕。在为期4天的视察过程中，市人大常委会法制工委、城建工委、财经工委、农村工委、华侨外事民宗工委、内司工委、教科文卫工委等7个工作委员会全员出动，对广州市国资委、发改委、城管委、中院、建委等多个政府部门和各个区，就不同热点议题展开了视察工作。这其中，还包括对多个部门及热点问题的暗访。暗访首日，视察组也确实听到了“治个感冒要跑三四趟医院”、“社区医院开不出‘三甲’医院的药，造成病人回流”等最真实的声音。

From yesterday began to,Guangzhou city people's congress standing committee at the end of the concentrated inspection pulled open heavy curtain.During the four days of inspection process,The municipal people's congress standing committee legal working committee/Urban construction working committee/Financial working committee/Rural working committee/Overseas Chinese foreign affairs of the people working committee/Steering committee taiwo/Education such as steering committee 7 working committee overall turnout,Sasac to guangzhou/Development and reform commission (NDRC)/ChengGuanWei/then/Is built appoint wait for a number of government departments and each area,Different issues on the inspection work.the,Also include the multiple departments and hot issue of investigations.First and,ShiChaZu also really heard"Cure a cold to run three or four trip to the hospital"/"Community hospitals could not open‘top’Hospital medicine,Cause patients return"Such as the real voice.

　　

暗访 investigations

　　实录 memoir

　　声音1 能不能给点尊严？ Voice 1 can you give me some dignity?

　　限额花费，感冒要跑三四次医院 Limit cost,Caught a cold to run three or four times a hospital

　　虽然不是周末，越秀区六榕街社区卫生服务中心还是挤满了前来看病的社区居民，这其中退休的老年人占了绝对多数。正在排队等取药的退休职工陈耀国、曹美容就围着视察组，就他们正在享受的职工医疗保险提出了意见：

Although not a weekend,Yuexiu district of six banyan street community health service center or filled with to come to a doctor of community residents,The retired old people accounted for absolute majority.Are waiting in line take medicine ChenYaoGuo retired worker/Cao beauty is ShiChaZu around,Will they are enjoy of insurance of worker medical treatment to put forward opinions:

　　“从这个月起，我们看一次社区医院的门诊一次限额花费30元，而且每次过来都要掏10元的门诊挂号费，真正开药的费用只有20元。老人喜欢开中药，看个感冒，20块钱根本开不了几剂，只能一次一次跑，看个感冒都要跑三四次。”陈耀国拿着手里的处方单直摇头。

"From this month,We see a community hospital outpatient service a limit cost 30 yuan,And every time come to take 10 yuan of outpatient service registration fee,Real prescribe costs only $20.The old man like open Chinese medicine,See a cold,20 dollars fundamental open a few agent,Only once a run,See a cold all want to run three or four times a year."ChenYaoGuo took his ChuFangChan straight shook his head.

　　曹美容一开口也反映的是同样的问题：“医保给我们退休职工在社区定点医院的待遇是每人每月300元，为什么又要额外限制每次看病的花费只能是30元呢？30块钱真的是什么病都看不了，能不能请政府给我们老百姓小小尊严，相信我们能用好这每月的300元。”

Cao beauty a open also reflect the same problem:"Health care to give us retired worker in the community fixed-point hospital treatment is each every months 300 yuan,Why did he see a doctor every time the cost of additional restrictions is only 30 yuan?30 dollars is really what disease can not see,Can you please the government to give us common people a little dignity,Believe that we can use these 300 yuan a month."

　　

声音2 病人怎能留得住？ Voice 2 patients can keep them?

　　开药受限，社区医院难开医保药 Prescribe limited,Community hospital medical insurance drugs is difficult to start

　　针对每次30元的门诊统筹上限，正在坐诊的社区卫生服务中心内科副主任医师蔺青表示，社区医院实施的是基本药物零差价制度，砍掉了之前国家允许的15%的药品加成，完全按进货价销售，药价比部分药店的还要便宜，这让20块钱也能开出比较多的药。“老人家一般希望来一次医院就开完300块定额的药，但是作为医院，必须严格执行卫生部门诊处方条例的相关规定操作，急诊病人只能开3天的药量，普通门诊病人只能开出7天的药量，慢性病病人才能一次开出30天的用药量。也希望老人能理解。”

For every time 30 yuan outpatient service as a whole ceiling,Are ZuoZhen community health service center medicine of doctor of vice director of LinQing said,Community hospital implementation is the basic drug zero spread system,Cut off before the state allows 15% of the drug addition,Completely according to sales prime cost,Prices than part of pharmacy be cheaper,It makes $20 also can open more medicine."Old man general hope to a hospital and then open the 300 pieces of norm medicine,But as the hospital,The ministry of health must be strictly implemented outpatient prescription regulations related instructions,Emergency patient can only open 3 days of dosage,Ordinary outpatient can open an dose of 7 days,Chronic illness patient can open a 30 days of exposure leels.Also hope that the old man can understand."

　　但是作为医生，蔺青表示，最大的困扰是社区医院可以开的医保药品目录有限制，很多三甲医院可以开的“经典”医保好药品不在目录内，一些从“三甲”医院分流来的病人，因为开不出自己用惯的药品，只能再回流到三甲医院。

But as a doctor,LinQing said,The biggest trouble is community hospital medical insurance drugs can open directory has limit,A lot of 3 armour hospital can open"classic"Health care good drug is not within the directory,Some from"top"Hospital shunt to patients,Because could not open his used drugs,Only then return to 3 armour hospital.

　

　声音3 社区医院很难顶！ Voice 3 community hospital is hard to top!

　　慢性病多，一年亏了170多万元 More chronic diseases,A year lost more than 170 yuan

　　社区医院除了药品难满足患者，陈洁霞医生还算了一笔账：医保给参保人的待遇是300元每月的定额，用足的话，一年是3600元；但社保部门在与社区医院结算时，却是按每个选点人每年400元的标准，两者相较，让医院亏损很多。“因为选点社区医院的很多都是老年人，慢性病多，每年基本是用足定额的。而选择社区医院的年轻人很少很少，难以补足老年人超支的部分，上一个医保结算年度，医院因为这部分差额造成的亏损高达170多万元。”

Community hospital in addition to drug difficult to satisfy the patients,ChenJieXia doctors also calculate a bill:Medical insurance protects a person to pay is 300 yuan monthly quota,For the full word,A year is 3600 yuan;But social security department in hospital and community when settle accounts,According to each person is choosing the standard of 400 yuan a year,Compared with both,Let the hospital loss a lot."Because setpoint community hospital many are elderly,More chronic diseases,Each year the basic is to use the full quota.Choose community hospitals of young people very few,Difficult to make up the old part of the overspend,A medical insurance settlement annual,The hospital because this part of the balance cause losses as high as more than 170 yuan."

　　

官方解释 The official explanation

　　延长医保缴费 Extend medical insurance capture to expend

　　职工影响不大 Worker the impact is not big

　　问：此次广州医保条例草案表示，广州拟规定职工医保缴费年限延长5年，为何要延长5年缴费，是不是因为医保缺口？

ask:The guangzhou health-care bill said,Guangzhou quasi regulation worker medical insurance capture expends fixed number of year extension 5 years,Why want to extend 5 years capture to expend,Is it because health gap?

　　郑玉华：广州目前职工医保缴费仅为10年，是全国最短的。北京、天津、长春、武汉等城市缴费要25年到30年。现在国家原则上提出，不同地区的医保参保人，可以转移接续医保参保关系。如果广州不延长缴费年限，那些缴费年限更长地区的参保人会向广州转移医保关系，增加广州市医保基金的支出。同时延长职工医保缴费，对职工影响不大。

ZhengYuHua:Guangzhou at present worker medical insurance capture to expend only for 10 years,Is the shortest.Beijing/tianjin/changchun/Wuhan and other cities pay cost to 25 years to 30 years.Now the country put forward in principle,Different parts of the medical insurance protects a person,Can transfer in the medical insurance ginseng protect relationship.If guangzhou doesn't extend capture expends fixed number of year,The capture expends fixed number of year longer area protects a person to guangzhou transfer medical insurance relationship,Guangzhou increase medical insurance fund spending.At the same time extends worker medical insurance capture to expend,The impact is not big to the worker.

　　问：为何医保报销是医保局，医保费的收取却要去地税部门缴纳？

ask:Why medical insurance to submit an expense account is medical insurance bureau,The medical insurance fee charge will go to pay the land tax section?

　　郑玉华：目前广州地税在收取医保费上，流程繁杂、差错率高，影响广州社保服务管理效率，导致参保人不能享受正常待遇，我们人社部门屡屡收到投诉。2009年之前，医保费用的确是我们收的，一直运作顺畅。当年省里突然来了个通知，就变成了地税部门收费，他们也十分困惑，硬件也不成熟。所以这次立法，我们建议社保费征收，还是划归我们人社局负责。

ZhengYuHua:At present guangzhou land tax in charge on the medical insurance fee,Process multifarious/Error rate high,Guangzhou influence social security service management efficiency,Lead to ginseng protect people cannot enjoy normal treatment,Our club department repeatedly received complaints.2009 years ago,The medical insurance cost is indeed we reap,Has been operating smoothly.The province suddenly to a notice,Became land tax section charge,They are also very confused,Hardware is not mature.So the legislation,We suggest that social insurance premium collection,Or put under our club bureau is responsible for.

　

　医保现状 Medical insurance status

　　广州大病医保未有出台时间表 Guangzhou medical insurance not a serious illness on schedule

　　市人社局明确表示：拒付医院过度医疗费用 City people club bureau made clear:Protest hospital excessive medical treatment cost

　　针对暗访中的问题，以及目前医保运行的情况，当天下午市人大常委会法制工委就邀请市人社局等相关部门进行了座谈。“广州居民的大病医保制度，还未有出台时间表。目前我们还在进行内部测算。”市人社局巡视员郑玉华告诉羊城晚报记者。

According to the problems of investigations,And now medical insurance operation condition,In the afternoon the municipal people's congress standing committee legal working committee will invite city people club bureau and other related departments to the discussion."Guangzhou residents of the medical insurance system of a serious illness,Haven't come schedule.At present we have in the internal measure."City people club bureau inspector ZhengYuHua told the yangcheng evening news reporter.

　

　广州医保基金连续缺口4年 Guangzhou medical insurance fund continuous gap 4 years

　　由政府财政掏钱填补 The government pays to fill

　　市人大常委会副主任李力在座谈会上提出疑问：广州市居民的大病医保制度，什么时候能够建立起来？

The municipal people's congress standing committee, deputy director of the LiLi in symposium proposes the question:Guangzhou residents of the medical insurance system of a serious illness,What time can set up?

　　市人社局巡视员郑玉华表示，广州居民医保是2008年才开始建立，一直未有居民大病医保制度。“大病医保是一种补充医保制度，最近国家、省里要求各地建立大病医保制度。这里有两个前提条件：广东先行先试，同时当地居民医保基金的结余至少要有半年以上。”郑玉华说，广州并不是试点城市，同时广州居民医保基金已经连续缺口4年。“已经统计出来的数据显示，广州居民医保2009年亏1.3个亿，2010年、2011年预计亏1.6个亿，2012年预计缺口超过1.8个亿。”

City people club bureau inspector ZhengYuHua said,Guangzhou residents' medical insurance is 2008 years began to build,No residents medical insurance system has been a serious illness."A serious illness medical insurance is a kind of supplementary medical insurance system,Recently the national/Province requires all medical insurance system to establish a serious illness.There are two premise condition:Guangdong first try first,At the same time, local residents of the medical insurance fund balance should have at least more than half a year."ZhengYuHua said,Guangzhou is not pilot cities,Meanwhile, guangzhou residents medical insurance fund has continuous gap 4 years."Have of the statistics of data display,Guangzhou residents health 2009 kui 1.3,In 2010,/In 2011 is expected to kui 1.6,In 2012 is expected to gap more than 1.8."

　　虽然合计起来广州居民医保预计已经亏近5个亿，郑玉华表示，参保市民无须担心，“根据国家规定，居民医保基金的缺口，由政府财政掏钱填补。”

Although total up guangzhou residents' medical insurance is expected to have kui nearly 5,ZhengYuHua said,Ginseng protect citizens do not need to worry about,"According to the provisions of the state,Residents of the medical insurance fund gap,The government pays to fill."

　　郑玉华会后向羊城晚报记者透露，广州的大病医保还未有出台时间表。制度的出台需要慎重地规划。目前市人社局还在做内部测算，有结果后，需要报省里批复。谁也说不准什么时候出台。

ZhengYuHua after the meeting to the yangcheng evening news reporter revealed,Guangzhou medical insurance haven't a serious illness on schedule.System come on stage requires careful planning.At present the city people club board also doing internal measure,After the,Need to reply province.Who can tell what time come.

　　

定额制度在执行中被扭曲了 Quota system in the course of execution is distorted

　　医院受到利益驱动 The hospital is interest drive

　　市人大法工委副主任邢翔在座谈会上表示，调研中，很多社区医院抱怨，由于医保部门搞了定额制度，医院的慢性病、重病病人每月的医疗费远远超过了医保基金支付的定额。定额制度影响病人就医权利，同时医院面临亏本。

The municipal people's congress deputy director of the FaGongWei XingXiang in forum said,Research in,A lot of community hospital complaining,Due to the medical insurance department make the quota system,Hospital chronic/Serious illness patient monthly medical treatment cost far more than the medical insurance fund payment quota.Quota system influence patients go to a doctor right,At the same time facing the hospital at a loss.

　　“医保部门的定额，是按照一家医院几年医疗费和病人的数量，平均下来计算的。”市人社局医保处张学文处长介绍，他打了一个比方，“比如一个医院有100个病人，医院当年医疗费总支出是100万元的话，那么该医院每个病人定额就是1万元。但这不是说每个病人都用到了1万元，可能13个人的费用，远远超过1万，而87个人的费用，又低于1万。”

"Medical insurance department quota,Is according to a hospital medical treatment and a few years the number of patients,The calculation of the average down."City people in social medical insurance bureau chief zhang is introduced,He gave a example,"For example a hospital has 100 patients,The hospital medical treatment is 1 million yuan in total words,So the hospital each patient quota is 10000 yuan.But this is not to say that each patient with up to 10000 yuan,May 13 personal expenses,Far more than 10000,And the cost of 87 people,And less than 10000."

　　张学文说，定额制度在医院的执行中，被医生扭曲了。“在定额制度下，有医生给病人看病，一看才花了4000元，就又给病人搞两个检查，花足1万元。原来是100个病人中，87个花得少的病人补足13个花得多的病人。而现在，医院倒好，将87个不要用那么多钱的病人都拔高到1万元，感冒本来50块钱搞定，非要开个150块钱的药。这样一来，医院的费用肯定超了。”

Zhang said,Quota system in hospital in the execution,Is the doctor distorted."In the quota system,A doctor to see a doctor to the patient,A look at just spent 4000 yuan,He gave the patient make two inspection,Take full 10000 yuan.It is in 100 patients,87 spend less patients complement 13 spend much of the patients.And now,Untimely hospital,Will 87 don't use so much money of patients are above the 10000 yuan,Cold was 50 dollars fix,Don't want to open a $150 medicine.so,The cost of the hospital must be transcended."

　　张学文说，广州医保基金已经给了医院26%的支付空间，即将医院利润上调26%，但是医院还是要超支。“这是医院受到利益的驱动。”

Zhang said,Guangzhou medical insurance fund has been to the hospital to pay 26% of the space,The hospital profits increased 26%,But the hospital or overspending."This is the hospital by the interests of the drive."

　　郑玉华表示，医院应该以治愈病人为目的，而不是花光医保定额为标准。对于医院超支问题，医保基金每年拒付10%的医院费用。

ZhengYuHua said,The hospital should to heal the patients for the purpose,Rather than take the light medical insurance rating as the standard.For hospital overspend problem,The medical insurance fund every year protest 10% of hospital cost.

　

　强制学校代收医保受到抨击 Compulsory school collection was attacked by medical insurance

　　根本没有隶属关系 No subordinate relationship

　　本报此前报道了“广州中小学医保费由学校代收引争议”，座谈会上，到底学校该不该收学生医保费，也引起了热议。

This newspaper had reported"Guangzhou middle and primary school medical insurance fee collection by the school cause the dispute",symposium,What school students should accept medical insurance fee,Also caused a hot debate.

　　中山大学法学院教授李挚萍直言：强制学校代收医保费用不太合理。“我来自学校，学校和社保部门没有隶属关系。不能强制学校去收医保费用，学校不是责任主体，只是提供一个学生参保的便利平台。政府应该鼓励学校去做这事，而不是不做了去处罚。”

Zhongshan university law school professor li zhi ping the truth:Compulsory school collecting the medical insurance cost is not reasonable."I am from the school,Schools and social security department no subordinate relationship.Can't forced schools to collect the medical insurance cost,The school is not the responsibility of the main,Just provide a convenient platform students ginseng.The government should encourage schools to do this thing,Not done to punishment."

　　郑玉华解释说，目前全国大部分地区都是学校收取学生医保。

ZhengYuHua explained,At present in most parts of the country are school students for medical insurance.

　　“2008年广州以学校为单位参保时，学生参保率为80%。2009年后中小学生由个人到街道参保后，学生参保率逐年下降，到2011年不到50%。为此，我们才提出今年9月1日，中小学生医保重新由学校统一跟学费一起收取。”郑玉华说，教育部门也对学籍系统进行了改造，学校收取医保，不会加重学校负担。(记者 黄丽娜 杨辉）

"Of the 2008 guangzhou to the school for the unit when ginseng,Students participating insurance rate is 80%.After 2009 primary and middle school students by individual to street after ginseng,Students participating insurance rate to drop year by year,In 2011 to less than 50%.therefore,Before we put forward this year on September 1,,Primary and middle school students to medical insurance by the school uniform with tuition charge together."ZhengYuHua said,Education department also to school system was reformed,Schools to charge medical insurance,Don't aggravate burden of school.(Reporter HuangLiNa Yang hui)