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医改重头戏来了

2017-08-25 07:07:00   中国青年网

本报记者宜秀萍 实习生姜斯佳

公立医院是医疗服务体系的主体,是解决群众看病就医的主战场。与之相对应,公立医院综合改革是深化医药卫生体制改革的“重头戏”和难啃的“硬骨头”,也是决定医改成败的关键。8月24日,省政府新闻办召开新闻发布会,宣布从8月26日零时起,省级15家公立医院全部取消药品加成(中药饮片除外),实行零差率销售,新的医疗服务价格也同步实施,8月底前,我省11个非国家公立医院改革试点市州也将全部取消药品加成。至此,我省公立医疗机构将彻底告别“以药补医”的时代,医改重头戏全面唱响。

患者负担总体不增加

公立医院综合改革全面推开后,患者就医负担会增加吗?这是公众最关心的问题。当天的新闻发布会上,省卫计委、省发改委有关负责人对此均给出了明确的答案:改革后,患者负担总体不会增加。

据介绍,实行药品加成是计划经济时期国家为弥补政府投入不足等出台的政策,即允许公立医院在药品进价基础上加价销售。在医疗卫生事业发展过程中,该政策曾经发挥了积极作用,但随着形势的发展变化,医疗机构趋利行为显现,成为看病贵的原因之一。取消药品加成,破除以药补医机制是扭转公立医院逐利行为的突破口,也是公立医院综合改革必须解决的首要问题。

“全部取消药品加成,核心是破除‘以药补医’的传统机制,医疗服务价格改革是关键环节。”省发改委副主任陈波解释,调整后的《甘肃省省级医疗服务项目价格(2017版)》医疗服务项目由原来的1万余项减少到8408项,分为三类项目管理。第一类为基本医疗服务项目共计8014项;第二类为市场调节价的医疗服务项目共计390项;第三类为特需医疗服务项目共计4项。

此次调整针对的主要是第一类基本医疗服务项目,其中提高了诊疗、护理、手术(5090项)、治疗等项目价格共计6113项,降低了检查、检验共计1231项服务项目价格,对长期病患者的康复类、神经类、血液透析等670项服务项目未进行调整。调整后,大型仪器检查价格平均降低8.3%;检验平均降低19.7%;护理平均增长89.9%;手术按级别平均增长43.8%(除麻醉、辅助操作部分);治疗平均增长19.8%。

陈波介绍,为验证价格改革方案的合理性,省发改委抽取了省管医疗机构前20个病种700份病历进行病种费用测算,调整后病人住院费用整体有所下降,公立医院次均住院费用水平相对稳定,未增加患者负担。

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