病有所医渐成现实 “大医改”道阻且长 BingYouSuoYi gradually into reality "Big medical"Way resistance and long

　　本报记者 王怡波 Our reporter WangYiBo

　　黄芬(化名)一家刚过了个踏实年。

HuangFen(alias)A just after a solid years.

　　过年前的一次医疗费报销，让她避免了“因病返贫”的命运。她成为山东省报销新农合大病保险的首名受益者。两个月前，她5个月大的儿子因患小儿先天性心脏病接受手术治疗，前后花费74698元。

Before the Chinese New Year a medical treatment expense,Let her to avoid the"Poverty due to illness"fate.She became a reimbursement of shandong province new farming together a serious illness insurance beneficiary name first.Two months ago,She is five months old son for children with congenital heart disease surgery,Before and after spending 74698 yuan.

　　经过新农合基本医疗报销和大病保险报销后，黄芬的压力一下子减轻到12120元，不到原费用两成。原本笼罩在一家人头上的巨额医疗费“乌云”，烟消云散。

After the new agriculture together basic medical reimbursement and serious illness insurance after reimbursement,HuangFen pressure suddenly reduce to 12120 yuan,The original cost less than twenty percent.Was shrouded in a family head huge medical treatment"Dark clouds",Vanish into thin air.

　　黄芬的命运，是两个多月来各地出台大病医保方案效果初现的缩影。这些旨在减轻群众看“大病”负担的政策，则只是4年来新医改艰难推进取得的成果之一。

HuangFen fate,More than two months to come across a serious illness medical insurance plan effect of the early epitome.These aims to reduce the masses to see"A serious illness"Burden policy,The new medical reform is four years hard push one of the achievements.

　　几年来，医改每有一次动作，便有无数民众神经为之紧张。尤其在十八大报告以及十八大后各地出台的新执政方案中，“医疗”无疑是最引人关注的领域之一。扩大大病保险范围、力推“医药分开”、探索先看病后付费模式……频繁出台的这些举措，不断填补保障空白、解决保障难题。

In the past few years,Cure every once action,There is many people nervous to nervous.Especially in the eighteenth big report and after eighteen big around on the introduction of the new ruling scheme,"medical"Is undoubtedly the most remarkable one of the field.Expand insurance coverage of a serious illness/push"Medicine separate"/Explore to see a doctor first for mode...Frequent on these measures,Ensure continuous fill blank/Solve the security problem.

　　卫生部最新数据显示，2012年，我国新农合的覆盖率保持在95%以上，人均筹资290元；2012年前3个季度，20种重大疾病的实际报销比例达到66%，89%的统筹地区实现省内互联互通，及时结报。

The ministry of health the latest data show,In 2012,,The country's new farmers joint coverage to stay above 95%,Raised funds of 290 yuan per capita;2012 years ago three quarters,Twenty kinds of major disease of the actual reimbursement ratio reached 66%,89% of the province as a whole area to realize interconnection and interflow,Timely report and.

　　2月20日下午，国务院办公厅发布关于基本药物制度和基层运行新机制的意见，从完善基本药物采购和配送、加强基本药物使用和监管、深化编制人事和收入分配改革、完善稳定长效的多渠道补偿机制几方面提出一整套新机制。其中还明确，基层医疗机构一般诊疗费原则10元左右。

Twenty days afternoon feb.,Issued by the general office of the state council about essential drugs system and the basic operation mechanism is opinion,From the perfect basic drug procurement and distribution/Strengthen basic drug use and supervision/Deepen the establishment personnel and income distribution reform/Perfect long-term stability of the multi-channel compensation mechanism is put forward a set of mechanism.It clearly,Grassroots medical institutions in general fee principle 10 yuan.

　　随着保障体系的全面建立，“病有所医”正在成为现实。但整个医疗行业仍有不尽如人意之处。今年1月深圳窗口行业满意度调查显示，24个窗口行业的满意度中，医疗行业服务得分最低。

With the establishment of a security system,"BingYouSuoYi"Is becoming a reality.But the whole medical industry still have defects.January shenzhen window industry satisfaction survey,24 window industry in satisfaction,The medical industry service lowest score.

　　一些专家认为，更及时、高效、公平的医疗环境，应该成为医改步入深水期和攻坚期后需要努力的方向——这也正在成为不可忽视的重大民意期待。一则“乌龙报道”引起的讨论热潮，验证了民众的这种期待。

Some experts say,More timely/efficient/Fair medical environment,Reform should be into deep water period and after GongJianQi need direction - this is also become an important public opinion to ignore.a"Uron reports"The discussion upsurge of cause,Verify the people are looking forward to this.

　　近日，央视等媒体报道的“先看病后付费制度将全面推行”消息，引发民众热切关注。有网友在微博上说：“终于到了命比钱重要的时代了。”

recently,CCTV and other media reported"To see a doctor for the full implementation of the system will be"news,Cause people eager concern.Netizens in micro bo said:"Finally came to life than money important era."

　　但是，2月19日，这一消息迅速被卫生部否认。卫生部官员表示，“先看病后付费”的模式短期内无法全面推行，今年肯定是不可能的，卫生部倡导在有条件地区开展试点，但从未要求“全面推行”，目前也没有具体的推行时间表。

but,On February 19,,The news was quickly denied the ministry of health.Health officials said,"After the first doctor pay"Model in the short term can't the full implementation,This is certainly not possible,The ministry of health advocate in the conditional region pilot,But never ask"The full implementation of the",There are no specific implementation timetable.

　　其实，早在2010年，卫生部就在“关于进一步改善医疗机构医疗服务管理工作的通知”中明确提出，各地卫生行政部门要积极稳妥推行“先诊疗，后结算”模式。只不过，受社会征信体系、医保报销水平等各种条件限制，这一模式一直未能大范围铺开，但卫生部支持“先诊疗，后结算”模式的态度十分明确。

In fact,As early as in 2010,The ministry of health in"On further improving medical institutions of medical service management work of the notice"Put forward in,The administrative department of public health around to implement active and steady"First diagnosis and treatment,Settlement after"mode.just,The social credit system/Medical insurance reimbursement level conditions,The model have been unable to big range spread out,But the ministry of health support"First diagnosis and treatment,Settlement after"Model of attitude is very clear.

　　“对民众来说，这确实是美好的期待，从大方向来说，医院也肯定应该往这个方向走。”中国医院协会副秘书长庄一强认为，这条“乌龙新闻”被辟谣的过程，恰恰折射出了当前医改存在的最严重问题——虽然“大医改”口号多次被提出，但许多地方还只是在搞“小医改”，只由卫生部门负责，财政局、人社局等关键部门不与卫生系统“同下一盘棋”，如果真要放开“先诊疗，后结算”，医院承担风险，政府财政又不兜底负责，自然无法打开局面。

"For people to,This is really good looking forward to,From the way it,The hospital is sure to go to this direction."China hospital association deputy secretary-general chong a strong think,This article"Uron news"Moved by the process,Just reflects the current reform of the most serious problems there, though"Big medical"The slogan was put forward many times,But many places have just doing"Small medical",Only by health department is responsible for,Bureau of finance/One of the key departments such as club with health system"With playing a game of chess",If you really want to let go"First diagnosis and treatment,Settlement after",Hospital risk,The government is responsible for financial and not out,Nature is unable to open the situation.

　　庄一强告诉中国青年报记者，实际上，已经试点“先诊疗，后结算”的医院数据显示，这种模式下，逃费的微乎其微，再扣掉医保部分，政府如果愿意兜底，所需资金并不多，“我相信地方政府肯定有这个财力，但他们不一定愿意。”

A strong told the China youth daily reporter,In fact,Have pilot"First diagnosis and treatment,Settlement after"Hospital data display,This mode,Flee costs very little,Then subtract part of medical insurance,The government if willing to reveal all the details,The funds required for the is not much,"I believe that the local government must have the financial resources,But they are not willing to."

　　“医学是技术问题，医疗是社会问题。现在的医改，钱要找财政，职工、居民医保要找人社部门，编制要找编办，价格得找物价局……”在庄一强看来，卫生部门其实只是负责卫生事业的一个技术部门，具体进行医改时，更多地只能依靠真正掌握大权的其他各级政府部门，“这时如果无法取得共识，医改就成了‘小医改’，推行一个新政策尚难，何况要在全国范围内推进。”

"Medicine is technical problems,Medical treatment is a social problem.Now the reform,Money to find financial,worker/Medical residents to find someone to club department,Prepare to find BianBan,The price have to find price bureau..."In the village a strong it seems,The health department responsible for health but a technical department,Specific to the medical reform,More can only rely on the mastery of other government departments at all levels,"Then if could not come to an agreement,Reform became‘Small medical’,Carrying out a new policy is still difficult,How much more will the nationwide propulsion."

　　北京地区医改被庄一强视为“大医改”的典范。“北京至少形成各个部门在医改上共同发力的局面，这样就能真正推进医改。”庄一强说，而其他许多省市，实际上还只是“小医改”。

Beijing is a strong as the medical reform"Big medical"model."Beijing at least form each department in the reform, together with the power of the situation,This can really promote reform."Chong said a strong,And many other provinces and cities,In fact is just"Small medical".

　　记者在财政部发布的报告上看到，2012年北京市医疗卫生支出99.2亿元，增长31.9%。其中，32.2亿元用以支持公立医院改革，建立与服务量和绩效考核挂钩的新型财政补偿机制，着力改善百姓就医环境；27.4亿元用于推进市级公费医疗改革，对城镇医保和新型农村合作医疗基金给予补助；3.6亿元用来开展基本药物专项整治。

Reporter in the ministry of finance issued report to see,In 2012, Beijing medical health spending 9.92 billion yuan,Growth of 31.9%.the,3.22 billion yuan to support the reform of public hospitals,Establishment and services and performance evaluation hook new financial compensation mechanism,People go to a doctor to improve the environment;2.74 billion yuan used to promote the reform of the medical treatment,On urban medical insurance and the new rural cooperative medical fund subsidies granted;360 million yuan to carry out special control basic drugs.

　　早在2009年，国务院便成立由16个部门组成的深化医药卫生体制改革领导小组，由中共中央政治局常委、国务院副总理李克强任组长。“中央的大方向是对的，但是到了地方，医改就不一定真的那么受重视了。”庄一强说，据他了解，许多城市的医改工作由副市长分管，很多工作协调开展起来比较难，“要真正形成‘大医改’局面，各级医改应该由一把手直接负责。”

As early as in 2009,The state council and the department established 16 of deepening medical health system reform leading group,By the standing committee of CCCPC political bureau/Vice premier li keqiang RenZuChang."The way is right,But in place,Reform would not really valued the."Chong said a strong,According to his understanding,In many of the cities by the deputy mayor in charge of medical work,A lot of work coordination carried out more difficult,"To form a truly‘Big medical’situation,Cure at all levels should be directly responsible for by a hand."

　　安徽芜湖几年来在医疗改革取得的成绩颇受认可。一些研究者在分析其成功经验时，就时常提及：“因为他们省市各级医改都是一把手直接抓。”2012年，青海也提出建立医改“一把手”负责制，明确要求各级政府“一把手”要做到亲自抓医改。

Anhui wuhu for several years in the medical reform achieved quite recognized.Some researchers on the analysis of its successful experiences,Is often referred to:"Because they are a cure at all levels and directly grasp."In 2012,,Qinghai also proposed reform"a"Responsibility system,Clear requirements at all levels of government"a"To do personally stresses the cure.

　　“‘大医改’道路还很长。”庄一强说，十八大提出的关于医改的方向很明确，但要实现目标，关键还在于地方怎么落实，“不能光听见楼梯响，却不见人下来”。

"‘Big medical’There is still a long way."Chong said a strong,Eighteen forward the reform about the direction is very clear,But in order to achieve a goal,The key lies in how to implement the place,"Can't hear stair ring,But no one down".