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药品零加成政策落地有喜有忧 低价药现“招标死”

2017-05-15 02:50:03   经济参考报

按照全面推开公立医院综合改革的通知,国内各级各类公立医院将于今年9月底前全部取消药品加成。《经济参考报》记者在已经取消药品加成的福建、湖南、四川等省采访发现,群众就医负担普遍减轻,但一些地方由于改革“单兵突进”,也出现了配套补偿举措不到位导致公立医院“自掏腰包”填缺口、取消药品加成导致低价药“招标死”等现象。

药品零加成红利渐显

随着一些省份公立医院药品取消加成,进行零差率销售,“以药补医”情况正逐渐改变,给群众真正带来了实惠,避免了“因病返贫”。

去年12月20日起,四川开始实施城市公立医院取消药品加成政策。成都新都区龙桥镇49岁村民庄云说:“不久前我父亲因患有早期结肠癌,到一家大医院住院做了手术,花了3.8万元手术费。然后转送到新都区第二人民医院住院康复治疗,预交了1000元的治疗费,住院10多天后护士送来了清单,我一开始还不太敢看,觉得肯定要花好几千,打开一开,全部住院自费费用只有300多元!”

福建患者徐先生因慢性乙肝需要常年服药。他给《经济参考报》记者算了一笔账:“治疗乙肝的药物拉米夫定一盒有14片,过去是54元,现在只要38.5元,对我们慢性病患者来说,一个月就能少花几百元,‘减负’效果特别明显。”

“药品加成是上世纪80年代开始对公立医院的一种补偿政策,在市场经济条件下逐步演变成以药补医机制,使公立医院偏离了公益性轨道,导致了药品价格虚高,推动了医药费用不合理上涨。”成都医学院附属医院药剂科主任袁明勇说。

福建省政府副秘书长赖碧涛说,福建三明从2013年“试水”破解“以药养医”问题,并同步建立了补偿新机制,通过提高医疗服务价格等多个渠道,补偿取消药品加成减少的收入,有效控制了医疗费用不合理增长,降低了患者医药费用负担。2015年开始,福建全省在全国率先推开公立医院药品“零差率”销售。

福建省卫计委主任朱淑芳说,2016年福建全省公立医院药品耗材占比同比下降4.64个百分点,体现医务人员技术与劳务价值的诊察护理手术治疗等医疗服务收入占比同比提高2.51%。

今年4月8号,《北京市医药分开综合改革实施方案》正式发布,3600多家医疗机构围绕“医药分开、规范基本医疗服务项目、实施药品阳光采购”三个方面进行改革,彻底告别以药养医,实现补偿机制的“大换血”。改革后,药品费用和药费占比双下降,医疗服务和费用变化符合改革预期。

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