新京报讯 （记者蒋彦鑫）继友谊医院、朝阳医院试点“医药分开”后，从12月1日起，同仁医院、积水潭医院、天坛医院将成为第三批试点单位。

The Beijing news - (Reporter JiangYanXin)The friendship hospital/Chaoyang hospital pilot"Medicine separate"after,From December 1,,Tongren hospital/Ji shui tan hospital/The temple of heaven hospital will become the third batch of pilot unit.

　　据医改办相关负责人介绍，三家医院的试点方案与前两批一样，即取消15%的药品加成、诊疗费、挂号费，增设42至100元的医事服务费，其中医保定额报销40元。

According to the medical reform to do relevant controller introduces,Three hospitals of pilot scheme and the former two batches of the same,That is 15% of the drug addition to cancel/fee/Registration fee,Add 42 to 100 yuan of medical service charge,The medical insurance rating to submit an expense account 40 yuan.

　　三家医院均为大专科、小综合 Three hospitals are big college/Small comprehensive

　　昨日，北京市医改办召开新闻发布会宣布，12月1日起，同仁、天坛、积水潭医院将实施和朝阳、友谊医院相同的试点方案，即取消原15%的药品加成，药品实行进价销售；取消目前门诊5元、7元、9元、14元的挂号费、诊疗费，按医师职级设立42元、60元、80元、100元的门诊医事服务费，医保患者每人次可报销40元。

yesterday,Beijing do medical held a news conference to announce,On December 1,,colleagues/The temple of heaven/Ji shui tan hospital will be implemented and sunrise/Friendship hospital the same pilot scheme,That is to cancel the original 15% of drug addition,The purchase price, drug sales;Cancel the current outpatient 5 yuan/7 yuan/9 yuan/14 yuan registration fee/fee,According to doctors rank set up 42 yuan/60 yuan/80 yuan/100 yuan of outpatient service medical service charge,Medical insurance patients each time can submit an expense account 40 yuan.

　　缘何选定这三家医院？市医管局局长封国生表示，这三家医院是学科特色突出的综合性医院，属于大专科、小综合，就诊人员有一定的相似性。这三家医院试点的经验，可以为未来专科医院开展试点奠定基础。

Why these three hospitals selected?City hospital authority chief seal countries born says,The three hospitals is discipline characteristic outstanding comprehensive hospital,Belong to large specialized subject/Small comprehensive,Medical personnel have certain similarity.The three hospitals in the experience of the pilot,Can for future specialized subject hospital pilot lay the foundation.

　

　试点后日增2130个号源 After the pilot growing 2130 number source

　　封国生介绍说，三家医院共3712张床位，2011年门诊量483万人次，住院11.1万人次。

Seal countries born said,Three hospitals, 3712 beds,In 2011 MenZhenLiang 4.83 million person-time,111000 people in hospital.

　　试点医药分开后，三家医院将增加出诊医师134名，届时，每天的普通号源增加1280个，专家号源增加850个。

Pilot medicine after separately,Three hospitals will increase home visit physician 134,the,Daily average number source increase by 1280,ZhuanGuHao source increase by 850.

　　比如同仁医院，眼科普通号由原来的每日500个，增加到725个；专家号整体增加号源22%。“由于药物占比本身比较低，药品价格压缩的空间就要小一些。”封国生说，为此医院试点后除了控制医疗行为外，将在医疗服务上下工夫，解决看病难、挂号难的问题。同时，也可在更大范围内评估医药分开的效果和可评估性。

Such as tongren hospital,Eye ordinary number by original daily 500,Increased to 725;ZhuanGuHao overall increase number source 22%."Because of low drugs than itself,The price of drugs compression space will be smaller."Seal countries student said,Therefore the hospital after the pilot in addition to control the medical behavior,Will be in the upper and lower time of medical service,Solve difficulties in getting/Registered the difficult question.At the same time,Also can be in wider range evaluation medicine separate effect and measurable.

　　

■ 热点 S hot

　　药品取消加成患者检查费不会增 Drug cancel addition patients inspection fee will not increase

　　与友谊医院和朝阳医院相比，此次三家医院的特点是药占比较低，也就是药品收入占医院总收入的比例在40%左右。

And friendship hospital and compared to chaoyang hospital,The three characteristics of the hospital is medicine of relatively low,Is the drug income accounted for the proportion of total revenue hospital at around 40%.

　　有患者担心，随着药品加成取消，会不会过度检查会增多。

Patients have worried about,As drug addition to cancel,Excessive examination will be increased.

　　北京市医改办主任韩晓芳表示，患者不必过度担心。由于医院实行总额付费制度，无论检查费还是药费，都在医保总额里。医院如果超支是要自己承担一部分的。而整体费用越低，对医院来讲才是增收因素。因此医院会主动控制费用的增长，会合理地控制医疗费用。

Beijing medical director do HanXiaoFang said,Patients need not excessive worry.Due to the hospital total pay system,No matter inspection fee or expenses for medicine,In the medical insurance amount.The hospital if overspend is to oneself bear part of the.And the lower overall cost,On hospital speaking is increasing factors.Therefore the hospital will be the rising cost of active control,Will reasonably controlling medical expense.

　　“过去是老百姓多花钱，医院就多挣钱。改革后，医院只能挣服务费。”韩晓芳说。

"The past is common people spend more money,The hospital will earn more money.After the reform,The hospital can only earn service charge."HanXiaoFang said.

　　此外，降低耗材价格，与降低药品价格同样重要，这也是减轻患者负担的重要途径。

In addition,Reduce material price,And lower drug prices are also important,This is also an important way to reduce the burden of patients.

　　

医保总量控制不影响病人看病 Medical insurance of total amount control does not affect the patient to see a doctor

　　针对此前有人在网上曝出，由于医保总额超标，有医院拒收病人的情况，市医改办有关人士表示，从当前看，医保和医疗费用确实出现一定增长。但北京医保总额预付的医疗机构33家，总体费用增长和控制情况比较好。

According to someone on the net after the exposure,Due to the medical insurance amount exceeds bid,The hospital has refused the patient's condition,City do cure the sources said,From the current see,Health care and medical expenses do appear a certain growth.But Beijing medical insurance amount advanced medical institutions and home,The overall cost growth and control conditions are good.

　　北京市人社局副巡视员蒋继元表示，当前对医院医保进行总量控制，对医疗机构有指标，但这个指标花完后还是要再给的。指标花完各有原因，有的是因为医院人员增加导致超标，有的则是因为管理不到位，对后一种情况，会对医院有整改措施。但这些都属于内部管理，对老百姓就医不会有影响。同时，当前最大的问题是把一些浪费、不合理的医疗支出控制住。

Beijing people club bureau deputy inspector JiangJiYuan said,The current medical insurance of the hospital total quantity control,For medical institutions have index,But the index after flowers or to give the.Index to spend each have reason,Partly because of the increased hospital personnel exceeds bid,Others because management is not in place,A kind of circumstance,On hospital has rectification measures.But these all belong to the internal management,People go to a doctor to has no influence.At the same time,The biggest problem is put some waste/Unreasonable medical expenditure control.

　　■ 新举措

S new measures

　

　天坛医院 The temple of heaven hospital

　　中西医禁跨科开药 The cross section of traditional Chinese and western medicine to prescribe medicine

　　为了方便医生书写，医院开发了表格式门诊电子病历，针对不同的症状和疾病类别，设计了不同的病历模板。避免了传统手写病历模式的许多不足，如字迹潦草、诊断无据、诊断和治疗溯源性差等问题。

In order to facilitate the doctor writing,The hospital development the form type clinic electronic medical records,According to the different symptoms and disease category,Design the different medical records template.To avoid the traditional medical record pattern written many insufficiencies,As with scribbled/Diagnosis finds/Diagnosis and treatment of the issue such as difference of traceability.

　　据介绍，此次率先在神经内科试点，推出门诊电子病历，并进一步在普通外科、乳腺科、泌尿科、骨科、呼吸科、肾内科、血液科等科室推广。

According to introducing,The pilot took the lead in the neurology department,Launch clinic electronic medical records,And further in general surgery/Division of mammary gland of/urology/orthopaedic/Respiratory medicine/Urology department/The section office such as onset promotion.

　　同时医院还制定协议处方，是以循证医学为基础，根据国内外疾病诊疗指南及医院实际情况，以固定组合存在的常用的规范处方。

At the same time, the hospital has also formulated agreement prescription,Evidence-based medicine is based,According to the domestic and foreign disease diagnosis and treatment guidelines and the reality of hospital,At a fixed combination existing common standard prescription.

　　门诊电子病历和协议处方实行后，医院可以通过信息系统实现医疗质量监控和环节控制。不能达到“三符合”要求的病历或处方，会进入病历点评和处方点评程序，发现问题医院将给予责任人相应处罚，严重者会被取消处方权。

Outpatient service electronic medical records and agreement after a prescription,The hospital can through the information system to realize medical quality monitoring and link control.Cannot achieve"With three"Requirements of the medical records or prescription,Will enter medical records comment on and prescription comment on program,Find out problems hospital will give the corresponding punishment,Or will be cancelled ChuFangQuan.

　　实行分科开药原则，西医科室不可跨科开药。比如，神经外科、神经内科、外科、内科、妇产科、儿科、中医科、皮肤科、眼科、耳鼻喉科等使用中药，只能在中医科开处方（个别科室的部分中成药和中药感冒类OTC除外）；中医科不能开具注射剂和西药（西药感冒类OTC和10种慢性病的常用西药除外）。

A branch prescribe principle,Western medicine department shall not cross section prescribe.For example,neurosurgery/Neurology department/surgery/medical/Department of gynaecology and obstetrics/pediatric/Traditional Chinese medicine department/Dermatological department/eye/Otolaryngology, the use of traditional Chinese medicine,Only in traditional Chinese medicine department prescribe(Individual departments part of the traditional Chinese medicine and traditional Chinese medicine cold class except OTC);Traditional Chinese medicine department can't draw injection and western medicine(Western medicine cold kind of OTC and 10 kinds of chronic disease commonly used except western medicine).

　

　同仁医院 Tongren hospital

　　热门科室增加号源 Popular department increase number source

　　同仁医院增加重点学科知名专家门诊出诊次数，眼科普通号由原来的每日500个号增加到725个，专家号整体增加22%。

Tongren hospital increase key discipline famous expert outpatient service home visit frequency,Eye ordinary number by original daily 500 number increased to 725,ZhuanGuHao overall increased by 22%.

　　将眼科中心为应对暑期就诊高峰而设立的晚间门诊延续下去，实现常态化。

The eye center in response to a summer peak and the establishment of the evening outpatient service continue,Realize normalization.

　　每天对金额大于400元以及所有抗菌药物处方进行点评；每月对销售金额、销售数量排序前20位的药品进行动态监控及超长预警，对超常使用药品的处方进行抽样点评；对全院用药金额排名前10位的医师的处方进行专项点评。

The amount of more than 400 yuan to every day and all antimicrobial prescription comments;Monthly sales amount/Sales volume ranking top 20 drugs for dynamic monitoring and early warning long,To exceed constant use of the drug prescription sampling comment on;The amount of drug partial top ten physicians prescription, make a special campaign to comment on.

　

　积水潭医院 Ji shui tan hospital

　　药费超标将发警示 Expenses for medicine overweight will issue a warning

　　设立科室次均药品费用警示机制，对次均药品费用超标科室将通过书面、短信等形式发出警示，督促各科室对销售金额前10位的药品进行监测，并形成反馈机制。由医改领导小组采取管理措施，并上报医院药事管理与药物治疗学委员会，对相关药品做出限制使用或从用药目录中剔除。

Set up department second all drug expenses warning mechanism,To second all drug expenses exceed bid department will through the written/Text messages and other forms a warning,Urge the department of sales amount of top ten drug monitoring,And form feedback mechanism.Reform by the leading group take management measures,And report to hospital pharmacy management and pharmacotherapeutics committee,The relevant to restrict the use of drugs or from drug directory to eliminate.

　　对单张金额大于400元的处方及使用抗菌药物的处方全部进行点评，由专家组进行合理用药讨论，对不合格处方按照合理用药相关管理规定进行处罚。

More than 400 yuan to the amount of single prescription and use of antimicrobial drug prescription all comments,The expert group to discuss the rational use of drugs,For the unqualified prescription according to rational drug use related management provisions of punishment.

　　明确规定中医不能开西药，西医只能开2种中成药，不能开草药。

Specific provision can not open the western medicine of traditional Chinese medicine,Western medicine can only open two kinds of traditional Chinese medicine,Can't open herbs.

　　急诊患者不得开具中成药，开具中药注射剂需要经过中医科会诊。

Emergency patients may not draw proprietary Chinese medicine,Draw Chinese medicine injection need to pass traditional Chinese medicine department consultation.

　　本组稿件采写/新京报记者 蒋彦鑫

The manuscript collection &composition/Beijing news reporter JiangYanXin