新华视点：同样的医保卡为何待遇不同？ Xinhua viewpoint:The same medical insurance card why different treatment?

　　近来，一些手持医保卡的病人在一些大医院就医时，不时会遭遇“推诿”、“歧视”的尴尬，是何原因导致了医院服务态度如此不逊？

recently,Some patients with medical insurance card in some large hospital when go to a doctor,Will encounter from time to time"shuffle"/"discrimination"awkward,What causes the hospital service attitude so rude?

　　党的十八大报告要求，整合基本医疗保险制度，健全全民医保体系。然而现行医保体系中，不同身份的社会成员其医保卡支付能力是不一样的，如何让医保这一“改革红利”惠及更多群众？新华社“新华视点”记者对此进行了调查。

The party's eighteen big reporting requirements,Integrated system of insurance of primary medical treatment,Improve the medical insurance system.However the current medical insurance system,Different members of society as its ability to pay medical insurance card is not the same,How to make health care this"Reform bonus"Benefit more people?The xinhua news agency"Xinhua viewpoint"This reporter were investigated.

　　

医保资金：一方面“吃紧”，一方面“紧吃” Medical insurance funds:On the one hand"tight",On the one hand"Tight eat"

　　近日，北京杨女士的丈夫被北京中医药大学第三附属医院以“床位紧张”为由拒收，原因是医院的“医保额度已用完”。

recently,Beijing Yang lady's husband is Beijing university of Chinese medicine in the third affiliated hospital"Beds nervous"For rejection,The reason is the hospital"Medical insurance limit has run out".

　　医院推诿医保病人情况时有发生，有的医院甚至动员治疗一半的病人提前出院，“等有了医保额度再住进来”。

Hospital medical shuffle patients often occur,Some hospitals mobilization treatment half of patients discharged in advance,"Have medical insurance limit to dwell in".

　　来自济南市社保局的统计显示，2011年，济南有270名医保病人被医院拒收。据该市社保局有关负责人分析，一般是医疗费用高或病情严重的医保患者容易被拒收，因为医保部门对医院每次就医者费用进行考核，假如人均每次费用的指标为1万元，而病人需要花2万元，医院就不太愿接收，宁愿接收一些小病患者。

From the statistics show that social security bureau in jinan city,In 2011,,Jinan has 270 health care hospital patients were rejected.According to the relevant person in charge of the city's social security bureau analysis,The general is the high cost of medical treatment of patients with serious illness or medical insurance to be rejected,For health care providers to hospital every time the medical cost evaluation,If the cost of per capita each index for 10000 yuan,And the patient need to spend 20000 yuan,The hospital is not willing to receive,Would rather receive a few patients.

　　山东省千佛山医院肾内科主任许冬梅说，一个尿毒症患者，医保每年只报销5.5万元，而实际发生的医疗费用一年差不多10万元，这意味着每接收一个尿毒症的医保患者，医院要倒贴4万多元。

Shandong above hospital urology department director XuDongMei said,A uremic patients,Only 55000 yuan a year medical insurance reimbursement,And the actual medical costs about $100000 a year,This means that each receiving a uremic patients with health care,The hospital to DaoTie 40000 multivariate.

　　医院反映，由于公共财政对医院投入不足，而且较多集中在基建和设备方面，迫使医院通过创收弥补运行费用不足，“而从医保病人身上赚不到多少钱，谁愿意接收？”

Hospital reflect,Because of public finance to the insufficient investment in hospital,And more focused on infrastructure and equipment,Force hospital through the earned income make up for lack of operating cost,"From health care patients can't make much money,Who would like to receive?"

　　为了控制费用，济南一些医院提出，当期医保资金用完后，不准接收新的医保病人，哪个科室接收，由哪个科室承担病人的医疗费用。“干了活，不但拿不到钱，还要往里赔钱，谁敢接收这样的病人？”济南一家三甲医院一名外科医生抱怨说。

In order to control cost,Jinan some hospitals put forward,The current medical insurance funds after use,Not receiving the new health care patients,Which department receiving,Which department take the patient's medical treatment cost."Dry the live,Not only can't get the money,Also to be out of pocket,Who dare to receive such patients?"Jinan a 3 armour hospital a surgeon complained.

　　一方面医保资金不够用，另一方面，有限的医保资金被浪费。记者在山东等地采访发现，有的患者仅作身体检查就要住院，因为城镇居民医保只报销住院费用，不报销门诊费用；还有的医保病人大量开药，据说“医保的钱不用白不用，因为不用也得不到什么好处”。

On the one hand medical insurance fund is not enough,On the other hand,The limited medical insurance money is wasted.Reporter in shandong province and other interviews found,Some patients will only make the body check in hospital,Because the medical insurance for urban residents only submit an expense account charge of be in hospital,Do not submit an expense account outpatient service cost;And the cure a patient to prescribe,It is said that"Medical insurance money don't white don't,Because there is no also can't get any good".

　　山东大学齐鲁医院采购处处长谢力认为，当前的医保制度存在一些漏洞，不鼓励医保病人少看病，似乎谁不去开药谁吃亏，造成有限的医保资金被浪费，需要治疗的病人因资金不足而被拒收。

Shandong university qilu hospital purchase marshal XieLi think,The current medical insurance system there are some loopholes,Don't encourage health care less patient to see a doctor,No one seems not to prescribe who suffer,Cause the limited medical insurance money is wasted,Patients need treatment due to lack of money and be rejected.

　　

资金统筹范围小，替代功能“打折扣” Capital plan as a whole limits small,Alternative function"discount"

　　中国社科院经济研究所公共政策研究中心主任朱恒鹏认为，在医保制度下，池子越大，风险越小。而总额预付制等于把各个定点医院分成一个个小池子，医院又把医保资金分到每个科室，科室再把额度分配给医生，“池子越划越小，一旦用完，医生除了推诿还有别的办法吗？”

By the Chinese academy of social sciences institute of economic research, director of the center for public policy ZhuHengPeng think,In the medical insurance system,The pool,Risk is smaller.And the total advance system is equal to each point hospital into a small pool,The hospital and medical insurance funds to every department,Department again quota allocation to the doctor,"The smaller the pool stroke,Once finished,The doctor in addition to shuffle there another way?"

　　一方面，国家工作人员与城镇职工医保资金没有统筹使用，导致医保的替代功能难以充分发挥；另一方面，医保机构对医院的监督不够，导致一些社保资金浪费。

On the one hand,State functionaries and town worker medical insurance funds are not used as a whole,Lead to health care to give full play to replace function;On the other hand,Medical insurance institutions to the supervision of the hospital is not enough,Cause some social security fund waste.

　　“我们还没有这样的能力监督医院。”济南市社会保险事业局定点医疗机构管理处副处长李晓坦承。

"We have not this kind of ability supervision and hospital."Jinan city bureau of social insurance undertakings to nod medical establishment, deputy director of the office LiXiao admits.

　　以山东省立医院为例，济南市医保费用仅占其业务收入的不到10%。“医院不在乎这点儿钱。对医院来说，最愿意接收的是自费病人、公费医疗病人，以及金融、电力等垄断性行业的医保病人，其职工平均年龄低，就医率低，资金支付能力强，而不愿接收当地的普通医保病人。”

By shandong provincial hospital as an example,Jinan health care costs accounted for only less than 10% of its business income."The hospital doesn't care about this some money.To the hospital for,The most willing to receive the patient is at one's own expense/Medical treatment the patient,And financial/Such as power monopoly industry health care patients,The worker average age is low,Doctor rate is low,The funds to pay for ability,Rather than receiving local general health care patients."

　　为了防范医院拒收医保病人，济南社保局在总额预付制度中设定了10%的质量保证金，如果院方拒收医保病人，其质量保证金将被扣罚。

In order to prevent the hospital medical insurance patient refused,Social security bureau in jinan total prepaid system set a 10% quality margin,If the hospital medical insurance patient refused,Its quality margin will be punish.

　　然而，对一些大医院来说，其利润率一般在30%至40%，即使被扣10%质保金，也影响不了多少收益。

however,For some large hospital is,Its profit margin is in commonly 30% to 40%,Even if be button ZhiBaoJin 10%,Also influence not how much income.

　　据了解，医保机构在医院面前缺少“话语权”，一个主要原因是医保资金的增长跟不上医疗费用的增长。

It is understood,Medical insurance institutions in the hospital of before"voice",One of the main reasons is the growth of the medical insurance fund couldn't keep up with the rising cost of medical treatment.

　　专家指出，只有扩大医保的统筹覆盖面，才能增强医保机构与医院方面的“议价能力”，提高普通患者的实际医保水平。

Experts say,Only to expand health care coverage as a whole,To enhance health care institutions and the hospital"Bargaining power",Improve the actual level of patients with general medical insurance.

　　山东大学公共卫生学院教授尹爱田认为，公立医院“一家独大”，民营医院成长比较困难，也使医保机构在医院面前没有选择余地，本该处于优势的付费方反而处于弱势，导致公立医院“店大欺客”。

Shandong university school of public health YinAiTian think professor,Public hospital"monopoly",Civilian battalion hospital grow more difficult,Also make the health care organization in front of the hospital have no choice,Should have in the advantages of paying party but weak,Lead to public hospital"Store large QiKe".

　　

行政分割不破除，医保“红利”被缩水 Don't break the administrative division,Medical insurance"bonus"Be shrink

　　我国现行医保体系庞大，如城镇职工医保、城镇居民医保和新农合组成的基本医保，由人社部门与卫生部门负责管理；涉及国家工作人员的公费医疗归财政部门管理；针对城乡低收入人群的医疗救助，由民政部门负责管理等。

Our current health care system large,Such as medical insurance for urban workers/Medical insurance for urban residents and new farming together composed of basic medical insurance,The club department and health department is responsible for management;State personnel involved in the medical treatment to the financial department of the management;Low-income people in urban and rural medical assistance,By the civil affairs departments responsible for the management, etc.

　　在“碎片化”的医保体系中，不同身份的社会成员其保障力度不同，容易形成分配不公。中国社科院工业经济研究所研究员余晖认为，社会医疗保险制度应由分散化转向集中化、一体化，最终实现参保人员缴纳一样的费用，获得一样的保障待遇。

in"fragmentized"In the medical insurance system,Different members of society as its security strength is different,Easy to form unfair distribution.By the Chinese academy of social sciences researcher at the institute of industrial economy reflects that,Social medical insurance system should by decentralization to centralization/integration,Finally realize ginseng protect personnel to pay the cost of the same,Get the same to ensure treatment.

　　与此同时，我国城镇职工和城镇居民医保正在向地级市统筹推进，而新农合大多还是县级统筹，所以防范风险能力较弱。专家建议，扩大统筹覆盖面，尽快实行省级统筹。

meanwhile,Our country town worker and medical insurance for urban residents are suggested to promote as a whole,The new agriculture close most at or above the county level or as a whole,So preventing risks ability is weak.Expert advice,To expand coverage as a whole,As soon as possible to the provincial level as a whole.

　　“如果山东省17市的医保联合起来，成立医保协会，就有了与大医院进行谈判的能力。如果医保病人占到医院病人总数的四五成，院方就会坐下来协商。如果医保病人占到70%，‘超支自理、结余归己’原则就会发挥作用，过度医疗行为就会得到控制；而医保病人与医院发生纠纷，医保机构也会参与维权。”李晓说。(“新华视点”记者 王海鹰、李亚红、程士华)

"If the city of shandong province medical insurance together,Medical insurance association was founded,There is a large hospital and the ability to negotiate.If the health of the patient to the hospital of the total number of patients into four or five,The hospital will sit down and consultation.If health care patients account for 70%,‘Overspend physical/Balance to have’Principle will play a role,Excessive medical behavior will get control;And health care and hospital patients a dispute,Medical insurance agencies will also participate in rights."LiXiao said.("Xinhua viewpoint"Reporter WangHaiYing/LiYaGong/ChengShiHua)