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三医联动,关键在“联”

2017-08-24 08:26:57   中国青年网

□ 王丽荣 田珍都

联动就是多方互动,相关利益方相互配合、共同行动。说到底,医疗、医保、医药“各吹各的号、各唱各的调”,没法“心往一处想、劲往一处使”,主要是部门利益在作怪。

协调推进医疗、医保、医药的“三医联动”,是深化医改的重中之重。作为新医改的重点,公立医院改革能否做到“三医联动”,直接影响新医改的进展和成效。尽管我国公立医院改革政策设计上注重做到“三医联动”,但在现实中,“三医”仍各自为政,尽管都在推动改革,但推动的方向目标、力度节奏不一致、不协调。这种状况的出现,既有思想认识方面的原因,也有工作机制和部门利益方面的原因:

各部门的工作目标方向不完全一致。这是“三医”没有实现配套联动的首要原因。可以说,“三医”相关职能部门的目标任务、利益诉求并不相同。实际工作中,部门目标任务往往压倒改革整体目标。可以说,由于没有处理好部门职责与其在公立医院改革中的作用之间的关系,使得相关部门更多注重履行部门职责,而忽视如何更好地推动实现公立医院改革整体目标。说到底,医疗、医保、医药“各吹各的号、各唱各的调”,主要是部门利益在作怪。

判断标准和实施路径尚不清晰明确。一方面公立医院改革最终要改成什么样式、“三医联动”的具体判断标准还不清楚,也即改革目标不明确。尽管国家一直在提“三医联动”,但如何才算实现了联动,还没有明确规定。另一方面,公立医院改革内容较多,理应分清轻重缓急、先后次序,做到环环相扣、相互配合。然而当前改革主要集中在医药方面,医疗、医保方面改革进展缓慢。容易改的基本都改了,剩下的大都是硬骨头。下一步改革重点是什么,如何突破?尚没有清晰规划,只是摸着石头过河。可以说,要推进“三医联动”亟待明确目标、设计好路线,否则很可能滑到哪里算哪里。

工作推进机制不健全。顾名思义,联动就是多方互动,相关利益方相互配合、共同行动,而目前各地成立的医改领导小组并未有效发挥统筹协调作用,有关改革往往是一个部门主导,其他部门参与不够或没有参与。比如,医院年度医保基金额度以及医保报销范围、比例等均主要是医保经办机构说了算,医院、患者话语权缺失或不足。又比如,对于药品、耗材采购,医保经办部门、医院均缺乏必要参与权,主要由省级药品集中采购平台与药品生产流通企业之间进行谈判。同时,当前“三医”没有实现联动的一个重要原因是缺乏责任追究机制。只有实行严格问责,才能推进部门分工协作,才能确保政策落实到位。

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