记者调研发现：无一患者逃费，“小病大看”缓解 Reporter investigation found that:No patients escape fee,"Ailment big see"ease

　　

临沂日照 诊后付费并不难(走基层·蹲点调研) Linyi sunshine after diagnosis is not difficult to pay(Go grassroots · CunDian research)

　　6月起，山东全省县及以下医疗机构开始推行“先诊疗后付费”服务模式。记者近日赶赴山东临沂、日照县区调研发现，在全民医保体系下，县及以下基层医疗机构实行该模式并不难。

June,Shandong province county and the following medical institutions began to introduce"First for diagnosis and treatment"Service mode.Recently, reporters rushed to shandong linyi/Rizhao county survey found,In the medical insurance system,County and the following basic medical institutions implementing this mode is not difficult.

　　

没钱能住院 不用交押金 No money can need not pay the deposit in hospital

　　“以前报销少，住院平均每天报销后也要花100多元，现在报销多了，起付线100元，其余报90%。”

"Submit an expense account before less,The average hospitalization day after submit an expense account to spend 100 yuan,Now the submit an expense account,The fu biao since the line 100 yuan,The rest to 90%."

　　在临沂市费县探沂镇中心卫生院二楼内科病房，记者和沈家村农民高飞攀谈起来。高飞因为患肺气肿，在中心卫生院住了一个星期，总共才花了不到100元。他告诉记者：“村里的人都愿意在卫生院看病。没钱也能住院，不用再交押金。而且住了半个月还不如以前一天花的钱多。”

Linyi city fei county in the town center on the second floor of the institutes of interpretation of exploration medical ward,Journalists and shenyang village farmer goofy stuck up a conversation.Goofy because with emphysema,In the center health center lived for a week,A total of only cost less than 100 yuan.He told reporters:"People in the village are willing to see a doctor in the health center.Have no money to also can be in hospital,Don't have a deposit.And lived half a month before as a day spent more money."

　　探沂镇中心卫生院院长丰佩田介绍，从去年11月1日开始，该卫生院实行“先诊疗后付费”模式，患者住院时只需要提供新农合证、身份证复印件，签订“先诊疗后付费”协议书，就可以住院。

Interpretation of exploration in the centre of the town of institutes of FengPeiTian is introduced,From last year to begin on November 1,The health center to"First for diagnosis and treatment"mode,Only when the patient in the need to provide new farming joint card/Id photocopy,sign"First for diagnosis and treatment"agreement,Can be in hospital.

　　临沂市卫生局局长吕富说， 截至目前，山东临沂市所有基层医疗卫生机构、36所县区级医疗机构开展了先诊疗后付费服务模式，受益群众达33.1万人次，医疗机构累计垫付资金达2.5亿元。全市农民参保率达到99.97%，报销比例提高，小病回流基层，卫生院门诊量增加了约40%。

Linyi city health bureau chief reeve said, So far,Linyi city of shandong all basic medical and health institutions/36 county district medical institutions to carry out the first diagnosis and treatment for service mode,The benefit to 331000 people,A medical institution accumulated funds paid 250 million yuan.The farmers' participating insurance rate reached 99.97%,Reimbursement ratio improve,Ailment reflux grassroots,Health center MenZhenLiang increased about 40%.

　　隔了一天，在日照市莒县长岭卫生院病房，记者见到了77岁的荆培英。记者和她聊天的时候，已住院10多天的荆培英满脸笑容，一旁照顾她的外甥给记者算了一笔账：“以前报销少，住院平均每天报销后也要花100多元，现在报销多了，起付线100元，其余报90%。基本药物零差价销售后，常吃的头孢哌酮由原来的28元降到2元多。”

Every day,In rizhao city JuXian changling health hospital ward,Reporters saw the 77 - year - old JingPeiYing.Journalists and she chat of time,Already in hospital more than 10 days of JingPeiYing to smile from ear to ear,One side to take care of her nephew to reporter calculate a bill:"Submit an expense account before less,The average hospitalization day after submit an expense account to spend 100 yuan,Now the submit an expense account,The fu biao since the line 100 yuan,The rest to 90%.Essential drugs zero price difference after sales,Often eat of cefoperazone by original 28 yuan to more than $2."

　　莒县卫生局局长贾绍友认为，对患者来说，这是一种支付方式的变革，以前患者要先凑一笔钱，最后才能去报销。这种方式方便患者，也是医疗行为公益性的体现。

JuXian surgeon general JiaShaoYou think,For patients to,This is a kind of payment change,Before patients want to gather together a sum of money,The ability to submit an expense account.This way is convenient patients,Public welfare is the embodiment of the medical behavior.

　　

逃费有惩罚 可能被起诉 Flee fee have punishment may be prosecuted

　　“新农合卡成为信用凭证，加上信息系统的管理手段，使该付费方式的变革在基层实行比较容易。”

"New farmers joint card become credit vouchers,Add information system management method,Make the payment of the change in the basic unit are easy to implement."

　　“先诊疗后付费”考验的是患者的信用，要是患者逃走了怎么办？在采访中，记者发现，实行该模式的地方，没有一个患者逃费。

"First for diagnosis and treatment"The test is the patient's credit,If patients ran away?In the interview,Reporter discovery,Implementing this mode place,Not a patient fled fee.

　　丰佩田给记者提供了一份材料，探沂镇全镇5万多农民都参加了新农合，住院起付线低，只有150元，其余政策范围内报销95%，个人自付费用较少。1—6月，报销千元以上的707人，万元以上的仅有5人。

FengPeiTian to reporter provides a material,Exploratory interpretation of the town more than 50000 farmers to participate in the new agriculture together,Hospital up pay line low,Only 150 yuan,The rest of the policy range 95% to submit an expense account,Individual out-of-pocket costs less.1 - June,To submit an expense account one thousand yuan of above of 707 people,Ten thousand yuan only five people.

　　同样，费县、莒县因为参合率近100%，报销得多，花费的钱少，基本上没有拖欠费用的。此外，两个地方都推行了信息化建设，建立了县域内的卫生信息化系统，实行即时结算。

The same,Fei county/JuXian because ginseng adds up to rate nearly 100%,Expense than,Spend less money,Basically no default cost.In addition,Two places are carrying out the informatization construction,The county set up within the health information system,Implement instant settlement.

　　费县实现了县、乡、村三级医疗卫生机构与卫生管理部门之间联网，为农民免费办理二维码电子新农合证，并采集照片建立脸谱识别系统，实现了新农合报销、健康档案、就医信息“一卡通”。

Fei county realized county/township/Village level 3 medical and health institutions and health management between departments networking,Free for farmers deal with two-dimension code electronic new farming joint card,And collecting photos to establish face recognition system,To realize the new agriculture close to submit an expense account/Health file/Medical information"card".

　　莒县建立了集医院管理、基本公共卫生服务、药品管理、新农合、财务管理、乡村卫生一体化、卫生人力资源管理、绩效考核于一体的卫生综合管理信息平台，网络延伸至村卫生室。

JuXian built collect hospital management/Basic public health services/Drug management/New farmers joint/Financial management/The integration of rural health/Health human resource management/Performance appraisal in the integration of health comprehensive management information platform,Network extending to the village clinic.

　　“先看病后交钱，挑战个人诚信问题。然而，在全民医保和报销比例提高，个人花费减少的情况下，新农合卡成为信用凭证，加上信息系统的管理手段，使该付费方式的变革在基层实行比较容易。”吕富说。

"After the first doctor make money,Challenge personal integrity problem.however,In the universal coverage and submit an expense account proportion to improve,Personal cost reduced circumstances,New farmers joint card become credit vouchers,Add information system management method,Make the payment of the change in the basic unit are easy to implement."Reeve said.

　　在长岭卫生院门口的墙上，清楚标明“先治病、后付费”的实施对象、内容，对逃费患者也有惩罚办法。如果患者出院时一次性结清费用有困难，可以分期付款。如果到期未能付清，下次住院不能享受该优惠政策，医疗机构还可以到法院起诉。

In changling health centre at the entrance of the gate of the wall,clearly"To cure/for"Implementation object/content,To escape fee patients also have punishment measures.If patients when released from the hospital disposable settlement costs have difficulty,Can instalment.If due to pay,The next hospital cannot enjoy the preferential policies,A medical institution also can Sue to the court.

　　

“小病不大看” 资金强管理 "Ailment not see" Funds strong management

　　

“机构垂直、人员专职、定期轮岗、异地任职”强化新农合资金管理 "Institutions vertical/Personnel full-time/Regular work shift/In different"Strengthen the new agriculture close fund management

　　记者在多家卫生院采访发现，这些卫生院住院的人都比较多。探沂中心卫生院床位使用率达到99.1%，同比上升119%。上冶卫生院床位使用率达到88.69%。长岭卫生院一位医生告诉记者，如今入院人次比以前多了很多，尤其是冬天的时候，比以往增加近一倍。

Reporter in the interview found that several institutes,These health center hospital are more.Exploratory interpretation center health hospital beds utilization rate reached 99.1%,Up 119%.The art institutes on bed utilization rate reached 88.69%.Changling health center a doctor told reporters,Now to the hospital people a lot more than before,Especially in winter,Nearly double than ever before.

　　先看病后交钱的服务模式改变，加上药价下降、报销比例上升，卫生院就诊人次增多，会不会给新农合资金的管理带来风险？吕富介绍，临沂强化了新农合内部管理，在国内首创了“机构垂直、人员专职、定期轮岗、异地任职”的管理模式。采取了县区合管办向乡镇新农合经办机构派驻审核员及经办机构主任的做法，实现了新农合管理经办与乡镇卫生院医疗服务相分离。在外部监管上，强化了医保基金的监管。“这种垂直管理模式，让经办管理人员一年调换一个乡镇工作，加上信息系统的实时监控，对资金管理更加有力。”

First the doctor make money after the service mode of change,Plus drug prices decline/Expense ratio rose,Health hospital see a doctor more people,Will give new farming joint capital management risks?Reeve is introduced,Linyi to strengthen the new agriculture close internal management,In the domestic initiative"Institutions vertical/Personnel full-time/Regular work shift/In different"Management mode.Take the counties close tube to do new farming villages and towns close in the auditor and orgnaization of agency of orgnaization of agency of the practice of director,To realize the new agriculture joint management and medical service orgnaization of township health center phase separation.In the external supervision,To strengthen the supervision of the medical insurance fund."This kind of vertical management mode,Let handling management personnel in a swap a villages and towns work,Add information system of real-time monitoring,To fund management more powerful."

　　费县卫生局局长金岩认为，新农合垂直管理，以及对医生的绩效管理，新农合总额预付制度，药品的控制制度，四个措施杜绝了很多“小病大看”的可能。“以前输液的非常多，现在老百姓要求输液，医生不愿意用，输液人次减少了60%多。”

Fei county health bureau chief JinYan think,New farmers joint vertical management,And to the doctor's performance management,New farmers joint amount prepaid system,Drug control system,Four measures to eliminate the many"Ailment big see"may."Before infusion very much,Now people requirements infusion,The doctor is not willing to use,Infusion people more than a 60% decline."

　　

蹲点感言 CunDian testimonials

　　

让基层医疗回归公益 Let the primary care regression public welfare

　　乡镇卫生院面向基层群众，面对的是常见病、多发病，即大家说的小病。小病花的钱不多，但是改革之前却和大医院一样，看病要先带上一堆现金。患者住院期间还心惊胆战，就怕钱不够。如今，不用带钱也能住院，农民敢看病也看得起病了。先看病后付费，从表面上看，仅仅是就医流程的一个细节改变，却大大方便了老百姓。基本医疗服务回归公益属性，也从一定程度上倒逼医生改变诊疗行为，不用再“看钱看病”。

Township health center for the masses,With common diseases/Frequently encountered disease,That you said ailment.Ailment spend a little money,But before the reform, and as big hospitals,The doctor must first take a pile of cash.During a hospitalization still shake with fear,They were afraid not enough money.now,Don't take money also can be in hospital,Farmers dare to see a doctor to also respect ill.After the first doctor pay,On the face of it,A doctor is just a detail process of change,But has greatly facilitated the common people.The basic medical service return to public attribute,Also from a certain extent DaoBi doctor change medical behavior,Don't have"Look at the money the doctor".

　　如今在新农合、城镇居民医保几乎覆盖所有基层的条件下，我国政府办的基层医疗卫生机构基本上都可以实行先看病后交钱。在基层医疗正在逐步回归公益性的大背景下，该流程的改变，将让基层百姓尤其是农民更加真切地感受到医改的实惠。(记者 李红梅)

Now in the new agriculture together/Medical insurance for urban residents almost covers all the basic conditions,Our country government does basic medical and health institutions basically can implement first after the doctor make money.In primary care is gradually return to the background of public welfare,The process of change,Will let grassroots people especially the farmers more really feel the medical benefits.(Reporter LiGongMei)