“以药养医”是个几十年的老话题，也是如今绝大多数大医院经济收入的主要来源之一。

"To raise the medical medicine"A few decades old topic,And now most of the large hospital economy the main source of income.

　　简单来说，一片药，经过统一招标采购后，进入医院后卖给患者时，可以在进价的基础上加成15%。这部分收入归医院，补充政府投入不足，医院需要用这笔钱发工资、买设备、盖大楼……

In simple terms,A pill,After unification after purchase,Enter the hospital sell to patients,On the basis of the purchase price, can be in 15% bonus.This part of the income to the hospital,Add the lack of government's input,The hospital need to use this money to pay/Buy equipment/Cover building...

　　从今年7月1日开始，北京市公立医院的改革进入深水区，破解以药养医的难题从北京友谊医院开始；9月1日，试点推广到北京朝阳医院。12月1日，北京同仁医院、北京积水潭医院和北京天坛医院在同一天也开始推进医药分开试点。

From July 1st,Beijing public hospital reform into the deep water area,Crack in medicine have medical problems from Beijing friendship hospital began;On September 1,,Pilot promotion to Beijing chaoyang hospital.On December 1,,Beijing tongren hospital/Beijing ji shui tan hospital and the temple of heaven in Beijing hospital on the same day also began to promote medical separate pilot.

　　医药分开试点的是一笔大账，这其中，既涉及取消药品加成，取消挂号费、诊疗费，设立医事服务费这样与患者直接相关的明面账，也有看不见的健康账，更有长远的社会账和效益账。

Medical separate pilot is a big account,the,Cancellation is related to not only the drug addition,Cancel the registration fee/fee,Establishment of medical service and patients that directly related MingMian accounts,Also see health accounts,More long-term social accounts and benefit account.

　医院账 Hospital account

　　医院收入略有增加 The hospital income increased slightly

　　医务人员收入有所增长 The medical staff income increased

　　北京市各医院虽然启动医药分开试点的时间不一样，但方案完全一样。在北京友谊医院开始试点时，北京朝阳医院的执行院长陈勇格外关心友谊医院试点的情况。因为北京朝阳医院是今年年初确定的两家试点医院中的一家。

The Beijing hospital although start medicine separate pilot time is not the same,But scheme exactly the same.In the Beijing friendship hospital began when the pilot,Beijing chaoyang hospital executive director Chen yong particularly concerned about friendship hospital pilot situation.Because Beijing chaoyang hospital is determined at the beginning of this year the two pilot of a hospital.

　　友谊医院的数字怎么样？医院的收入到底是增是减？陈勇关心的这些问题，很快就有了积极的答案。9月6日，北京市医改办主任韩晓芳坐在了北京城市管理广播电台的直播室。在直播间里，韩晓芳说，“很多人问我这个问题：药品加成15%取消了，是不是医院就受损失了？”韩晓芳回答：“实际上不是，这次政策实际上是做了一个收入结构的调整，也就是把原来的药品加成，再加上取消的挂号费和诊疗费，一共三项收入，转化为医事服务费收入，所以，对于医院而言，是一个收入结构的调整；对患者而言，支出项目作调整了。再通过提高医保报销的水平，每个人给定额报销40元，这样患者的负担下降了。”

The number of friendship hospital?What is the hospital income increase is reduced?Chen yong care of these problems,Soon have a positive answer.On September 6,,Medical director of the Beijing do HanXiaoFang sitting in the Beijing urban management ZhiBoShi radio.In the could not,HanXiaoFang said,"A lot of people have asked me this question:Drug addition 15% is cancelled,Is the hospital will be lost?"HanXiaoFang answer:"In fact is not,This policy is actually made a income structure adjustment,Also is the original drug addition,Plus cancelled the registration fee and fee,A total of three income,Into medical fees,so,In a hospital in,Is a income structure adjustment;As for patients,Spending project adjusted.To improve the level of the medical insurance reimbursement,Everyone give quota expense and yuan,So the burden of patients dropped."

　　医保报销水平提高了，医保能不能承受？这关乎新机制的可持续发展。韩晓芳说，经过测算，取消以药养医的试点如果在全市推广开，全市医保资金增加支出13个亿，“我们全市医保资金是能够承受的；与此同时，当医保控费的效应越来越强时，医保资金的支出还会有所下降。所以从动态上看，医保基金的支出应该是平稳变化，可能略有增加，但不会增加太多，从长期看，医保资金将呈现出减少的趋势。”

To improve the level of medical insurance reimbursement,Medical insurance can bear?It's about the sustainable development of the new mechanism.HanXiaoFang said,After measuring,Cancel to medicine to raise the medical pilot if in the city promotion open,The medical insurance fund spending increases 13,"We the medical insurance fund is to be able to afford;meanwhile,When the effect of medical insurance cost control is more and more strong,Medical insurance capital spending will also decline.So from on the dynamic,The medical insurance fund spending should be smooth change,May slightly increase,But won't add much,In the long run,Medical insurance funds will present a downward trend."

　　陈勇在朝阳医院医药分开试点运行一周后，也真切地感受到，患者掏的钱少了，医院的收入还略有增加，医务人员的收入有所增长。

Chen yong in chaoyang hospital medical separate pilot run after a week,Also a real sense,Cut the patients with less money,The hospital income increased slightly,The medical staff income increased.

　患者账 Patients account

　　医保患者次均费用下降 Health care patients second all costs down

　　患者个人负担减轻 Patients personal burden

　　今年7月1日，北京友谊医院第一个取消“以药养医”，所有的药品一律取消加成，以进价销售；同时，取消挂号费、诊疗费，设立医事服务费。患者看病选医生，按照医生的职级不同，患者所要承担的医事服务费也不相同：主治医生医事服务费为42元，副主任医师、主任医师、知名专家的医事服务费分别为60元、80元和100元。北京市医保患者可以直接报销40元，也就是说北京医保患者自己需要负担的医事服务费最低只有2元，而在改革之前，患者挂个主治医师的号，自付部分为3元，相当于北京医保患者看普通门诊价格还下降了50%；但看专家号，即使是最便宜的副主任医师，本市医保患者也要自付20元，最贵的知名专家号则需要自己负担60元。配套的举措还有急诊的挂号费、诊疗费取消，设立急诊的医事服务费为62元，本市医保患者自付2元。

On July 1 this year,Beijing friendship hospital first cancel"To raise the medical medicine",All drugs are cancelled addition,To purchase price, sales;At the same time,Cancel the registration fee/fee,Set up medical service charge.Choose a doctor with a doctor,According to the different rank,Patients have to bear the medical service charge is not the same:Attending physician medical service fee is $42,Of doctor of vice director of/Chief physician/Famous experts of medical service is sixty yuan respectively/80 yuan and 100 yuan.Beijing health care patients may directly submit an expense account forty yuan,That is the Beijing health care patients need to afford medical service charge minimum only 2 yuan,In the reform and before,Patients on the attending doctor number,Since the pay part is 3 yuan,Beijing is equivalent to the average outpatient service medical insurance patients see prices also fell 50%;But look at ZhuanGuHao,Even the most cheap, deputy director of the physician,The city also want to pay medical insurance patients since twenty yuan,The most famous ZhuanGuHao is need to bear his own sixty yuan.Supporting measures and emergency of the registration fee/Cancellation fee,The establishment of emergency medical service fee is 62 yuan,Since the city health care patients pay $2.

　　一方面是药价降了，一方面是多了医事服务费。很多老百姓就要算算，到试点医院看病划算吗？

On the one hand is prices down,On the one hand is the medical service charge.A lot of people will have to calculate,To pilot hospital deal?

　　如果挂普通号，肯定不吃亏。以北京市医保患者为例，原来挂号费和诊疗费报销后自付3元，现在医事服务费报销后只要自己掏2元；同时药价下降了。与在其他医院相比，开药多少都划算。如果挂专家号，不是为了看病，而是为了开药，那么即使挂最便宜的副主任医师号，也得自付20元，而在非试点医院，本市医保患者只需要自付5元。为了“挣回”这15元的差价，按照药品平均取消15%的加成来算，开的药至少要达到115元才能与原来基本持平，如果挂知名专家号则需要开药达到288元，才能“保本”。

If hang ordinary number,Sure does not suffer.Beijing health care patients as an example,The original registration fee and fee reimbursement from pay after 3 yuan,Now medical service charge after reimbursement as long as themselves to pay the $2;At the same time, prices fell.Compared with other hospitals,Prescribe how much all bang for the buck.If ZhuanGuHao hang,Not to see a doctor,But to prescribe,So even if hang the cheapest of doctor of vice director of number,Have to pay from twenty yuan,And in other hospitals,The city health care patients need only self pay 5 yuan.In order to"Earn back"The 15 yuan price difference,According to an average of 15% of the drug to cancel to calculate bonus,Open medicine at least $115 to achieve with the original flat,If hang famous ZhuanGuHao requires prescribe amounted to 288 yuan,can"break-even".

　　友谊医院试点一周后，北京市医院管理局公布的数据显示，该院总计为患者让利药费164.82万元，加上取消的挂号费、诊疗费，与医事服务费收入基本持平，医院实际收益略有增加，初步达到了“患者负担不增加、医院收入不减少”的目标；门诊次均费用与前一周相比下降11.82元；次均药费下降32.04元；医保患者自付部分从133.53元下降到105.16元，下降28.37元，下降比例为21.27%。从费用情况来看，通过医药分开和加强医生合理用药管理，医保患者次均费用、药费均下降，患者个人负担减轻。

The pilot friendship hospital a week later,The Beijing hospital authority figures showed,The hospital patients with a total of 1.6482 million yuan for the profits,And cancelled the registration fee/fee,And medical fees is flat,Hospital real income increased slightly,Reached a preliminary"Patients do not increase the burden/The hospital income does not reduce"goal;Outpatient service times a week before all cost and drop compared to 11.82 yuan;Second all medicine down 32.04 yuan;Since medical insurance patients pay part from 133.53 yuan ($) to 105.16 yuan,Down 28.37 yuan,21.27% decline.Judging from the cost,Through the medical separate and strengthen the management of the rational use of drugs,Health care patients second all expenses/Medicine decreased,Patients personal burden.

　改革账 Reform bill

　　医生服务行为良性转变 The doctor service behavior positive change

　　患者就医习惯良性转变 Medical treatment in patients with benign change habits

　　11月底，北京市医院管理局再次公布了北京友谊医院和北京朝阳医院的试点数据。这组漂亮的数据被北京市医院管理局局长封国生总结为：达到了“患者负担不增加、医务人员受鼓舞、医院发展添活力”的预期效果。

By the end of November,The Beijing hospital authority once again announced Beijing friendship hospital and Beijing chaoyang hospital pilot data.This group of beautiful data by the Beijing hospital authority kingdom seal life summed up in:reached"Patients do not increase the burden/Medical staff encouraged/The hospital development add vitality"Expected effect.

　　封国生说，友谊医院和朝阳医院分别启动四个月和两个月的“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，其中次均药费下降17%左右，且趋势平稳、效果持续，实实在在减轻了患者的负担。

Seal countries student said,Friendship hospital and chaoyang hospital were start four months and two months"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,The second all expenses for medicine by about 17%,And stable trend/Effect lasts,Reduce the burden of the patients, the.

　　友谊医院与今年上半年相比，医药分开试点改革四个月监测数据表明医保患者药占比从77%下降到64%，降幅达到17%；门诊医保患者次均医疗费用由450元下降到380元，降幅16%，门诊医保患者自付费用由176元下降到103元，降幅41%；住院医保患者例均医疗费用由18608元下降到16174元，降幅13%。

Friendship hospital and compared in the first half of this year,Medical separate pilot reform four months monitoring data show that health care patients for medicine than dropped from 77% to 64%,Fell to 17%;Outpatient service medical insurance patients second all medical expenses by 450 yuan ($) to 380 yuan,A drop of 16%,Outpatient service medical insurance patients out-of-pocket cost from 176 yuan ($103) to yuan,A drop of 41%;In all cases patients with health care medical costs by 18608 yuan ($) to 16174 yuan,A drop of 13%.

　　朝阳医院与今年上半年相比，医保患者药占比从70%下降到58%，下降幅度为18%；门诊医保患者次均医疗费用由394元下降到358元，下降9%，门诊医保患者自付费用由185元下降到106元，下降43%；住院医保患者例均医疗费用由17830元下降到15466元，下降13%。

Chaoyang hospital and compared to the first half of this year,Health care for patients with medicine than dropped from 70% to 58%,A decline of 18%;Outpatient service medical insurance patients second all medical expenses by 394 yuan ($) to 358 yuan,Fell by 9%,Outpatient service medical insurance patients out-of-pocket cost from 185 yuan ($106) to yuan,Fell by 43%;In all cases patients with health care medical costs by 17830 yuan ($) to 15466 yuan,Fell by 13%.

　　改革要成功，只有患者一方面“叫好”不够。封国生说，此次取消以药养医，医务人员的劳动价值得到体现，医院收益得到了提高。两家医院都按照医药分开整体方案和市医管局绩效考核的要求建立了新的绩效考核体系，贯彻了“多劳多得、优劳优得”的原则，友谊医院和朝阳医院医务人员绩效工资较改革前均增长30%以上，并通过控制成本和不合理医疗费用，医院收益均得到不同程度提高。

Reform to be successful,Only if the hand"gave"enough.Seal countries student said,The cancel to raise the medical medicine,Medical staff labor value be reflected,The hospital income improved.Two hospitals in medical separate the overall program and the municipal hospital authority performance evaluation requirements to establish a new performance evaluation system,Implement the"More pay for more work/Optimal pains to optimal"principle,Friendship hospital and chaoyang hospital medical staff performance salary is before reform all increase by more than 30%,And through the control cost and reasonable expenses for medical treatment,The hospital income will be improved to varying degrees.

　　患者花钱少了，是不是服务打了折扣？第三方调查显示，患者的满意度提高了，患者就医得到有效引导。两家医院的问卷调查都显示：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。改革后，一部分常见病患者有效引导到了普通门诊就诊，专家挂号难问题得到了一定缓解。封国生说，通过试点改革，触动了医院管理体制、运行机制等深层次变革，医院办院和管理理念、医生服务行为、患者就医习惯都发生良性转变。具体表现在“三个加强”：一是成本控制进一步加强；二是用药管理进一步加强；三是医德医风建设进一步加强。北京友谊医院、朝阳医院“医药分开”试点取得初步成效，在全国大型公立医院改革中迈出了可喜的一步，为北京市乃至其他城市大型公立医院改革积累了宝贵经验。

Patients with less money,Is service played discount?The third party survey,The satisfaction of patients improved,Medical patients effectively guide.Two hospitals questionnaire are displayed: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.After the reform,Part of the common diseases patients effectively guide the general outpatient clinic,Experts registered difficult problem has been some relief.Seal countries student said,Through the pilot reform,Touch the hospital management system/Operation mechanism and deep change,With the hospital and management concept/The doctor service behavior/Patients go to a doctor habit occurs benign transformation.The specific performance in the"Three strengthen":One is to further strengthen cost control;The second is to further strengthen the management of drug;The third is to further strengthen the construction of medical ethics.Beijing friendship hospital/Chaoyang hospital"Medicine separate"Pilot achieved initial results,In the national large-scale public hospital reform take a good step forward,For Beijing and other cities large public hospital reform has accumulated valuable experience.

　　12月1日，北京3家专科特色突出的医院：北京同仁医院、北京积水潭医院和北京天坛医院开始进行医药分开试点。试点医院迅速从原来的两家推广到5家。新试水的3家医院虽然方案相同，但绝不是原来两家试点医院的简单复制。同仁医院眼科和耳鼻喉科的学科特色非常突出，积水潭的骨科和烧伤科是领头羊，天坛医院的神经外科名声赫赫。与此相对应的是，这3家医院重点学科的患者来自全国四面八方，医保患者比例相对比较低。但这3家医院非重点学科的光景则完全不同，有些非重点科室的专家担心今后会“吃不饱”。封国生说，与友谊医院、朝阳医院相比，这3家医院不仅具有综合医院代表性，还呈现了一定的专科医院特点，在这3家医院试点，可以为下一步专科医院开展医药分开试点工作奠定良好的基础。

On December 1,,Beijing three specialized outstanding characteristics of hospital:Beijing tongren hospital/Beijing ji shui tan hospital and the temple of heaven in Beijing hospital to medical separate pilot.Pilot hospital quickly from the original two extended to five.The new test the waters of the three hospitals although the same plan,But it is not the original two pilot hospital simple reproduction.Tongren hospital eye and ent discipline characteristic is very outstanding,Ji shui tan orthopedic and acute is leaders,The temple of heaven hospital neurosurgery illustrious reputation.The flipside is,The three hospitals key discipline of the patients from all over the country in all directions,Health care patients ratio is relatively low.But the three hospitals not key discipline? Is completely different,Some of the key department of experts worry about the future"Do not have enough to eat".Seal countries student said,And friendship hospital/Compared to chaoyang hospital,The three hospitals has not only general hospital representative,Also presented certain specialized subject hospital characteristics,In this 3 hospitals pilot,For the next step specialized subject hospital medical separate trial work lay a good foundation.

　取消 cancel

　　“以药养医”进程 "To raise the medical medicine"process

　　■5月18日 全市召开公立医院改革启动大会，对公立医院改革进行统一部署。

S may, and the reform of public hospitals at the start,In public hospital reform unified deployment.

　　■7月1日 北京友谊医院启动以医药分开为核心的综合改革试点。

S on July 1, Beijing friendship hospital start to medicine separately for the core of the comprehensive reform pilot.

　　■9月1日 北京朝阳医院启动以医药分开为核心的综合改革试点。

S on September 1, Beijing chaoyang hospital start to medicine separately for the core of the comprehensive reform pilot.

　　■12月1日 北京同仁医院、北京积水潭医院和北京天坛医院启动第三批试点。

S on December 1, Beijing tongren hospital/Beijing ji shui tan hospital and the temple of heaven in Beijing hospital start the third batch of pilot.

　　■2013年 北京市属21家大医院有望全部进行试点。（贾晓宏）

S 2013 Beijing municipal and big hospital is expected to all pilot project.(JiaXiaoHong)