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梁万年:深化医改要解决“难、贵、管”

2018-12-20 梁万年 中国卫生杂志

党的十九大对深化医改作出明确部署,一是要完善供应健康政策;二是要加快建立中国特色的基本医疗卫生制度;三是要构建优质高效的医疗卫生服务体系。

党的十九大对深化医改作出明确部署,一是要完善供应健康政策;二是要加快建立中国特色的基本医疗卫生制度;三是要构建优质高效的医疗卫生服务体系。

2018年下半年,深化医改重点任务从7个方面制定了50条任务,并明确相关部门和地方的需求、分工以及推进的时间表、路线图。医改下一步的工作重点主要聚焦在3个方面:第一,解决看病难问题。第二,缓解看病贵问题。第三,解决医疗卫生系统或者机构的管理问题。

针对看病难问题

针对看病难问题,第一个解决办法是对资源进行有效配置。在优质资源稀缺的状况下,首先要谋求资源的增量,可以通过发展社会力量办医增加资源供给。其次要对人力资源加大培养力度。对于存量资源,要进行优化配置。一方面充分发挥现有资源的效率和效益,进行合理的分工、定位,使不同级别的医疗机构真正回归各自的功能定位,同时能够得到合理的补偿,实现良性运行。第二个解决办法是继续推动分级诊疗。牢牢抓住医联体、家庭医生签约服务和远程医疗3个抓手。第三个解决办法是今年医改重点任务中提出的规划布局,规划国家医学中心和区域医疗中心,真正实行区域分开。第四个解决办法是构建以人为本,以健康为中心的医疗服务体系,把医疗机构回归到本来的定位,进行有效协同,结束当前无序竞争。

针对看病贵问题

针对看病贵问题,第一个关键点是药品降价。药品降价有3个重要的环节,一个是前端的研发和生产环节。近年来,国务院陆续出台针对仿制药、儿童用药以及药品生产流通使用环节等一系列政策,对于药品投入研发、技术创新和保证供应方面都作出了明确规定,政策体系正在逐步完善。第二个环节是流通领域发力。去年,全国200个城市推行了“两票制”,“两票制”的实施挤出了很大一部分药品价格水分。第三个环节也是最核心的,就是临床医生的合理用药。第二个关键点是实现大病不出县。重点是县医院能力提升,其核心是专科能力建设。第三个关键点是医保制度改革。我国医保支付方式正在由后付逐渐走向预付,把过去检查检验和药品支出由过去的利润端变成医院的成本端,通过这种方式来激发医院的内在动力。第四个关键点是强化公共卫生,强化预防为主,强化健康教育和健康促进,真正让老百姓少得病,晚得病,得病后早发现、早诊治。

针对管理的问题

针对管理的问题,一个层面是对于各级政府真正落实办医责任管医责任进行督导、考核、评价;另一个层面是对医疗卫生机构的管理,真正落实《关于建立现代医院管理制度的指导意见》。同时,加强公立医院党的领导,发挥支部的战斗堡垒作用,发挥党员的先锋模范作用。要加强公立医院的考核评价,国家卫生健康委和有关部门负责制定医院考核评价的指标体系和方案,并且选取部分医院进行考核,根据医疗机构不同的功能定位,将维护公益性、任务落实情况、职工和群众的满意度,以及可持续发展的能力作为主要评价指标,以此来维护政府办公立医院的本质和宗旨。

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    2018-12-22 tidiq
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    2018-12-20 jimmyyin

    够扯

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1775857, encodeId=afa81e7585709, content=<a href='/topic/show?id=7864660e9be' target=_blank style='color:#2F92EE;'>#深化医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66079, encryptionId=7864660e9be, topicName=深化医改)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c1e138833678, createdName=lsndxfj, createdTime=Sun Mar 31 20:17:00 CST 2019, time=2019-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1287060, encodeId=f60f128e06060, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Sat Dec 22 02:17:00 CST 2018, time=2018-12-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355940, encodeId=a2623559407e, content=够扯, beContent=null, objectType=article, channel=null, level=null, likeNumber=112, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQATvGgiaMKNVvxNf0yhLsYOhNPiaHgTUl6xdntTzXT1Y5MHTStTB4Yrumicp8swRtzmIamzRj80yiaIgn/0, createdBy=e504105739, createdName=jimmyyin, createdTime=Thu Dec 20 13:29:14 CST 2018, time=2018-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=355930, encodeId=1c7235593085, content=好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!, beContent=null, objectType=article, channel=null, level=null, likeNumber=102, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRuUXgacXpPeW0x8Z3Qr9c3I2kTic4ZIpR29iaftYgkjRcbv982icYMtqANBPYBgPnOia6mVtX76qMXuc/0, createdBy=d85d1636106, createdName=lietome2, createdTime=Thu Dec 20 12:11:51 CST 2018, time=2018-12-20, status=1, ipAttribution=)]
    2018-12-20 lietome2

    好文,值得点赞!认真学习,应用于实践!谢谢分享给广大同好!

    0

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