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公立医院综合改革下半年全面推开 破除“以药补医”

2017-07-26 01:49:20   经济参考报

十八大以来,中国医改向更深领域更广层面迈进。2017年,公立医院综合改革力度空前,医疗费用增长幅度持续下降,医疗保险覆盖面稳定在95%以上,群众就医负担不断减轻。专家认为,使医院回归公益性质、医生回归看病角色、药品回归治病功能,今年医改围绕破除以药补医,建立维护公益性、调动积极性的公立医院运行新机制,在控制医疗费用方面取得较大进展,切实增强了人民群众的获得感。据了解,今年下半年,有关部门将协调推进管理体制、医疗价格、人事薪酬、药品流通、医保支付方式等改革。

进展公立医院综合改革力度空前

十八大以来,城市公立医院改革从试点起步,由点及面,稳步推进。改革重心由搭建框架向制度建设转变,由医院改革向县域综合改革转变,由单项改革向医疗、医保、医药联动改革转变。从2010年的17个公立医院综合改革试点城市扩展到2015年的100个,2016年增至200个。

国家卫生计生委主任李斌7月24日表示,目前,公立医院综合改革在20个省份、242个城市和全国所有县(市)推开,分级诊疗试点城市扩大到321个,家庭医生签约服务超过3.2亿人,2017年9月底前,我国将全面推开公立医院综合改革,所有公立医院全部取消药品加成(中药饮片除外)。

事实上,随着我国公立医院综合改革路径逐渐清晰,改革显现初步成效,尤其是在三医联动和上下联动方面力度空前,形成了一批符合实际、可复制、可推广的典型经验。今年4月,北京市率先在全市范围内取消药品加成,公立医院以药品进价销售给患者,多项医疗服务价格调整,医保支付和财政补助同步跟进。

医改也为患者带来了实实在在的“获得感”。国家统计局北京调查总队近日在二三级医院中完成的调查显示,91.7%的患者支持改革,82.2%的患者认为医改有利于分级诊疗,90%以上的患者满意就医状况。

从全国范围看,全国各级公立医院通过取消药品加成、调整医疗服务价格、加大政府投入,收入结构趋于合理。城市公立医院药品收入占医疗收入的比例持续下降,2012年为44.8%,2013年为43.3%,2014年为42.2%,2015年为42.8%,2016年为39.6%。同时,逐步提高医疗服务收入在医院总收入中的比例。

亮点医疗卫生保障体系全面建立

从小山村到大城市,十八大以来,一张覆盖全国的医保网络逐步成型,成为我国医改最大的亮点之一。

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