有大医院不收医保病人，患者想住院得先签“自费协议”；有医保病人好不容易住进医院，花到医保限额，得先出院，过上9天再办住院，一年多能住30次院……医院也在抱怨，我一方面要救死扶伤，一方面还要限制入院人数，超额了我要自掏腰包……医保支付这是咋了？昨天，有医院负责人向记者表示，如今的医保政策不管是缴费、支付，还是调节金的使用，都需要改革，且要做到公开透明。

A great hospital not to receive health care patients,Patients want to sign in"At one's own expense agreement";Have health care to patients in the hospitals,Flowers to medical insurance limit,Have to discharge,A nine days in hospital to do,A year can live 30 yuan...Hospitals have also complained that,On the one hand I want to healing the wounded and rescuing the dying,On the one hand and limit the number of admission,Excess I want my own...Medical insurance payment this is zha?yesterday,A hospital chief told reporters,Today's medical insurance policy whether pay cost/pay,Or adjust the use,Need reform,And to be transparent.

　　

现状 status

　　要么签自费协议要么反复出院入院 Or sign agreement at one's own expenses or repeated the hospital admission

　　“现在想住大医院，人家一听是医保病人就不收！”最近，不断有市民向本报反映，省城有大医院拒绝接收医保病人。“你要想住院，也行，得和医院签订‘自费协议’，也就是说住院期间得全是自费，你说这是什么事？！”

"Now want to live in big hospitals,Listen to the somebody else is health care the patient will not accept!"recently,Continued to reflect our citizens,Provincial capital have big hospital refused to receive health care patients."You want to hospital,Also do,And a hospital‘At one's own expense agreement’,That is all in hospital is at one's own expense,You said this is what's the matter?!"

　　市民吴女士也说了自家的经历，查出直肠肿瘤后，医院先说“暂时无法接收医保病人”；托关系找到另一家医院，医保限额费用只够做一次手术，没法住院继续治疗；做完了手术，只能选择另一家专科医院继续治疗。

Citizens ms wu also said his experience,Find out after rectal cancer,Hospital say first"Temporarily unable to receive health care patients";Joe relationship find another hospital,Medical insurance limit cost was only enough to do an operation,Can't continue to treatment in hospital;Finished the operation,Can only choose another specialized subject hospital continue to treatment.

　　医生告知吴女士，医保病人住院报销限额最多是1.4万元，若想医保报销，花到1.4万元后必须要先出院，而且不能马上再入院，9天后再办入院，差一天也办不进去。“如果一直不出院，那超过1.4万元的费用就要自己掏腰包。”于是，吴女士只能不停地办出院再办入院。“从2011年5月至今，我已经住了近30次院了。”吴女士无奈地说。

The doctor told ms wu,Patients in hospital medical insurance reimbursement most limit is 14000 yuan,Medical insurance reimbursement to,To spend $14000 to the hospital after the first,And I can't go right to the hospital,9 days to do be admitted to hospital,Sent a day also do not go in."If has not been discharged,The more than 14000 yuan fee will be paid to yourself."so,Ms wu can only be kept for the hospital to do be admitted to hospital."From May 2011 so far,I have lived for nearly thirty times out of hospital."Ms wu said helplessly.

　　记者从部分医生那儿了解到，患者所说的这些情况，都属实。

Reporters from part to understand the doctor there,Patients had said these conditions,Are true.

　　“我觉得现在做医生真不容易，不仅要给患者看好病，还要给患者看好钱。”省城某三甲医院一位内科主任告诉记者，他觉得现在太累了，一方面医院业务量要增长，医院要求他的住院患者每年要有一定比例的增长；同时，医院又下达医保限额，不仅限定医保病人数，还限定金额。“现在绝大多数病人都是医保病人，这怎么控制？你说这医患关系能不紧张吗？”

"I think now do the doctor is not easy,Not only to good disease patients,Patients have to good money."Provincial capital a 3 armour hospital a head of the medical department told reporters,He felt so tired now,On the one hand the hospital volume will increase,The hospital asked his hospitalized patients every year to have a percentage of growth;At the same time,The hospital and medical insurance to limit,Not only the third limited medical insurance,Also limit the amount of."Now most of the patients were health care patients,This how to control?You say the doctor-patient relationship can not nervous?"

　　

限金额 Limit amount

　　医院撵病人是医保病人花费超额了 The hospital out patient is health care patients spend the excess

　　省城一家医院的管理人员告诉记者，目前济南市的医保政策，弄得医院也精疲力竭。“不管大小医院，每年4月份，医保经办机构都会和定点医院签订管理合同，其中最重要的一条就是费用支付问题。”

The management of the provincial capital hospital told reporters,At present the jinan city medical insurance policy,Get the hospital also burned out."No matter size hospital,In April every year,Protects agency orgnaization will and designated hospital management contract signed,One of the most important one is to pay fees problem."

　　该人士告诉记者，费用支付主要就是限定出院病人的费用额度，“每家医院都不一样。”他说，一般市级医院每个出院病人的额度是5000-8000元，济南市中心医院能到1万元，省级医院在1万到1.3万元或1.4万元。“其实这个额度标准和七八年前相比并没有太大变化，只是略微增加了一点点。”

The source told reporters,Pay fees is mainly limited amount of the cost of the discharged patients,"Every hospital is different."He said,General municipal hospital each discharge the patient's limit is 5000-8000 yuan,Jinan central hospital can come to 10000 yuan,Provincial hospital in 10000 to 13000 yuan or 14000 yuan."In fact the limit standards and eight years ago have not changed much,Just slightly increased a little."

　　他告诉记者，医保经办机构是按月将出院病人的费用付给医院，医保机构也仅是支付限额之内的费用，且还要扣掉10%的质保金，这个质保金一年之后才拨付。“如果超额了，超10%，双方各负担一半，再超了，医保机构就支付很少了。”

He told reporters,Medical insurance agency orgnaization is to press month the cost of the discharged patients to the hospital,Medical insurance agencies also is only pay the cost of the limit,And will retain 10% of the ZhiBaoJin,This ZhiBaoJin allocated a year later."If the excess,Over 10%,Each half burden,Super again,Health care institutions pay less."

　　他给记者举了个例子：假设一个住院病人在某省级医院住院，出院花费1.7万元，医保经办机构给医院的限额是1.3万元，那么医保机构能够给该病人报销的数额是，首先扣除超限的4000元，再扣除10%的质量保证金，次月划给医院的是比11700元多一点点。“但医院看的是总数，假设医院这个月出院10个病人，一共花了15万元，而每个病人限额是1万元，那么医保经办机构下个月拨给我的只有9万元多一点。多余的5万元，医院自己承担。这势必造成医院撵病人的情况。”

He sent the journalist an example:Suppose that a hospital patients in a provincial hospital,The hospital cost 17000 yuan,To the hospital medical insurance agency orgnaization limit is 13000 yuan,So health care institutions can give the patient is the amount of reimbursement,The first deduction transfinite 4000 yuan,To deduct 10% quality margin,Monthly row to the hospital is a bit more than 11700 yuan."But the hospital looking at total,Assume that the hospital discharge this month 10 patients,A total of spent 150000 yuan,And every patient limit is 10000 yuan,So protects agency orgnaization to next month I only 90000 yuan more.Redundant 50000 yuan,Hospital should be responsible for the.This certainly will cause the hospital bundle the patient's condition."

　　

限人数 Limit the number of

　　每个医生能收多少个医保病人年初就限定死了 Each doctor receive many health care patients died at the beginning of limit

　　“最让我们感到疑惑并讨厌的是，除了定额外，医保机构还限定病人数。”这位管理人员告诉记者，限定的病人数是这样确定的：去年接收了多少医保病人，今年会在这个基数的基础上增加10%-20%。“超得多，也不拨付。”

"The most let us feel doubt and hate is,In addition to the quota,Medical insurance agencies also limit the third."The official told reporters,The third is limited so sure:How much health care patients received last year,This year will be the basis of this base increased by 10% - 20%."Super than,Also not appropriate."

　　有了人数限制，有了定额限制，医保机构一年能给医院拨付多少钱，基本也就框定了。“这就逼着医院不得不把‘人头’指标下放到各个科室，科室再把‘人头’分给医生，医生自己再分到每个月，他一个月能接几个医保病人，也就限定死了。”该管理人员说。

A number of restrictions,The quota restrictions,Health care institutions a year to the hospital how much money can be allocated,Basic is the casing."This will make the hospital had to‘head’Index down to each department,Department again‘head’Among doctors,The doctor himself again to every month,He a month can pick a few health care patients,Also limit is dead."The management personnel said.

　　在这种情况下，科室要是自己放开口子接医保病人，医院只能扣各个科室的钱，科室再扣医生的钱。“在这种情况下，医生不得已发明了‘自费协议’，对不起：我手里的名额用完了，你要想治病就签‘自费协议’……特别是一些手术，患者没办法，只能自费。”

In this case,Department if their open cut joint health care patients,The hospital can only button each department of money,Department to buckle the doctor's money."In this case,The doctor forced invented‘At one's own expense agreement’,I'm sorry:The number of my hand out,If you want to sign the cure‘At one's own expense agreement’...Especially some surgery,Patients can't,Only at one's own expense."

　　该人士告诉记者，去年，自己的家人也曾遭遇过“自费协议”。后来找了种种关系，托了好多人，才弄到一个按医保治病的名额，顺利手术。“像那位患者一年多住了将近30次院，这也是医院的权宜之计。我们叫‘分解住院’，其实对医院来说，这个做法会超人次，人次满了，医院也会让她换医院住院。”

The source told reporters,Last year,His family had encountered"At one's own expense agreement".Then find the various relations,Joe good people,To get a medical insurance according to the number of cure,Smooth operation."Like the patients more than a year to live for nearly thirty times court,This is also the hospital shake-up.We call‘Decomposition in hospital’,In fact, to the hospital,This practice will super people,People full,The hospital will let her in hospital."

　　

算笔账 's examine

　　中小医院一年垫付一两百万医疗费大医院能到上千万甚至更多 Small and medium-sized hospital in a big hospital medical someones disbursements to millions of even more

　　既然医保机构限制这么严，医院不签“定点医院”不行吗？

Since medical insurance institutions so strict restrictions,Hospital does not sign"Designated hospital"Can't you?

　　该人士告诉记者，对大医院来说，它不愁病号，它也不稀罕那么多的医保病人。“但是如果不定点，老百姓会不满意，最好的医院不定点，什么医院能成为定点？！医保经办机构会被人诟病，因为这是百姓的看病需要。”

The source told reporters,For large hospital is,It is not sorrow patient,It is not rare so many health care patients."But if you don't point,People will not be satisfied,The best hospital not point,What hospital can be a point?!Protects agency orgnaization will be for,Because this is the people need to see a doctor."

　　但是对于中小医院来讲，他说，“医院不敢不签‘定点’，毕竟越来越多的人纳入医保覆盖，真不签，就没人来看病了。”

But for small and medium-sized hospital speaking,He said,"The hospital can't not sign‘point’,After all, more and more people into the medical insurance coverage,Don't sign,No one to see the doctor."

　　他给记者算了一笔账，对于中小医院，保守计算，一年医院自己垫付的医疗费在一两百万元，省级大医院得到上千万，甚至更多。

He sent the journalist calculate a bill,For small and medium-sized hospital,Conservative calculations,One year own hospital medical advances in controlled ten thousand yuan,Provincial hospitals get millions of,Even more.

　　

解难题 Solution problem

　　医保金收费和使用能够公开透明？统筹比例和门规病种范围该收一收 Medical insurance gold to charge and use transparent?Overall proportion and door gauge diseases range the accept a charge

　　那么，如何破解目前的医保看病难题？该人士告诉记者，医保经办机构严管医院思路是对的，但是做法可以探讨。

so,How to break the current health problem to see a doctor?The source told reporters,Protects agency orgnaization standard hospital thinking is right,But it can be done to explore.

　　“目前咱们的医保制度是‘低水平、广覆盖’，以收来定支。我的第一条建议就是随着人们生活水平的提高，我们的医保缴费水平可以再提高一些，这是根本解决之策。”“再一个就是，医保经办机构必须向社会公示：到底收了多少钱、向每家医院支付多少钱，医院自己承担的钱。”该人士表示，由于医保经办机构还设置一定的“调剂金”额度，而目前这个“调剂金”使用不透明，“关系好的多给点，不好的少给点，这个可不行。也得向社会公示。”“目前进入平均统筹的比例大约能到70%，我觉得这个口子开得挺大，可以适度收一收；还有门规病种，范围也有点太大，建议也收一收。”

"At present our health care system is‘Low level/Wider coverage’,To accept to set a.My first piece of advice is along with the improvement of people's living standard,Our medical insurance pay cost level to improve some,This is the fundamental solution of the policy.""Another is,Protects agency orgnaization must to the public:Exactly how much money received/Every hospital to pay much money,The hospital should be responsible for the money."The people said,Due to the medical insurance agency orgnaization also set a certain"Adjusts gold"line,And the"Adjusts gold"Use opaque,"Good relationship to point,Poor little give point,This can not.Also to the social public.""Now enter the average percentage of plan as a whole about to 70%,I think the cut open a lot,Can moderate the one receiver;And door gauge diseases,Range is a bit too big,Proposals to accept a charge."

　　对于该管理人员的最后一条建议，日前，有市民拨打“民声连线”，建议缩减病种范围。 （记者 杨芳　实习生　李静静）

For the management of the last piece of advice,a,Have people call"Praised attachment",Suggest reduction of disease. (Reporter YangFang LiJingJing interns)