“开展先诊疗后付费模式试点”，2013年又一次被写入卫生部年度工作要点。“先看病后付费”究竟何时才能全面实现？卫生部医政司医疗管理处处长焦雅辉19日接受新华社记者专访时表示，对此无法给出时间表，今年肯定是不可能的。

"To carry out diagnosis and treatment for the first pilot model",In 2013, the ministry of health was again write annual work points."After the first doctor pay"When on earth can achieve?The ministry of health YiZhengSi medical management everywhere telephoto, bright 19 to accept an interview with xinhua news agency said,It can't give a timetable,This is certainly not possible.

　　她说，卫生部倡导在有条件地区开展试点，但是，“先看病后付费”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。

She said,The ministry of health advocate in the conditional region pilot,but,"After the first doctor pay"In the short term can't national promotion,The department of health has never raised"The full implementation of the"requirements.

　　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。患者在门急诊诊疗时，可先预缴押金，不必在接受每项诊疗服务时单独缴费，待本次所有诊疗过程结束后再统一结算。这种模式可以明显减少患者排队次数，节约就诊时间，一定程度上改善患者就医体验，受到普遍欢迎。

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.Patients in this when diagnosis and treatment,The deposit can be paid in advance,Don't have to accept every individual pay cost when medical services,For the diagnosis and treatment process all after settlement.This model can significantly reduce the number of patients in line,Save time to get,To a certain extent, improve patients' medical experience,popular.

　　在总结人民医院试点工作基础上，卫生部2010年1月发出《关于进一步改善医疗机构医疗服务管理工作的通知》，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。

At the conclusion of the people's hospital based on pilot work,The ministry of health issued in January 2010[On further improving medical institutions of medical service management work of the notice],Requires all simplify this service process,Active and steady implementation of the"First diagnosis and treatment,Settlement after"mode.

　　据焦雅辉介绍，近年来，针对门急诊患者，各地积极探索开展“先诊疗后结算”试点；不仅如此，针对住院患者，目前全国已经有青海、山东、河南等20多个省份在省级或地市级层面试点“先住院后付费”模式。参加新农合等医保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由个人承担的相应部分，而归医保报销的费用则由医院与相关管理机构结算。但是，这种模式要在全国推行，一些基本条件尚不具备。

According to JiaoYaHui introduced,In recent years,In this patient,In all actively explore"After the first diagnosis and settlement"pilot;Not only that,In hospitalized patients,The country has qinghai/shandong/Henan, etc more than twenty provinces in the provincial or prefecture-level level pilot"After the first pay in hospital"mode.The new agriculture such as joint medical insurance of the patients in hospital can not pay the deposit,To the hospital need to hand in all medical expenses by individual to assume the corresponding parts,And the cost of medical insurance reimbursement to the hospital and related management offices.but,This model to implement in the country,Some basic conditions still does not have.

　　她说，我们的社会征信体系还不够完善。在“先诊疗后付费”模式试点中，虽未出现大面积的恶意欠费逃费，但个别地区还是有患者逃费现象发生。若是没有医保的患者恶意逃费，医院不能获得医保补偿，也无法向患者追讨医疗费用；医保的保障水平也有待进一步提高。医保能报销的比例越高，个人承担的费用越少，出现少量逃费后对医院的影响越小。现在三种医保统筹层次、筹资水平不同，保障力度不一。从实际报销比例来看，医院垫付资金风险仍较大；各地医保结算尚未实现全国联网，异地就医的患者往往还是要自己先掏钱交费，再回到原籍报销……

She said,Our social credit system is still not perfect.in"For the first diagnosis and treatment"Mode in the pilot,Though not a massive malicious owe fled fee,But in some areas there are still patients escape fee phenomenon.If it were not so health care of the patients malicious escape fee,The hospital can't get medical insurance compensation,To the patient cannot require medical costs;Medical insurance safeguard level also further improve.The proportion of medical insurance can submit an expense account is higher,The cost of the individual to assume the less,Appear a few fled fee to the hospital the little more influence.Now three medical insurance as a whole level/Funding level different,Security strength differ.From actual reimbursement scale,Hospital disbursements fund risk is still large;Medical insurance settlement has not yet realize all the networking,Different treatment patients often still want oneself to pay fee,Back to home to submit an expense account...

　　焦雅辉说，各省份实际情况不同，当前医改重点也不同。“先诊疗后付费”模式只能逐步推进、试点先行，不能硬推。这不是医改的硬性指标，不能作为行政命令。我们倡导这类便民利民的经验做法，各地若觉得具备条件、切实可行，可以选择借鉴。(记者吕诺)

JiaoYaHui said,Each province actual situation is different,The key reform is different also."For the first diagnosis and treatment"Model can only be promoted step by step/pilot,Can't push hard.This is not the cure hard index,Not as an administrative order.We advocate this kind of the convenience and benefit of the practice experience,If you think all qualified/feasible,Can choose reference.(Reporter LvNuo)