一个早在2007年就诞生的“小医生含泪10问卫生部长”的帖子最近又在网络走红。正在参加全国政协会议的卫生部副部长黄洁夫昨天以“一个老医生”的身份，用长达90分钟时间公开回应这位医生网友，坦言“如果基层医生对医改如此困惑和沮丧，中国的医改就无法成功”，并直言“给予医生自由执业权是医改方向”。

A born as early as 2007"Asked the little doctor tearful 10 health minister"Post again recently in the network.Is the national committee of the conference of health huang jiefu at yesterday"An old doctor"The identity of the,With 90 minutes online public response to the doctor,admitted"If the doctor is so confused and frustrated to reform at the local level,China's health care reform will not be able to succeed",And the truth"Give the doctor free practice right is the direction of reform".

　　

问 q

　　行业利益 Business interests

　　医疗行业为什么不能追求利益最大化？ Why not seek to maximize the interests of the medical industry?

　　黄洁夫承认，医院是服务行业，是典型的市场行为。但是，与其他服务行业有很大不同，由于职业道德所限，不能去争取“利益最大化”。医院的“公益性”是指医院不把谋利当作主要目的，而是以维护民众健康与社会效益为追求目标。“以病人为中心”是行业的工作准则，如果争取利益最大化，就会走上“邪路”。

Huang Jiefu admitted,Hospital is a service industry,Is a typical market behavior.but,With other service industry are quite different,Due to the limitation of professional ethics,Can't go to fight for"Benefit maximization".The hospital"The public welfare"Refers to the hospital not to profit as a main purpose,But to safeguard public health and social benefits for the pursuit of goals."Taking patient as the center"Is the job of the industry standards,If the interests to maximize,Will be on"astray".

　

　问 q

　　医生工资 Doctors wage

　　医院搞“科室核算”医生工资从何而来？ The hospital to"Department of accounting"The doctor salary to come from?

　　目前我国还没有一家由政府全额拨款的公立医院。政府给医院的财政投入大约只占10%左右，90%的收入必须靠医院服务收费获得。各医院都搞“科室核算”，科室按核算绩效给员工发奖金，激发了各科室追求经济利益的积极性。为办好医院，院长会主动或被动地以各种方式激励创收，从而导致备受民众诟病的过度医疗、大处方，大检查等不良行为，导致国家医疗费用过快增长。

At present our country has not been a full funding of public hospitals by the government.The government financial input to hospital accounted for only about 10%,Get 90% of their income must rely on hospital service charge.Hospitals have"Department of accounting",According to the accounting department performance bonuses to employees,Inspired the enthusiasm of each department the pursuit of economic interests.To do a good job in the hospital,Dean will actively or passively in a variety of incentives to generate revenues,Which can lead to excessive medical treatment under public criticism/excessive,Big checks and other bad behavior,Cause of the country medical treatment charge excessive growth.

　　黄洁夫表示，由于不合理的价格管制，大部分医疗服务定价并未考虑人力成本，出现诸如手术使用的耗材和设备费用明显高于手术劳动费用等不合理现象，医生的劳动价值得不到合理体现，其阳光收入过低。在扭曲的价格体制下，公立医院以药养医和检查收费成了普遍的补偿机制。

Huang Jiefu said,Due to the unreasonable price controls,Most of the medical service pricing does not take into account the human cost,Appeared such as the use of consumables and equipment costs are significantly higher than surgery labor costs, such as unreasonable phenomenon,The doctor's labor value is not reasonable,The sunshine income is too low.Under the distorted price system,Public hospital medicine for the medical and inspection fees become common compensation mechanism.

　

　问 q

　　工作时间 Work time

　　医生常年超负荷工作如何保持良好态度？ Doctors work overload all the year round how to keep a good attitude?

　　黄洁夫说，为满足患者就医需求，很多大医院开放号源，导致很多医生超负荷工作，每周工作时间在70小时左右的医务人员占了多数。与辛勤付出不相匹配的是医生的收入和社会地位的相对下滑，这是一些医生对医改持消极观望情绪的原因。让医生有较高的社会地位、体面的收入，是社会进步的标志。

Huang Jiefu said,To meet the demand of patients go to a doctor,A lot of big hospital open source,Lead to many doctors overload,Working hours per week in 70 hours of medical personnel accounted for the majority.With hard work does not match the relative decline of the doctor's income and social status,This is some doctors to reform a negative wait-and-see mood.Let the doctor had a higher social status/A decent income,Is the sign of social progress.

　　

问 q

　　医患关系 The doctor-patient relationship

　　医患关系紧张应由医生负主要责任吗？ The doctor-patient relationship nervous should be mainly responsible for the doctor?

　　黄洁夫认为，医患矛盾主要是因为民众的医疗服务要求与优质医疗资源不足及医疗卫生体制改革滞后造成的。医生和病人都是医疗冲突的受害者。绝大多数医生救死扶伤，无意被奉为“白衣天使”，也不容忍被丑化为“白狼”。

Huang Jiefu think,The doctor-patient contradiction is mainly due to people's health service requirements and high quality medical resources and health care system reform lags behind.Doctors and patients are the victims of medical conflicts.Most of the doctor to heal the wounded and rescue the dying,Not be as"White angel",Don't stand for been demonised"The white Wolf".

　　

问 q

　　免费医疗 Free medical care

　　先治病后收钱恶意欠费怎么办？ After cure malicious owe the money to do first?

　　黄洁夫认为，在没有具备“全民免费医疗”条件下，不宜全面推行“先看病后付费制度”。现在医改，要钱找财政部，要人要找人保部，要编制要找编办，价格得找发改委……卫生部门只是负责卫生事业的技术部门，具体医改时，更多地依靠上述政府部门，如果无法取得共识，肯定不能在全国范围内推行“先看病后付费”的新政。

Huang Jiefu think,When there is no have"The free medical care"Under the condition of,Not fully implementing"To see a doctor first after paying system".Health care now,To search for the Treasury money,Figures for the ministry,To prepare for public,Prices have to find the national development and reform commission...Department of health is responsible for the department of health technology,Specific health care reform,Relying more on the government department,If you cannot agree,Certainly cannot push across the country"To see the doctor before they are paid"The New Deal.

　　北京多家医院在尝试支付体制改革，试行医药分开，取消药品加成，试行医事服务费作为财政补偿。这是一项有意义的改革尝试。但是政府的财力是有限的，单纯用政府财政去补贴医院因取消药品加成造成的损失难以长久。如果没有符合当前医疗市场运行规律的医疗服务支付体制的综合改革，很难形成合理的医院补偿机制。

Beijing hospitals in an attempt to pay system reform,Try out medicine separately,Cancel the drug addition,As a financial compensation for medical service.This is a meaningful attempt at reform.But the government's financial resources are limited,Use the government fiscal subsidies for cancel the drug bonus damage from the hard for a long time.If not in conformity with the current medical market operation rule pay system of comprehensive reform of medical services,It is difficult to form a reasonable compensation mechanism for hospital.

　　

问 q

　　医改进展 Health care reform progress

　　卫生部做了些什么事情？ The ministry of health, did some what things?

　　黄洁夫说，他与卫生部长陈竺共事几年，非常理解他的难处。“他有激情，有事业心，并想尽快解决人民群众看病就医的问题，但医改道路艰难曲折。作为一名从事分子生物和血液病临床研究的科学家，他也在个人专业发展中作出了牺牲。”

Huang Jiefu said,He a few years working with health minister Chen zhu,Very understand his difficulties."He has a passion,Has the dedication to work,And want to solve the problem of people's hospital as soon as possible,But reform ways are hard and tortuous.As a clinical research scientist engaged in molecular biology and diseases of the blood,He also made a sacrifice in the personal professional development."

　　黄洁夫说，推动公立医院改革试点，大量配套政策与举措要多个部委之间合作，而跨部门协调历来都是要费大量时间和精力的。

Huang Jiefu said,Promote the pilot reform of public hospitals,A large number of supporting policies and measures to cooperation between various ministries,The inter-departmental coordination has traditionally been to cost a lot of time and energy.

　　黄洁夫建议，国家应该保障支持有限的公立医院，形成以公立医院与民营医院共同构成的医院体系。民营医院也应该是公益性医院，应与公立医院享有同等待遇。公立医院由政府承担，社会则着力去建立一个以“医生自由执业”为基础的医生人力资源市场和一批高水平的非营利民营医院，才能解决在市场经济规律下的中国医疗体制问题。

Huang Jiefu advice,Countries should support limited public hospital,Formed in a public hospital and private hospital constitute system of hospital.Private hospitals should also be public hospital,Should work with public hospitals have equal treatment.Public hospitals are to be borne by the government,Society is focus on to build a"The doctor free practice"Doctors on the basis of the human resources markets and a high level of non-profit private hospitals,To solve it in a market economy under the rule of China's medical system problem.

　　晨报首席记者 崔红 文并摄

Morning news chief correspondent Cui Gong and perturbation

　

　■建言医改 S Suggestions and reform

　　分级诊疗 缓解看病难 Hierarchical diagnosis and reduce medical care

　　晨报讯(首席记者 姜葳 记者 陈琳)全国人大代表、北医三院大外科主任刘忠军昨天参加北京团第三次全体会时表示，解决好看病难问题，要通过分级诊疗来实现病有所医。他透露，以北医三院为例，医改两年来门诊量未降反升。

Morning news(Chief reporter jiang Veda reporter Chen Lin)The National People's Congress/Founding of large surgical director of the research LiuZhongJun BeiJingTuan third plenary will said yesterday,To solve difficult problems,To multi-form by grading diagnosis and treatment.He said,By founding the research, for example,Healthcare reform over the past two years MenZhenLiang yet".

　　刘忠军代表在发言时认为，要解决好看病难问题，分级诊疗和社区医疗工作的力度还得加强。他分析说，医改“十二五”规划提出的重要任务之一是要提高基层医疗卫生机构服务能力，建立健全分级诊疗双向转诊制度，明显提高基层医疗卫生机构门急诊量占门急诊总量的比例。

LiuZhong comes in to speak,To solve the problem of good medical care,Grading diagnosis and treatment also need to strengthen and community medical work.He said analysis,Health care reform"The 12th five-year"Planning put forward one of the important tasks is to improve the basic-level medical health agency service ability,Establish and improve the classification diagnosis and two-way referral system,Improve grassroots medical institutions door of er visits this proportion of the total.

　　“但近两年来实际的情况是，三甲医院的门急诊量不是降低了，而是升高了。”徐代表以所在的北医三院为例，2010年门诊总量是243万人次，2011年达到276万人次，2012年超过了323万人次。他分析认为，这种情况如果持续，一方面会加剧患者的住院难，另一方面也促使三甲医院盲目扩大规模。

"But the truth is in the past two years,3 armour hospital er visits is not reduced,But the rise in."Representatives to xu's founding as an example. The research and,2010 outpatient amount is 2.43 million,In 2011 to m,More than 3.23 million people in 2012.He analysis,If this situation continues,On the one hand, hospitalized patients with difficult,On the other hand also prompted 3 armour hospital expand blindly.

　　刘代表认为，实现分级诊疗，引导患者就近就医，并最终缓解看病难，有赖于提高医师队伍的整体水平和能力。他建议借助发达国家医生培养的经验，在全国范围内建立完整的专科医师培训体系，加强医师培训和职业准入，以真正实现分级诊疗。

On behalf of liu thinks,Implement grading diagnosis and treatment,Guide patients to go to a doctor,And eventually relieve the difficult,Owes a lot to improve the overall level and capacity of physician team.He suggested that with the help of a doctor training experience of developed countries,Across the country set up complete specialist training system,Strengthen the education of the physician and career access,To truly achieve classification diagnosis and treatment.

　　■

s建言养老 "Pension

　　三级体系 解决养老问题 Level 3 system solve the pension problem

　　晨报讯(记者 徐晶晶)今年我国老年人口数量将突破2亿大关。养老问题也成为两会上代表委员关注的话题。昨日，全国政协委员、中日友好医院院长许树强建议，建立二级医院、社区医院和疗养院三级养老服务体系，并将康复养老机构中的康复医疗费用纳入医保支付范畴。

Morning news(The reporter Xu Jingjing)China's elderly population will exceed 200 million mark this year.Endowment problem has become a focus on two representatives of the topic.yesterday,The CPPCC national committee/China-japan friendship hospital dean Xu Shujiang advice,Establish secondary hospitals/Community hospitals and nursing homes level 3 endowment service system,And pension institutions of rehabilitation medical expenses into the category of medical insurance payment.

　　许树强委员介绍，今年全国老年人口数量将突破2亿大关，达到2.02亿，近年来慢性病患病老年人数持续增加，2012年为0.97亿人，2013年将突破1亿人大关。针对老年人必然伴随的疾病和养老问题，许树强认为，当前最突出的矛盾是医疗机构承担着十分繁重的疑难重症诊疗任务，不可能满足老年人长期住院进行治疗、康复和生活养护的要求。

Xu Shujiang members is introduced,The elderly population will exceed 200 million mark this year,Up to 202 million,In recent years, the number of elderly chronic illnesses continue to increase,In 2012 to 097 million,In 2013 will exceed 100 million people.Problems and pension for the elderly is associated with the disease,Xu Shujiang think,Currently the most prominent is the contradiction of the medical institutions bear the task is very heavy mysterious illness diagnosis and treatment,Can't satisfy the elderly long-term hospitalization for treatment/Rehabilitation and maintenance requirements of life.

　　许树强建议，建立覆盖全国的三级养老服务体系。也就是说，在现有医疗、康复和护理资源条件下，选择部分符合条件的疗养院、二级医院、社区医院向以康复医疗服务为特色的康复养老机构转型，逐步形成覆盖全国的三级康复养老服务体系。同时，对养老机构从业人员进行康复知识与基本技能培训，有计划地引进康复医学人才。

Xu Shujiang advice,Establish three-level pension service system covering the whole country.That is to say,In the existing medical/Under the condition of rehabilitation and nursing resources,Select part conform to the conditions of a nursing home/The secondary hospital/Community hospitals for medical service of rehabilitation to pension institution transformation,Gradually formed the tertiary recovery of endowment service system covering the whole country.At the same time,For pension institutions from personnel of course of rehabilitation knowledge and basic skills training,Introduce rehabilitation medicine talents in a planned way.

　　在养老费用负担方面，许树强建议将康复养老机构中的康复医疗费用纳入医保支付范畴。同时，鼓励民间和境外资本投资兴办以康复医疗服务为特色的老年养护机构。

In terms of pension cost burden,Xu Shujiang proposed to endowment institutions of rehabilitation medical expenses into the category of medical insurance payment.At the same time,Encourage private and foreign capital invested in elderly maintenance organization characteristic of rehabilitation medical services.

　　

王执礼：应为糖尿病人开健康课 The king of the ritual:Should a person with diabetes health class

　　晨报讯(记者 王歧丰)昨天，全国政协委员王执礼在接受记者采访时提出，我国糖尿病发病人口总数已达9000万，但95%以上的糖尿病人却没有认真系统地学习糖尿病自我管理知识，希望政府能指导医疗机构立即开展专门健康课堂。

Morning news(Reporter Wang Qi feng)yesterday,CPPCC member wang of li in an interview,Diabetes in China a total of 90 million people,But more than 95% of diabetes patients have no serious diabetes self-management knowledge systematically,Want the government to guide medical institutions specializing in health class immediately.

　　王执礼委员表示，我国是糖尿病发病人数最多的国家，且发病率还在不断增加，资料显示，我国糖尿病患病率从20世纪90年代0.5%上升到21世纪9.7%左右。另据一项资料显示，我国20岁以上糖耐量低减人群达6253万人口，并且每年以8%的速度转化为糖尿病，每年新增糖尿病人群400万至500万左右。

The king of board member said,China is a country with the largest number of diabetes,And the incidence of a disease are increasing,According to,Diabetes prevalence in China since the 1990 s to 0.5% in the 21st century is about 9.7%.According to a data show,Our country more than 20 years old low glucose tolerance decreased population of 62.53 million people,And into diabetes at a speed of 8% every year,An annual increase of diabetes population around 4 million to 5 million.

　　王执礼委员指出，据他对381例糖尿病病人问卷调查表明：90%以上的糖尿病人在患病前，不知糖尿病高危人群的概念，没有采取科学的生活方式干预糖尿病发生，83%左右的糖尿病人患病后，缺乏科学系统的治疗，缺少科学的知识和正确操作技能。95%以上的糖尿病人认为仅血糖平稳就是治疗成功，没有认真系统地学习糖尿病自我管理知识及科学采取自我管理行为。

King of board committee pointed out,According to questionnaire survey for 381 cases of diabetic patients:More than 90% of diabetes patients in front of the disease,I do not know the concept of diabetes in high-risk groups,Did not take scientific lifestyle intervention in diabetes,About 83% of diabetes patients after illness,Lack of scientific system of treatment,Lack of scientific knowledge and operation skills correctly.More than 95% of people think that diabetes blood sugar steady is the only treatment success,No serious diabetes self-management knowledge systematically and science take self management behavior.

　　王执礼委员呼吁，中国应该立即效仿欧美国家，在医疗机构及社区卫生服务中心建立正规的糖尿病教育中心，创新对糖尿病高危人群以及糖尿病人科学管理的新模式，减少糖尿病高危人群的发病率，针对高危人群的健康状况，制定科学合理的预防方案，一旦发现糖代谢异常的危险信号，可以早期给予医学干预，阻断糖尿病发生、发展的因果锁链。

King of board committee called for,China should immediately follow the European and American countries,In medical institutions and community health service center set up formal diabetes education center,Innovation to populations at risk for diabetes and diabetes are the new model of scientific management,To reduce the incidence of diabetes in high-risk groups,In view of the high-risk population health,Making scientific and reasonable prevention plan,Once found abnormal glucose metabolism of danger signals,Can give early medical intervention,Diabetes occurs/The development of the chain of cause and effect.