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破解以药养医须坚持“三医联动”

2017-05-15 10:54:54   经济参考报

湖南省医改办专职副主任、省卫生计生委体改处处长王湘生表示,“两票制”有利于规范流通秩序,提高流通效率,治理药品流通领域的乱象。

“药品流通是一个节点到另一个节点,中间节点少了,监管更有效了,也能加快建立药品的流通追溯体系,保障药品安全。”四川省卫生计生委药物政策与基本药物制度处处长邹礴说,两票制将在当前药品领域刮起一股清风,以往的层层加价、医生回扣等行业潜规则将被打破,让群众受益、医生清白、监管更有效,形成多赢的格局。

“下猛药”还要看疗效。对于全国两票制的落实,邹礴认为,两票制落地还需要加强多部门的合作,建立部门联动机制,同时细化相关行业的标准,尤其是根据各省省情制定细化措施,在保障药品及时供应的前提下,有序推进。

记者了解到,在两票制落地的同时,四川已在全省实现了“五位一体”的阳光采购,以信息化平台为载体,将药品、医用耗材、医用设备、诊断试剂、二类疫苗全部纳入阳光采购,切实降低虚高价格。

数据显示,开展药品集中分类采购后,四川相同通用名药品的价格与10年前相比,平均降幅为42%,最大降幅达94%;实施医用耗材阳光采购3年内,年均降幅为7.4%,年均节约采购资金近3.2亿元。

提升医务人员积极性

“我现在每个月比改革前增加了1千多元的收入。”成都新都区第二人民医院康复科主任陈邦忠说,改革后,自己的收入不降反增,以前科室收入分配有“封顶线”,干得再多也不会多拿一分钱,现在没有这层“天花板”了,大家的积极性都被调动起来了,科室医护人员平均收入都有所上升。

陈邦忠的感受来自于近年来成都新都区探索的医院法人治理改革。长期以来,政府管理部门与医院之间责权边界不清、医院内部“行政化”色彩浓厚,一直是公立医院的“顽疾”。取消药品加成后,如何释放医院内生活力?

理事会、管理层、监事会组成了法人治理决策、执行、监督机构……2012年8月至今,新都区第二人民医院探索法人治理机构建设已经4年多,医院对外拓展和内部管理更加自主。

李雪是新都区第二人民医院的工会主席,从2012年8月开始,她担任该院第一届监事会监事长,承担监管医院运行的责任。“以前只需要干好自己工作就行了,现在还要随时关注医院的发展,不能只顾自己的‘一亩三分地’,还要考虑到全院的未来。”李雪说。

“院长一个人说了不算,对院长也是一种保护和关爱,杜绝了权力的滥用。”新都区第二人民医院院长刘旭东说,法人治理核心是决策层、执行层、监督层等利益相关者之间的权力和利益分配与制衡关系的制度安排,保障了医院决策民主、科学,运行规范、可控,监督实时、有效。

福建省卫计委医院管理局局长明强认为,医务人员是医改的主力军,法人治理等现代医院管理体制为政府权力下放搭建了平台,让医院在业务拓展和内部管理上拥有了更多自主决策权,从根本上释放了医院的内生活力。(记者 董小红、陈弘毅、帅才)

(责编:王子侯、乔雪峰)

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