山东无棣县海丰街道卫生服务中心，医生正在给徐重德量血压。

Shandong wudi haifeng street health service center,The doctor is to xu heavy DeLiang blood pressure.

　　本报记者　李维娜摄

Our reporter LiWeiNa perturbation

　　【调查背景】

[Research background]

　　自今年8月1日起，山东省无棣县在全县推行住院“全报销”制度，凡是参加新农合、城镇居民基本医疗保险的城乡居民在乡镇卫生院（含两处街道社区卫生服务中心）住院，缴纳200元后，基本医疗费用全部报销。

Since August 1st,Shandong province in the implementation of the county hospital"Full reimbursement"system,All the new agriculture together/Urban resident basic medical insurance for urban and rural residents in the township health center(Including two place street community health service center)hospital,After paying 200 yuan,Basic medical treatment charge all reimbursement.

　　在财力比较薄弱的情况下，无棣县在全省率先推行“全报销”制度，实施状况如何？是否仍需要大量财政补贴？是否还存在过度医疗？带着这些问题，记者走进无棣县进行调查。

In terms of weak situation,Wudi in the province takes the lead in pushing"Full reimbursement"system,Implementation situation how to?Still needs a large number of financial subsidies?Whether there are excessive medical treatment?With these questions,The reporter walks into wudi were investigated.

　　①　住院人数会不会“井喷” (1) the number of hospital will"blowout"

　　自己要交200元　没病不会瞎住院 You want to make 200 yuan have no disease not blind in hospital

　　“以前住院花费太多，咱农村人负担不起，得了病能拖就拖；现在只交200元钱，其他费用都不用咱自个管了。”在无棣县海丰街道社区卫生服务中心住院的病患谭宝峰说。

"Before hospitalization cost too much,I can't afford the rural people,Got a disease can drag will drag;Now only pay 200 yuan,I don't have other expenses from the pipe."In wudi haifeng street community health service center hospital patients TanBaoFeng said.

　　谭宝峰患有比较严重的高血压，去年9月份以来经常头疼、头晕。之前他总担心住院花费多，就一直拖着。在得知住院“全报销”的政策之后，他决定住院。

TanBaoFeng suffer from serious hypertension,Often have a headache since last September/dizziness.He always worry about before hospitalization costs more,Just drag.In that hospital"Full reimbursement"Policy after,He decided to hospital.

　　因医疗负担重，农民常说“救护车一响，一头牛白养”，无棣希望通过住院“全报销”结束这种因病致贫的情况。

For medical burden,Farmers often said"The ambulance rang,A cow white have",Hope that through in company"Full reimbursement"End this become financially-difficult situation.

　　自今年8月1日起，无棣县实行“免费医疗”以来，海丰街道社区卫生服务中心的医务人员每天都忙个不停。据海丰街道社区卫生服务中心副主任郭树军介绍，2011年8月至11月，服务中心住院患者有130多人次，而今年8月至11月，住院患者达427人次，9月单月住院患者就达150多人次。

Since August 1st,Wudi to"Free medical care"since,Haifeng street community health service center of medical staff every day busy.According to haifeng street community health service center, deputy director of the GuoShuJun is introduced,In August 2011 to November,Service center hospital patients have more than 130 people,And in August to November,427 people hospitalized patients,September month alone hospitalized patients with more than 150 people.

　　“乡镇医院病患大幅度增长甚至翻倍是正常的，主要是有些原来应该住院而在家保守治疗的患者，在新政策的鼓励下前来住院，经过4个月的时间已经基本消化完毕。”无棣县卫生局副局长佘洪林说。

"Township hospital patients increased greatly and even double is normal,Mainly some originally should be in hospital at home and conservative treatment of patients,In the new policy encouragement to hospital,After four months of time has been basically finished digestion."County health bureau deputy director SheHongLin said.

　　据无棣县农合办副主任王清泉说，病患在乡镇医院住院，接诊大夫是要签字全程负责的，并不是随便想住就住，想住多久就住多久，病患住院“井喷”现象不会出现。

According to the deputy director of the county agricultural joint WangQingQuan said,Patients in the township hospital,Accepts the doctor is to sign the whole responsible,And not just want to live live,Want to live as long as you live long,Patients in hospital"blowout"Phenomenon will appear.

　　他说，推行住院“全报销”政策，有效解决了以往老百姓有病拖延治疗的现象，提高了老百姓的健康意识。一些常见病、多发病、慢性病以及康复期治疗的病患仅在乡镇卫生院花费200元就能得到较好的治疗。同时，疑难病、潜在病、急重症等复杂病例可以早发现并实现双向转诊促进病患合理分流。这对老百姓的健康水平是一个很大的提升。

He said,Implementation of hospital"Full reimbursement"policy,Effectively solves the common people sick delay treatment phenomenon,To improve the people's health awareness.Some common diseases/Frequently occurring disease/Chronic disease and convalescence patients only in rural hospitals spend 200 yuan can get very good treatment.At the same time,difficult-and-rare-case/Potential disease/Urgent severe and complicated cases can be found early and realize the two-way referral to promote the patient reasonable shunt.The common people's health level is a big promotion.

　　“家里都有一大摊子事儿，没病没灾的，谁会跑这住院？”正在西小王乡中心卫生院住院的张秀燕说，“像普通感冒这样的病，在村卫生室里吃药打针，几十块钱就够了，到这住院得花200块钱，不合算不说，关键是撇家舍业的耽误工夫啊。有时还得让家人陪着，现在打工一天还挣百八十块呢，搁谁谁没病住得下去？”

"Home has a big stall business,Have no disease no plague of,Who will run the hospital?"Is the west wang township center health center hospital ZhangXiuYan said,"Like the common cold this disease,In the village in the clinic medicine injections,Dozens of dollars is enough,To this hospital have to spend 200 dollars,Don't bang for the buck not,The key is left their homes of delay time ah.Sometimes have to make family with,Now a days work still earn eighty pieces of it,Put aside who have no disease live down?"

　　②　医保基金能不能承受 (2) the medical insurance fund can bear

　　资金源于新农合　加强控制降费用 Capital comes from the new agriculture together to strengthen the control of cost down

　　无棣全县43万人，住院“全报销”将是一笔很大的开销。作为财政弱县，无棣如何负担？

The company 430000,hospital"Full reimbursement"Will be a big spending.As financial weak county,Company how to burden?

　　无棣县农合办主任关秀林告诉记者，这项政策所涉及的资金基本与县财政无关，住院“全报销”的资金来源是新农合基金。

Wudi farmers joint GuanXiuLin director told reporters,This policy involves the capital basic and county financial independent,hospital"Full reimbursement"Sources of funding is a new agriculture joint fund.

　　据关秀林介绍，2012年无棣县新农合基金总额达13770.85万元，每年的新农合基金收支基本平衡，而实施住院“全报销”政策之后，新增补偿费用达到1352万元。为能保证住院“全报销”的可持续性，消化新增补偿费用，在不增加财政负担的前提下，通过实施“一调双控”，确保新农合基金能够全额、公平、有效地用在参合参保的老百姓身上。

According to GuanXiuLin introduced,In 2012, wudi new farmers joint fund amounting to $137.7085 million,Every new farmers joint fund balance basic balance,And the implementation of hospital"Full reimbursement"Policy after,New compensation fees amounted to 13.52 million yuan.To ensure that hospital"Full reimbursement"sustainability,Digest new compensation fees,In the premise of increasing financial burden,Through the implementation"Find double control",Ensure that the new agriculture joint fund can be full/fair/Effectively used in ginseng add up to ginseng protect people body.

　　“一调”，即调整乡镇卫生院住院补偿起付线、报销比例。新农合乡镇卫生院住院起付线、报销比例由150元、80%分别调整为200元、100%；城镇居民基本医疗保险乡镇卫生院住院起付线、报销比例由500元、70%分别调整为200元、100%。

"find",Adjustment is the new start to pay compensation in line/Reimbursement ratio.New farming villages and towns health center hospital close to start to pay of the line/Reimbursement ratio by 150 yuan/80% adjustment for 200 yuan/100%;Basic medical insurance for urban residents in township health center start to pay of the line/Reimbursement ratio by 500 yuan/70% adjustment for 200 yuan/100%.

　　“双控”，就是既控制乡镇卫生院次均费用和单病种费用，又控制县内其他医疗机构医药费用的不合理增长。

"Double control",Is not only control the new times are cost and single disease cost,The county and control other medical institutions of medical expenses are not reasonable growth.

　　“乡镇卫生院今年1—5月份次均报销费用是2275元。现在乡镇卫生院次均报销费用是1200元，超出1200元的部分，由医院自己承担，年终总结算。”关秀林说，据测算，单病种次均费用最多可下降50%，县内其它医疗机构次均费用平均下降20%左右。通过控制实现了全县住院总体费用、次均费用、病人自付费用“三下降”。全县可减少新农合不合理支出1700万元左右，完全能够消化掉“全报销”后新增费用。

"Township health center this year 1, 5 months time are to submit an expense account fee is 2275 yuan.Now the new times are to submit an expense account fee is 1200 yuan,More than 1200 yuan of part,The hospital for yourself,Year-end summary is."GuanXiuLin said,According to the calculation,A single disease are the most cost can reduce 50%,The county other medical institutions second all cost decrease 20%.Through the control realized the county hospital overall cost/Second all cost/The patient out-of-pocket costs"Three down".The county can reduce new farmers reasonable or unreasonable spending 17 million yuan or so,Can digest"Full reimbursement"After the new charges.

　　佘洪林说，引导像高血压、高血脂等潜在病人到医院就医，提前对其进行干预，以免发展成重病，避免了老百姓得重病的痛苦，也为老百姓省了钱。目前，通过建立健康档案，排查出全县有4万多名潜在的慢性病患者，对他们进行干预治疗，保守估计人均节省费用300元，就可减少老百姓负担1300多万元，这笔账很划算！

SheHongLin said,Guide like high blood pressure/High blood fat, as well as other potential patients to the hospital,The early intervention,In order to avoid develop into serious illness,To avoid the common people became ill pain,Also for people to save money.At present,Through the establishment of health records,The punch out more than 40000 potential with a chronic illness,The intervention treatment,Conservative estimate per capita cost saving 300 yuan,It can reduce the burden of people more than 1300 yuan,The bill is pretty good!

　　截至今年11月底，住院“全报销”政策，共节省群众医药费用585.45万元，节省住院自付费用191.32万元，有效降低了群众的住院花销。

By the end of November this year,hospital"Full reimbursement"policy,Save the total medical costs 5.8545 million yuan,Save hospital out-of-pocket cost 1.9132 million yuan,To reduce the cost of the hospital.

　　③　过度医疗会不会产生 (3) will produce excessive medical treatment

　　不靠卖药来补医　工资全额走财政 By selling medicine to make a full medical wages go financial

　　“全报销”政策下，乡镇卫生院是否会通过过度医疗来赚取新农合基金？而“双控”措施的推行，是否会使医院担心超过规定费用，而给患者“保守治疗”？

"Full reimbursement"policy,Township health center will through the excessive medical treatment to make the new agriculture joint fund?and"Double control"The implementation of measures,Whether it will make the hospital worry exceed the prescribed fee,And give patients"Conservative treatment"?

　　12月14日上午，海丰街道杨坊村村民赵振霞正躺在社区卫生服务中心的病房里打吊瓶，她患有脑梗塞后遗症，左半身瘫痪不能动，在该中心住院康复治疗已经3天了。她的主治医师谭有伟告诉记者，依据病情，她需要住院两周左右，差不多要花费4000元。

On December 14 morning,Haifeng street Yang fang village ZhaoZhenXia is lying in the community health service center hospital room to play DiaoPing,She was suffering from cerebral infarction sequela,The left half paralyzed couldn't move,In the center hospital rehabilitation therapy for 3 days.Her attending doctor tan have wei told reporters,According to the condition,She need to be hospitalized for two weeks or so,About to spend 4000 yuan.

　　“病人住院时长都会有一个参考标准，而且接诊大夫要全程负责。”谭有伟说，像赵振霞这样的当然不能在治疗费用达到1200元就让她出院，得为病人的病情负责。

"Patients hospitalized duration will have a reference standard,And accepts the doctor to the responsible for."Tan have wei said,Like ZhaoZhenXia this of course not in treatment costs 1200 yuan let her discharge,For the patient's condition is responsible for.

　　郭树军说：“每个病人的住院情况，医院和县里都要进行核查，如果存在过度医疗，是要追究卫生院责任的，产生的费用由卫生院承担。当然治疗不到位也不行，因为患者要对卫生院的满意度测评。对一些重症病人，卫生院会及时向上转诊，怕贻误了病情。”

GuoShuJun said:"Each patient situation of be in hospital,County hospital and to check,If there is excessive medical treatment,Is shall be investigated for responsibility of health center,Any charges for the health center.Of course treatment does not reach the designated position also not line,Because the patient to the hospital satisfaction assessment.For some severe patients,Health center will keep up referral,Fear of delay the disease."

　　在海丰街道社区卫生服务中心大厅，一块电子显示屏上显示着基本药物价格、检查项目收费价格公示，方便老百姓监督。为了管住以药补医的恶习，无棣规定，“全报销”的药物范围为基本药物，卫生院卖药实行基本药物零差价。

In haifeng street community health service center hall,A piece of electronic screen display the basic drug prices/Check the project price public charge,Convenient people supervision.In order to control with medicine for medical bad habits,Provisions of company,"Full reimbursement"Drug range as the basic drugs,Health center sell medicine practice basic drug zero spread.

　　基本药物没有了以药补医的市场，那么，乡镇卫生院会不会拿非基本药物来牟利呢？佘洪林说，各乡镇卫生院基本药物种类非常丰富，基本能够满足病患治疗需求；而非基本药物最多也就20种。县卫生局还规定使用非基本药物产生的费用不能超过患者住院总费用的10%，超出部分由乡镇卫生院自行承担。

Essential drugs without the medicine for the medical market,so,Township health center will take the essential drugs for profit it?SheHongLin said,The township health center essential drugs sort very rich,Basic can satisfy the patient treatment needs;Instead of essential drugs only twenty kinds of.County health bureau also provides use a basic medicines costs no more than 10% of the total cost in hospital patients,Beyond part shall be borne by the township health center.

　　为配套住院“全报销”政策，无棣将乡镇卫生院变为全额拨款事业单位，乡镇卫生院职工工资由县财政统一发放，有效杜绝了医护人员从病人身上“揩油”。

In hospital for supporting"Full reimbursement"policy,The new company will become full funding institution,Township health center worker pay unified by the county finance issue,Effective to eliminate the medical personnel from patients"hijack".

　　目前，“全报销”还仅在乡镇卫生院实行，能否将其推广到县级医院甚至更高的层次？

At present,"Full reimbursement"Also only in the township health center,Can be extended to the hospital at or above the county level or higher level?

　　对此，关秀林解释，如果在试运行阶段，县级医院就完全执行住院“全报销”，新农合基金会承受不住。下一步，对于住院“全报销”，在总结经验的基础上，将进行配套改革，把住院“全报销”逐步推进至县级医院。

this,GuanXiuLin explain,If the trial run,Hospital is a full implementation at or above the county level hospital"Full reimbursement",New farmers joint foundation bear.The next step,For hospital"Full reimbursement",On the basis of summarizing experience,Will be supporting reforms,The hospital"Full reimbursement"Gradually to the hospital at or above the county level.

　　制图：蔡华伟

drawing:CaiHuaWei