【编者的话】

[The editor,]

　　按照北京市公立医院改革的整体部署，北京朝阳医院自9月1日实施医药分开试点。医药分开之后，患者的负担减轻了吗？医保基金支出增多了吗？医生用药更合理了吗？三个多月之后，本报记者来到朝阳医院探访。

In accordance with the deployment of the reform of public hospitals in Beijing,On September 1, Beijing chaoyang hospital since the implementation of the pharmaceutical pilot separately.After medicine separately,The burden of the patients with ease?The medical insurance fund spending increase?Doctors use more reasonable?After more than three months,Our reporter came to chaoyang hospital visits.

　　“十八大·一线探落实”特别策划到此告一段落。

"18, a line out"To the end special planning.

　　半个多月以来，本栏目探访中央政策在各地的落实情况，报道了各地的新举措、新探索。特别策划告一段落，但为民生的鼓与呼仍将继续，敬请关注。

Since more than half a month,This column to visit central policy across the country to carry out the situation,Reported around the new measures/The new exploration.Special planning,But for people's livelihood of drum and will continue,Please pay attention to.

　

　靠什么控制不当处方 By any improper control prescription

　　

“把开(可疑)处方的医生名字露出来，就是要曝光他” "The open(suspicious)Prescription of doctors name come to light,Is to expose him"

　　“把开(可疑)处方的医生名字露出来，不要遮住，就是要曝光他！”

"The open(suspicious)Prescription of doctors name come to light,Don't cover,Is to expose him!"

　　朝阳医院院长助理童朝晖这句话，是在12月10日的处方点评会上，当着各科室主任说的。会议室的投影仪，正在幕布上映出一张被挑出来的可疑处方。

Chaoyang hospital dean assistant children from zhaohui this sentence,Prescription is on December 10, comment on the meeting,The presence of the various branches of said.Conference room of the projector,Are the curtain on a suspicious of be pick out prescription.

　　“他开的药实在是太多了。”在征求参加点评会的各科室主任意见之后，大家都同意对这名医生进行处罚。

"He opened the medicine is really too much."After will seek to comment on the various branches of opinion,We all agree to this doctor is punished.

　　随后，对抽查出来的另外5张处方，点评专家组也都达成了相应的处理意见。

then,On spot check out the other 5 prescription,Comment on the panel also reached the corresponding processing opinion.

　　童朝晖介绍，朝阳医院刚开始医药分开的时候，处方点评会主要对大处方进行重点检查，对单张处方金额较低的做抽查。现在处方合格率显著提升，开始转向对一贯处方比较多、药占比比较高的科室和医生个人，以及使用比较集中的重点药品，进行重点监测和抽查。

Children from zhaohui introduced,Chaoyang hospital medicine separate beginning,Prescription comment on will mainly focus on DaChuFang inspection,For single prescription amount lower do spot check.Now prescription rate significantly increased,Begin to turn to more consistent prescription/Medicine department and doctors of poor people,As well as the comparison of the key aspects of centralized drug use,For the monitoring and audit.

　　“刚刚医药分开的时候，因为大家不太习惯，改起来也难，那个时候抽查出来的不合理处方最高达到14%”。朝阳医院执行院长陈勇介绍，“经过一个月的点评和管理之后，后两个月不合理处方的比例维持在百分之一点几，不超过2%。不合理用药的行为被控制下来了，与之对应的行医模式和行为也随之在转变。”

"Just medicine separately,Because you are not used to,Change it to,The spot check out when the unreasonable prescriptions of the highest 14%".Chaoyang hospital executive director Chen yong,"After a month after the review and management,The proportion of two months after the unreasonable prescriptions at point a few per cent,No more than 2%.Don't rational drug use behavior has been under control,And the corresponding practice mode and behavior of also in the change."

　　那么，为什么还有不到2%的不合理处方会顽固存在呢？

so,Why there is less than 2% of the unreasonable prescriptions will be stubborn exist?

　　冰冻三尺非一日之寒，陈勇介绍，以药养医，药品加成政策实行20多年了，很多医生毕业以后都是在以药补医的体制和机制下学习做医生的。多年以来，大家已经养成了大处方的习惯。政策调整以后，要立刻合理用药，有一定的难度。

Rome wasn't built in a day,Chen yong introduced,Medicine to support medical,Drug bonus policy shall be more than twenty years,Many doctor after graduation is on medicine for medical system and mechanism of learn to do a doctor.Over the years,We have formed the habit of DaChuFang.After the policy adjustment,Immediately to rational drug use,Has the certain difficulty.

　　但是有时候，更大的阻力来自患者。

But sometimes,Greater resistance from patients.

　　在医保报销比例提高，覆盖面扩大，患者负担减轻之后，很多患者倾向于医生开药越多越好。很多人觉得，即使药多了吃不了，往家里的小药箱里存着也是好的。

In the medical insurance reimbursement ratio increased,A broader,After patients burden,Many patients tend to be the doctor prescribe the more the better.Many people think,Even if can't eat more medicine,Go home in the small medicine with is also good.

　　为缓解来自患者的阻力，朝阳医院专门设立咨询窗口，希望通过临床药师的窗口服务，来指导患者如何用药。陈勇说，“我们也希望有关媒体能配合医改，加大宣传关于合理用药的好处，乱用药的坏处。”

For relief from the resistance of the patients,Chaoyang hospital set up information window,Hope that through the window of the clinical pharmacists,To guide patients to use drug.Chen yong said,"We also hope to can cooperate cure of the media,Strengthen propaganda about the benefits of rational drug use,The disadvantages of using medicineatwill."

　　

医保支出会不会猛增 Health care spending will be increased

　　院长算细账：医保还少支出9块钱呢 Dean is detailed account:Less health care spending $9

　　家住南城的王玉静老人，来趟朝阳医院得坐一个多小时的公交车，对年逾六旬的她来说是一个较大的负担，她说，“我每个月要吃两三百块钱的药，来这儿开药能节省30多块钱。”

WangYuJing old man living in Beijing,Come to chaoyang hospital to sit more than an hour of the bus,For more than sixty years of her is a great burden,She said,"I take medicine of 2300 money every month,Here to prescribe medicine can save more than 30 dollars."

　　朝阳医院执行院长陈勇介绍，试点三个月以来，医保患者次均药品费用205.5元，跟今年上半年相比下降了71.9元，下降25.9%。和去年同期相比，下降了69块钱，降幅达25.1%。医保患者门诊次均费用359.3元，跟上半年相比下降了34.6元，下降8.8%，和去年同期相比下降了30.3元钱，下降7.8%。患者门诊次均自付费用104.8元，跟上半年相比下降80.3元，下降43.4%，跟去年同期相比下降了21.3元，下降16.9%。住院患者出院例均费用，跟上半年相比下降2383.04元，降低13.37%，跟去年同期相比，下降1006.2元，下降6.12%。住院患者出院例均自付费用，跟上半年相比下降428.4元，下降9.01%，跟去年同期相比下降了351.9元，下降8.06%。

Chaoyang hospital executive director Chen yong,Pilot since three months,Medical insurance patients all drugs cost 205.5 yuan,Compared with the first half of the year dropped to 71.9 yuan,Decreased by 25.9%.Compared with the same period last year,Dropped by $69,Drop of 25.1%.Outpatient medical insurance patients all cost 359.3 yuan,Compared with in the first half of the year dropped to 34.6 yuan,Decreased by 8.8%,Compared with the same period last year dropped by 30.3 yuan,Decreased by 7.8%.Patient outpatient service times are expense to 104.8 yuan,Compared with the first half of the decline of 80.3 yuan,Decreased by 43.4%,Compared with the same period last year dropped to 21.3 yuan,Decreased by 16.9%.Hospital patients discharged patients,Compared with the first half of the decline of 2383.04 yuan,Reduced by 13.37%,Compared with the same period last year,Dropped to 1006.2 yuan,Decreased by 6.12%.Hospital patients discharged all expense,Compared with the first half of the decline of 428.4 yuan,Decreased by 9.01%,Compared with the same period last year dropped to 351.9 yuan,Decreased by 8.06%.

　　无论是门诊还是住院，患者的负担都减轻了。患者的负担减轻了，医保基金支出增加了吗？

Whether outpatient or hospitalization,The burden of the patients are relieved.The burden of the patients with ease,Increase the medical insurance fund?

　　这种担心不是没有道理。医药分开以后，医保基金要承担门诊患者每人每例40元的医事服务费，医保支出会不会骤增？

This worry is not without reason.After medicine separately,Medical insurance fund should undertake outpatient patients per person per 40 yuan of health care services,Health care spending will be increased?

　　“通过我们的试点来看，医保支出并没有明显的增加。”陈勇表示，从朝阳医院的数据来看。这3个月平均算下来，跟去年同期比，每人次医保报销金额减少了9块钱。

"Through our pilot,Health care spending and no obvious increase."Chen yong said,From the perspective of the data of chaoyang hospital.This 3 months on average,With the same period last year,Each time the medical insurance reimbursement amount reduced the $9.

　　他给记者算了一笔细账：医保患者每人次药费下降了70块钱左右，按70%的医保报销比例来算，医保对于每人次药费的报销减少将近50块钱，每人次增加的医事服务费是40块钱，一加一减以后，医保少支出9块钱的结果是合理的。

He gave reporters calculated a detailed account:Medical insurance patients each time expenses down about 70 dollars,According to 70% of the medical insurance reimbursement ratio to calculate,Medical insurance for each time reimbursement of expenses reduce nearly 50 dollars,Each time the increase of the health care service is 40 dollars,One plus one after reduction,Health care spending less $9 result is reasonable.

　　患者费用怎么降低的 Patients with how to reduce the cost

　　医药利益分开后,用药更合理了 Medical benefits after separately,Use more reasonable

　　患者负担降低了，医保支出没增加，医院收益没减少。这可能吗？

Patients with reduced the burden,Didn't increase health care spending,Hospital income didn't decrease.This may be??

　　“很多人都有这样的疑问。”陈勇告诉记者，这个疑问之所以产生，是因为少算了一个利益相关方——药商。以前，医院要获得15块钱的收益，就要卖出115块钱的药。医保负担其中的80.5元，患者自己要掏34.5元。医院被迫给药商打工。

"A lot of people have this question."Chen yong told reporters,This question is,It is because a stakeholder - 2.before,The hospital to get 15 dollars,Will sell 115 dollars.Medical insurance burden of 80.5 yuan,Patients with oneself will take 34.5 yuan.The hospital was forced to work for 2.

　　陈勇说，“以前医院要挣40块钱，医生得卖出307块钱的药。现在医药分开，实际上是医药利益分开了，利益导向改变了，医保直接给医院40块钱的医事服务费。这项改变并不是药品加成转到医事服务费，单纯数字上的一个转换，而是从根本上改变了公立医院的补偿渠道，过去公立医院是三个补偿渠道：服务收费、财政补助、药品加成收入。现在是两个，没有了药品加成收入。”

Chen yong said,"Before hospital to earn $40,Doctors have sold 307 dollars.Now medicine separately,Is in fact a medical benefits,Interest has changed,Medical insurance 40 dollars directly to the hospital medical service.The change is not a drug addition to health care services,Simple number to one of the conversion,But fundamentally changed the compensation for public hospital channel,Public hospitals are three compensation channels in the past:Service charge/Financial aid/Drug bonus income.It is two,No drug bonus income."

　　补偿渠道的变化，让医生可以不再受利益机制的牵扯。用药更合理，医疗质量也并没有降低。陈勇介绍，医药分开之后，输液人次明显下降，用药量也明显减少，但是各项医疗指标，诊断符合率、治愈率、院内感染发生率……都没有出现恶化的情况。这说明，医疗质量保持不变的情况下，医疗费用降低了，这个降低是一个合理的降低。

Compensate for the change of the channel,Let the doctor can no longer subject to the benefit mechanism is involved.Use more reasonable,Medical quality has not reduced.Chen yong introduced,After medicine separately,Infusion passengers to be markedly reduced,There is also significantly reduced,But health indicators,Diagnostic accuracy/Cure rate/Incidence rate of nosocomial infection...Don't have the worse situation.This suggests that,Under the condition of medical quality remain the same,Medical treatment cost decreased,It is a reasonable reduction.

　　“以前的过度用药不仅加大了患者的负担，而且可能带来副作用。”他说，“医药分开带给老百姓最大的实惠。作为一个医生，我认为是用药更安全更合理了，这比省几个钱的意义重大得多。”

"Before the excessive use of not only increase the burden of the patients,And may bring side effects."He said,"Medicine separately bring people the biggest benefit.As a doctor,I think it's more reasonable use safer,This is much more significant than save some money."

　　“但是取消药品加成之后，又有一些新的问题。因为朝阳医院试点取消加成，我们的药品全而且药价低，形成了一个价格的洼地，把可以在社区开药的患者都倒吸回来了，这对三甲医院的医疗资源也是一种浪费。”陈勇说，“希望医改的配套措施尽快实施，比如对社区基药目录进行调整，来适应现在的变化。”

"But cancel after drug addition,And there are some new problems.Because chaoyang hospital pilot to cancel the bonus,We all the drugs and low prices,Formed a price of depressions,Can prescribe medicine in the community of the patients have fallen back,The 3 armour hospital of medical resources is also a kind of waste."Chen yong said,"Hope the reform of supporting measures as soon as possible,Such as community based medicine catalogue adjustments,To adapt to the changes in the now."

　　【链 接】 [Chain connect]

　　公立医院收入不靠卖药 Public hospital income by selling drugs

　　2012年，国务院印发《 “十二五”期间深化医药卫生体制改革规划暨实施方案》(以下简称《规划》)。《规划》提出，要扭转公立医院逐利行为。以破除“以药补医”机制为关键环节，推进医药分开，逐步取消药品加成政策，将公立医院补偿由服务收费、药品加成收入和财政补助三个渠道改为服务收费和财政补助两个渠道。医院的药品和高值医用耗材实行集中采购。

In 2012,,The state council issued by[ "1025"Deepen the reform of medical and health system during planning and implementation plan](Hereinafter referred to as the[planning]).[planning]Put forward,To reverse the public hospital for profit.In order to break"In medicine for healing"Mechanism for the key link,Promote medicine separately,Drugs have been phased out bonus policy,The compensation for public hospital by the service charge/Drug bonus income and financial aid three channels to service charge and two channels of financial aid.Hospital medicine and high value of medical consumables shall implement centralized purchasing.

　　“十二五”时期，医疗费用的增加将得到控制。《规划》指出，将次均费用和总费用增长率、住院床日以及药占比等控制管理目标纳入公立医院目标管理责任制并作为绩效考核的重要指标，及时查处为追求经济利益的不合理用药、用材和检查及重复检查等行为。

"1025"During the period,The increase of medical expenses will be under control.[planning]Pointed out that,This all cost and total cost rate/In hospital bed, as well as the medicine is control management goal into public hospital management system and as an important index of performance appraisal,In a timely manner and to the pursuit of economic interests don't rational drug use/Timber and check and repeated examination, etc.

　　各级卫生行政部门负责人不得兼任公立医院领导职务，逐步取消公立医院行政级别。提高医务人员待遇，严禁把医务人员个人收入与医院的药品和检查收入挂钩。

The health administrative departments at all levels of public hospital shall not concurrently hold leadership positions,Public hospital administrative level have been phased out.To improve staff salary,Is strictly prohibited to medical personnel individual income and the hospital drug and check the income.