制度得以顺利实施的话，对于医疗机构和医保部门，顶多就是程序的内部流转，而对于病人来说，无需预交医保报销部分费用，其意义不仅仅是手续的简化。“先看病后付费”制度不妨且试行且观察，在落实中完善。

If the system implementation,For medical institutions and health care providers,At most is the internal flow program,And for the patient,Medical insurance reimbursement without surrender some fees,Its significance is not only simplified procedures."After the first doctor pay"System might as well and trial and observation,In order to improve the.

　　对于有媒体报道“年内全面推行‘先看病后付费’制度”一事，卫生部医政司医疗管理处处长焦雅辉19日说，卫生部倡导在有条件地区开展试点，但从未要求“全面推行”。受社会征信体系、医保报销水平等条件限制，这种模式短期内无法全面推行。

For media reports"The full implementation of the years‘After the first doctor pay’system"about,The ministry of health YiZhengSi medical management everywhere telephoto, bright 19 said,The ministry of health advocate in the conditional region pilot,But never ask"The full implementation of the".The social credit system/Medical insurance reimbursement level conditions,This model in the short term can't the full implementation.

　　“先看病后付费”制度是一个典型的帕累托改进，在没有使任何人境况变坏的情况下，使得至少一个人变得更好。制度得以顺利实施的话，对于医疗机构和医保部门来说，并不需要增加太多成本，顶多就是程序的内部流转，而对于病人来说，无需预交医保报销部分费用，其意义不仅仅是手续的简化。如果医保支付比例是80%的话，等于说病人只要交2万元，就能看10万元的病，对于经济不宽裕、交不起巨额押金的患者来说，是一个何等的利好。

"After the first doctor pay"System is a typical pareto improvement,In no circumstances for anyone to change bad situation,Make at least one better.If the system implementation,For medical institutions and health care providers for,Do not need to add much cost,At most is the internal flow program,And for the patient,Medical insurance reimbursement without surrender some fees,Its significance is not only simplified procedures.If the medical insurance payment proportion is 80% words,As much as to say patients should pay 20000 yuan,Can see the 100000 yuan of disease,For the economy is not bounteous/Can not afford to pay huge deposit for patients,What is a good.

　　随着医保覆盖面的扩大，医保支付比例的提升，再加上“先看病后付费”制度的实施，必将有效地缓解公众“看病难”、“看病贵”、“看病不方便”的焦虑，让公众切切实实享受到发展成果。可以说，这是一项实实在在的民生工程、民心工程。管理部门也意识到这一点，卫生部于2010年发布的《关于改进公立医院服务管理的若干意见》，就提出“逐步实现患者先诊疗后结算”，并在河北、河南、山东等地试点。一些地方，生育保险的享受者到医院就诊或生孩子，其费用也是由医院与医保局直接结算，无需就诊者预先支付，受到公众的好评。

With the enlargement of medical insurance coverage,Medical insurance payment proportion of ascension,plus"After the first doctor pay"Implementation of the system,Will effectively ease the public"Difficulties in getting"/"The doctor your"/"The doctor not convenient"anxiety,Let the public to really enjoy the achievements of development.Can say,This is a real people's livelihood project/Morale project.Management department also aware of this,The ministry of health issued in 2010[About the improvement of public hospital service management some opinions],Puts forward"Gradually realize patients after diagnosis first settlement",In hebei and/henan/Shandong province and other pilot.Some places,Birth insurance enjoyment of others to hospital or children,The cost also by the hospital and medical insurance bureau direct settlement,Issued without advance payment,By the public praise.

　　主管部门对“先看病后付费”持审慎态度是可以理解的，政策愿景再好，也不能无视现实困境。“先看病后付费”是医保制度的子项，医保制度没能解决的问题都或多或少影响此项政策的执行力。譬如，报销水平差异、异地结算困难、信息共享瓶颈、医院意愿不足、存在恶意逃费……虽然困难多多，总是可以克服，与医保制度一起完善。

Competent departments of"After the first doctor pay"A prudent attitude is understandable,Policy vision again good,Also cannot ignore the real predicament."After the first doctor pay"Is the items of the medical insurance system,Medical insurance system can't solve the problem are more or less affect the policy implementation.Such as,Submit an expense account level difference/Different settlement difficult/Information sharing bottleneck/Hospital intend to shortage/Existing malicious escape fee...Although many difficulties,Can always overcome,Medical insurance system and improve together.

　　就说普遍担心的患者恶意逃费问题吧，其实也并不难解决。既然，医院担心患者连医保之外的“小钱”都不愿意交，那也可以采取过去的“老办法”，每天催促患者将个人应交的部分交足，不能拖欠。实在不行，医院可以与社保部门联手，建立起诚信系统，对于恶意逃费者，以后就诊时将不再享受“先看病后付费”的优惠，甚至将其医保卡锁定，直到完全缴清上次个人应支付费用为止。相信稍有正常理性的人，也不会因小失大，拿自己的诚信记录、医疗保障开玩笑。实践也证明了这一点，山东省1256家医院于2012年6月试点“先看病后付费”制度，1个月内仅有120名患者恶意逃费，仅占患者人数的0.013%。

He said general worry about patients malicious escape cost issue it,Are not difficult to solve.since,The hospital patients with worry even outside of medical insurance"penny"Are not willing to pay,It can also take the past"Old way",Every day will urge patients individual part of the payable to pay the full amount,Cannot default.Is not really good,The hospital can and social security department as well as,Establish credit system,For malicious fled the fee,To see a doctor later will not enjoy"After the first doctor pay"discount,Even the medical insurance card lock,Until fully capture the last individual should cover the cost so far.Believe that a normal rational man,Will not keep the tail from wagging the dog,Take his credit record/Medical security kidding.Practice also proved this point,1256 hospitals in shandong province in June 2012 pilot"After the first doctor pay"system,1 months only 120 patients malicious escape fee,Accounted for only 0.013% of the number of patients.

　　试点地区的感受是，“先看病后付费推广没那么难”。既然如此，那就应该考虑将这项制度尽快铺开，让更多公众及早受益。什么制度都一样，不可能等到尽善尽美、无懈可击之后才施行，“先看病后付费”制度不妨且试行且观察，有什么问题可以在实践中解决，在落实中完善。(练洪洋)

Pilot areas feel is,"To see a doctor for promotion is not so difficult".so,It should consider the system spread out as soon as possible,Let more public benefit as soon as possible.What system,Can't wait until as good as it gets/Perfect and later,"After the first doctor pay"System might as well and trial and observation,What's the problem can solve in practice,In order to improve the.(Practice HongYang)