【直报网3月30日讯】（人民日报）新医改走过6个年头，“看病贵”依然是社会各界热议的话题。

CNDSN March 30th news [] (people's daily) the new medical reform over the past 6 years, "the doctor your" is still a hot topic of the various circles of society.

有人说，医改是世界性的难题，在中国这样的人口大国、发展中国家更是难上加难。但是，这不是我们漠视这个问题的理由。健康是群众的基本需求，医改是全面建成小康社会的重要保障。近几年，医改大刀阔斧，药价多次调整，医保标准不断提高，惠民力度不断加大，但不少人仍有看病贵、负担重的“痛感”。

Some people say, health care reform is a worldwide problem, in such a large population, China developing countries is even more difficult. However, this is not the reason we ignore this problem. Health is the basic needs of the masses, health care reform is fully completed an important guarantee for the well-off society. In recent years, health care reform boldly prices adjusted several times, health standards continue to improve, Huimin has intensified, but many people are still expensive and heavy burden "pain".

在并不便宜的医疗消费面前，医保有无奈，医院道苦衷，医生诉委屈，患者倒苦水。我们试图去接近那个最大公约数，结果发现，越深入，越具体，越觉得问题的复杂和难解，真是有点剪不断理还乱的感觉。

In the face of not cheap medical consumption, medical insurance are helpless, Hospital Road difficulties, the doctor v. grievances, patients with inverted grievances. We tried to get close to the greatest common divisor, the results found, more in-depth, more concrete, more think problem is very complex and difficult to understand, is really a little cut constantly tangled feelings.

是什么稀释了医改的“获得感”？

The dilution of health reform "gets the flu"?

打不完的清单

Do not hit list

“进了医院，有时钱就像纸一样了”

"In the hospital, sometimes money is like paper"

前些年，北京大学专家在江苏某地调查医改时，一位农妇说出来的一句话——“进了医院，有时钱就像纸一样了”，引起了许多人的共鸣。

A few years ago, experts from the Peking University survey of health care reform somewhere in Jiangsu, a woman speak a word -- "into the hospital, sometimes money is like paper", caused many people.

前不久，患者陈平安在某医院做了一个非常普通的手术，术后住院期间，有一天被催缴药费，由于家属没在医院，他就临时凑了2000元先交了，结果，药房当天还是无法正常供药——他补交的钱还不够一天的药费。

Not long ago, with Chen Pingan made a very common operation in a certain hospital, during the postoperative hospital stay, one day be a medicine, because their families are not in the hospital, he is temporarily collected 2000 yuan to pay, results, or can not be normal for pharmacy day drug -- drug he pay enough money a day.

武汉协和医院院长王国斌等医学界的人大代表和政协委员们，在今年的全国两会上都坦陈，看病贵，的确是一个客观事实。

NPC deputies and CPPCC members medicine Wuhan Union Hospital Dean Wang Guobin, in this year's national NPC and CPPCC on Doutan Chen, expensive, is indeed an objective fact.

国家卫计委统计公报显示，2013年全国卫生总费用达3万亿元以上，三四年时间上升了1万亿元，超过了居民收入的增速。

The National Health Planning Commission statistical bulletin shows that in 2013 the national total health expenditure amounted to 3 yuan of above, three or four years increased 1 trillion yuan, exceeded income growth.

打印不完的医院费用清单，到底有多少难解的疙瘩？

Print don't finish the hospital bill, exactly how much hard a knot in one's heart?

算不清的“打折”

If they can't clear "sale"

“政策报销比”与“实际报销比”咋差那么多？

"So many policy reimbursement ratio" and "the actual reimbursement ratio" how bad?

在全民医保体系基本建立的今天，看病贵的“痛感”明显，不仅因为医疗费的总价居高不下，还在于患者的“实际报销比”常常明显低于“政策报销比”。

In the medical insurance system basically established today, expensive "pain" is obvious, not only because of the medical expenses of the price is high, but also in patients with "the actual reimbursement ratio" is often significantly lower than the policy of "reimbursement ratio".

所谓“政策报销比”，是指剔除了自费部分后的报销比例；而“实际报销比”是包含了自费部分的报销比例——患者的直接感受是来自这里的，他们只认“花出去多少钱，报回来多少钱”这笔账。

The so-called "policy, reimbursement ratio" refers to the part of the cost of reimbursement after rejecting the proportion; and "the actual reimbursement ratio" include direct feeling at their own expense reimbursement ratio -- part of the patients is from here, they only "spend how many money, the newspaper back much money" this account.

转诊、大医院自费比例高

Referral, at their own expense, a high proportion of hospital

现在，我国基本实现了人人医保，这是历史的巨大进步。但是，医保看病，不等于自己不需要掏钱。

Now, China has achieved all health care, this is great progress of history. However, medical treatment, is not equal to you don't need money.

这是某省会城市部分三甲医院2014年住院病人自费比例的数据：新农合病人转诊到省会三甲医院就诊的，自费率为57.93%；转诊到省会城市的城镇职工，自费率36.48%；省会城市自身的医保职工，自费率24.54%。无论是哪种情况，患者的“实际报销比”都低于“政策报销比”。什么原因？

This is the data 2014 hospitalized patients at their own expense proportion of a certain city in part 3 armour hospital: a new patient referral to the provincial capital 3 armour hospital, at their own expense rate was 57.93%; referral to urban workers in the provincial capital city, at their own expense rate 36.48%; health care workers in the capital city itself, since the rate of 24.54%. In either case, patients with "the actual reimbursement ratio are lower than the" policy "reimbursement ratio". What is the reason?

湖北省卫计委要求，基层医疗卫生机构基本药物的使用量和销售额不低于80%，二级医疗机构基本药物使用量和销售额比例为40%至50%，三级医疗机构基本药物使用量和销售额比例为25%至30%。基本药物，是医保可以全部报销的药品。

Hubei Province Health Planning Commission requirements, basic drugs in basic medical and health institutions use quantity and sales of not less than 80%, the proportion of sales amount and use of essential medicines two medical institutions from 40% to 50%, the proportion of sales amount and use of essential medicines three medical institutions was 25% to 30%. The basic medical insurance drugs, is can full reimbursement of drugs.

武汉著名的协和医院和同济医院，目前都只有部分科室接受医保病人的就诊，多数科室并非医保的定点医疗单位。

The famous Peking Union Medical College Hospital and Tongji Hospital in Wuhan, are only partially departments to accept Medicare patients for treatment, the medical unit is not the most departments of medical insurance.

转诊的层级越高，报销的比例就越低，这是转诊的原则。以湖北当阳新农合农民为例，如果在乡镇医院住院就医，800元以内可全部报销，800元以上则报销85%；如果转诊到省级医疗机构，报销比例就降为45%至55%。

Referral level higher, reimbursement proportion is lower, this is a referral principle. Taking Hubei Dangyang NRCMS farmers for example, if in the township hospital for medical treatment, less than 800 yuan of all claims, more than 800 yuan to submit an expense account is 85%; if the referral to medical institutions at the provincial level, reimbursement ratio is reduced to 45% to 55%.

级别高的医院，基本药物的使用比例就会相对较低；而转诊到高级别的医院，报销的比例也会因转诊而“打折”。基本药物用得少了，自费的药物和检查治疗等，就可能会多用。还有，材料费有的不能报销，有的只报一小部分。如果是跨省异地的病人，还有可能因为不同地区的政策和医疗价格上的差异，导致病人个人负担加重，等等。这样综合下来以后，“实际报销比”会低于“政策报销比”。

High level of hospital, the basic drug use proportion will be relatively low; and referral to a high level of hospitals, reimbursement ratio will for referral and "discount". The basic drug is used less, at their own expense, drugs and examination and treatment, may use. Also, the cost of materials and some can not be reimbursed, some only a small part of. If the remote provinces of the patient, there may be because of differences in different regions of the policy and medical price, lead to personal burden of patients increased, etc.. After such a comprehensive down, "the actual reimbursement will be lower than the policy of" reimbursement ratio "".

同样的手术悬殊的收费

The same operation between charging

同样是痔疮手术，此院收费近4万元，彼院只需1万元；此医院术后要上导尿和引流管，彼医院不用，不仅省费用，患者也少痛苦；从麻醉的环节看，前者半身麻醉，后者只局部麻醉；从术后消炎环节看，前者持续一周以上，每天挂一些“高大上”的静脉注射液，后者一般只挂两天；前者对伤口不做任何局部的处理，后者坚持每天用廉价的中药，对伤口进行局部的消炎……超出很多人想象的是，一个很普通的手术，不同的医院，手术的路径和收费，竟有如此大的差别。

The same is haemorrhoid operation, the school charges nearly 40000 yuan, this school only 10000 yuan; to the catheterization and drainage tube after operation of the hospital, this hospital without, not only cost saving, patients were also less pain; from the anesthesia link to see, the former spinal anesthesia, the latter only local anesthesia; from the postoperative inflammation link, the former lasted for more than a week, every hang some "tall" intravenous injection, the latter usually hang two days; the former does not do any part of the treatment of wounds, who insists that with cheap Chinese medicine, wound for local inflammation...... Many people imagine is exceeded, a very common operation, different hospitals, path and charging operation, so there is big difference.

Hospital medical expenses, elastic or great. Therefore, it is suggested, to some common diseases, quota management insurance trial of disease. Higher than the fixed costs, not all borne by patients, the hospital will take part; lower than the standard, the curative effect after patients signed endorsement, can implement the reward to the hospital. Let the hospital also produce power less money, good disease.

并非无解方程式

Is not no solution equation

控制医疗费用过快增长，是医改必须啃下的硬骨头。

Medical expenses control fast growth, health reform must face to hoe.

武汉市中心医院副院长杨国良和武汉市第五医院党委副书记崔水保建议，政府应另外适当投入，通过购买商业医疗保险的途径，补充解决大病治疗费的问题，避免少数大病患者过多占用多数医保人员的参保费用。同时，要提高参保人员一般疾病的实际报销比例，从面上减轻看病贵的“痛感”。

Yang Guoliang vice president Wuhan Central Hospital and Wuhan City Fifth Hospital deputy party secretary Cui Shuibao suggested, the government should also appropriate inputs, by continuing to buy commercial medical insurance, supplementary to solve the ill treatment of costs, avoid a few serious illness patients too much occupied most health care personnel participating cost. At the same time, to improve the general disease of the insured the actual reimbursement ratio, from the surface to reduce the expensive "pain".

此外，不少人认为，现行的药品政府采购体制，容易形成某种新的价格垄断，不利于降低药价。这种背景下，甚至出现了某些医院的药价高过药店价格的现象。对此，湖北现在允许二级以上医疗机构探索以带量采购的方式与药品企业进行议价采购，药品议价以全省二级以上医疗机构药品集中招标的中标价格为议价基准，其最终采购价格不得超过基准价格；执行药品零加成政策的医疗机构，按药品的实际采购价格销售。未执行药品零加成政策的医疗机构，以实际采购价格按照国家和省价格主管部门规定的作价方法加成后销售。

In addition, a lot of people think, the current system of government procurement of pharmaceuticals, easy to form a new price monopoly, not conducive to reduce drug prices. Under this kind of background, and even the emergence of some hospital drug prices higher than the drugstore price phenomenon. In this regard, Hubei now allows more than two medical institutions to explore with the amount of purchase way and drug enterprise bargaining procurement, drug bargaining in the province more than two medical institutions drug centralized bidding bid price for the bargaining reference, its final purchase price shall not exceed the benchmark price of drug; a medical institution policy zero plus, according to the actual purchase price of sale of the drug. The medicine to medical institutions policy zero is not executed, to the actual purchase price in accordance with the provisions of the state and the province, the pricing method of the competent departments of price plus sales.

坚持医保、医疗、医药“三医联动”改革，看病贵，就不会成为一个无解方程式。

Adhere to the medical insurance, medical, pharmaceutical "three medical interaction" reform, expensive, would not be a solution to the equation.

（原标题：人民日报调查：医改大刀阔斧 仍难解百姓“看病难”之痛）

(original title: People's daily survey: health care make snap is still obscure people "see" pain)

责任编辑：小申

Editor: small Shen