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观察丨以“北京样本”拓展医改思路
时间:2017-09-04 点击率 : 848

观察丨以“北京样本”拓展医改思路

    在改革处于爬坡过坎的关键期,总结和推广成熟改革经验,充分发挥典型经验对全局改革的示范、突破、带动作用,有利于进一步坚定信念、攻坚克难,有利于创新体制机制、突破利益藩篱,有利于加快建立中国特色基本医疗卫生制度,为推进健康中国建设奠定坚实基础。


    下好医改这盘棋,既要大处着眼又要小处落子,既要敢破敢立又要步步为营

  北京医药分开综合改革实施4个多月,出现“五上升五下降”的喜人变化:基层诊疗量、技术劳动收入、可分配收入、医保保障、医疗救助上升,药费、药占比、二三级医院诊疗量、大型设备检查费、医保患者负担下降。国家统计局北京调查总队的调查显示,九成以上患者支持认可改革、满意就医状况。“北京样本”为全国医改提供了可复制、可推广的经验,值得称赞。

  医改是一道世界性难题,被称为社会政策的“珠穆朗玛峰”。作为首都,北京面临的医改形势更为错综复杂。“善弈者谋势,不善弈者谋子”。下好医改这盘棋,既要大处着眼又要小处落子,既要敢破敢立又要步步为营,这样才能棋高一着,满盘皆活。

  总揽全局,用好三医联动“指挥棒”。医疗、医保、医药是医改的“三驾马车”。过去,“三匹马”缺乏统一的“指挥棒”,各使各的力,各行各的道。从全国各地的实践看,三医联动得好,改革就有实效;三医联动得不好,就会出现联而不动、动而不联的局面,难以形成合力。北京医药分开综合改革规模空前,3700多家医疗机构按照统一部署,同城同步实施改革。医疗、医保、医药整体联动,互相配合,释放三医联动的“叠加效应”,体现了医改的整体性、协同性和系统性,形成了高效运转的体制机制。

  重点突围,追求公共利益最大化。破除以药补医机制,是医改的一块“硬骨头”,牵一发而动全身。北京医改坚持公益性方向,敢于碰硬,破旧立新,体现了攻坚克难的智慧和勇气。例如,取消挂号费和诊疗费,设立医事服务费,提升医务人员技术劳动价值;取消医药加成,实行零差率销售,切断医生和药品之间的利益链;实行药品阳光采购,挤压药品价格的虚高空间。通过一系列改革举措,破除了医疗机构追求药品收入的逐利机制,解决了一部分医疗服务项目收费显著低于成本的问题,使中医、儿科、妇产、护理、传染病等部分短板专业得到发展,公立医院逐步回归公益性轨道。

  稳扎稳打,用价格杠杆撬动分级诊疗。“大医院人满为患,小社区门可罗雀”,这是一道医改难题。北京市合理分级设置医事服务费,医保报销政策向基层倾斜,释放了明确的引导基层首诊的价格信号,促进了分级诊疗制度建设。改革后,三级医院、二级医院门急诊量下降,一级医院及基层医疗卫生机构诊疗量增加,一些常见病、多发病逐步分流到基层机构,大医院的“战时状态”得到有效缓解,有限的专家资源能够更好地服务于危急重症患者,医疗资源配置趋于合理。

  兜住底线,让人民群众更有获得感。北京市加强医疗保险和医疗救助力度,将医事服务费纳入基本医保范围,让大多数患者利益不受损。落实对特殊人群的优惠政策,60岁以上本市老人到一级医院和社区就诊,医事服务费全部免除,高血压、糖尿病等慢性病患者可在社区获得105种常用药品。针对长期住院的精神病人,调整报销政策,实施按床日付费,减轻了患者家庭负担。将社会救助对象的报销比例提高10个百分点,封顶线提高50%,保障了困难群众利益。改革以来,城乡医保患者个人负担总体下降,医保制度发挥了保基本、补短板、兜底线的重要作用。

  全国医改一盘棋,北京医改关乎全局。当前,深化医改进入深水区和攻坚期,利益调整更加复杂,体制机制矛盾凸显。在改革处于爬坡过坎的关键期,总结和推广成熟改革经验,充分发挥典型经验对全局改革的示范、突破、带动作用,有利于进一步坚定信念、攻坚克难,有利于创新体制机制、突破利益藩篱,有利于加快建立中国特色基本医疗卫生制度,为推进健康中国建设奠定坚实基础。星星之火,可以燎原。“北京样本”不应是医改“孤本”,而应是值得借鉴推广的医改“范本”。

来源:人民网-人民日报

作者:白剑峰    责任编辑 钱振霄


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