12月1日起，北京市同仁医院、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、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。三家医院表示，医事服务费的60%分配给医务人员，其中30%直接奖励临床医务人员，30%用于提高全院医务人员的收入(12月2日《新京报》)。

On December 1,,Beijing 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/Additional medical service charge.According to the different rank,From the attending physician/Of doctor of vice director of/Chief physician to famous experts,Medical service charge for 42 yuan respectively/Sixty yuan/80 yuan and 100 yuan.Three hospitals said,60% of the medical service assigned to the medical staff,30% of the direct bonus to clinical medical staff,30% used to improve the income of partial medical personnel(On December 2,[The Beijing news]).

　　实行“医药分开”是我国医改的既定目标，旨在破除“以药养医”旧机制。这一改革在大方向上无疑是正确的:一方面，因为有药品加成存在，医院卖药有利可图，医生多开药、开贵药便成为必然，加重了患者的负担。而从本质上看，医院是医疗机构而非医药公司，其价值应体现在“医”上而不是“药”上，因此药品加成理应取消。另一方面，目前有些医疗服务价格是偏低的，比如普通门诊挂号费只有几块钱，与医生的劳动付出不相称。以前医生通过开药来“堤内损失堤外补”，药品加成取消后，医疗服务价格势必有所提高，让医生的服务价值得到应有体现，同时弥补医院的收入损失。

implement"Medicine separate"Is China's reform of the established goal,Aims to break"To raise the medical medicine"Old mechanism.The reform in the way that it is right: on the one hand,Because there are drug addition exist,Hospital sell medicine profitable,The doctor prescribe more/Open your medicine will become inevitable,Increased the burden of the patients.And from essentially looked,The hospital is not a medical institution and pharmaceutical companies,Its value should be reflected in"medical"Rather than"medicine"on,So drug addition should be cancelled.On the other hand,At present some medical service price is low,Such as general outpatient service registration fee only a few dollars,And the doctor's labor pay don't match.Before the doctor to prescribe medicine through to"DiNa loss embankment fill outside",Drug addition was cancelled,The medical service price will be improved,Let the doctor's service value should be reflected,At the same time make up for the hospital income loss.

　　当然，民众最为关心的问题显然是:取消药品加成、增设医事服务费，如此“一降一升”会不会增加患者的负担?进而，医事服务费标准应当据何而定?从北京市三家医院的情况看，这两个问题还不明朗，因而让人放心不下。

Of course,The people most concern is obviously: cancel the drug addition/Additional medical service charge,so"A drop a liter"Will increase the burden of the patients?then,Medical service charge shall be according to the standard of what and decide?From the view of three hospitals,These two problems is not clear,So can let a person be at ease.

　　因每个患者病情不同，“一降一升”后，有些人看病费用可能降低，有些人看病费用可能增加，这不奇怪。但就医院而言，如果其总体收入相比改革之前提高了，或者人均看病费用增加了，无疑表明改革加重了患者的负担。个中关键在于，医事服务费依据什么确定，标准是否适当合理，不能由医院自说自话，至少应以不增加医院总体收入，即以不增加人均看病费用为原则。另外，按照北京市的规定，医保基金对医事服务费给予定额报销，每人次40元，这意味着，患者自己需承担2元至60元不等的医事服务费，这会不会加重患者负担?更重要的是，取消药品加成虽能在一定程度上遏制“大处方”，但是，目前业已存在的“大检查”会不会随之泛滥?

For each patient was different,"A drop a liter"after,Some people see a doctor may lower the cost,Some people see a doctor costs may increase,It's not strange.But in the hospital,If the overall income increased compared to before reform,See a doctor or per capita cost increased,No doubt that reform increased the burden of the patients.Key lies in the,Medical service charge by what decide,Whether a reasonable standard,Not since the hospital speaking,At least should not increase hospital overall income,That is to see a doctor not to increase the per capita cost for the principle.In addition,According to the regulation of Beijing,The medical insurance fund for medical service charge give quota to submit an expense account,Forty yuan each time,This means that,The patient's own need to take 2 yuan to sixty dollars medical service charge,It will aggravate burden of patients?More important is,Cancel the drug addition can be in a certain extent contain"DaChuFang",but,At present the already existing"examination"Will not flowed?

　　报道中举的一个例子更让人不放心:一名副主任医师每看一个门诊病人，医院收取60元医事服务费，其中18元(30%)用于对出诊医生的奖励。一名副主任医师出诊一天可看40个病人，获得的奖励达720元。这或许体现了医生的价值，但简单算一下，一名副主任医师一个月出诊15天即可获得1万多元的收入，而且这仅仅是其收入的一部分，另外还有正常的工资和奖金。这样的收入高不高?可能每个人的看法不同，但有一点可以肯定，“体现医生的价值”要符合当前国情，医生的收入应当高一些，但也要与国民人均收入水平相协调。

ZhongJu reported an example more let a person do not rest assured: an associate chief physician each see a outpatient,Hospital charge sixty yuan medical service charge,The eighteen yuan(30%)Used for home visit the doctor's reward.A of doctor of vice director of home visit one day to see forty patients,The reward for $720.This may reflect the value of the doctor,But simple count,A deputy chief physician a month home visit 15 days can obtain 10000 yuan income,But this is only part of the income,In addition to normal wage and bonus.Such a high income is not high?May everyone's opinion,But one thing is for sure,"Reflect the value of the doctor"Want to accord with the current situation,The doctor's income should be higher,But also with the national per capita income level coordination.

　　无论是整个医药卫生体制改革，还是破除“以药养医”机制，其最终目标之一就是减轻患者负担、解决“看病贵”问题。对于医院来说，提价往往积极，提得越多越好;降价多是消极，降得越少越好。因此，对于怎样实行“医药分开”，怎样降低药价、提高医价，需有更加周密合理的制度安排，并且加强监管。如果“一降一升”的结果反而增加了患者的整体负担，这样的改革很难说成功。(晏扬)

Whether the medical and health system reform,Or break"To raise the medical medicine"mechanism,Its ultimate goal is to reduce the burden of patients/solve"The doctor your"problems.To the hospital for,Prices often actively,Propose the more the better;Price is negative,Drop as little as possible.so,On how to implement"Medicine separate",How to reduce prices/Improving medical price,Should be more careful and reasonable system arrangement,And strengthening the supervision of.if"A drop a liter"Results they have increased the whole burden of patients,This reform success it's hard to say.(YanYang)