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卫生部副部长直言医务人员不能消极"被医改"
2010-07-09 07:45 南方日报
前天傍晚,张茅结束了3天访粤行程,从深圳乘机返京。
7月5日至7日,国务院深化医改领导小组副组长、卫生部党组书记、副部长张茅,马不停蹄地到广州、东莞、深圳,对多家大医院、民营医院、社区卫生中心展开密集调研,展示务实、开明的作风。
上任首次访粤,正逢新医改进入攻坚之年,他对广东诸多创举赞赏有加,也寄予厚望。在去机场的路上,张茅一脸微笑,接受南方日报记者的独家采访。
深圳人大为中医药立法,是好的探索
南方日报:这是您上任后首次来粤调研,对广东的医改工作有何评价?
张茅:我有几年没来广东了,这次发现广东变化很大,开了眼界。广东的医改探索,起好步、开好局,创造了不少好经验。
我这次印象比较深的是,深圳的社区卫生中心实行“政府主导、院办院管”,由大医院来办辖区内的几家社区卫生中心,实行一体化管理,专家定期下社区,解决了社区没人才的问题,提高群众信任度,实现“小病在社区”分流大医院的病人。这个探索很好,值得推广。
广东的中医药强省建设也成效显著。广东省中医院吸引全国名老中医到广东传授绝活,医院开展的针灸推拿等特色疗法,现在已经不多见了。深圳市人大还专门为中医药立了法。如何发挥中医药在医改中的作用,是医改的重要内容,广东做了很好的探索。
另外,广东发动社会力量办医,东莞、深圳民营医疗机构占医疗机构总量的30%左右,形成多元办医格局,方便群众看病。
抗生素滥用是个大问题
南方日报:公立医院改革是医改难点,很多医院院长担心,药品加成政策一旦取消,医院很难维持。但这次您反复强调,要发挥医务人员在医改中的主力军作用,公立医院改革试点要稳妥推进,能否说是给他们派了定心丸?
张茅:钟南山院士曾说过,医改存在“两头热、中间冷”,就是政府和群众热,大医院的医务人员冷,担心他们利益受损。其实,医务人员不是消极地“被医改”,而是医改的主力军,要积极投身医改。不发挥医务人员的积极性,医改不可能成功。
南方日报:最近各地陆续爆出“天价药”、“暴利药”问题,有什么办法遏制药价虚高?
张茅:药价问题很复杂。目前看来,我们的药品集中招标还没能切实降低虚高药价,需要进一步研究。国家的小药厂太多太散,我认为,招标办法应进一步完善,量价挂钩,保障质量安全、降低价格。
过去对药品价格说的较多,但药品质量不能忽视。安全是首要问题。我在西部一些村卫生室看到,一些药物便宜得太离谱,就让他们送去检验一下,到底有多少有效成分?
抗生素滥用也是一个大问题。现在基层医院、大医院动不动就给群众挂水、打点滴,被称作“三素一汤”(抗生素、激素、维生素、盐水)。这不仅浪费医疗资源,还造成严重的耐药性,会成为一个影响中华民族健康的大问题,必须重视加以解决。我们要大力推广安全适宜的基本药物,改变医院趋利性,遏制抗生素滥用问题。
医改投入考验地方官员政绩观
南方日报:新医改方案中提到,医药价格改革要降药价、提劳务。但不少群众担心,一头降一头升,最终看病负担还是重。
张茅:现在的医药价格有些扭曲,药价虚高,但医疗劳务价格偏低。一个合格的全科医生起码要读5年大学,3年临床培训,从事的又是高知识、高风险的行业,但现在我在调研的医院看到,挂号费比较低,一个护士护理费一天才7元,不能体现医务人员的劳动价值。而且这种扭曲的价格体系,容易诱导医生靠开药、开化验单挣钱,而不是靠医疗技术和服务。
南方日报:中央提出3年新增8500亿元投入医改。但有人担心,中央的钱是下去了,但地方尤其是一些欠发达县市的配套资金难以到位。
张茅:有些地方财政确有困难,但也存在思想认识的问题。今年我国经济形势持续向好,前5个月全国财政收入增长30.8%。要把蛋糕切好,更多的资金要用于民生。
这涉及官员的政绩观问题。过去我们一些干部忙着抓大项目、把GDP搞上去,而对于医改这些要花大钱的民生项目,就不太积极。现在中央高度重视医改工作,情况已经有所改变。最近关于“神木模式”的讨论比较热,我去过神木,它是百强县,财力较足,人均400元补贴群众医疗。如果我们的百强县都这么做,更多的群众就能得到实惠。
刚才,雷于蓝副省长告诉我,广东有个地市领导干部说,我这条路不修,下一任还可以去修；但这个医院不盖不行,百姓等着看病啊。当然,路也是可以修的,但能否把有限财力优先投到医疗卫生等民生项目,确实考验干部的认识水平和执政能力。
医改不能一蹴而就,社会要有合理期望值
南方日报:您多次强调,医改是一项长期、艰巨的任务。但能否通俗地告诉老百姓,新医改3年下来,能解决什么问题?
张茅:确实,医改是一个世界难题,美国经济那么发达还在搞医改。中国还是一个发展中国家,人口多、底子薄,医改不能一蹴而就,社会的期望值不能太高。
本届政府这3年医改,能做什么呢?首先,新农合人均补贴从目前的120元要提高到300元,这样农民看病报销比例和封顶线就能大幅提高。而且,针对儿童先天性心脏病、白血病这两种大病,今年已经和民政部联合启动救助试点。
其次,基本药物制度3年内覆盖全国所有乡镇卫生院、社区医院,让群众用上安全、有效、便宜的药物,降低看病负担。
第三,公共卫生9大项目都在实施,农村妇女免费筛查乳腺癌、宫颈癌,3年给100万贫困白内障患者免费复明。
公立医院改革还需探索,但方向是明确的,就是要体现公益性,遏制医院的趋利性。我们要刹住公立医院的贷款、负债行为。现在医院攀比买设备、盖大楼,不惜贷款借钱,最后还是转嫁到患者身上。深圳市政府出资建设医院,现在公立医院无一贷款负债,确实很难得,体现了政府责任。
张悟本事件应引起反思
对于前段时间沸沸扬扬的张悟本事件,我认为应该引起反思。这既说明群众对健康资讯的渴盼,也暴露了我们权威准确信息的发布还不够。健康教育、预防为主,不能只靠疾控中心,大医院的专家也有责任。我们在医改方案中提出,要在中央电视台设立健康频道,这还在推动中。健康教育也应该纳入学校教育,学生除了学语数英、搞应试教育,还得有充足课时学健康知识。这应该上升到国民健康教育的高度,来推动解决。
撰文:南方日报记者陈枫
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Deputy Minister of Health with respect medical personnel can not be negative "by medical reform"
2010-07-09 07:45 Nanfang Daily
The day before yesterday evening, Zhang Mao ended three days Guangdong visit, fly back to Beijing from Shenzhen.
5 to 7 July, the State Council Leading Group deepening medical reform deputy head of the Ministry party secretary, Zhang Mao, vice minister, non-stop to Guangzhou, Dongguan, Shenzhen, on several major hospitals, private hospitals, community health centers to intensive research, demonstrate a pragmatic, open-minded style.
Took first visit to Guangdong, coincided with a new medical reform has entered a crucial year, he praised Guangdong plus a number of pioneering, but also high expectations. The way to the airport, Zhang Mao, his face a smile, accepted an exclusive interview with Nanfang Daily Press.
Traditional Chinese Medicine, Shenzhen People's Congress for the legislation is good to explore
Nanfang Daily: This is your first time since taking office Laiyue research work on medical reform in Guangdong any comment?
Zhang Mao: I have not come to Canton a few years, and this time found that Guangdong has changed dramatically, opening the eyes. Medical reform in Guangdong to explore, a good start, a good beginning, to create a lot of good experience.
I am deeply impressed this is the implementation of community health centers in Shenzhen, "government-led Yuan Ban hospital management", by the large area of the hospital to run several community health centers, the implementation of integrated management, community experts on a regular basis to address no to the question of community, enhance public trust and achieve "minor illness in the community," diverting large hospital patients. The exploration well worth promoting.
Construction of Traditional Chinese Medicine of Guangdong province has achieved remarkable results. Guangdong Provincial Hospital of Traditional Chinese Medicine to attract national names and old to teach unique skills to the Guangdong Hospital of Traditional Chinese characteristics, such as carrying out the therapy, is rarely seen now. Shenzhen Municipal People's Congress has also set up specifically for the Chinese medicine method. How to play Chinese medicine's role in health care reform is an important part of medical reform, Guangdong has done a very good exploration.
In addition, Guangdong to launch social forces to run Medical, Dongguan, Shenzhen, private medical care institutions, medical institutions, 30% of the total form multiple doctors do pattern convenient for people see a doctor.
Overuse of antibiotics is a big problem
Nanfang Daily: Medical Reform of public hospital reform is difficult, and many hospital directors worry that drugs policy to be abolished addition, the hospital is difficult to maintain. But this time you are repeatedly stressed the need to play to medical personnel in medical reform in the main force, the pilot reform of public hospitals to secure progress, whether that is to give assurance that they sent?
Zhang Mao: Academician Zhong Nanshan has said there is medical reform, "two hot, intermediate cold", that the Government and people heat, cold large hospital medical staff, worried about their interests. In fact, the medical staff does not passively "by medical reform," but the main force of medical reform, medical reform should be an active part. Do not play the enthusiasm of the medical staff, medical reform can not succeed.
Nanfang Daily: Recently, one after another around the burst "Costly medicine", "profiteering drug" problem, check to hold down prices in what way?
Zhang Mao: drug prices are complex. Now it seems that our medicines can effectively reduce the concentration of the tender has not unrealistically high drug prices, need further study. National pharmaceutical companies too much and too little scattered, I think, bidding methods should be further improved, and capacity price linked to ensure quality and safety, and lower prices.
The past, said drug prices more, but the quality of medicines can not be ignored. Security is top priority. I have a number of village clinics in the west to see some drugs cheap too far off the mark, let them send test it, in the end the number of active ingredients?
Overuse of antibiotics is also a big problem. Now hospital, large hospitals give people hanging motionless water, intravenous fluids, is called the "three elements of a soup" (antibiotics, hormones, vitamins, salt). This is not only a waste of medical resources, but also cause serious drug resistance will become a major problem affecting the health of the Chinese nation, must be addressed seriously. We should vigorously promote the safety of appropriate essential drugs, to change the hospital seeks profit nature, contain antibiotic abuse.
Medical reform concept into the test performance of local officials
Nanfang Daily: The new medical reform plan mentioned in the, pharmaceutical price reform to lower drug prices, Tilao service. But many people worry that a falling one liter, or the heavy burden of the final medical treatment.
Zhang Mao: the current price of some distortion of medicine, hold down prices, but the low price of medical services. A qualified general practitioner at least 5 years to the University of Reading, 3 years of clinical training, is also engaged in high-knowledge, high-risk industry, but now I see in the research hospital, a low registration fee, a nurse care, and a genius 7 yuan, can not reflect the value of medical staff working. And that the distorted price system, easily induced by a doctor to prescribe, to open the laboratory to make money, rather than medical technologies and services.
Nanfang Daily: Central made 3 additional 850 billion yuan invested in health care reform. But some people worry that the money is going central, but less developed areas, particularly in some cities and counties of the matching funds is difficult to place.
Zhang Mao: Some local governments are really hard, but there are also ideological understanding of the problem. This year the economic situation continues to improve, the first 5 months of fiscal revenue nationwide increased 30.8%. Cake should be cut and more money to be used for livelihood.
This involves the performance of officials view the issue. Grasping some of our cadres were busy over the last big projects to boost GDP, but for medical reform the livelihood of these hugely expensive project, it is not active. Now the work of central government attaches great importance to medical reform, the situation has changed. Recently on the "Giant Tree Model" in a fairly hot, I have been sacred trees, it is hundred counties, a more adequate financial resources, 400 yuan per capita public health subsidies. If our hundred counties to do so, more people can get benefits.
Just now, Lei Yulan, Vice Governor told me that there are cities of Guangdong, the leading cadres, I do not repair this road, the next can to repair; but the hospital does not cover No, people waiting for medical care ah. Of course, the road also can repair, but could give priority to the limited financial resources invested in health care and other livelihood projects, really test the level of awareness of cadres and the ability to govern.
Medical reform can not be done overnight, must have reasonable expectations
Nanfang Daily: You repeatedly stressed that health care reform is a long, arduous task. However, whether popular to tell people, new medical reform over 3 years, to solve the problem?
Zhang Mao: Indeed, the medical reform is a world problem, the U.S. economy is still engaged in less developed health care reform. China is still a developing country with a large population, weak economic foundation, medical reform can not be achieved overnight, and social expectations can not be too high.
3 years of this government that medical reform, what can you do? First, the new rural cooperative subsidies per capita from the current 120 yuan to 300 yuan to improve, so that farmers see a doctor reimbursement and can substantially increase the cap line. Moreover, for children with congenital heart disease, leukemia, both seriously ill, this year, and the Ministry of Civil Affairs have jointly launched rescue pilot.
Second, the essential drugs system 3 years covering all township hospitals, community hospitals, so that the people access to safe, effective, inexpensive drugs to reduce the burden of medical care.
Third, the public health in the implementation of the 9 major projects, rural women free screening for breast cancer, cervical cancer, 3 years to 100 million poor cataract patients free Fuming.
Reform of public hospitals need to explore, but the direction is clear, is to reflect the public interest, the hospital seeks profit of containment. We have to check the credit of public hospitals, liabilities behavior. Hospital comparisons now to buy equipment, build buildings, loans to borrow money at the end they passed on to patients. Construction of the Shenzhen Municipal Government funded hospitals, public hospitals are not a loan liabilities, really hard to come by, and reflects the government responsibility.
Zhang Wu of the incident should cause reflection
Gordon Chang uproar for some time ago in this event, I think it should cause reflection. This not only shows the eager public health information, also exposed the release of our authority is not enough accurate information. Health education, prevention, can not rely on CDC, large hospitals have a responsibility to the experts. We are in the healthcare reform package proposed to set up health channel CCTV, which also promote. Health education should also be included in school education, the number of English language, students learn, practice oriented education, school health class had to have sufficient knowledge. This should rise to the height of the national health education to promote the settlement.
Author: Chen Feng, the Nanfang Daily Press
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