今年，卫生部将全面推行“先看病后付费”制度。“原来看病是自己先垫付，看完走医保报销;现在是医院垫付，病人看完病只用交自己的那部分，其余由医保部门支付给医院。此外，原来住院需要交一大笔押金，现在只用签署《住院治疗费用结算协议书》就可以直接住院了”(2月19日《扬子晚报》)。

This year,The full implementation of the sanitation department"After the first doctor pay"system."Originally the doctor is his first disbursements,Finish see go medical insurance reimbursement;Now is the hospital disbursements,Patients with watching the disease into the part,The rest pay by health care providers to the hospital.In addition,The original hospital to need to pay a large sum of deposit,Now only signed[Hospitalization cost settlement agreement]You can directly in the hospital"(On February 19,[Yangzi evening news]).

　　“先看病后付费”的好处显而易见。一方面，取消预先付费和缴纳押金，大大减轻了患者的资金周转压力，使其能安心配合医生治疗;同时，不用每做一项检查就排一次队缴费，有利于优化医疗服务流程，减少患者看病就医等候时间。此前，山东的部分医院已经进行了试点。以最早推行这一模式的济宁市为例，实施两年来累计受益人群64万余人，未出现1例恶意逃费的患者。

"After the first doctor pay"The advantage is obvious.On the one hand,Cancel pay up front and pay the deposit,Greatly reduce the patient's capital turnover pressure,Make it can feel at ease with the treatment;At the same time,Don't make a check will row a team pay cost,Help to optimize medical service process,Reduce hospital patients waiting time.after,Shandong part of the hospital has conducted a pilot program.The earliest to implement this model of jining city as an example,In the past two years the implementation of the total benefit of more than 640000 people,Does not appear in 1 malicious escape fee of the patients.

　　不过，这并不意味着全面推行“先看病后付费”只需简单复制即可。和所有后付费制度一样，“先看病后付费”不能忽视风险问题，比如病人无力承担相关费用，或是恶意欠费等等。山东大学公共卫生学院卫生管理与妇幼卫生系主任徐凌忠指出，该模式能否推广取决于三个方面，“一是医疗保障制度的覆盖面和筹资水平，覆盖面越广，医疗费用实际报销水平越高，推广的可行性越好;二是当地居民的信用水平，诚信度越高，推广的可行性越好;三是当地经济发展水平，经济发展水平越高，人们的实际支付能力越强，出现恶意欠费的现象越少”。显然，当“先看病后付费”从区域试点到全面推行，发达城市和贫困乡村之间的地区差异、高收入者和低收入者的群体差异等等，都是横亘面前的现实考验。

but,This does not mean that the full implementation of the"After the first doctor pay"By simply copying.And all for the same system,"After the first doctor pay"Can't ignore risk problem,Such as the patient cannot afford charges,Or malicious owe, etc.Shandong university school of public health, health management and maternal and child health department XuLingZhong pointed out,This model can promote depends on three aspects,"One is the medical security system coverage and funding level,The wider coverage,The actual medical expenses reimbursement the higher level,The feasibility of the promotion of the good;The second is the local residents' credit level,Higher credibility,The feasibility of the promotion of the good;The third is the local economic development level,The higher the level of economic development,People's actual ability to pay is stronger,Appear the phenomenon of malicious owe less".obviously,when"After the first doctor pay"From the area to the full implementation of the pilot,The developed cities and rural poverty between regional difference/High earners and low-income group differences and so on,Which is the presence of a reality check.

　　必须看到，此前推行“先看病后付费”服务模式的医疗机构，绝大多数是县级以下的基层医院，由于其看病整体费用低，大大消弭了患者支付能力和诚信水平的风险。如果在市级、省级大医院推行，相关费用高，且存在异地报销结算的问题，医院所面临的风险自然此消彼长。再者，与东部地区相比，中西部地区经济水平相对落后，难以避免出现无力归还高额医疗费用的现象。

Must see,After implementation of the"After the first doctor pay"Service mode of medical institutions,The vast majority of the basic-level hospitals is below the county level,Because of its low cost of the whole to see a doctor,Greatly level in patients with the ability to pay and integrity level of risk.If the municipal/Provincial big hospital implementation,Costs associated with high,And there is a different to submit an expense account settlement problem,Hospital of the risks they might face characterised by nature.moreover,Compared with the eastern region,The Midwest regional economic level is relatively backward,Unable to return to avoid the phenomenon of high medical costs.

　　“先看病后付费”的目标是改善医疗环境和医患关系，实现政府、公众、医院的多赢。作为一项带有公益色彩的改革，不能让医院独自承担风险，必须通过配套措施，实现政府、公众、医院的责任分担、风险共济，为该模式的推广保驾护航。

"After the first doctor pay"Goal is to improve medical environment and doctor-patient relationship,Realize government/public/Hospital to win more.As a public welfare reform with color,Can't let alone hospital risk,Must be through the supporting measures,Realize government/public/The hospital burden sharing/Risk in all aid,For the promotion of the model to escort.

　　首先，加快医保全国统筹。目前，各地医疗费用封顶线、报销比例不同，甚至医保药品目录、诊疗项目也有差异，从而造成异地报销困难。必须提高医保统筹层次，在全国统一医保政策、实行一致的医药目录和报销政策，让异地就医报销畅通无阻;其次，建立个人征信系统。根据患者的还款情况，给予不同的信用评级，如恶意欠费，将影响其以后就诊和住院报销，甚至可以考虑与银行贷款、就业等挂钩，提高其失信成本。此外，设立专项救助基金。一方面，医院遭遇恶意欠费后，专项基金先行垫付，再由医保部门向患者追讨，减轻医院的资金压力和维权成本;同时，对于确因经济困难无力支付者，由基金为其代付，保障医院和患者的权益不受到损失。(张枫逸)

First of all,To speed up the national health care plan as a whole.At present,All medical expenses top line/Reimbursement to the different proportion,Even catalog of medicines and medical insurance/Diagnosis and treatment projects are also different,Resulting in different difficulties to submit an expense account.Must improve the health level of overall planning,In the unified national medical insurance policy/A consistent medicine catalogue and reimbursement policy,Let different medical reimbursement unimpeded;secondly,Establishing personal credit system.According to patients' repayment condition,Give different credit rating,Such as malicious owe,Will affect the future clinic and hospital to submit an expense account,Can even consider and bank loans/Linked to employment,Improve the faithless cost.In addition,Set up a special relief fund.On the one hand,The hospital after the encounter malicious owe,Special fund first disbursements,Again by health care providers to visit patients,Reduce the hospital financial pressure and rights protection cost;At the same time,To really due to the economic difficulties to payer,The fund for the pay for another,Safeguard the rights and interests of the hospital and patients from loss.(ZhangFengYi)