去年，本市在多家三甲医院启动医药分开改革试点，医改进入实质性阶段，试点初显成效。在这一届政协会上，与民生息息相关的百姓就医问题也成为很多来自医疗卫生领域委员热议的焦点。委员们纷纷就公立医院改革、民营医院发展前景、医疗保障、全科建设等问题各抒己见。

Last year,The city is home to more than 3 armour hospital medical separate start pilot reform,Reform has come into a substantial stage,At the beginning of the pilot results show.In this session of political consultative conference meeting,And the people's livelihood of the people closely related medical problem has become a lot from medical and health fields of the focus of the hot debate.The members are just public hospital reform/Civilian battalion hospital development prospects/Medical security/Construction of general ideas.

　　

慢性病要有年度“指导价” Chronic disease to have annual"pricing"

　　

　　

发言人：贾继东 spokesman:JiaJiDong

　　

　　

市政协委员、首都医科大学附属北京友谊医院肝病中心主任 CPPCC members/The capital university of medical sciences, Beijing friendship hospital affiliated, director of the center for liver disease

　　核心观点：针对部分常见慢性病，由医保部门、卫生行政部门、医学专家共同参与，制定一个慢性病目录，科学测算目录中病种一年医疗总费用，以年度为单位进行医保报销，不必过分计较次均费用。尽快实现门诊开药全市联网。

Core ideas:In view of the partial common chronic diseases,The health department/Administrative departments of public health/Medical experts participation,Develop a chronic disease directory,Scientific measurement directory disease in a medical total cost,In the medical insurance reimbursement units,Don't haggle over time all expenses.As quickly as possible outpatient prescriptions the networking.

　　贾继东认为，单次费用下来了有很多原因，比如医生减少了不合理用药、过度用药，这是好的，不过也有一部分原因是现在通过限制开药的时间周期和开药量进行控制。一次开药少了，次均费用也少了，可是病人一年当中去开药的次数就会增加。一味地强调次均，没有考虑到次数问题，就造成矛盾：老病号希望每次多开点药，一年能少跑几趟医院，而医生又只能执行规定开药不超标。

JiaJiDong think,Single cost down there are a lot of reasons,Such as the doctor does not reduce the rational drug use/Excessive use,This is good,But there are also part of the reason is now through the limit of time period and open prescribe the drug control.A less prescriptions,Times are less cost,But the patient a years to prescribe the number will increase.Blind emphasis on second all,Do not take into account the number problem,Will cause contradiction:Old patient hope every time develop some medicine,A year less can run several trips to the hospital,And the doctor can only implement regulations prescribe not overweight.

　　因此，贾继东建议，制定一个针对“老病号”的慢性病目录，科学测算目录中的病种一年的医疗总花费大概多少，找出一个合适的额度，最好以年度为单位来报销，一年就给负担这么多，这个额度要足以满足看这种病的基本医疗需求。超出部分，比如患者希望用更好的药，就得由个人负担。这样，医生和病患就可共同商量固定费用怎么花。患者来说，可以少跑几趟医院；对医生来说，可以减少很多不必要的冲突和麻烦；对医保来说，可以进行总量控制。

so,JiaJiDong Suggestions,To develop a"The old patient"Chronic directory,Scientific measurement of the disease in a directory of medical total cost probably how many,Find out a suitable amount,In the best units to submit an expense account,A year to burden so much,This line to see enough to meet the demand of primary medical treatment of the disease.Beyond part,Such as hope to patients better use of the drug,Will have to be borne by the individual.this,The doctor and patient can discuss common fixed cost how to spend.For patients with,Can be less run several trips to the hospital;To the doctor for,Can reduce a lot of unnecessary conflict and trouble;For medical insurance for,Can total quantity control.

　　为了防止病患在多家医院开药现象，贾继东表示，实现门诊开药全市联网很重要，现在只有医保部门可以联网掌控患者开药信息，但各医院的医生看不到外院医生开的药。

In order to prevent patients in hospitals prescribe phenomenon,JiaJiDong said,To realize the outpatient prescriptions networking is very important,Now only medical insurance department may prescribe information network control patients,But the hospital doctor to see which the doctor prescribed medicine.

　　

创新科室解决重症患者“压床” Innovation department solve in severe cases"press"

　　

　　

发言人：李刚 spokesman:Li gang

　　

　　

市政协委员、卫生部中日友好医院重症医学科(ICU)主任 CPPCC members/The ministry of health in the sino-japanese friendship hospital medicine(ICU)director

　　核心观点：有条件的大医院可以借鉴国外的一些成功经验，建立类似于辅助通气呼吸治疗中心和长期急症医疗中心性质的科室，来解决大医院重症和急诊科室长期压床的问题。同时，提高新农合医保额度至城镇医保，把新农合纳入城镇医保一体化管理。

Core ideas:Conditional big hospitals can learn abroad some successful experience,To establish similar to relief vent breath therapy center and long-term nature of the emergency medical center department,To solve the large hospital emergency department severe and long-term press problem.At the same time,New farmers improve medical insurance line close to the urban medical insurance,The new farming town together into the integrated management of medical insurance.

　　李刚认为，虽然北京的医疗资源居全国首位，但多数三甲医院门急诊及病房仍经常人满为患。究其原因，除了患者较多造成住院难以外，还有一个重要原因就是危急重症病人的出口不畅：特别是急诊和重症医学科(ICU)的一些病人，经过救治虽然没有了生命危险，但在相当长时间内仍脱离不了呼吸机，甚至需常年带机。“这两类压床病人的日益增多，严重阻碍了新的危急重症患者在大医院的救治和住院，影响了医疗质量，也带来一定的安全隐患。”李刚告诉记者，在他的科室，有的病人带着呼吸机一住就是六七年。

Li gang think,Although the Beijing medical resources occupies the national first place,But most 3 armour hospital outpatient emergency care and ward is still often crowded.Investigate its reason,In addition to patients in hospital more cause to outside,There is another important reason is that for emergency and severe cases in the patient's export impeded:Especially in emergency and critical care medicine(ICU)Of some patients,After treatment although no life dangerous,But in a quite long time still from the breathing machine,Even need to perennial machine."These two types of press the patient's increasing,Seriously hindered the new critical critically ill patients in the hospital treatment and hospitalization,Affected the quality of medical treatment,Also bring some potential safety problems."Li gang told reporters,In his department,Some patients with respiratory machine room is 67.

　　而在一些发达国家，大医院有呼吸辅助治疗病房，比如一些慢阻肺病人，一个月之内尝试两次脱机都不成功之后，就会被转入呼吸辅助治疗病房，那里有呼吸机、呼吸治疗师、物理康复师等。因此，李刚委员建议，有条件的大医院可以借鉴国外一些成功经验，建立类似于辅助通气呼吸治疗中心和长期急症医疗中心性质的科室，解决压床问题。

And in some developed countries,Big hospitals have breathing adjuvant therapy ward,Such as some slow resistance pulmonary disease person,Within a month try two off line are not after the success,Will be moved to breathing adjuvant therapy ward,There are breathing machine/Respiratory therapists/Physical KangFuShi etc.so,Li gang members suggest,Conditional big hospitals can learn abroad some successful experience,To establish similar to relief vent breath therapy center and long-term nature of the emergency medical center department,Solve the press problem.

　　另外，作为一名重症医学科的专家，李刚也关注到了一些大病如：肿瘤、需透析治疗的慢病患者等，因病返贫的情况仍存在。他认为，这在一定程度上说明了本市医保体系仍需进一步完善、扩大。他建议，提高新农合医保额度至城镇医保，把新农合纳入城镇医保一体化管理，完善并提高一老一小医保的覆盖面及额度，明确大病、特殊疾病的界定标准，扩大其范围及医保额度。

In addition,As a severe medicine experts,Li gang also attention to some serious illness such as:tumor/Dialysis patients to slow, etc,The situation of poverty due to illness still exist.He thinks,This, to a certain extent, illustrates the city health care system still need to be further perfected/expand.He suggested that,New farmers improve medical insurance line close to the urban medical insurance,The new farming town together into the integrated management of medical insurance,Perfect and improve an old small medical insurance coverage and limit,Clear a serious illness/Special disease definition standard,Enlarge its scope and amount of medical insurance.

　　

特需市场应由民营医院提供 The special market should provide the private hospitals

　　

　　

发言人：董瑞 spokesman:DongRui

　　

　　

市政协委员、北京康益德中西医结合医院院长 CPPCC members/Beijing KangYiDe combine traditional Chinese and western medicine hospital dean

　　核心观点：公立医院应退出特需市场，回归公益性。所有的特需市场应该由民营医院提供，包括康复、护理和养老市场。本市应建民营综合或专科三甲医院，开发高端特需市场。

Core ideas:Public hospital should quit from the special market,Regression public welfare.All of the special market should provide the private hospitals,Including rehabilitation/Care and pension market.This city should be built private comprehensive or junior 3 armour hospital,The development of high-end special market.

　　作为一家民营医院管理者，在此次医改中，董瑞格外关注民营医院发展问题。他给记者报出了一系列数据：截至2011年底，本市有一级以上医院569家，其中公立医院276家，民营医院293家，民营医院的总数虽已超过了公立医院，然而，从床位和人员数据来看，民营医院仅占全部资源的三分之一左右，二级以上仅十几家。从2011年一组诊疗数据看，北京市医院诊疗人次数为10434.1万人次，占北京市医疗机构的64.6%，其中公立医院占91.3%，民营医院医院仅占8.7%。2011年，北京市出院人数187.9万人次，其中公立医院占91.0%，民营医院仅占9.0%。

As a private hospital administrators,In the reform of,DongRui pay close attention to the development of private hospitals problem.He sent the journalist offering a series of data:By the end of 2011,The city has more than 569 level hospital,The public hospital 276,Civilian battalion hospital 293,The total number of civilian battalion hospital is already more than public hospital,however,From the beds and personnel data to see,Private hospitals accounted for only about a third of all resources,More than a dozen only secondary.From 2011 a group of medical data to see,The number of people of Beijing hospital diagnosis for 104.341 million people,Beijing accounted for 64.6% of the medical institution,The public hospitals accounted for 91.3%,Civilian battalion hospital hospital accounted for only 8.7%.In 2011,,The number of hospital 1.879 million people,The public hospitals accounted for 91.0%,Private hospitals accounted for only 9.0%.

　　根据卫生部医改精神，未来规划发展中，公立医院的特需医疗将逐步退出，回归公益，专为百姓提供基本医疗服务。董瑞认为，民营医院完全可以承担起特需市场。然而目前本市只有极少量的民营三级专科医院。因此，他建议在北京至少建立1至2所1500张床位以上、能达到三甲标准的综合医院，2至3所1000张床位以上三级甲等专科医院，来满足北京高端特需人群的需要。另外，在现有的北京市属三甲医院当中拿出1所综合、1所专科，采取股份制形式或国办民管形式转制为营利性医院。

According to the ministry of health reform spirit,In the development of future planning,Public hospital special medical will gradually exit,Regression public,Designed for people to provide basic medical services.DongRui think,Civilian battalion hospital can assume the special market.However, the city only a minimum amount of private tertiary hospitals.so,He suggested that in Beijing set up at least 1 to 2 more than 1500 beds/Can reach the top of the standard comprehensive hospital,2 to 3 1000 beds above three level of first-class specialized subject hospital,To meet the needs of the people in Beijing special high-end.In addition,In the current Beijing municipal hospital take out 1 of comprehensive/1 junior,Take stock form or map form to manage for the conversion of the nonprofit hospital.

　　董瑞认为，医院职能要分工明晰，公立医院立足于基本医疗服务，所有的特需市场，包括康复、护理和养老市场，都应该由民营医院提供。

DongRui think,Hospital function to clear division of labor,Public hospitals based on basic medical service,All of the special market,Including rehabilitation/Care and pension market,Should provide the private hospitals.

　　

三甲医院设全科医生对接社区 3 armour hospital set general practitioners butt community

　　

　　

发言人：王以新 spokesman:WangYiXin

　　

　　

市政协委员、首都医科大学附属北京安贞医院教育处副处长 CPPCC members/The capital medical university affiliated Beijing anzhen hospital, deputy director of the education

　　核心观点：学习和借鉴国外经验，在具有全科医师培训基地资格的三甲医院设置全科医学科(包括门诊和病房)，解决患有多系统疾病患者看病难的问题。

Core ideas:Learn from foreign experience,In a general practitioner qualification training base of 3 armour hospital Settings general medicine(Including outpatient and ward),Solve with multisystem disease patients see a doctor difficult question.

　　为了解决很多中老年患者同时患有多系统疾病、就医难的问题，王以新认为，应该在全市所有三甲医院建设独立的全科医疗科。王以新表示，我国已步入老龄化社会，中老年患者人数逐年增加，他们常常同时存在多系统疾病，到三甲医院看病，即使病情稳定，也不得不到2至3个专业科室就诊，非常麻烦。在目前环境下，本市客观存在着许多复杂、疑难的疾病同时涉及多个专业。而且，目前大医院分科过细，使医生知识面变窄：一方面，易形成“管状视野”，因而不能有效解决许多患者综合、复杂的问题；另一方面，各专业医生仅考虑各自系统或器官的疾病，未能在整体水平上快捷诊治患者，有可能给患者身心带来许多痛苦。

In order to solve a lot of old patients at the same time with many system disease/Go to a doctor the difficult question,WangYiXin think,Should be in the city all 3 armour hospital construction independent general medical department.WangYiXin said,China is stepping into the aging society,The number of elderly patients increased year by year,They are often at the same time in system disease,To the hospital to see a doctor,Even if their condition is stable,Also have to to 2 to 3 professional department to see a doctor,Very trouble.In the current environment,The objective in this city there are many complex/Difficult disease involving multiple professional at the same time.and,The hospital branch carefully,The narrow range of knowledge:On the one hand,Easy form"Tubular vision",Therefore cannot effectively solve many patients comprehensive/Complicated problem;On the other hand,All the professional doctor only consider their system or organ diseases,Not in the overall level of diagnosis and treatment on patients with fast,Likely to bring a lot of pain in patients with body and mind.

　　王以新告诉记者，目前中国注册的全科医疗科职业医师数仅有8万余名，仅占医师总数的4.3%。而在重视基层卫生的国家和地区，全科医生一般占医师总数的三分之一甚至二分之一以上。西方发达国家的实践证明，全科医生对基层常见病多发病诊疗、病人康复及转诊、疾病预防及控制等负有重要职能，居民80%的健康问题在社区就可得到有效处理，全科医生也因此被誉为居民健康的“守门人”。

WangYiXin told reporters,At present Chinese registered general medical department occupational physician number more than 80000 only,Accounted for only 4.3% of the total number of doctors.In primary health attention of countries and regions,General practitioners generally accounted for one third of the total number of physicians even more than half.The western developed countries proved,General practitioners to basic common disease frequently occurring disease diagnosis and treatment/The patient rehabilitation and referral/Disease prevention and control and so on have important function,80% of the residents in the community health problems can get effective treatment,General practitioners and therefore is regarded as the health of the residents"porter".

　　因此， 王以新建议，学习和借鉴国际的经验，在具有全科医师培训基地资格的三甲医院设置全科医学科(包括门诊和病房)。由三甲医院中的全科医学科对应周边社区医疗服务中心，方便全科医生之间的转诊会诊。　(记者 徐晶晶 摄影 首席摄影记者 蔡代征)

so, WangYiXin Suggestions,Learn from international experience,In a general practitioner qualification training base of 3 armour hospital Settings general medicine(Including outpatient and ward).The general medicine by 3 armour hospital corresponding peripheral community medical service center,Convenient between general practitioners of referral consultation.(Reporter XuJingJing photography chief photographers tsai basis)