公立医院将取消行政级别 实行全员聘用制
黄洁夫昨天在政协小组讨论会上发言。本报记者范继文摄
本报讯（记者郭鲲）“单靠增加钱无法恢复公立医院的公益性。”“没有600万医护人员中绝大多数的满意，就没有13亿人民对医疗卫生的满意。”……昨天，全国政协委员、卫生部副部长黄洁夫在小组讨论时表示，目前热议的公立医院试点改革，是要对30年来公立医院形成的“趋利”体制进行彻底改变的大手术。
他透露，公立医院将取消行政级别，实行全员聘用制。
■关于医院公益性
单靠投钱不能恢复公益性
“医疗改革的实质是公立医院的改革，无论公共卫生、基本药物制度、医疗保障以及医疗服务都是围绕公立医院展开的。”黄洁夫说，目前公立医院试点改革中存在一个误区，就是强调卫生经济学、强调加大对公立医院的财政补贴，但是单靠增加钱无法恢复公立医院的公益性。
“我也做过医生、当过院长，改革开放之初医院情况是病房条件差、病床少、医护人员少，当时社会上说有‘两把刀’最热，一个是杀猪的屠刀，一把是医生的手术刀。”黄洁夫说，为了改变卫生资源不足和群众医疗需求的矛盾，当时政府提出了医院承包经营、药品加成、融资创收的政策。
“经过三十年的发展，现在公立医院的运营管理、医生的绩效考核、医院的发展方向，都已经从过去以病人为中心转到以效益为中心。”黄洁夫说，没有钱医院就存活不了，发不了工资、奖金少，人才就流失，缺少学科带头人，医院就没有竞争力。
“因此，现在单靠增加钱无法恢复公立医院的公益性。”黄洁夫说，现在公立医院试点改革，就是要对公立医院进行大手术，对近30年来公立医院形成的“趋利”体制进行彻底改变。
改革需兼顾600万医护人员
如何实现公立医院公益性的回归呢？黄洁夫认为，必须调动全国600万医护人员的积极性和创造型。
“我举个例子，我做医生的时候，医院里面有一两块钱的感冒处方，给病人的输液药品也是医院自己生产的，很便宜，现在几百块钱的透析血液那时候只要20块钱。医生看到病人只一个想法，希望病人尽快好。”
黄洁夫说，现在不一样了，医生面对病人，除了看病，还要考虑经济问题，如果开便宜药，医院要亏本，科室的效益要落后，自己的奖金也落空。
“药价降了那么多次，为什么老百姓还觉得贵，除了药厂停止生产、改名字换包装外，医生的态度也是重要原因。”黄洁夫表示，公立医院的改革必须要让广大医护人员满意，没有600万医护人员绝大多数的满意，就没有13亿人民对医疗卫生的满意。
黄洁夫表示，公立医院改革对医护人员来说是一个发展的机遇，“通过改革将医生以前的‘趋利’成分去掉，让医生事业的崇高重新回归，此外，还要让医生的收入感到满意，愿意让儿孙去考医院，这样的医改才是成功的医改。”黄洁夫说。
公益性不是提供免费医疗
对公立医院的“公益性”问题，黄洁夫给予解释：“对于普通患者来说，公益性不是你去公立医院就会免费医疗，我国到2050年也不可能全面免费医疗。”
黄洁夫解释，我国去年医疗卫生总体费用16000多亿，人均医疗卫生费用1200元，而如果免费提供医护、体检、核磁共振，释放全部医疗需求，远远不止16000亿能够解决。美国的人均医疗卫生费用为7000美金，英国4500美金，如果我们搞免费医疗，经济上根本不可能承受。
黄洁夫说，除了经济原因外，我国没有家庭医生、社区就诊率低以及医疗资源不均衡等原因都决定了我国不可能免费医疗。“我们只能保障贫穷、弱势的群众看得上病，看得好病，有收入的人要为自己的健康和医疗卫生付出一部分钱，先富裕起来的人多出一些钱来享受高端的保健服务。”
■关于药事费
药事费被外界误读
黄洁夫解释说，目前社会上之所以对公立医院改革方案中的“药事费”颇多议论，是因为药事费定义不清，存在被误读。
“药事费是药剂科的问题，跟医院的药品加成没有任何关系。”黄洁夫介绍，“公立医院改革要剥离药品加成，取消以药养医，但医药分离需要一个过程。不是简单的经济问题，还牵扯到医院的管理、文化、效益等深层次问题。”
黄洁夫说，医院都有药房，有药剂师，他们都是医院的职工，都是事业单位的编制，享受着事业单位的工资待遇、职称晋升，如果将药房从医院剥离，这些人怎么办？职称、待遇、子女上学、住房、退休怎么办？
“此外，药剂科不单是卖药的，还有很多药事管理具有大量的技术要求，比如我们做肝脏移植中有个免疫药，药剂师必须要随时查看血液中的浓度，要根据血液浓度调配药品。”黄洁夫说，医药分开不是说医生在治病的过程中进行医药分开。
“药事费不是在开药中间增加钱，取代药品加成的弥补。”黄洁夫形象地说，药品加成驱使医生去开价格高的药，医疗费用提高后，医生的收入可能会减少，但老百姓会得到实惠，过去是花了很多钱，结果得到了很多没用的东西，现在是你花了钱，但是可以得到应有的东西，这是医药分开的初衷。
■关于临床路径
改变百姓就医方式
对于临床路径，黄洁夫解释，对于普通患者，“临床路径”就是解决两方面问题，一个是如何去就医的问题，一个是进入医院后怎么接受诊断和治疗。
“现在很多患者去看病，只知道医院的名字，都跑到有名气的医院去。实际上每个医院都有各自的特点，小病首先到基层的医院就诊。”黄洁夫认为，就医的途径必须将整个医生体系建立起来，包括全科医师、专科医师、住院医师等，将来社区医生是全科医师，并不是看小病的“小医生”。
临床路径的第二方面是进入医院后如何进行诊断和治疗的程序，黄洁夫介绍，今后的方向是规范化的治疗，对一个病，做什么检查、怎么科学诊断、如何选择治疗方式等都将有据可查。
■关于医改前景
绩效工资上不封顶
公立医院试点改革后会是什么情景呢？实行全员聘用制、绩效工资上不封顶、医院营利部分和非营利部分严格分开……黄洁夫如此勾勒解释。
黄洁夫认为，公立医院试点改革后，在人事制度方面，实行全员聘任制度，打破目前公立医院事业编制、职员、雇员、临时聘用医生的身份界定，医院自主地设定人员的配置。
在工资分配方面，实行岗位绩效工资制度，医院要在政府核定的总额内，自主地确定分配方法，按照自己医院的特色，扶植重点领域研究，医护人员绩效工资不封顶，与工作表现、工作量和技术要素挂钩。
在医疗收费和医保付费政策方面，医院将非营利服务和营利服务分开，“做双眼皮、隆胸的应该收费”。其中，营利性的、特需的约占10%，适用于多层次的高端服务。而其他非营利性的医疗费用，如手术费等也将合理提高。
公立醫院將取消行政級別實行全員聘用制
2010年03月07日03:49京華時報郭鯤
黃潔夫昨天在政協小組討論會上發言。本報記者范繼文攝
本報訊（記者郭鯤）“單靠增加錢無法恢復公立醫院的公益性。”“沒有600萬醫護人員中絕大多數的滿意，就沒有13億人民對醫療衛生的滿意。”……昨天，全國政協委員、衛生部副部長黃潔夫在小組討論時表示，目前熱議的公立醫院試點改革，是要對30年來公立醫院形成的“趨利”體制進行徹底改變的大手術。
他透露，公立醫院將取消行政級別，實行全員聘用制。
■關於醫院公益性
單靠投錢不能恢復公益性
“醫療改革的實質是公立醫院的改革，無論公共衛生、基本藥物製度、醫療保障以及醫療服務都是圍繞公立醫院展開的。”黃潔夫說，目前公立醫院試點改革中存在一個誤區，就是強調衛生經濟學、強調加大對公立醫院的財政補貼，但是單靠增加錢無法恢復公立醫院的公益性。
“我也做過醫生、當過院長，改革開放之初醫院情況是病房條件差、病床少、醫護人員少，當時社會上說有'兩把刀'最熱，一個是殺豬的屠刀，一把是醫生的手術刀。”黃潔夫說，為了改變衛生資源不足和群眾醫療需求的矛盾，當時政府提出了醫院承包經營、藥品加成、融資創收的政策。
“經過三十年的發展，現在公立醫院的運營管理、醫生的績效考核、醫院的發展方向，都已經從過去以病人為中心轉到以效益為中心。”黃潔夫說，沒有錢醫院就存活不了，發不了工資、獎金少，人才就流失，缺少學科帶頭人，醫院就沒有競爭力。
“因此，現在單靠增加錢無法恢復公立醫院的公益性。”黃潔夫說，現在公立醫院試點改革，就是要對公立醫院進行大手術，對近30年來公立醫院形成的“趨利”體制進行徹底改變。
改革需兼顧600萬醫護人員
如何實現公立醫院公益性的回歸呢？黃潔夫認為，必須調動全國600萬醫護人員的積極性和創造型。
“我舉個例子，我做醫生的時候，醫院裡面有一兩塊錢的感冒處方，給病人的輸液藥品也是醫院自己生產的，很便宜，現在幾百塊錢的透析血液那時候只要20塊錢。醫生看到病人只一個想法，希望病人盡快好。”
黃潔夫說，現在不一樣了，醫生面對病人，除了看病，還要考慮經濟問題，如果開便宜藥，醫院要虧本，科室的效益要落後，自己的獎金也落空。
“藥價降了那麼多次，為什麼老百姓還覺得貴，除了藥廠停止生產、改名字換包裝外，醫生的態度也是重要原因。”黃潔夫表示，公立醫院的改革必須要讓廣大醫護人員滿意，沒有600萬醫護人員絕大多數的滿意，就沒有13億人民對醫療衛生的滿意。
黃潔夫表示，公立醫院改革對醫護人員來說是一個發展的機遇，“通過改革將醫生以前的'趨利'成分去掉，讓醫生事業的崇高重新回歸，此外，還要讓醫生的收入感到滿意，願意讓兒孫去考醫院，這樣的醫改才是成功的醫改。”黃潔夫說。
公益性不是提供免費醫療
對公立醫院的“公益性”問題，黃潔夫給予解釋：“對於普通患者來說，公益性不是你去公立醫院就會免費醫療，我國到2050年也不可能全面免費醫療。”
黃潔夫解釋，我國去年醫療衛生總體費用16000多億，人均醫療衛生費用1200元，而如果免費提供醫護、體檢、核磁共振，釋放全部醫療需求，遠遠不止16000億能夠解決。美國的人均醫療衛生費用為7000美金，英國4500美金，如果我們搞免費醫療，經濟上根本不可能承受。
黃潔夫說，除了經濟原因外，我國沒有家庭醫生、社區就診率低以及醫療資源不均衡等原因都決定了我國不可能免費醫療。 “我們只能保障貧窮、弱勢的群眾看得上病，看得好病，有收入的人要為自己的健康和醫療衛生付出一部分錢，先富裕起來的人多出一些錢來享受高端的保健服務。”
■關於藥事費
藥事費被外界誤讀
黃潔夫解釋說，目前社會上之所以對公立醫院改革方案中的“藥事費”頗多議論，是因為藥事費定義不清，存在被誤讀。
“藥事費是藥劑科的問題，跟醫院的藥品加成沒有任何關係。”黃潔夫介紹，“公立醫院改革要剝離藥品加成，取消以藥養醫，但醫藥分離需要一個過程。不是簡單的經濟問題，還牽扯到醫院的管理、文化、效益等深層次問題。”
黃潔夫說，醫院都有藥房，有藥劑師，他們都是醫院的職工，都是事業單位的編制，享受著事業單位的工資待遇、職稱晉升，如果將藥房從醫院剝離，這些人怎麼辦？職稱、待遇、子女上學、住房、退休怎麼辦？
“此外，藥劑科不單是賣藥的，還有很多藥事管理具有大量的技術要求，比如我們做肝臟移植中有個免疫藥，藥劑師必須要隨時查看血液中的濃度，要根據血液濃度調配藥品。”黃潔夫說，醫藥分開不是說醫生在治病的過程中進行醫藥分開。
“藥事費不是在開藥中間增加錢，取代藥品加成的彌補。”黃潔夫形像地說，藥品加成驅使醫生去開價格高的藥，醫療費用提高後，醫生的收入可能會減少，但老百姓會得到實惠，過去是花了很多錢，結果得到了很多沒用的東西，現在是你花了錢，但是可以得到應有的東西，這是醫藥分開的初衷。
■關於臨床路徑
改變百姓就醫方式
對於臨床路徑，黃潔夫解釋，對於普通患者，“臨床路徑”就是解決兩方面問題，一個是如何去就醫的問題，一個是進入醫院後怎麼接受診斷和治療。
“現在很多患者去看病，只知道醫院的名字，都跑到有名氣的醫院去。實際上每個醫院都有各自的特點，小病首先到基層的醫院就診。”黃潔夫認為，就醫的途徑必須將整個醫生體系建立起來，包括全科醫師、專科醫師、住院醫師等，將來社區醫生是全科醫師，並不是看小病的“小醫生”。
臨床路徑的第二方面是進入醫院後如何進行診斷和治療的程序，黃潔夫介紹，今後的方向是規範化的治療，對一個病，做什麼檢查、怎麼科學診斷、如何選擇治療方式等都將有據可查。
■關於醫改前景
績效工資上不封頂
公立醫院試點改革後會是什麼情景呢？實行全員聘用制、績效工資上不封頂、醫院營利部分和非營利部分嚴格分開……黃潔夫如此勾勒解釋。
黃潔夫認為，公立醫院試點改革後，在人事制度方面，實行全員聘任制度，打破目前公立醫院事業編制、職員、僱員、臨時聘用醫生的身份界定，醫院自主地設定人員的配置。
在工資分配方面，實行崗位績效工資制度，醫院要在政府核定的總額內，自主地確定分配方法，按照自己醫院的特色，扶植重點領域研究，醫護人員績效工資不封頂，與工作表現、工作量和技術要素掛鉤。
在醫療收費和醫保付費政策方面，醫院將非營利服務和營利服務分開，“做雙眼皮、隆胸的應該收費”。其中，營利性的、特需的約佔10%，適用於多層次的高端服務。而其他非營利性的醫療費用，如手術費等也將合理提高。
Public hospitals will cancel the full implementation of the executive-level appointment system
At 3:49 on March 7, 2010 Jinghua Shibao Guo Kun
Huang Jiefu CPPCC panel discussion yesterday in a statement. Reporter Ji-Wen Fan Photo
(Reporter Guo Kun) "can not be restored by adding more money to public hospitals, public welfare." "No 6 million health care workers in the vast majority of satisfaction with the 1.3 billion people have no health care satisfaction." ... ... Yesterday CPPCC National Committee members, Vice Health Minister Huang Jiefu in the panel discussion said that the current hot-pilot reform of public hospitals is to make the past 30 years in public hospitals to form the "benefits or reduce" system to conduct a thorough change of major surgery.
He said, public hospitals will cancel the administrative level, the implementation of full appointment system.
■ With regard to the hospital public service
Money alone can not restore public welfare investment
"Health care reform is essentially the reform of public hospitals, regardless of public health, essential drugs, medical care, security and medical services are carried out around the public hospitals." Huang Jiefu said that the current reform of public hospitals in the pilot that there is a misunderstanding, that is, emphasizing health economy study, emphasized that increasing financial subsidies for public hospitals, but money alone can not be restored in public hospitals to increase public welfare.
"I have been a doctor, served as president of the beginning of reform and opening up the hospital ward situation is poor, fewer hospital beds, medical personnel less society at that time, said a 'two knives' hottest, one a butcher knife, one is the doctor's scalpel. "Huang Jiefu said that in order to change the lack of health resources and medical needs of the masses of the conflict, when the Government has proposed a hospital contract management, drug addition, finance income-generating policies.
"After three decades of development, is now operational management of public hospitals, doctor's performance appraisal, the hospital's development direction, have been patient-centered from the past to focus on efficiency." Huang Jiefu said that without the money hospitals can not survive , hair can not pay, bonuses less talent on the drain, lack of academic leaders, the hospital will not be competitive.
"So, now the money can not be restored simply by increasing public interest in public hospitals." Huang Jiefu said that now the pilot reform of public hospitals is to carry out major surgery on public hospitals for the past 30 years in public hospitals to form the "benefits or reduce" system to conduct a thorough change.
Reform must take into account six million health care workers
How to achieve the return of public service in public hospitals do? Huang Jiefu that it was important to mobilize the country's 6 million health care initiative and creative.
"Let me give an example, I did a doctor, hospital inside 12 money cold prescription drugs to the patient's fluid is produced by the hospital itself is very cheap, and now a few hundred dollars at that time in dialysis of blood money as long as 20 . a doctor to see patients just an idea and hope the patient as quickly as possible. "
Huang Jiefu said that it is different, and doctors confronted with a patient, in addition to medical treatment, but also considering economic issues, if open cheap medicine, the hospital will suffer a loss, the effectiveness of departments to be backward, their own prize money did not happen.
"Drug prices down so many times, why people still find it expensive, in addition to pharmaceutical companies to stop production to change the name for the packaging, the doctor's attitude is also an important reason." Huang Jiefu said the public hospitals to make broad health care reform must be satisfied, the vast majority of 6 million health care workers is not satisfied with the 1.3 billion people have no health care satisfaction.
Huang Jiefu said the reform of health care in public hospitals is a development opportunity, "through reform of a doctor prior to the 'benefits or reduce' components removed to allow doctors to re-return to the noble cause, in addition, the income of the doctor is satisfied with , willing to let my children and grandchildren to take a hospital, such change is the success of the medical health reform. "Huang Jiefu said.
Public welfare is not to provide free medical care
On public hospitals, "public welfare" issue, Huang Jiefu to explain: "For the average patient, the public interest would not you go to public hospitals, free medical care, my 2050 can not be fully free medical care."
Huang Jiefu explained that the overall cost of health care in China last year, more than 16,000 billion, per capita health care costs of 1,200 yuan, and if the free health care, medical, nuclear magnetic resonance, the release of all medical needs, far more than 1.6 trillion to solve. U.S. per capita health care costs 7000 U.S. dollars, the United Kingdom 4500 U.S. dollars, if we engage in free medical care, the economy simply can not afford.
Huang Jiefu said in addition to economic reasons, China has no family doctor, community attendance rate is low as well as medical resources, imbalance and other reasons have decided the country can not be free medical care. "We can only protect the poor, disadvantaged people see on the disease, see a good disease, of those with income for their health and health care to pay part of the money, the first rich people more money and enjoy the high number of health care services. "
■ With regard to staff costs of drugs
Pharmaceutical costs have been misreading the outside world
Huang Jiefu explained that the reason why in today's society for public hospital reform program in the "Pharmaceutical Affairs fee" quite a lot of discussion because of the unclear definition of Pharmaceutical charges, there have been misread.
"Department of Pharmacy, Pharmaceutical costs are the problem, with the addition of hospital medicine has nothing to do." Huang Jiefu description, "public hospital reform in addition to spin-off drugs, abolishing the use of drugs to support medical care, but the medicine is the need for a process of separation. Is not a simple economic issues, but also involves the management of the hospital, culture, benefits, and other deep-seated problems. "
Huang Jiefu said the hospital has a pharmacy, a pharmacist, they are hospital employees, are the establishment of institutions, public institutions enjoy wages, job promotion, if the spin-off from the hospital pharmacy, these people how to do? Job title, treatment, their children's schooling, housing, retirement how to do?
"In addition, Department of Pharmacy is not just sell drugs, and there are a lot of Pharmacy has a large number of technical requirements, such as we do have a liver transplant in the immune drugs, pharmacists have to keep track of blood concentration of the blood concentration of the deployment according to Drugs. "Huang Jiefu said that Chinese medicine is not to say doctors separated during the process of healing medicine separately.
"Pharmaceutical costs are not increased in the middle of prescribing the money to replace the drug-plus make up." Huang Jiefu image to say that drugs plus high prices driven by a doctor to open the medicine, medical costs increase, the doctor's income may be reduced, but the people will receive benefits, in the past spent a lot of money, the result has been a lot of useless things, and now that you spent a penny, but you can get what is rightfully ours, which is separate from the original intention of medicine.
■ With regard to clinical path
To change the way people seek medical treatment
For the clinical pathway, Huang Jiefu explanation, for ordinary patients, "clinical path" is to solve two problems, one is how to go for medical treatment of the problem, one is to enter the hospital how to diagnosis and treatment.
"Now many patients go for help, only know the name of the hospital, all went to famous hospital. Virtually every hospital has its own characteristics, minor illnesses to the grass-roots hospital first." Huang Jiefu that the way to medical treatment must be set up the entire medical system, including general practitioners, specialist physicians, residents, etc., in the community doctors are general practitioners, not look at small disease "little doctor."
The second aspect of the clinical path on how to enter the hospital for diagnosis and treatment procedures, Huang Jiefu introduction, the future direction of standardization of treatment, for a disease, what to do inspections, how the scientific diagnosis, treatment and so on will be how to select evidence - to be investigated.
■ With regard to the prospects for health reform
Performance-based pay is not cap
After the reform of public hospitals in the pilot what scene it? The implementation of full employment, performance-based pay does not cap, hospitals and non-profit part of the profit part of the strict separation ... ... Huang Jiefu outlined to explain this.
Huang Jiefu that the pilot reform of public hospitals, in the personnel system, the implementation of full appointment system, to break the current cause of the preparation of public hospitals, staff, employees, defined as the temporary employment of doctors, hospitals independently set up staffing.
In the wage distribution, the implementation of job performance wage system, the hospital asked the Government the total amount approved, the independent distribution method to determine, in accordance with their own characteristics of the hospital, support key areas of research, health care workers wages are not cap performance, job performance, the workload and technical elements linked.
Pay for medical fees and medical insurance policy, the hospital will care as separate non-profit and for-profit service, "done to make eyes, breast of the fee should be charged." Among them, for-profit, special needs, about 10%, suitable for multi-level high-end services. While other non-profit medical expenses, such as surgical fees will also be a reasonable increase.