核心阅读 Core reading

　　医疗资源和群众需求的“区域倒挂”，其实是破解“看病难、看病贵”的一个潜在突破口。一方面，优质医疗资源主要集中在三甲医院，大医院“一号难求、一床难求”；同时，县区医院医疗服务水平相对偏低，难吸引病人，发展后劲不足。

The medical resources and demand"Area fuchsia",It is cracked"Difficulties in getting/The doctor your"A potential breakthrough.On the one hand,High quality medical resources mainly concentrated in the hospital,Large hospital"It is difficult to find a number/It is difficult to find a bed";At the same time,County hospital medical service level relatively low,Difficult to attract patients,Lack of development in the future.

　　一方有平台，一方有资源，存在合作双赢的空间。国家政策也鼓励有条件的大医院通过托管、重组等方式向郊县医院辐射。但公立医院的分级管理模式，让双方对这类合作有点投鼠忌器。

One party has the platform,A square has the resources,There the space of win-win cooperation.National policy also encourage conditional big hospital through the trusteeship/Restructuring mode to suburban county hospital radiation.But public hospital classification management mode,Let both sides of this kind of cooperation in a glass house should not throw stones.

　　一直没有三甲医院的北京大兴区，主动放下产权方面的顾虑，提出“不求所有，但求所用”的方案，把区内一所有合作基础的二甲医院整体托管给北京城区内的一家三甲医院，并承诺5年合作期内财政投入不变。尽管未来可能面临的产权改革方向还不明朗，但双方还是放下顾虑加大投入，进入深度合作。更重要的是，这种盘活县区医疗资源的方式，能给当地居民带来实惠。

There has been no 3 armour hospital of Beijing daxing,Active down property concerns,Put forward"Not all,But for the"scheme,All the area a cooperation foundation of the whole hospital managed to get a 3 armour hospital in Beijing,And promised during the period of 5 years cooperation financial investment unchanged.Although the future may be faced with property right reform direction is not clear,But both sides still down concerns increasing investment,Into depth cooperation.More important is,The county revitalize the medical resources way,Can bring benefits to local residents.

　　

整体托管的必要性何在？ What is the necessity of the whole trust?

　　县区医院有医疗需求，靠自身条件难满足 County hospital have medical needs,Rely on their own conditions difficult to satisfy

　　一大早，家住北京市大兴区清源西里小区的朱秀云老人吃过早饭，就一人溜达着来到广安门医院南区。

Early in the morning,In Beijing's daxing district located right of the old man ZhuXiuYun after breakfast,A man came to the hospital stroll the gate.

　　今年76岁的朱秀云患有心律不齐和糖尿病。“前几年，为了我看病一家子都没少受罪。要挂广安门医院的专家号，排上一宿队，也不一定能挂上。”朱秀云说，“现在好了，广安门医院南区开到我们小区门口了，一样是名专家坐诊。”

This year 76 - year - old ZhuXiuYun with arrhythmia and diabetes."Before a few years,In order to see me family didn't suffer less.To hang the gate of the hospital ZhuanGuHao,Row a night team,Also can not hung up."ZhuXiuYun said,"Ok now,The hospital gate open to our village at the door,The same is ZuoZhen expert."

　　老人家门口的广安门医院南区，原为大兴区中医院，由大兴区政府整体托管给中国中医科学院广安门医院后更名而来。这是北京市公立医院改革中，首次尝试以托管模式将城区优质医疗资源向郊区转移。

The old man of the front gate hospital,Daxing district hospital of traditional Chinese medicine originally,Daxing district by the whole managed to China academy of traditional Chinese medicine hospital and the gate after the name.This is the Beijing public hospital reform,First try to trust mode will be high quality medical resources city to suburb transfer.

　　大兴区位于北京城南，离主城区不远，但由于历史布局原因，一直缺少好医院、大医院。全区常住人口超过140万，长期没有三甲医院。整个北京南城，过去也仅有6家三级医院，还多为专科医院。

Daxing district is located in the south of Beijing,Not far away from urban,But owing to historical reasons layout,Has been the lack of good hospital/Large hospital.The permanent population of more than 1.4 million,No 3 armour hospital for a long time.The Beijing south,The past is only six tertiary hospital,For more specialized subject hospital.

　　中国社会科学院经济研究所公共政策研究中心主任朱恒鹏说，我国的优质医疗资源主要集中在三甲医院，县区一级医疗服务水平相对较低。“引导一般诊疗下沉到基层，把大部分门诊和住院留在县区及以下医疗机构，是医改的目标。这需要大力提高县区级医院的水平。”

Economic research institute of the Chinese academy of social sciences, director of the center for public policy research ZhuHengPeng said,High quality medical resources in our country mainly concentrated in 3 armour hospital,County level medical service level is relatively low."Guide the general medical sinking to the grassroots,Most of the clinic and hospital stay in counties and the following medical institutions,Is the goal of reform.The need to raise the level of the county district hospital."

　　“随着生活环境和服务设施的提高，群众对优质医疗资源的渴望也越来越迫切。”大兴区卫生局副局长李爱芳，时任大兴区中医院院长，她说，两家医院原来是网络携手医院，有对口扶持的基础，也有医改的大背景，但托管需跨越的政策障碍不少，双方前后共洽商了近一年时间。

"With the development of the living environment and the improvement of service facilities,The high quality medical resources to desire too more and more urgent."Daxing district health bureau deputy director weak-minded youth,The daxing of hospital of traditional Chinese medicine,She said,Two hospitals was network to the hospital,With a support base,Also have the background of the reform,But managed to cross the policy many obstacles,Both sides were negotiation before and after nearly a year.

　　她还记得，决定合作前，区领导曾经问：自己干，中医院多长时间能达到广安门医院的水平？她回答，凭当时的发展速度，几乎不可能。“如果能和广安门医院联合，则可能实现跨越式发展”。

She still remember,Decision before cooperation,District leaders asked:Do it on his own,Hospital of traditional Chinese medicine how long can reach the level of the gate of the hospital?She answered,With the development speed,Almost impossible."If the gate and hospital joint,May realize the great-leap-forward development".

　　于是，新的广安门医院南区2011年3月29日举行揭牌仪式，8月29日正式开诊，9月1日正式升级为三级甲等中医医院。

so,The new hospital gate on March 29, 2011 held a celebration ceremony,On August 29, officially begin,On September 1, officially upgrade is three level of first-class hospital of traditional Chinese medicine.

　　托管一年多，当地群众实实在在受益了。原先在城区凌晨两三点排不上的专家号，现在家门口就能看了。甚至有外地患者慕名而来。“这里也是广安门医院，大专家天天在这里坐诊啊！”

Hosting more than a year,Truly, truly, the local people benefit.The original in the city in the silent row of ZhuanGuHao,Now can see the door.Even foreign patients over."Here is also the hospital gate,Big experts here everyday ZuoZhen ah!"

　　2011年9月至2012年8月，广安门医院南区门急诊78.4万人次，同比增长79%；业务收入2.94亿元，增长72%。出院患者数、病床使用率也大幅提高。

September 2011 to August,The gate the hospital outpatient emergency care 784000 people,Year-on-year growth of 79%;Business income is 294 million yuan,Growth of 72%.Discharge cases/The bed utilization also increase.

　　

托管后怎么保证投入？ The trusteeship council how to guarantee investment?

　　地方财政投入不变，托管方移植本部管理 Local finance into the same,Hosting party transplant the management

　　一家是隶属于大兴区的二甲医院，一家是隶属于中国中医科学院、由中央财政拨款的三甲医院。朱恒鹏说，公立医院是分级管理，人事财务等都归地方各级政府管，因此，跨区域跨级别的托管、推行医院间紧密型合作比较难。

One is, indeed, is the dimethyl hospital,A is a subsidiary of China academy of traditional Chinese medicine/The central financial appropriation of 3 armour hospital.ZhuHengPeng said,Public hospital is classification management,Personnel finance under the local governments at all levels tube,so,Cross area to cross level of trust/Implementation of the hospital close cooperation between more difficult.

　　尽管国家政策鼓励有条件的大医院，按照区域卫生规划要求，通过托管、重组等方式促进医疗资源合理流动，但合作双方都有顾虑。

Although the national policy to encourage conditional big hospitals,According to the regional health planning requirements,Through the trusteeship/Restructuring mode to promote the rational flow of medical resources,But cooperation both of us have concerns.

　　因此，一般的医院“托管”，仅限于派出单位安排管理骨干，通过输出医疗技术和管理等方式，提高被托管医院的医疗技术和服务能力。而广安门医院南区的合作，一开始就走向了“深度融合”。从揭牌之日开始，广安门医院就对南区实行“统一管理，单独核算”的运营机制。

so,The general hospital"managed",Limited to sending unit management backbone,Through the output medical technology and management, etc,Increase in trust hospital medical technology and service ability.The gate of the hospital and the cooperation,The start to"Depth fusion".From the date on which the official,The gate to the southern district hospital"Unified management,Accounted for separately"Operating mechanism.

　　广安门医院南区执行院长胡元会说：“注入了广安门医院的品牌，意味着我们要按照同一医院、同一品牌、同一文化、同一水平的目标进行建设。”

The gate the hospital executive director of hu yuan will say:"The gate into the hospital brand,Mean that we should according to the same hospital/The same brand/The same culture/The same level of target construction."

　　胡元会介绍，为使南区医疗水平尽快达到三甲标准，广安门医院派骨干力量进入南区管理层，移植本部管理方式。“截至去年7月，本部协助、指导南区修订完善各项规章制度规范操作流程、应急预案等245个；7月以来，还有30多个规章在修改。”胡元会本人就是广安门医院的副院长。

Hu yuan will introduce,In order to make the medical treatment as soon as possible to achieve top level standard,The gate hospital sent backbone force into the southern district management,Transplant the management mode."By July of last year,To assist the/Guiding the revision and perfect the rules and regulations of standard operation process/245 emergency plan etc;Since July,There are more than 30 rules in the modification."Hu yuan will I gate is vice President of the hospital.

　　本部对南区医务人员进行系统培训，同时派出专家到医院南区出诊。目前，本部派出科室主任或骨干人员21人长期在南区工作，平均每周安排78名专家赴南区出诊，南区人员则到本部轮训。

The southern district of medical personnel training system,At the same time send the specialist to visit the hospital.At present,The department director or backbone personnel sent 21 people in the south side work for a long time,The average weekly arrangement 78 specialists to the south side house call,South side the personnel to the training in rotation.

　　广安门医院肾病科主任占永立，也是南区肾病科的主任，每周四固定在南区工作，下属分管诊疗、住院的两个副主任也同时管理两区。南区原先没有肾病科，根据三甲标准新建了这个科室。托管后新建的科室还有肿瘤科、疼痛门诊、足踝专题门诊等。有的科室初创时，从主任到护士，都是本部过来支援的。

The gate of the hospital ShenBingKe of forever,Is also the director of the ShenBingKe,Every fixed in the work,Subordinates for diagnosis and treatment/In the hospital, deputy director of the two sides also management.Southern district had not ShenBingKe,According to the standard of the top new department.The trusteeship council of the new department and oncology/Pain clinic/Ankle special outpatient service, etc.Some of the original department,From the director to nurse,This is to support.

　　李爱芳介绍，托管后，大兴区不是什么都不管，而是“三不变”：医院公益性质不变，财政投入不变，原有人员身份不变。

Introduced weak-minded youth,Custody after,Daxing not ignore everything,but"SanBuBian":The hospital public properties unchanged,Financial investment constant,The original personnel status unchanged.

　　有了双方的投入，医院的硬件也有改善。仅新建北京南城规模最大的血液透析中心及先进的检验生化流水线，就投入了3000多万元。南区还用上和本部一样的信息化系统，由于“后发优势”，还用上了新版本。

The both sides of the input,The hospital hardware also improved.Only new Beijing Beijing's largest hemodialysis center and advanced inspection biochemical assembly line,Into more than 3000 yuan.South side also use and the same information system,because"Advantage of backwardness",Also use the new version.

　　南区骨科主任张辉是大兴区中医院的老人，他感触更深的是南区医护人员自身的变化。“40岁以下的，必须到本部学习半年，40至50岁的，学习三个月，以达到三级医院水平。大家的压力大了，但医术、收入和自豪感都提高了。外出参与学术交流，我也从听众变成了讲师。”

The orthopaedic director zhang hui daxing district hospital of traditional Chinese medicine is the old man,He is feeling more southern medical staff own change."Under the age of forty,Must to study the half a year,Forty to fifty years old,Learn three months,In order to achieve the level of tertiary hospital.All the pressure,But medical/Income and pride are improved.Go out to participate in academic exchanges,I also from the audience into a lecturer."

　　主管业务的副院长王如然说，南区的人才培养已经走上了良性循环的轨道。“过去很多名校的毕业生都看不上我们，现在博士、博士后也愿意来应聘了。”

The competent business WangRuRan vice President said,Southern district personnel training has a virtuous cycle of orbit."In the past a lot of school graduates were we,Dr. Now/Postdoctoral also would like to apply for the."

　

　长期合作如何明晰产权收益？ Long-term cooperation how to clear property income?

　　地方“不求所有、但求所用”，双方要积累互信 place"Not all/But for the",Both parties should accumulate mutual trust

　　大兴区与广安门医院签订了5年的“托管合同”，走过一年多，双方都对未来合作充满乐观。

Daxing and hospital gate signed 5 years"Trusteeship contract",Through more than a year,Both sides is full of optimism for the future cooperation.

　　胡元会说，对广安门医院来说，收获有三个方面：一是品牌影响力和软实力的提升，二是拓展发展空间，实现集约化发展，“聚集在主城区的三甲医院目前普遍面临着业务饱和、空间受限的难题”，三是为医改做了一些贡献。

Hu yuan will say,For the gate of the hospital,Harvest has three aspects:One is the brand influence and the promotion of soft power,The second is developing space,To realize intensive development,"Gathered in the urban area of 3 armour hospital currently facing business saturation/The problem of limited space",Three is to do some contribution to the reform.

　　肾病科是一个很好的例子。本部原来只有36张病床，要增加床位非常难。现在增加了南区20张床位，一些病人可以调配到南区稳步治疗，整个肾病科的诊疗量有了突破。对广安门医院而言，通过与大兴区的合作，积累互信，未来有望在京南有更大的发展。

ShenBingKe is a good example.The original only 36 beds,To increase the bed is very difficult.Now increases the south side and beds,Some patients can be transferred to the treatment of steadily,The whole ShenBingKe ZhenLiaoLiang of a breakthrough.The gate of the hospital in,Through the cooperation and build,Accumulation mutual trust,The future is expected to be in the south of Beijing have greater development.

　　“原来的二级医院实现飞跃成为三甲医院，也方便当地老百姓就医。”朱恒鹏对一年多的托管效果持乐观态度，“这是一次提高基层医疗服务水平、能力和质量的有益探索。”

"The original secondary hospital realize leap become 3 armour hospital,And the convenience of local people go to a doctor."ZhuHengPeng for more than a year of hosting effect optimistic,"This is a improve the medical service level/The ability and quality of useful exploration."

　　区县政府也有积极性。因为北京市医改方案一直在倡导，新建医疗机构，特别是区域医疗中心重点向新城、城市南部等地区布局，推进城区优质医疗资源向郊区县扩展。

Area county government also have enthusiasm.Because Beijing has been advocating reform scheme,New medical institutions,Especially regional medical center key to Newcastle/In the southern city layout, etc,High quality medical resources to promote city JiaoOuXian extension.

　　大兴区区委书记林克庆、区长李长友明确表示，“不求所有，但求所用，大兴区探索托管模式，目的是把优质医疗资源吸引过来，把城里的知名大医院吸引过来，给当地居民带来真正的实惠。”虽然托管了，但大兴区对医院的投资不变，随着医院人员的引进，财政预算还要增加。随着医院承载能力接近饱和，当地已开展广安门医院南区二期项目筹建事宜，计划无偿提供43亩土地建新院区。

Daxing district party committee secretary LinKeQing/Warden LiChangYou made clear,"Not all,But for the,Daxing explore trusteeship mode,The goal is high quality medical resources attracted,The city famous hospital attracted,For local residents to bring real benefits."Although the custody,But daxing on hospital investment unchanged,With the introduction of hospital personnel,Budget will increase.Along with the hospital carrying capacity close to saturation,The local hospital has carried out the gate the phase ii project planning matters,Plan to provide free and finish a new mu of land.

　　广安门医院院长王阶表示：虽然还有多家地方政府希望广安门医院托管当地医院或在当地办院，但目前精力有限，先尽力做好广安门医院南区，为医改创新积累经验。

The gate of the hospital said zhu:Although there are several local governments hope at guang an men hospital managed a local hospital or in a local hospital to do,But the present energy limited,To try to do well in the hospital gate,For medical innovation accumulate experience.

　　但是，5年之后呢？托管之后，是否需要进一步进行产权改革？朱恒鹏说，双方的合作除了互信，更重要的是建立产权清晰、权益共享的法人治理结构。“双方有了更明确、牢固的产权纽带，医院会有更大的发展。”朱恒鹏认为，“如果能成功探索出一种新模式，相信会有更多三甲医院放下疑虑，积极参与盘活、提升县区级医疗资源。”本报记者 余荣华

but,Five years later??Custody after,If you need further the reform of property right?ZhuHengPeng said,Cooperation in addition to mutual trust,More important is to establish clear property rights/The sharing of rights and corporate governance structure."Both sides have a more clear/The property right of the strong ties,The hospital will have greater development."ZhuHengPeng think,"If we can successfully find a new model,Believe that there will be more 3 armour hospital down doubts,Actively participate in revitalize the/Ascension county district medical resources."Our reporter YuRongHua