昨日，协和医院女医生于莺微博爆料，有医院将总额“指标”包干到医生头上，每位医保病人定额10500元。于莺认为“这样下去，医疗就彻底成为有钱人和官员的特权了”。截至昨晚，微博转发量已达7万条。

yesterday,Union medical college hospital women doctors in the warbler weibo announcement,Is there a hospital will be total"indicators"Lump sum to the doctor on the head,Medicare patients quota of 10500 yuan per person.The warbler think"Along the way,Medical treatment has completely become a wealthy people and the privilege of officials".As of last night,Microblogging forwarded the amount has reached 70000.

　　对此，北京市人社局相关负责人回应，对于医院简单“包干”，将指标定额下派给科室、医生的“以包代管”做法，人社部门是“坚决反对的”。

For this,The relevant person in charge of Beijing people club bureau to respond,Simple for hospital"Lump sum",Will target fixed dispatching department/The doctor's"In package of escrow"practice,People club department is"Is firmly opposed to the".

　“指标”不能“以包代管” "indicators"Can't"In package of escrow"

　　昨日，于莺发微博称收到一名医院同行的微信，截图显示该医院向全体医师下达指标，每位医保病人的诊治定额为10500元，若超额，将由科室、个人承担。

yesterday,The warbler tweeting said received a hospital colleague's micro letter,Screenshot shows the hospital a quota to the physicians,Each medicare patient diagnosis and treatment of quota of 10500 yuan,If excess,Will by the department/Individual to assume.

　　随后，记者致电于莺，她表示出于对当事医生的保护，无法透露是哪家医院。

then,Reporters call the warbler,She said for the protection of party a doctor,Which cannot be revealed is the hospital.

　　对此，北京市人社局相关负责人回应，对于医院简单“包干”，将指标定额下派给科室、医生的“以包代管”做法，人社部门是“坚决反对的”，“如果有医院这样做影响到患者的诊疗，就不配承担医保任务。”

For this,The relevant person in charge of Beijing people club bureau to respond,Simple for hospital"Lump sum",Will target fixed dispatching department/The doctor's"In package of escrow"practice,People club department is"Is firmly opposed to the","If there is a hospital do affect the patient's diagnosis and treatment,Is not worthy to be responsible for health care."

　　北京市卫生局局长方来英表示，医院必须提供给患者最适宜的治疗，“任何政策都不能导致基本医疗服务质量受到影响。”

Director of Beijing municipal health bureau said to English,Hospital must provide the most appropriate treatment,"No policy can lead to basic medical and health service quality is affected."

　探索更科学定“指标” To explore more scientific"indicators"

　　记者了解到，实际上北京对于总额预付制的考核管理，是同医疗行为、患者满意度等挂钩的。如果医院在此方面考核不达标，即使“花钱”控制在指标范围内，也会按一定比例扣减指标金额。

The reporter understands,Actually in Beijing for the total amount of advance evaluation management system,With medical practice/Patient satisfaction, etc.If the hospital assessment is not standard in this line,Even if the"To spend money"Control in the range of indicators,Amount will be deduct by certain proportion index.

　　对于如何更科学合理地确定“指标”，令医院不至于承受过重压力从而影响患者诊疗质量，市医改办主任韩晓芳近日表示，北京正在对此进行探索。比如综合考虑病的复杂难度、结合绩效评估等。

For how to more scientific and reasonable to determine"indicators",To hospital without too much under pressure which affect patients diagnosis and treatment quality,City health Han Xiaofang, director of the office said recently,Beijing is to explore.Such as considering the complexity of the disease is difficult/Combined with the performance evaluation, etc.

　　据悉，目前北京共有33家二三级医院已试点总额预付制，今年试点有望再扩大。记者获悉，这33家试点医院总额预付制“指标”的执行情况，有望适时向社会公布。

It is understood,At present a total of 33 two tertiary hospitals in Beijing has pilot system of total amount paid in advance,The pilot is expected to expand again.Reporters learned that,The total 33 pilot hospital system in advance"indicators"The implementation of,To timely to publish to the society.

　■ 焦点 S the focus

　　总额指标该不该“包干制”？ Should total index"Supply system"?

　　昨日，北京市人力社保局相关负责人明确表示，医院简单将总额指标“包干”给医生，这种“以包代管”的行为是人社部门坚决反对的。他提出，医院应该通过精细化管理，控制医疗费用的不合理增长，而不是简单地为医生下达任务指标。

yesterday,The relevant person in charge of human social security bureau of Beijing made it clear,Simple hospital will total index"Lump sum"To see the doctor,This kind of"In package of escrow"Behavior is resolutely opposed to people club department.He put forward,Hospitals should through fine management,Control the unreasonable growth of medical costs,Rather than simply as the doctor orders indexes.

　　北大人民医院院长王杉表示，医保部门对医疗机构进行控费，是合理的，也是国际惯例。如果对医疗费用总额不加以控制，医疗机构会过度检查过度治疗。因此，任何一种医保支付方式，都会控费，但只是对不同患者群体，适应性不同。无论哪种控费制度，压力在医院，最多是科室，要按病种设计更合理的诊疗路径；不会分解到具体某个医生。但从目前网络上热议的微博内容来看，医院采取了简单粗暴的办法，把医保控费压力强加在每个医生身上，应该是医院内部管理问题。

Peking University people's hospital dean Wang Sha said,Health care services for medical institutions for charged fees,Is reasonable,Is also international practice.If not controlled with total health care costs,Medical institutions will excessive check excessive treatment.so,Any kind of medical insurance payment,Will be charged fee,But just in different patient populations,Adaptability to different.No matter what kind of control system,Pressure in the hospital,At most a department,Press disease to design more reasonable path of diagnosis and treatment;Will not break down to a specific doctor.But from the current debate on the network's weibo content,Hospital adopted a simple and crude way,The medical insurance fee pressure on every doctor,Should be the hospital internal management problems.

　“指标”是否影响患者就医？ "indicators"Whether affect the patients go to a doctor?

　　北京市人力社保局表示，目前北京所有的医保定点医疗机构都已实行总额管理，也就是都会有“指标”。作为医保基金的一种管理手段，管理的对象是医疗机构，而不是医保病人。即使医院用光了管理指标，也不存在医保就一律不能报销的问题。

Beijing human social security bureau said,Now Beijing has all of the medical insurance fixed-point medical institution management,There will be"indicators".As a kind of medical insurance fund management,Management of the object is medical institutions,Instead of medicare patients.Even if run out of hospital management,There is no reimbursement medical insurance will not be problem.

　　北京市的基本医疗保险实行按项目结算，即医疗机构发生的医保应支付项目，由医保基金给予支付。实行总额管理后，结算方法没有改变，医院发生的超过总额管理指标的部分，医保基金仍给予支付。因此，总额管理不涉及医疗费用结算方式的调整，不会影响对医疗机构的结算，更不会影响个人的就医和医疗待遇。

Beijing basic medical insurance project settlement is carried out,The medical institutions should pay for health care projects,By the medical insurance fund to pay.After a total management,Settlement method has not changed,Total hospital happened more than part of the management indicators,Still to pay medical insurance fund.so,Total management does not involve the adjustment of the medical expense settlement way,Does not affect the settlement of medical institutions,Let alone the personal medical treatment and medical treatment.

　　但不少业内人士提出，“控费”恐使患者的医疗质量下降，有可能“控”掉合理的医疗费用，造成患者该看的病、该得到的医疗服务没有得到。

But many in the industry put forward,"Control cost"The fear of decreased patient quality of care,Is likely to"control"Reasonable medical expenses,Result patients with the disease/It didn't get the medical services.

制度设计如何规避负面效应？ System design and how to avoid the negative effects?

　　市医改办主任韩晓芳近日表示，北京正在对完善总额预付制进行探索，比如综合考虑病的复杂难度、结合绩效评估等因素，更科学合理地确定“指标”。

City health Han Xiaofang, director of the office said recently,Beijing is to improve the total prepaid system to explore,Such as considering the complexity of the disease is difficult/Combined with the performance evaluation and other factors,More scientific and reasonable to determine"indicators".

　　实际上，对于医保总额预付试点，北京已明确写入医院须规范医疗行为，做到合理检查、用药，并特别提出不得以任何理由推诿参保人员。

In fact,For total medicare pilot in advance,Beijing has clearly written to hospital must be the standard medical behavior,Do reasonable inspection/Drug use,And put forward in any special reason to shuffle ginseng protect personnel.

　　根据规定，实行总额预付制的医院在试点期间，除了要依据“指标”控制医疗费用过快增长外，还要接受一套和诊疗行为、患者评价相关的考核。考核的内容包括医院门诊和住院的人次，次均费用，住院与门诊比例，药品、耗材、自费占医疗费用比例，群众满意度等。

According to the regulation,Total amount shall be paid in advance of the hospital during the pilot,In addition to the basis"indicators"For controlling the excessively rapid growth of medical expenses,To accept a set of behavior and the diagnosis and treatment/Evaluation of patients with relevant evaluation.Assessment includes person-time of outpatient and hospitalization,All fees,Inpatient and outpatient proportion,drug/consumables/Out-of-pocket medical costs percentage,Satisfaction, etc..

　　如试点医院发生的医保应支付费用未“超标”，将能领取“指标”的全部金额；否则，还会按一定比例扣减指标金额。

If the pilot hospitals should pay for health care expenses is not"overweight",Will be able to receive"indicators"The total amount;otherwise,Amount will be deduct by certain proportion index.