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“以药养医”破局医改动真格 专家:有药品降价8.9%

2017-05-17 09:22:16   

原标题:“以药养医”破局医改动真格 专家:有药品降价8.9%

“今年的医改任务中明确了两个时间点,一是在今年7月31日前,所有地市必须要拿出城市公立医院综合改革的实施方案;第二是9月30日前,全国所有的城市公立医院都要取消药品加成(中药饮片除外)。”5月11日,国家卫生计生委就2017年深化医改重点工作任务举行专题发布会,国务院医改办专职副主任梁万年司长说。

分级诊疗、现代医院管理、全民医保、药品供应保障、综合监督……5项制度建设的56项任务,而其中,最受关注的无疑就是全部取消药品加成。2017年是工作落实年医改就这样大刀阔斧、真刀真枪地干起来了。取消药品加成后怎么办,老百姓能否人人享有公平的医疗卫生服务?

“腾笼换鸟”值得借鉴

“公立医院改革需要‘三医联动’:医保、医药和医疗要联动,很核心的一个任务就是要破除以药补医机制,建立新的公立医院运行机制,新的运行机制叫做维护公益性、调动积极性、保障可持续。”梁万年说。

而破除以药补医,最关键的一个切入点,就是取消药品加成。现在公立医院的主要补偿渠道有三个,即政府补助、医疗服务收费和药品加成。改革就是要把第三个补偿渠道去掉,由三个渠道变成两个渠道。对此,梁万年认为,福建省三明市的腾笼换鸟做法值得思考与借鉴。

腾笼换鸟的第一步是取消药品加成之后提高医疗服务项目收费。“如果没有腾出空间,势必就会增加老百姓的就医负担。”梁万年说,腾空间主要可以通过推行两票制、挤出高值耗材水分等举措进行流通领域的改革。此外,通过对医院诊疗行为的合理监管,可以为医保节省经费。

腾出空间之后就可以调结构了。“医生存在不合理诊疗行为的一个重要原因就是医疗服务价格体系没有理顺,不能反映医务人员的劳务价值。”梁万年认为,调结构主要就是提升体现医务人员劳动技术价值的医疗服务项目收费。

“一个很核心的标志,现在公立医院整个收入结构当中,过去药品、耗材这些物化为主的收入大概占到60%—70%之间,真正反映劳务技术价值的医务性收入也就30%左右。通过这种改革,能够使药品和耗材的总体收入占比下降到50%以下。”梁万年说。

梁万年指出,现在改革比较早的地区,比如福建三明市的药占比已经在30%以下了,反映劳务技术价格的收入比重由过去的30%左右现在提高到50%甚至60%。结构调整过来后,医院总收入含金量增大,可以反过来建立符合行业特点和岗位特点的薪酬制度,来充分调动医务人员的积极性,这样就真正做到了通过改革,使医院的运行没有受到影响,使医保基金可持续,使老百姓整体医疗负担没有增加,而医院进入良性的运行轨道。

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