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公立医院综合改革明年全面推开

2016-12-30 10:52:48   

原标题:公立医院综合改革明年全面推开

根据近期发布的“十三五”卫生与健康规划,明年将在各级各类公立医院全面推开综合改革,其中,医疗服务价格改革将成为重要内容之一。专家表示,医疗服务价格的调整,不是简单的涨价、补足,而是一个系统工程,医疗、医药、医保“三医”需协同推进,多方控制医疗费用不合理增长,确保不增加患者负担。

就记者了解,目前各地已出台了医疗服务价格改革实施方案。如四川省方案规定,根据医疗服务市场发展状况和“保基本”的要求,采取“小步快走”方式,分批次加快调整医疗服务项目价格。重点提高体现医务人员劳务价值、技术难度和风险程度的医疗服务项目价格,降低偏高的、不合理的大型医用设备检查治疗、检验等项目价格,防止价格异常波动。同步衔接医疗服务价格调整和医疗保险相关政策,确保医保基金可承受、患者负担总体不增加。

安徽省方案规定,年底前放开一批医疗服务收费项目价格,到2017年,逐步缩小政府制定价格范围。到2020年,逐步建立以成本和收入结构变化为基础的价格动态调整机制。向社会公布一批竞争比较充分以及个性化需求较强的公立医疗机构服务项目,实行市场调节价。非公立医疗机构提供医疗服务,医疗基金支付原则上不高于公立医疗机构提供的同类医疗服务价格。

事实上,本次改革剑指“以药养医”。“一所医院的收入70%来自于医疗服务收费,30%来自于检查、药品等收费项目,是比较理想的状态。而我国公立医院的收入来源中,药品加成是大头,一般占四成左右。因为医疗服务价格普遍低于成本,财政补贴又不到10%,只能靠药费、检查费贴补亏损。”业内人士表示,此次医疗服务价格改革,意在建立医患双赢的格局。让医务人员靠技术而非回扣吃饭,拿阳光薪酬过上体面生活,也就没有随便给患者开大检查、大处方的冲动,至少在医生这一环就可以缓解“以药养医”的情况。

山西省医疗机构管理研究所教授李梅接受采访时表示,现行医疗服务价格矛盾突出,医务人员提供的技术服务很多,但回报却不高。培养一名副高职称的大夫,从大学入学算起,大致需要15年左右的时间。现在,一名副高职称的大夫诊查费为5元/次,和付出不成比例。从床位费来说,现行床位费是14元/天,住院病人的身体、心理均受到创伤,服务难度可想而知。和市面上快捷酒店的床位费相比,医院的床位费不太合理。

清华大学经管学院医疗管理研究中心研究员曹健表示,目前很多医疗服务价格经过核算后发现是低于成本价的,并没有体现医务人员真正的劳务价值。而通过改革将降低的耗材、药物等费用腾挪到医疗服务上去,同时保证医保可承受,意味着患者基本医疗费用负担总体不增加。

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