昨日，一位男士在天坛医院咨询。当日，同仁医院、积水潭医院、天坛医院启动以医药分开为核心的综合改革。 新华社发

yesterday,A man in the temple of heaven hospital consulting.On that day,Tongren hospital/Ji shui tan hospital/The temple of heaven hospital start to medicine apart as the core of the comprehensive reform. The xinhua news agency hair

　　昨日零时，同仁医院、天坛医院、积水潭医院正式启动“医药分开”，取消15%的药品加成，药品按进价销售，同时取消挂号费等，增设医事服务费。

Zero hour yesterday,Tongren hospital/The temple of heaven hospital/Ji shui tan hospital official start"Medicine separate",Cancel the 15% of the drug addition,According to the purchase price, drug sales,At the same time to cancel the registration fee, etc,Additional medical service charge.

　　

医生开药比以前谨慎 The doctor prescribe caution than before

　　昨晨8时50分，天坛医院，患者张女士已经看完病，拿了药。

Yesterday morning 8 50 points,The temple of heaven hospital,Ms. Zhang patients have read disease,Took medicine.

　　她说，改革后不只挂号减钱，医生也只为她开了两盒外用擦剂，两盒内服药，感觉医生开药比以前谨慎了。

She said,After the reform not only registered reduce money,The doctor also only for she opened two boxes of exterior liniment,Two boxes of medicine,Feel the doctor prescribe the cautious than before.

　　张女士说，“以前医生每次都给开好几种、六七盒药，有的还让我中药、西药配合着吃。很多时候，病好了，药还剩一半，放放就过期了”。

Ms. Zhang said,"Every time before the doctor to the several kinds of/Six or seven box of medicine,Some still let me Chinese traditional medicine/Western medicine fit to eat.Most of the time,Disease good,Medicine still remain half,Put some will expire".

　　

5家医院开始试点 5 hospitals began to pilot

　　继友谊医院、朝阳医院后，这三家医院统一取消药价15%加成，全部药品按进价销售；取消延续多年的“3元、5元、7元、14元”挂号费和诊疗费，增设“医事服务费”。按照医生职级不同，从主治医师、副主任医师、主任医师到知名专家，“医事服务费”分别为42元、60元、80元和100元。

The friendship hospital/Chaoyang hospital,The three hospitals unified cancel prices 15% bonus,All drugs according to the purchase price, sales;Cancel the lasts for many years"3 yuan/5 yuan/7 yuan/14 yuan"The registration fee and fee,add"Medical service charge".According to the different rank,From attending doctor/Of doctor of vice director of/Chief physician to famous experts,"Medical service charge"42 yuan respectively/60 yuan/80 yuan and 100 yuan.

　　对这项增收费用，三家医院承诺60%用于增加医务人员收入，其中30%直接分配给出诊医生，旨在提高医务人员在改革中的积极主动性。按照“保障群众基本医疗需求”原则，北京医保基金对“医事服务费”给予定额报销，每人次40元。

The increasing cost,Three hospitals commitment 60% used to increase the income of the medical staff,30% of direct distribution to house call the doctor,Aiming at the improvement of the medical staff in the reform of the positive initiative.According to the"Ensure the basic medical needs"principle,Beijing to the medical insurance fund"Medical service charge"Give quota to submit an expense account,40 yuan each time.

　　截至目前，北京已有5家三甲医院开始“医药分开”改革，同时配套医保“总额预付”改革，旨在废除公立医院“以药养医”带来的大处方、过度用药、滥用检查及高值耗材等积弊，最终降低患者的医药费用。

So far,Beijing has five 3 armour hospital began"Medicine separate"reform,At the same time supporting health care"Amount prepaid"reform,Aimed at the abolition of public hospital"To raise the medical medicine"Brings DaChuFang/Excessive medication/Abuse of inspection and high value any material etc,Eventually reduce the medical expenses of patients.

　　北京市医改办主任韩晓芳说，今年7月1日和9月1日，友谊医院和朝阳医院率先启动的“医药分开”改革，初步取得成效，如果新增3家医院试点顺利，明年，“医药分开”将在市属三级医院中推开；央属大型医院也有望加入。

Beijing medical director do HanXiaoFang said,July 1, and September 1,,Friendship hospital and chaoyang hospital took the lead in the start"Medicine separate"reform,Preliminary achievements have been made,If new 3 hospitals pilot well,Next year,"Medicine separate"Will be in under the tertiary hospital push away;Central belong to large hospital is also expected to join.

　　

■ 焦点 S focus

　　特色大医院减负难

Features large hospital to alleviate the burden on

　　三家医院启动异常严格的临床用药监控、高值耗材使用评估

Three hospitals start abnormal strict clinical drug monitoring/High value consumables use evaluation

　　市医管局局长封国生说，天坛、同仁、积水潭三家医院，均是专科优势突出的综合医院，患者就诊以手术为主，费用中药费占比偏低。仅取消15%的药品加成，对患者负担控制将不明显。

City hospital authority chief seal countries student said,The temple of heaven/colleagues/Ji shui tan three hospitals,All is specialized advantage prominent general hospital,Patients medical primarily surgical,Fees accounted for more than on the low side.Only 15% of the drug addition to cancel,For patients burden control will not obvious.

　　同仁医院院长武冀湘坦言，目前，同仁药占比为38%左右，进一步控制“难度高”，还须通过加强处方监控，严控不必要的检查、耗材，推行日间手术等综合措施，降低患者总的费用负担。

Tongren hospital dean WuJiXiang said,At present,Colleagues medicine accounted for more than 38%,Further control"High difficulty",Must also by strengthening the prescription monitoring,Tight control of unnecessary inspection/consumables,Implementation of the ambulatory surgery, and other comprehensive measures,Reduce patients total expense burden.

　　同仁医院对金额大于400元以及所有抗菌药物处方进行点评；天坛医院规定，西医科室不得跨科室开药，中医科室不得开西药和注射剂。积水潭医院还将针对点评不合格的处方，进行“不合理用药”惩罚，首次即按照处方金额的两倍，对责任医生予以罚款；同一医生再犯，将扣罚当月奖金，直至停止医生处方权。对没有完成“药占比及次均费用”控制指标的科室，停止“医事服务费”分配奖励。

Tongren hospital to more than 400 yuan and all the amount of antimicrobial prescription comments;The temple of heaven hospital provisions,Western medicine department shall not cross section office prescribe,The doctor of traditional Chinese medicine department shall not open western medicine and injection.Ji shui tan hospital will also to comment on unqualified prescription,for"No rational drug use"punishment,For the first time according to the prescription is twice the amount,The doctor of responsibility shall be fined;The same doctor it again,Will punish that month bonus,The doctor ChuFangQuan until the stop.To not finished"Medicine of ratio and second all expenses"Control index of the department,stop"Medical service charge"Distribution reward.

　　此外，外地患者较多，对降低药占比也是一个严峻的挑战。

In addition,Foreign patients more,To reduce the drug for more than is also a serious challenge.

　　积水潭医院副院长蒋协远说，骨科外地患者占总就诊量65%左右。拉高患者次均医疗费用外，医生的开药量，也很难不突破限制。医院方面也正在与医保中心沟通，希望对部分疾病，实行“按病种付费”，让疾病的诊疗更加合理。

Ji shui tan hospital, vice President of the JiangXie far said,Orthopaedic field patients JiuZhenLiang accounted for about 65%.Pull up patients second all medical fees,The doctor's open dosage,Also it is very hard not to break through limit.Hospital also is working with health care center communication,Hope to part of the disease,implement"Press disease to pay",Let the disease diagnosis and treatment is more reasonable.

　　

■ 举措 S move

　　如何应对患者激增？

How to deal with patients surge?

　　增加医生增加号源

Increase the doctor increase number source

　　费用降低后医院就诊量如果大增如何应对？

Cost reduce hospital after a JiuZhenLiang if how to deal with?

　　市医管局局长封国生：试点大医院本身的诊疗需求量就很大。为防止医院出现患者激增的情况，各医院都已推出增加出诊医生、增加号源、推行预约分时就诊，重点科室开放晚间门诊，开设日间手术等举措。据初步统计，三家医院将增加出诊医师134名，改革启动初期，每天的普通号源可增加1280个，专家号源增加850个。

City hospital authority chief seal kingdom was born:Pilot big hospital itself medical demand is very big.In order to prevent the proliferation of hospital patients,Hospitals has launched increase house call the doctor/Increase number source/Implementation of the appointment time sharing see a doctor,Key departments open evening outpatient service,Open ambulatory surgery, and some other measures.According to preliminary statistics,Three hospitals will increase home visit physician 134,Reform the initial,Daily average number source can increase 1280,ZhuanGuHao source increase by 850.

　　如何限制滥用检查？

How to limit abuse inspection?

　　严控昂贵耗材检查

Tight control of expensive material inspection

　　取消药品加成后，“大处方”少了，“大检查”高值耗材会不会增多？

Cancel after drug addition,"DaChuFang"less,"examination"High value consumables will increase?

　　市医改办主任韩晓芳：“医药分开”并不是孤立的改革举措，试点医院还将试点按病种分组付费，控制不合理费用，包括不必要的检查和高值耗材。

Do HanXiaoFang city medical director:"Medicine separate"And is not isolated reform measures,Pilot hospital will pilot press disease to pay packet,Control unreasonable expenses,Including unnecessary inspection and high value consumables.

　　此外，北京市对“医药分开”试点医院设置的监测指标，不仅包括药占比下降，还要考核门诊医保患者次均医疗费用和住院患者例均费用等指标。目前，三家医院在试点“医药分开”同时，都启动了异常严格的临床用药监控、高值耗材使用评估以及大型检查奖惩措施。

In addition,Beijing to"Medicine separate"Pilot hospital set up monitoring index,Not only includes medicine than of decline,And assessment of outpatient service medical insurance patients second all medical expenses and inpatient cases have cost index.At present,Three hospitals in the pilot"Medicine separate"At the same time,All started the abnormal strict clinical drug monitoring/High value consumables use evaluation and large inspection rewards and punishments measures.

　　

■ 算账 S accounts

　　副主任医生一天720元

Doctor, deputy director of the 720 yuan a night

　　对于医事服务费的分配，三家医院承诺60%给医务人员，增加医务人员收入，提高积极性。其中30%直接奖励临床一线医务人员，30%用于提高全院医务人员的收入。这意味着，医生每看一个病人，只要用药合理，诊疗无意外，可以在原来基础上，多一份“奖金”。

For the distribution of medical service,Three hospitals 60% commitment to medical personnel,Medical staff income increase,Improve enthusiasm.30% of the direct bonus to clinical medical staff,30% used to increase the income of the partial medical personnel.This means that,The doctor whenever I see a patient,As long as reasonable drug,Without accident diagnosis and treatment,Can be based on the original,To a more"bonus".

　　以此次参与试点的一家医院一名副主任医师为例，每看一个门诊病人，医院可收取60元的医事服务费，其中30%，也就是18元，用于对出诊医生的奖励。副主任医师出诊一天，一般看40个病人，可获720元奖励。(记者魏铭言)

To participate in the pilot of a hospital a deputy chief physician, for example,Whenever I see a outpatient,The hospital may make the 60 yuan medical service charge,30% of them,Is 18 yuan,Used for home visit the doctor's reward.Of doctor of vice director of home visit one day,General see 40 patients,For 720 dollars award.(Reporter MingYan wei)