1月23日，记者来到县级公立医院改革试点单位(山东)邹城市人民医院，门诊大厅来往的病人络绎不绝，门诊挂号处还排起了长队。自去年10月1日起取消药品加成以来，该院门诊量平均一天达1200人次，与去年同期相比，增长了25.96%，与此同时，住院病人数比去年同期增长了16.2%。

On January 23,,The reporter comes to public hospital reform pilot units at or above the county level(shandong)Zoucheng city people's hospital,Outpatient service hall with patients in an endless stream,Outpatient service registration office also queue forme.Since last October 1 cancelled since drug addition,The hospital MenZhenLiang 1200 people a day on average,Compared with the same period last year,Increased by 25.96%,meanwhile,The third hospital than the same period last year increased by 16.2%.

　　按公立医院改革要求，今年1月1日，邹城市妇幼保健院、中医院、急救中心3家县级医院也开始进行医疗改革，提高医疗服务费用，以弥补实行药品零差价销售而减少的80%的合理收入。这一举措，有关医院和患者反应不一。

According to the requirement of reform of public hospitals,January 1,,Zoucheng maternal and child care service centre/Hospital of traditional Chinese medicine/First aid center at or above the county level three hospital also began to medical reform,To improve the medical service cost,To make up for the drug zero spread sales and reduced 80% of reasonable income.The move,The hospital and patient have different reactions.

综合性医院 Comprehensive hospital

信心十足 confident

　　自去年10月1日起，邹城市人民医院全部药品实行了零差率销售，基本药物使用比例80.7%，占总销售额的36.6%。今年1月1日起，邹城市妇幼保健院、中医院、急救中心也全面实行了药品零差价销售。公立医院补偿由服务收费、药品加成收入和政府补助三个渠道，改为服务收费和政府补助两个渠道。

Since last October 1,Zoucheng city people's hospital drugs all a zero rate sales,Essential drugs use proportion is 80.7%,Accounted for 36.6% of total sales.On January 1st,Zoucheng maternal and child care service centre/Hospital of traditional Chinese medicine/First aid center also to implement the drug zero spread sales.Public hospital compensation by the service charge/Drug addition income and government subsidies three channels,To service charges and the government subsidies two channels.

　　根据邹城市人民医院实施基本药物制度以来的数据统计显示，2011年10月-12月，人均门诊费用为242.32元，去年同期为222.17元，人均门诊费用平均降低20.15元；住院人均费用2011年10月-12月为5974.95元，去年同期为5155.26元，住院人均费用降低819.69元。

Zoucheng city people's hospital according to the implementation of essential drugs system since the data statistics,In October 2011 - December,Per capita outpatient service cost is 242.32 yuan,The same period last year is 222.17 yuan,The average per capita medical cost reduced to 20.15 yuan;The average cost in hospital in October 2011 - December is 5974.95 yuan,The same period last year is 5155.26 yuan,Per capita hospitalization cost reduce 819.69 yuan.

　　可以说，取消以药补医，群众享受到了改革带来的实惠；同时，提高医疗服务价格，也让邹城市人民医院等综合医院减少的合理性收入得到了补偿。

Can say,Cancel to medicine for medical,People enjoy the reform brings benefits;At the same time,To improve medical service price,Also let in zoucheng city people's hospital and general hospital to reduce the rationality of the obtained income compensation.

　　实施药品零差率销售后，原药品销售收入中的合理价差部分为医院减少的合理收入，即应补偿金额。去年12月29日，济宁市物价局、卫生局、人社局下发了《关于邹城市县级公立医院综合改革试点医药价格调整方案的意见》。补偿总金额中的20%由政府财政补偿，80%通过调整提高医疗服务价格补偿，提高的医疗服务价格项目门诊诊查费、住院诊查费、护理费、住院手术费，占应补偿金额的比例分别为15%、30%、25%、30%。

Implement drug zero rate after sales,The original drug sales revenue of the reasonable price for the hospital to reduce part of the reasonable income,That is the amount of compensation should be.Last December 29,,Jining city bureau of commodity price/health/People club bureau issued[About at or above the county level in zoucheng city public hospital comprehensive reform pilot medicine price adjustment scheme opinion].20% of the total amount of compensation by the government financial compensation,80% through the adjustment to improve medical service price compensation,Improve the medical service price project made outpatient service fee/Hospital inspecting fee/nurse/Hospital operation,The amount of compensation shall be accounted for the proportion of 15%, respectively/30%/25%/30%.

　　据介绍，2011年，邹城市人民医院的药品进货额为8144万元，合理差价为1235万元，价格调整应分担额约为988万元，政府应承担额247万元，据测算，价格调整后实际补偿金额为992万元，相比于应补偿金额略有盈余。这也让邹城市人民医院院长刘计山很有底气地表示，对改革继续深化“信心十足”。

According to introducing,In 2011,,Zoucheng city people's hospital drug purchase amount for 81.44 million yuan,Reasonable price differentials for 12.35 million yuan,Price adjustment should share amount is about 9.88 million yuan,The government should take amount is 2.47 million yuan,According to the calculation,After adjusting the amount of compensation for the actual price is 9.92 million yuan,Compared to the amount of compensation should be a surplus.This also let in zoucheng city people's hospital director liu meter mountain is a bottom spirit that,Continue to deepen the reform"confident".

　　中医院 Hospital of traditional Chinese medicine

　　入不敷出 Cannot make ends meet

　　邹城市人民医院手术室护士长吴琳说，住院手术费在现行标准基础上上调25%后，以前做一例阑尾炎手术需要手术费1000元，现在则需要1250元。由于手术室工作十分繁忙，每天大约要做30多例手术，因而手术费提价，对医院减少的合理收入来说是很大的补偿。

Zoucheng city people's hospital operating room charge nurse WuLin said,Hospital operation in current standard basis after increased 25%,Do before a appendicitis operation need operation fee is 1000 yuan,Is now need 1250 yuan.Due to the operating room is very busy work,About to do every day more than 30 cases of surgery,The price and operation,To reduce hospital reasonable income, can be a big compensation.

　　与综合性医院不同，邹城市中医院院长刘开军却没有对提价表现得十分乐观，因为这一举措并没有真正“抚平”取消药品加成对中医院带来的“伤害”。

And different comprehensive hospital,The hospital of traditional Chinese medicine in zoucheng city LiuKaiJun but no price to behave very optimistic,Because the measure and not really"ease"Cancel the drug addition to bring hospital of traditional Chinese medicine"damage".

　　刘开军介绍，对中医医疗机构来说，本身基础就比较薄弱，医院主要收入来源为中医诊疗技术和中药饮片等，相比于综合医院手术所占比重小很多。取消以药补医后，即便提高医疗服务费用，中医院依旧“入不敷出”。

LiuKaiJun introduced,To the traditional Chinese medicine for medical institutions,Itself foundation is weak,The main source of income for hospital of traditional Chinese medicine diagnosis and treatment technology and Chinese medicine yinpian, etc,Compared to general hospital surgery a much smaller proportion.Cancel to medicine for medical,Even improve the medical service cost,Hospital of traditional Chinese medicine is still"Cannot make ends meet".

　　2011年邹城市中医院经营状况显示，该院药品进货额为1722万元，根据测算，合理差价为269万元左右，政府应承担54万元，价格调整应分担额为215万元。但是按试点医药价格调整方案，价格调整后的实际补偿金额只有166.5万元，有48.5万元的缺口。按照去年的经营状况，缺口会达到70万元。

2011 in zoucheng city hospital of traditional Chinese medicine operating status display,The hospital drug purchase amount for 17.22 million yuan,According to the calculation,Reasonable price differentials for 2.69 million yuan,The government should take 540000 yuan,Price adjustment should share amount is 2.15 million yuan.But according to the pilot medicine price adjustment scheme,After the price adjustment of the actual amount of compensation is only 1.665 million yuan,There are 485000 yuan of gap.According to last year's operating status,Gap will reach 700000 yuan.

　　刘开军认为，近几年来一直提倡大力发展中医适宜技术，但是改革对于中医院来说无疑是很大的打击。对此，济宁市卫生局副局长张作辉表示，价格调整刚开始，诸如此类的新问题、新情况，稍后会根据实际情况作出调整。

LiuKaiJun think,In recent years has been advocated to develop appropriate technology of traditional Chinese medicine,But changes in hospital of traditional Chinese medicine, is undoubtedly a blow.this,Jining city health bureau deputy director ZhangZuoHui said,Price adjustment has just started,Such new problems/The new situation,Then according to the actual situation to make adjustment.

　　除此之外，试点县区之一的汶上县目前尚未提高医疗服务价格，由于汶上县提出手术费按照原价20%的比例提高价格，与邹城市县级公立医院执行的标准不一。“我们希望制定全市统一的标准，如果整个济宁的价格都不统一，势必引发很多不必要的矛盾。”张作辉说。

In addition,One of the pilot counties MenShangXian has yet to improve medical service price,Because MenShangXian operation is put forward according to the proportion of the original price 20% raise prices,And at or above the county level in zoucheng city public hospital executive standard differ."We hope to make the unified standard,If the whole jining prices are not unified,Certainly will cause a lot of unnecessary conflict."ZhangZuoHui said.

　　少数患者 A few patients

　　费用不降反升 Cost don't drop back up

　　记者了解到，此次医疗服务价格调整涉及到的门诊人次、住院人次、开放床位数、各项医疗服务收入等数据，都是按照2011年数据测算的。药品合理价差以2011年度的药品进价为基础，西药和中成药顺加15%的差率，中草药顺加25%的差率确定，经测算邹城4家试点公立医院应补偿总金额约为1751万元。

The reporter understands,The medical service price adjustment in the outpatient service people/Hospital people/Open bedspace/The medical service income and data,According to 2011 data of the measurement.Drug reasonable price with 2011 annual drug purchase price as the foundation,Western medicine and traditional Chinese medicine paramagnetic and 15% rate,The Chinese herbal medicine and 25% rate determined,According to the calculation of the four pilot zoucheng public hospital should compensate total amount is about 17.51 million yuan.

　　其中，补偿总金额中的80%，即1401万元需通过调整医疗服务价格补偿。应补偿金额分摊到拟调整的医疗服务项目后，护理费在原基础上上调了100%，住院诊查费也由每天2元提到14元。

the,80% of the total amount of compensation,That is 14.01 million yuan should be through the adjustment of medical service price compensation.The amount of compensation shall be apportioned to all the quasi adjustment of medical service projects,In the original basis nursing raised 100%,Hospitalization fee also made by every $2 to $14.

　　通过走访调查，大部分患者对上述部分调价并未太过在意。“尽管护理费、住院诊查费和手术费都提高了，但是由于这三项都在报销范围之内，所以患者还是能接受。”一位肾内科患者家属说，对于住院病人来说，取消15%的药品加成和提高医疗服务价格，在“一升一降”中，患者总体负担还是减轻了不少。

Through the ways of investigation,Most of the patients on the part of the price adjustment not too seriously."Although nurse/Hospital inspecting fee and operation are improved,But because of the three are within the scope of reimbursement,So patients can accept."A urology department patients family members said,For patients in hospital for,Cancel the 15% of the drug addition and improve the medical service price,in"A liter of a drop"in,Patients overall burden or reduce a lot.

　　与住院病人的“通情达理”不同，门诊病人颇有微辞：“以前挂个号才五块钱，现在整整翻了一番。”据介绍，目前普通门诊诊查费由每次2元提高到7元；专家门诊诊查费由每次6元提高到11元；知名专家诊查费由每次20元提高到25元；急诊诊查费由每次5元提高到10元。

And hospitalization of patients"reasonable"different,There is quite a WeiCi outpatient:"Before hanging a number to five dollars,Now all doubled."According to introducing,At present general outpatient inspecting fee by each 2 yuan up to 7 yuan;The cost of inspecting expert outpatient service every 6 yuan up to 11 yuan;Famous experts inspecting fee by every twenty yuan up to 25 yuan;The cost of emergency inspecting every 5 yuan up to ten yuan.

　　但是，由于门诊费用不在报销范围之内，以致于出现了少数患者就医支出反而较此前有所增加的情况。对此，刘计山建议，应尽快制定出台新农合、医保配套政策，将门诊治疗费用纳入报销范围，以切实达到县级公立医院综合改革惠民便民的目的。

but,Due to the outpatient service fee is not within the scope of reimbursement,That appeared a few patients go to a doctor instead of spending is increased after the situation.this,Liu meter mountain Suggestions,Should be formulated as soon as possible new farming together/Health supporting policies,The clinic treatment costs into the scope of reimbursement,In order to achieve the comprehensive reform of public hospital at or above the county level shall we the purpose of convenience.