【新闻背景】 [News background]

　　12月1日，北京市启动了第三批“医药分开”试点改革，分别是以大专科为特色的北京天坛医院、同仁医院、积水潭医院3家三级甲等综合医院。此前，北京市先后在友谊医院和朝阳医院启动了第一、二批以医药分开为核心的综合改革试点。

On December 1,,Beijing launched the third group"Medicine separate"Pilot reform,In big college respectively to the characteristics of the temple of heaven in Beijing hospital/Tongren hospital/Ji shui tan hospital three three level of first-class comprehensive hospital.after,Beijing friendship hospital and successively in chaoyang hospital launched the first/The second batch of to medicine separately for the core of the comprehensive reform pilot.

　　“医药分开”改革实行取消15%药品加成、挂号费和诊疗费，全部药品进价销售。同时设置医事服务费，实行分级定价。普通门诊、副主任医师、主任医师、知名专家门诊的医事服务费标准分别确定为42元、60元、80元、100元。门诊医事服务费由北京医保定额报销40元。取消药品加成，实行医药分开，患者负担能否减轻？能否彻底斩断“以药养医”？医院能否提供优质服务？

"Medicine separate"Reform practice cancel 15% drug addition/The registration fee and fee,All drug purchase price, sales.At the same time set up medical service charge,Grading pricing.General outpatient service/Of doctor of vice director of/Chief physician/The famous expert outpatient service medical service charge standard respectively determine for 42 yuan/Sixty yuan/80 yuan/100 yuan.Outpatient service medical service charge from Beijing medical insurance rating to submit an expense account forty yuan.Cancel the drug addition,Practice medicine separate,Patients can reduce the burden?Can completely cut off"To raise the medical medicine"?The hospital can provide high quality service?

　

　【核心观点】 [Core ideas]

　　观点一 View a

　　门诊药占比、次均费用、次均药费和住院患者例均费用均有不同程度下降，次均药费下降17%左右，患者负担减轻。　　

Clinic medicine accounted for more than/Second all cost/Second all expenses for medicine and inpatient cases have cost also decreased to different extent,Time for both fell about 17%,Patients burden.

　

　观点二 View two

　　“大处方”的判定须经过严格的专家组评审，不会单纯以价格作为评判标准，仍是以客观病情为主要判断依据。　　

"DaChuFang"The decision must pass strict group review,Not only to price as evaluation standard,Still is the objective condition as the main basis for judgment.

　　观点三 View three

　　医院管理从“以疾病为中心”转向“以病人为中心”，推进预约挂号，优化服务流程，推行全程主诊医师负责制。

Hospital management from"To disease as the center"steering"To the patient as the center",Propulsion make an appointment,Optimization service process,The implementation of the attending physician responsibility system.

　　一 问 能不能减轻患者负担 A q can reduce the burden of patients

　　记者：截至目前，北京已有5家三甲医院开始“医药分开”改革。医药分开，患者的负担能否减轻？

reporter:So far,Beijing has five 3 armour hospital began"Medicine separate"reform.Medicine separate,The burden of the patients can reduce?

　　北京市医管局局长封国生：友谊医院和朝阳医院启动“医药分开”试点以来，两家医院的门诊药占比、次均费用、次均药费和住院患者例均费用等指标均得到了不同程度的下降，次均药费下降17%左右，患者用药负担减轻。问卷调查显示：85%以上患者能接受医事服务费的价格，82%以上的患者对医生的服务能力满意，并认为看病沟通时间比以前长了。此次改革的三家试点医院，进一步验证医药分开改革路径是否正确，在更大范围内评估医药分开的政策效果和可推广性。

The Beijing hospital authority chief seal kingdom was born:Friendship hospital and chaoyang hospital start"Medicine separate"Since the pilot,Two hospital outpatient service of medicine than/Second all cost/Second all expenses for medicine and inpatient cases all expenses index were given different degree of decline,Time for both fell about 17%,For treating patients burden.Questionnaire survey:More than 85% patients can accept the price of medical service,More than 82% of the patients to the services of a doctor with ability,And that the doctor communication time than ever before long.The reform of the three pilot hospitals,Further validation medicine separate reform path is correct,In a wide range of separate evaluation medicine policy effect and can be applied.

　　记者：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。取消药品加成后，“大处方”少了，“大检查”高值耗材会不会增多？

reporter:The temple of heaven/colleagues/Ji shui tan three hospitals,All is specialized advantage prominent general hospital,See a doctor to surgical patients,Fees accounted for more than on the low side.Cancel after drug addition,"DaChuFang"less,"examination"High value consumables will increase?

　　北京医改办主任韩晓芳：“医药分开”并不是孤立的改革举措，实施价格、医保、财政、编制等政策联动综合改革，形成了有力的控费机制，形成了改革合力。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。

Beijing medical director HanXiaoFang do:"Medicine separate"And is not isolated reform measures,Implement price/Medical insurance/financial/Prepare policies linkage comprehensive reform,Formed a powerful control fee mechanism,Formed a reform force.Beijing to"Medicine separate"Pilot hospital set up monitoring indicators,Includes not only for medicine than down,And evaluation of outpatient service medical insurance patients second all medical expenses and inpatient cases have cost index.At present,Three hospitals are launched abnormal strict clinical drug monitoring/High value consumables use evaluation and large inspection rewards and punishments measures.

　　天坛医院院长王晨：医药分开取消了医院的药品加成，药品销售多少已与医院的收益无关，因此医院将不再关注如何多卖药，而是更加关注如何看好病，有利于促进合理用药。

The temple of heaven WangChen hospital dean:Medical separate cancelled hospital drugs addition,How many sales drugs has and the hospital income has nothing to do,So the hospital will no longer pay attention to how to sell medicine,But pay more attention to how to value disease,To promote rational drug use.

　　同仁医院院长伍冀湘：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:At present,Colleagues medicine accounted for more than 38%,Further control"High difficulty",Must through the strengthen prescription monitoring,Tight control of unnecessary inspection/consumables,Implementation of the ambulatory surgery, and other comprehensive measures,To reduce the burden of patients.

　　积水潭医院副院长蒋协远：合理大型检查纳入科室医疗绩效考核及执业医师考核指标。各临床科主任为本科室合理大型检查的第一责任人，并负责对本科室合理大型检查实施管理职责，负有管理责任。医院加强高值耗材引进管理，由专业委员会讨论通过报办公会讨论决定后，方可在临床使用；整顿目前高值耗材品种及品牌，组织专家组对目前使用高值耗材进行论证，减少相同品种耗材，规范耗材使用。

Ji shui tan hospital, vice President of the JiangXie far:Reasonable large check into the department of medical performance evaluation and assessment criteria of the medical practitioners.The clinical department director for undergraduate course room reasonable large check first responsible persons,And is responsible for the implementation of this department reasonable large check management duties,Are responsible for the administration responsibility.The hospital to strengthen the high value consumables management,The professional committee discussed through the newspaper club after the decision through discussion,Be in clinical use;The current high value material variety and brand,Organization expert group on the use of high value consumables are demonstrated in the paper,Reduce the same variety consumables,Standard consumables used.

　

　二 问 能不能破除以药养医 2 q can break to raise the medical medicine

　　记者：医药分开，能否调动医生的积极性？

reporter:Medicine separate,Can mobilize the enthusiasm of the doctor?

　　封国生：第三批试点医院将通过建立新型绩效考核机制，充分体现以服务质量、服务效率和患者满意度为核心的公益性目标，同时体现医务人员的劳动价值。逐步实现按劳取酬、优劳优得的目的，调动医务人员、充分挖掘医务人员潜能。这些体制机制方面创新将为医药分开推进提供可持续性保障，确保医药分开推进工作取得实实在在的成效。

Seal countries born:The third batch of pilot hospital through establishing the new performance evaluation mechanism,To fully reflect the quality of service/Service efficiency and the degree of satisfaction of patients is the core of the public welfare goal,At the same time reflect the medical staff of labor value.Gradually realize receive payment according to work/The purpose of optimal work best,Mobilize medical personnel/Full mining potential medical personnel.The system mechanism innovation will provide for pharmaceutical separate promote sustainable security,Ensure that medical separate propulsion job get real results.

　　韩晓芳：友谊医院和朝阳医院“医药分开”改革效果比预想的好。如果天坛、同仁和积水潭医院试点顺利，明年会继续扩大医药分开改革范围。试点就是要试错，通过实验看政策有没有什么问题，为全市推广改革制定方案做准备。明年将适时全面推行“医药分开”改革，央属医院也在积极研究推进加入试点。

HanXiaoFang:Friendship hospital and chaoyang hospital"Medicine separate"Reform effect good than expected.If the temple of heaven/My colleagues and ji shui tan hospital pilot well,Next year will continue to expand medical reform limits separately.The pilot is to trial and error,Through the experimental see policy have what problem,For the promotion of reform scheme for preparation.In the full implementation of the next year"Medicine separate"reform,Central hospital is also in the positive research to promote the pilot.

　　记者：为了严惩大处方行为、规范合理用药，三家试点医院都明确，经点评发现不合理用药行为问题严重的医生，将被取消处方权。实施医药分开，能否杜绝大处方？

reporter:In order to punish DaChuFang behavior/Standard rational drug use,Three pilot hospitals are clear,The comments found not rational drug use behavior problems serious doctor,ChuFangQuan will be cancelled.Implement medical separate,Can put an end to DaChuFang?

　　王晨：天坛医院已成立了一支20人的临床药师及科室临床医师队伍，对院内处方和医嘱合理用药进行审核、点评与公示，将结合门诊病历判断该处方是否合理。对于价格贵或者经药管会与药物治疗学委员会确定的重点监控品种，实施重点监控。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。

WangChen:The temple of heaven hospital has established a and the clinical pharmacists and department clinical physician team,In the doctor's advice to prescription and rational drug use audit/Comment on and public,Combined with outpatient records judge this prescription is reasonable.For the price is expensive or the medicine tube and pharmacotherapeutics committee established key monitoring varieties,Implement key monitoring.Hospital regulations,Western medicine department shall not cross department prescribe,The doctor of traditional Chinese medicine department shall not open western medicine and injection.

　　伍冀湘：医院将对每天金额大于400元、所有抗菌药物处方及全院用药金额排名前10位的医师处方进行点评，由专家组进行专项点评，对不合格处方进行处罚。每月则对销售金额、销售数量排序前20位的药品进行动态监控及超长预警。

WuJiXiang:The hospital will be greater than the amount of 400 yuan every day/All antimicrobial prescription drugs and the amount of partial top ten doctors prescription comments,The group have special comment on,For the unqualified prescription for punishment.The monthly sales amount/Sales volume ranking top twenty drug for dynamic monitoring and early warning long.

　　蒋协远：“大处方”的判定须经过严格的专家组评审，不会单纯以价格作为评判标准，仍是以客观病情为主要判断依据。如果病人确实需要，医师开出远高于400元的药也是符合规范。试点阶段，每日将随机选取1/3的处方单进行抽查。如果违规，第一次按该处方金额的数目乘以2对医师进行扣罚，第二次在扣罚处方金额两倍的基础上，再扣罚医师半个月奖金，第三次在扣罚处方金额两倍的基础上，再扣罚医师整月奖金，如果当事医师第四次出现高于400元的违规处方，不仅扣罚，还将收回该医师一年的处方权。

JiangXie far:"DaChuFang"The decision must pass strict group review,Not only to price as evaluation standard,Still is the objective condition as the main basis for judgment.If they really need,Doctor open far higher than 400 yuan of medicine is also in line with norms.Pilot stage,Daily will be randomly selected from a third of the ChuFangChan spot check.If the illegal,According to the prescription for the first time the number of amount multiplied by 2 to doctors to punish,The second time in two times the amount of punish prescription based on,To punish doctors half a month bonus,The third time in punish prescription amount on the basis of two times,To punish doctors month bonus,If the parties to the fourth time doctors in more than 400 yuan of the illegal prescription,Not only punish,The doctor will take a year of ChuFangQuan.

　

　三 问 能不能改进医院服务 3 q can improve hospital service

　　记者：实行医药分开，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，医院能否提供优质服务？

reporter:Practice medicine separate,Cancel continue years of 3 yuan/5 yuan/7 yuan/14 yuan registration fee and fee.Additional medical service charge,The hospital can provide high quality service?

　　封国生：医院管理从“以疾病为中心”转向“以病人为中心”，采取一系列惠民便民措施改善服务。一是推进预约挂号。采取电话、网络、窗口、复诊及社区转诊等多种预约模式，实行24小时预约挂号，努力解决“挂号难”问题。二是优化服务流程。设立门诊服务中心，集合导诊、预约、健康教育、咨询等功能；推行收费、取药一站式服务，实现检验结果自助打印、出院患者床边结算，缩短排队等候时间。三是推行全程主诊医师负责制。按照疾病分组或医疗技术，将科室医生分为若干团队，提供从门诊、住院到康复的全过程服务，确保诊疗的连贯性。

Seal countries born:Hospital management from"To disease as the center"steering"To the patient as the center",We take a series of measures to improve the service for the convenience.One is to make an appointment.Take phone/network/window/Return visit and community referral and so on many kinds of reservation mode,To make an appointment for 24 hours,Work hard to solve"Registered difficult"problems.The second is to optimize the service process.Outpatient service center set up,Set DaoZhen/appointment/Health education/Consulting function;Implementation fees/Medicine one-stop service,Realize self-help print test results/The hospital patients bedside settlement,Shorten the waiting time.The third is the implementation of the attending physician responsibility system.According to the disease group or medical technology,The department will be divided into several team,Provide from outpatient service/In the whole process of the rehabilitation service,To ensure the continuity of the diagnosis and treatment.

　　记者：实行医药分开，医院采取哪些便民惠民措施？

reporter:Practice medicine separate,The hospital take what we for the convenience of the measures?

　　王晨：天坛医院将挂号处和门诊收费处进行整合，实现挂号收费通柜，使患者可以在一个窗口完成挂号、交费，减少排队时间，方便患者就医。医院采取了普通号不限号的举措，医院一楼至四楼都开放挂号窗口，门诊、急诊挂号收费窗口最多可达20多个。医院在门诊大厅放置了一台安全用药咨询打印机，患者只需要输入药品名称，就可以打印简介明了的用药重点说明。医院推行门诊电子病历，规范医疗行为。在此基础上，神经内科还开具健康教育处方，为患者提供有针对性的健康指导。

WangChen:The temple of heaven hospital outpatient service cashier will registration office and integrate,Achieve registration fee through tank,So that patients can be in a window complete address/fee,Alleviate queue times,Convenient patients go to a doctor.The hospital take the normal number in any number of measures,The hospital the first floor to the fourth floor are open registration window,Outpatient service/Emergency registered fee window up to more than twenty.The hospital outpatient service hall in placed a safe medication consultation printer,Patients only need to enter a drug name,You can print profile clear medicine focuses on the instructions.The hospital outpatient service implementation of electronic medical records,Regulating medical behavior.On the basis of,Neurology department also issued the health education prescription,For patients with targeted health guidance.

　　伍冀湘：医药分开试点启动后，眼科普通号由原来的每日500个号增加到700个，专家号增加20%。眼科中心将夜间门诊常态化。从本月3日起，耳鼻咽喉头颈外科也将开放晚间门诊。医院建立三区一体化门诊服务，为患者提供一站式服务，将继续实行分时就诊，避免大量患者高峰期集中取号或候诊。

WuJiXiang:Medicine separated after the pilot start,Eye ordinary number by original daily 500 number increased to 700,ZhuanGuHao increased by 20%.Ophthalmic center will night outpatient normalization.From this month, within 3,Otolaryngology head and neck surgery will also open evening outpatient service.The hospital outpatient service areas to establish integration,Provide one-stop service for the patients,Will continue to implement a time,A large number of patients to avoid peak concentration take number or waiting.

　　蒋协远：积水潭医院采取重点科室普通号源不限号措施，增加重点科室出诊医师数量，增加专家出诊人次，非重点科室普通号的号源投放量增加10%。医院已将号源的95%投入预约挂号系统。医院完善退费、补方等服务流程，提供人性化服务。医院还为新街口、回龙观社区服务中心和社区卫生站提供预约专家门诊。(记者 王君平）

JiangXie far:Ji shui tan hospital take key department general number source no number measures,Increase the number of key departments home visit doctors,Increase the experts home visit people,The key department general number number source mechanization increased by 10%.The hospital has no source 95% investment make an appointment system.Hospital perfect refund/Fill party and service process,To provide the humanized service.The hospital is new street/Hui-long-guan community service center and community clinic pre-registered expert outpatient service.(Reporter WangJunPing)