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公立医院综合改革到底改了啥?

2017-09-02 08:15:57   中国青年网

两取消

药品加成

药事服务费

取消药品加成和药事服务费。药品加成,是过去国家在财力不足、对公立医院补助有限的情况下规定,公立医院可以在药品实际进价的基础上,上浮不超过15%的价格销售药品。今年9月,全市所有公立医院将全部取消药品加成(中药饮片除外)。药事服务费,是一项过渡性的政策,此次改革中,现行的药事服务费政策将停止执行。

一调整

医疗服务项目价格有调整

医疗服务项目价格有调整(见下表)。即根据“提升人力价值、降低物化价值”的原则,建立医疗服务价格调整机制。具体来看,调升诊察费、床位费、诊疗、手术、护理、中医六类共258项体现医务人员技术劳务价值的项目价格;降低CT、核磁共振、派特CT等三类共181项大型设备检查项目价格。

医疗服务项目价格调整情况表

(单位:元)

“六配套”

完善医保报销、财政补助、药品供应保障、医院监管、分级诊疗、便民惠民等六方面配套政策。

1.同步调整医保报销政策

凡是调升的医疗服务项目全部纳入医保报销范围。新项目中既包含有原医保甲类项目、又有乙类项目的情况,医保属性统一调升为甲类,报销就高不就低;相应提高精神病单病种医保按床日定额付费标准等。

2.建立财政分类补助机制

对公立医院取消药品加成后,经价格调整补偿率低于90%的医院,由财政实行分类补助,保护公立医院参与改革积极性。

3.加强药品供应保障

实施药品集中带量采购,发挥批量采购优势,进一步挤压药价水分;所有公立医疗机构全面实施药品采购“两票制”。

4.加强公立医院综合监管

强化公立医院成本核算控制,主动降低运行成本;加强医疗行为监管,防止过度检查、过度用药、分解治疗等不规范医疗行为;进一步控制医疗费用不合理增长。

5.有序引导分级诊疗

发挥价格和医保“杠杆”作用,对不同级别的医院门诊诊察费、床位费分别定价;对不同级别的医院、不同职称等级的医生差异定价;对不同等级的医院实行差异化医保报销政策,引导常见病、慢性病患者选择一、二级医院就诊。

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