宋 嵩制图

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　　20多个省份试点，短期无法全国推广，卫生部称—— More than twenty provinces pilot,Short-term cannot national promotion,The department of health said --

　　“先看病后付费”不搞一刀切(热点解读) "After the first doctor pay"Don't make one size fits all(Hot reading)

　　本报记者 白剑峰 潘俊强 王明峰 Our reporter BaiJianFeng PanJunJiang WangMingFeng

　　先交押金再住院，出院之后再报销，这是我们熟知的惯例。19日，有媒体报道，“先看病后付费”的诊疗模式将在我国全面推行，引起关注。

Pay the deposit in hospital again,After the hospital reimbursement,This is known as practice.19,Media reports,"After the first doctor pay"Medical model will be in full implementation of our country,concern.

　　多地试点的“先看病后付费”模式，到底推行得怎样？现在能全面推广吗？本报记者采访了卫生部有关负责人。

More pilot"After the first doctor pay"mode,The implementation of how?Can now comprehensive promotion?Our reporter interviewed the health ministry officials.

　　卫生部最新回应：从未要求“全面推行” The ministry of health the latest response:Never ask"The full implementation of the"

　　自2012年以来，山东、青海、河南等地推出“先看病，后付费”试点，深受百姓欢迎。目前，全国已经有20多个省份开展“先住院，后付费”试点，基本是在县级医院，主要针对新农合病人。其做法是：参加新农合的患者住院可不交押金，待出院时只需交纳全部医疗费用中个人自付部分，报销部分由医院与新农合机构结算。

Since 2012,shandong/qinghai/Henan etc to launch"First the doctor,for"pilot,People welcome by.At present,The whole nation has had more than twenty provinces to carry out"In the first,for"pilot,Basic is at or above the county level in the hospital,Aimed at the new agriculture close patients.It is the:The new agriculture joint of the patients in hospital can not pay the deposit,To the hospital just to pay medical treatment charge all the individual pays part,Part of the reimbursement by the hospital and the new agriculture close offices.

　　山东省无棣县居民杜福英就受益于这一政策。2012年10月，他因急性肺气肿发作到县人民医院就诊，没交一分钱押金就顺利住院做了手术，只在最后出院时结清了需要自己承担的2万多元费用，而报销前医药费则高达4.3万元。这对家境困难的他来说，可算帮了大忙。

County of shandong province DuFuYing residents will benefit from this policy.In October 2012,He was acute pulmonary emphysema attack to the county people's hospital,Don't pay a penny deposit is smooth in hospital to do the surgery,Only in the final settlement of the hospital need to pay themselves cost 20000 yuan,And before the reimbursement medical bills is as high as 43000 yuan.The family circumstances are difficult for him,Can calculate be a big help.

　　不过，针对有媒体报道的“先看病，后付费”诊疗模式将在我国全面推行，19日，卫生部医政司医疗管理处处长焦雅辉说，这一模式还在试点阶段，短期内无法全国推广，卫生部也从未提出过“全面推行”的要求。

but,According to media reports"First the doctor,for"Diagnosis and treatment mode will be in full implementation of our country,19,The ministry of health YiZhengSi medical management everywhere telephoto, hui said,This mode is still in the pilot stage,In the short term can't national promotion,The department of health has never raised"The full implementation of the"requirements.

　　焦雅辉介绍，2009年9月，卫生部委托北京大学人民医院探索开展“先诊疗，后结算”新型付费模式试点工作。在总结试点工作基础上，卫生部2010年1月发出通知，要求各地简化门急诊服务流程，积极稳妥推行“先诊疗，后结算”模式。今年1月，卫生部发布的《2013年卫生工作要点》提出继续完善新农合制度，开展先诊疗后付费模式试点、即时结报等便民服务。

JiaoYaHui introduced,In September 2009,Entrusted by the ministry of health people's hospital of Beijing university to carry out exploration"First diagnosis and treatment,Settlement after"The new pay model pilot work.At the conclusion of the trial work basis,The ministry of health issued a circular in January 2010,Requires all simplify this service process,Active and steady implementation of the"First diagnosis and treatment,Settlement after"mode.In January,Issued by the ministry of health[2013 health work points]We will continue to improve the proposed new agriculture system together,To carry out diagnosis and treatment for the first pilot model/Instant "news service for the convenience.

　　病人恶意欠费，医院垫付资金压力大，致全面推行难 The patient malicious owe,Hospital disbursements fund pressure,The full implementation of the difficult

　　“先看病，后付费”的服务模式让多地患者受益，可是各地推行情况并不一致。四川省都江堰市人民医院院长杨钊就对此大倒苦水。

"First the doctor,for"The service mode of let more patients benefit from,But all is not consistent implementation.Dujiangyan city of sichuan province people's hospital of the governor is right this big grumble.

　　“最大的困难是医疗欠费。我院为医保病人垫付了巨额费用，而医保局又不能及时支付给我院，影响到医院的正常运行；还有恶意逃费欠费的，个别病人经济条件较好，但就是不付医疗费。”杨钊呼吁，要推行这一模式，还要从政府层面完善制度，防止恶意医疗欠费。

"The biggest difficulty is medical debt.Our medical insurance for patient advances huge cost,And medical insurance bureau and can't timely payment to our college,Affect the normal operation of the hospital;And malicious escape fee Ross,Individual patient economic conditions are good,But just don't pay medical treatment cost."Governor called for,To implement the model,From the government to perfect the system level,Prevent malicious medical debt.

　　焦雅辉透露，“先看病，后付费”模式在全国大面积推行，目前还没有具体时间表，基本条件尚不具备，在实际工作中存在不少难点。

JiaoYaHui revealed,"First the doctor,for"The implementation of the model in large area,There is no specific timetable,Still does not have the basic conditions,In the practical work there exist a lot of difficulties.

　　一是医院垫付资金压力较大。随着住院病人的迅速增加，医院需要垫付大量资金，包括购买药品、耗材等。由于医保不能及时结算，很容易造成“医保欠医院，医院欠药商”的恶性循环。例如，2012年，山东省开展“先看病，后付费”的试点医院累计垫资达63.46亿元。

A hospital is paid great financial pressure.With the rapid increase in hospitalized patients,The hospital need to paid a lot of money,Including buy drugs/Material etc.Due to the medical insurance can't timely settlement,Very easy to cause the"Hospital medical insurance owe,Hospital owe druggist"Vicious cycle of.Such as,In 2012,,In shandong province"First the doctor,for"The pilot hospital accumulated mat endowment $6.346 billion.

　　二是病人欠费现象难以杜绝。由于医保报销比例有限，个人自付部分还较高，有的患者就会选择欠费。目前，我国的社会征信系统尚不完善，医疗机构之间也不联网，仅靠卫生部门很难解决患者欠费问题。2012年，山东省开展“先看病，后付费”的试点医院发生各类患者欠费达1253万元。据卫生部估算，全国医院“三无”(无身份、无责任机构或人员、无支付能力)病人每年欠费达30亿—40亿元。

The second is the patient to put an end to owe phenomenon.Medical insurance reimbursement ratio due to limited,Individual pays part is higher,Some patients will choose owe.At present,China's social credit system is not perfect,Between medical institutions is not networking,Only by the department of health is difficult to solve patients owe problem.In 2012,,In shandong province"First the doctor,for"The pilot hospital happen all kinds of patients owe $12.53 million.According to the ministry of health estimate,The national hospital"neutral"(No identity/No responsibility organization or personnel/No ability to pay)Patients owe each year 3 billion - 4 billion yuan.

　　鼓励各地逐步探索经验，不搞“一刀切” Encourage all gradually explore experience,Don't make"One size fits all"

　　焦雅辉说，我国各地情况千差万别，“先诊疗，后付费”模式只能先行试点，逐步推广，而不能搞“一刀切”。只有当基本条件都具备后，才能在城市大医院逐步推开。

JiaoYaHui said,Our country conditions differ in thousands ways,"First diagnosis and treatment,for"Model can only first pilot,Gradually promote,But can't make"One size fits all".Only when the basic conditions after all have,In the city big hospitals to gradually push away.

　　进行试点的地市，为推行“先诊疗，后付费”想了不少招儿。山东无棣县实行了“周转金预拨付”制度，医疗保险、新农合经办机构要按照上一年度月平均与医疗机构结算资金额，预拨一个月的额度给实行“先诊疗，后付费”的医疗机构作为周转金，用于缓解医院垫付资金压力。2012年共为全县公立医疗机构垫付资金800万元作为周转资金，年终结算多退少补，因此医保资金完全能够承受。

For pilot cities,For carrying out"First diagnosis and treatment,for"Think a lot of up.Shandong wudi implemented"Revolving fund allocated in advance"system,Medical insurance/New farmers joint agency orgnaization according to the average monthly and medical institutions and settlement funds,With a month's quota to implement"First diagnosis and treatment,for"Medical institutions as a revolving fund,To help the hospital disbursements fund pressure.2012 for the county public medical institutions disbursements fund 8 million yuan as a turnover,Year-end settlement retreat more fill less,So the medical insurance fund can bear.

　　针对恶意欠费问题，医疗机构也在探索解决。无棣县将恶意逃费患者纳入诚信“黑名单”，以后在全县任何定点医疗机构就诊时，将不再享受“先诊疗，后付费”服务。

According to the malicious owe problem,Medical institutions are also exploring the solutions.Wudi will be malicious escape fee patients included in good faith"blacklist",Later on the no designated medical institutions when see a doctor,Will no longer enjoy"First diagnosis and treatment,for"service.

　　此外，焦雅辉分析，我国存在新农合、城镇职工、城镇居民三类医保，统筹层次、筹资水平、报销政策都不同，各地医保机构尚未实现全国联网，很难实现异地结算。例如，新农合筹资主要以县为单位，各地筹资水平不同，保障水平也有差异。如果患者到县外就医，一家医院需要和不同地区、不同部门的医保机构结算，程序非常繁杂。因此，目前“先看病，后付费”试点主要在县级医院。对于多数异地就医患者来说，还是要先交费再报销。

In addition,JiaoYaHui analysis,There exists the new agriculture together/Town worker/Three kinds of medical insurance for urban residents,Level of overall planning/Funding level/Reimbursement policy is different,Medical insurance institutions around was not achieved nationwide network,It is difficult to achieve different ground settlement.Such as,New farmers joint financing mainly county as a unit,All different funding level,Security level are also different.If patients go to a doctor to outside the county,A hospital needs and different areas/Different departments of the medical insurance institution settlement,Program is very complicated.so,At present"First the doctor,for"Pilot mainly in the hospital at or above the county level.For most medical treatment for patients with different,Or must first submit an expense account fee again.