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国家医保局草拟医疗服务价格动态调整意见,价改牵动医药产业

2018-09-21 梁嘉琳 健康点healthpoint

国家医保局正在部署全国医疗服务价格改革情况调查,在评估成效的基础上,研究制定“关于建立健全医疗服务价格动态调整机制的指导意见”。这是国家医保局首次公开向医疗界系统阐释中国特色医疗保障制度路线图。下一步,国家医保局将建立健全具有中国特色的医疗保障制度,在医疗、医保、医药“三医联动”中发挥“基础性作用”。

国家医保局正在部署全国医疗服务价格改革情况调查,在评估成效的基础上,研究制定“关于建立健全医疗服务价格动态调整机制的指导意见”。这是国家医保局首次公开向医疗界系统阐释中国特色医疗保障制度路线图。下一步,国家医保局将建立健全具有中国特色的医疗保障制度,在医疗、医保、医药“三医联动”中发挥“基础性作用”。

9月20日,中国医院大会在北京举行。国家医疗保障局副局长李滔在主论坛的领导讲话环节透露,国家医保局正在部署全国医疗服务价格改革情况调查,在评估成效的基础上,研究制定“关于建立健全医疗服务价格动态调整机制的指导意见”。健康点了解到,这是国家医保局就首次公开向医疗界系统阐释中国特色医疗保障制度路线图。李滔表示,下一步,国家医保局将建立健全具有中国特色的医疗保障制度,在医疗、医保、医药“三医联动”中发挥“基础性作用”。

国务院办公厅印发的国家医保局“三定”方案提出,“推动建立市场主导的社会医药服务价格形成机制”,并在医药价格与招标采购司的职能中,提及“拟订药品、医用耗材价格和医疗服务项目、医疗服务设施收费等政策并组织实施”。这意味着,国家医保局从国家发改委手中,接过了医疗服务价格政策的制定权。

中国医药企业管理协会副会长王学恭坦言,包括医疗服务价格改革在内的公立医院改革,牵一发而动全身,改的是医院,影响的是用药,影响的是医疗机构的采购行为,对药品的生产、流通、使用都带来影响。

不过,上海一家大型三甲医院的前任副院长提醒说,如果各级医保部门只管医疗服务定价,而不管医疗资金来源,是解决不了问题的。“比如,公立医院想把医疗服务价格上调,但财政说那我就不补偿你了,患者又不愿意看病涨价,医保基金更是不能乱花钱。”因此,要想捋顺医疗服务的价格形成机制,要想根治“手术医生劳务技术收入不如家政工”问题,仍需医保、卫健、财政等多部门协调。

下一步:压药价,涨服务价格

8月29日,国务院办公厅印发的文件要求,今年下半年,由国家医保局牵头,由国家卫生健康委、国家中医药局负责,研究出台具体措施,推动各地按照“腾空间、调结构、保衔接”的思路,加快建立以成本和收入结构变化为基础、及时灵活的价格动态调整机制,通过规范诊疗行为,降低药品、医用耗材等费用腾出空间,优化调整医疗服务价格,重点优化调整体现医务人员技术劳务价值的价格,降低大型医用设备检查治疗和检验等价格。加快审核新增医疗服务价格项目。允许地方采取适当方式有效体现药事服务价值。

上海市卫生和健康发展研究中心主任金春林透露,近年来,上海市有关医疗服务价格管理部门(上海市社保局)委托该中心开发了价格动态调整模型(SPEED)。上海市政府近几轮医疗服务价格调整,均由上海市政府直接决策。2016年底,金春林曾在中欧国际工商学院分享道,医疗机构的价格结构调整包括:对有诱导需求的项目降价,对有成本效益的项目提价;体现技术劳务价值,拉开高技术含量、高难度风险项目同一般项目的价格差距;优先调整价格水平及比价关系偏离度较大的项目;充分考虑价格调整对患者、医保及医院的影响。

曾担任北京市卫生计生委主任的中国医院协会副会长方来英则在接受健康点采访时说,比单纯强调医疗服务价格调整更重要的是:在付费端,要明确财政支出、医保基金支出、患者自费支出的三个付费方的比价关系;在收费端,要明确哪些是需要重点发展的医疗技术,并为此提供更为灵活的价格政策,让患者用脚投票。

医疗服务价格改革,改的是医院,却对医药产业带来深远影响。

一方面,为保证患者的诊疗费用总体上不增加,要想提高医疗服务价格,只能同步压低药品、耗材、检查检验价格。

一位接近国家卫生健康委员会体制改革司的医改专家透露,下一步,继续按照腾空间、调结构、保衔接的思路,通过规范诊疗行为,降低药品、耗材费用腾出空间,优化调整医疗服务价格。坚持小步快走不停步,逐步理顺医疗服务的比价关系,让知识、技术、劳动得到尊重,让价格体现价值,大幅提高公立医院技术劳务收入的占比。

另一方面,在公立医院运行机制捋顺之前,强势的大型医疗机构一旦出现资金短缺,就会拖欠药品供应款。

上述医改专家认为,公立医院向药企“赖账”,不仅是医疗服务价格调整不到位的问题,还有公立医院前几年盲目扩张拖欠银行债务,以及医保支付滞后、欠费等多个因素。只有解决这几个问题,医保、医院、药企之间才不会出现“三角债”。

但一位医药行业协会负责人表示,医疗服务价格调整不能只拿药品费用开刀,实际上,受医院工作人员全口径纳入社保管理影响,医院的社保负担大幅提高,进而导致医院运营费用上升,这是医院出现普遍且较为严重资金缺口的重要原因。与此同时,有关主管部门要防止医院通过药品采购“二次议价”行为违规进行变相补偿。

“以技养医”落地难

“在北京,三甲医院的特级护理服务,每小时收费12块钱,还不如(雇佣)一位护工(的收费)。”

9月20日,在中国医院大会的主论坛上,一位国家卫生健康委员会司局级领导脱稿演讲,引发参会者自发掌声。他在现场解释说,医疗机构的收入分为两方面,政府补助和医疗服务收入。后者又分为医保报销、患者自付两块。对地方来说,政府投入可以忽略不计,公立医院院长面临补偿机制不健全的困境,“取消药品加成,医院限时限点、齐刷刷地执行了。但医务人员的劳务价值却是蜗牛式调整”。

实际上,早在2016年,国家发改委等四部门联合印发《推进医疗服务价格改革的意见》,要求到2020年,逐步建立以成本和收入结构变化为基础的价格动态调整机制,基本理顺医疗服务比价关系。积极探索建立通过制定医保支付标准引导价格合理形成的机制。

7月6日,作为中国人口第一大省的省会,郑州市提出,进一步变“以药养医”为“以技养医”。郑州市出台的《郑州市建立现代医院管理制度实施方案》要求,重点提高手术、诊疗、康复、护理、中医等体现医务人员技术劳务价值的项目价格,降低大型医用设备检查治疗和检验等的价格。

如今,距离四部门设定的2020年底的医疗服务价格动态调整机制的截止日期,只剩下2年3个月10天。在上海某大型三甲医院一位前任副院长眼中,公立医院价格改革,走得很慢,幅度很小,没有回归社会常识。

这位前任副院长说,由于整个价格严重倒挂,很难激发社会资本参与医疗的积极性,也很难激发医务人员的积极性。医疗服务定价控制在发改或医保部门手里,药品、耗材等定价则是市场化的。对于公立医院来说,成本端不可控,收入端也不可控。

上述国家卫生健康委员会司局级领导进一步说,在价格补偿机制不到位的情况下,医院要想发展,院长要把人才留住,就只能增加收入,这就导致公立医院产生趋利行为,与公立医院的公益性定位背道而驰。

国家拟督导公立医院补偿机制落地

多位受访专家表示,取消药品加成之后,医疗服务价格改革成为对公立医院最主要的补偿方式。按照国务院整体部署,截至2017年9月底,全国所有公立医院取消药品加成,实行药品零差率销售。

2018年3月,国家卫生健康委员会体制改革司司长梁万年在接受央视《面对面》节目访谈时被问到,取消药品加成后,医院原来这块收入靠什么补上?他回答:“全国总体上来看,目前约80%减少的加成是靠服务价格调整来弥补的。”然而,上述接近国家卫生健康委员会体制改革司的医改专家补充说,还有10%通过地方财政补偿,再有10%通过医院内部通过加强管理、提高效率、降低成本、自我消化

上述医改专家透露,今年上半年,国家卫生健康委员会对全国进行评估,各地的财政补偿基本到位,全国补偿总金额30多亿元,总体上超过10%的补偿比例。然而,部分地区和医院不同程度地存在补偿缺口的问题,全国缺口在80亿元左右,窟窿部分由财政填补,部分由医院自己承担。

为此,今年初,原国家卫生计生委等六部门印发文件,要求对公立医院取消药品加成减少的合理收入,要严格按照当地公立医院综合改革实施方案确定的补偿途径和比例执行,实现新旧机制平稳转换,确保公立医院良性运行。

具体而言,上述医改专家透露,在经历一轮调研、督导之后,国家有关部门还将奔赴各地进行督查,要求各地价格补偿不足的,要尽快启动新一轮的医疗服务价格调整工作;财政补偿不足的,要限期足额落实政府投入。

然而,价格调整滞后并不能成为公立医院综合改革拖延实施的理由,各级财政投入已经超过预期。

上述医改专家表示,2010年,新一轮医改的公立医院改革启动时,全国各级政府对公立医院的财政补助800多亿元,到了2017年,这个数字已经达到2000多亿,年均增长达到15%以上,高于同期的财政经常性支出的增幅。最开始,中央财政打算让地方财政承担财政补偿,但经过各方争取,中央财政明确,在2018~2020年每年安排专项资金100多亿元,继续支持公立医院综合改革。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1649066, encodeId=59cd164906671, content=<a href='/topic/show?id=edab350166e' target=_blank style='color:#2F92EE;'>#医疗服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35016, encryptionId=edab350166e, topicName=医疗服务价格)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd723724308, createdName=jiangfeng5075, createdTime=Mon Jun 10 01:15:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2027330, encodeId=52c5202e330b3, content=<a href='/topic/show?id=765660e2236' target=_blank style='color:#2F92EE;'>#服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60722, encryptionId=765660e2236, topicName=服务价格)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Wed May 15 07:15:00 CST 2019, time=2019-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925071, encodeId=bfa819250e1de, content=<a href='/topic/show?id=92e233124eb' target=_blank style='color:#2F92EE;'>#动态调整#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33124, encryptionId=92e233124eb, topicName=动态调整)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Fri Oct 12 18:15:00 CST 2018, time=2018-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280424, encodeId=07741280424d7, content=<a href='/topic/show?id=1bd3338451e' target=_blank style='color:#2F92EE;'>#医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33845, encryptionId=1bd3338451e, topicName=医保局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303575, encodeId=0af613035e597, content=<a href='/topic/show?id=90fa35013c4' target=_blank style='color:#2F92EE;'>#医疗服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35013, encryptionId=90fa35013c4, topicName=医疗服务)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da20314, createdName=lfcmxl, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1409675, encodeId=2ffa14096e564, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497194, encodeId=7f24149e19485, content=<a href='/topic/show?id=82b440848a4' target=_blank style='color:#2F92EE;'>#国家医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40848, encryptionId=82b440848a4, topicName=国家医保局)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82569313637, createdName=雕雕, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1649066, encodeId=59cd164906671, content=<a href='/topic/show?id=edab350166e' target=_blank style='color:#2F92EE;'>#医疗服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35016, encryptionId=edab350166e, topicName=医疗服务价格)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd723724308, createdName=jiangfeng5075, createdTime=Mon Jun 10 01:15:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2027330, encodeId=52c5202e330b3, content=<a href='/topic/show?id=765660e2236' target=_blank style='color:#2F92EE;'>#服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60722, encryptionId=765660e2236, topicName=服务价格)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Wed May 15 07:15:00 CST 2019, time=2019-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925071, encodeId=bfa819250e1de, content=<a href='/topic/show?id=92e233124eb' target=_blank style='color:#2F92EE;'>#动态调整#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33124, encryptionId=92e233124eb, topicName=动态调整)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Fri Oct 12 18:15:00 CST 2018, time=2018-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280424, encodeId=07741280424d7, content=<a href='/topic/show?id=1bd3338451e' target=_blank style='color:#2F92EE;'>#医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33845, encryptionId=1bd3338451e, topicName=医保局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303575, encodeId=0af613035e597, content=<a href='/topic/show?id=90fa35013c4' target=_blank style='color:#2F92EE;'>#医疗服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35013, encryptionId=90fa35013c4, topicName=医疗服务)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da20314, createdName=lfcmxl, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1409675, encodeId=2ffa14096e564, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497194, encodeId=7f24149e19485, content=<a href='/topic/show?id=82b440848a4' target=_blank style='color:#2F92EE;'>#国家医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40848, encryptionId=82b440848a4, topicName=国家医保局)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82569313637, createdName=雕雕, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1649066, encodeId=59cd164906671, content=<a href='/topic/show?id=edab350166e' target=_blank style='color:#2F92EE;'>#医疗服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35016, encryptionId=edab350166e, topicName=医疗服务价格)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd723724308, createdName=jiangfeng5075, createdTime=Mon Jun 10 01:15:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2027330, encodeId=52c5202e330b3, content=<a href='/topic/show?id=765660e2236' target=_blank style='color:#2F92EE;'>#服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60722, encryptionId=765660e2236, topicName=服务价格)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Wed May 15 07:15:00 CST 2019, time=2019-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925071, encodeId=bfa819250e1de, content=<a href='/topic/show?id=92e233124eb' target=_blank style='color:#2F92EE;'>#动态调整#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33124, encryptionId=92e233124eb, topicName=动态调整)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Fri Oct 12 18:15:00 CST 2018, time=2018-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280424, encodeId=07741280424d7, content=<a href='/topic/show?id=1bd3338451e' target=_blank style='color:#2F92EE;'>#医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33845, encryptionId=1bd3338451e, topicName=医保局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303575, encodeId=0af613035e597, content=<a href='/topic/show?id=90fa35013c4' target=_blank style='color:#2F92EE;'>#医疗服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35013, encryptionId=90fa35013c4, topicName=医疗服务)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da20314, createdName=lfcmxl, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1409675, encodeId=2ffa14096e564, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497194, encodeId=7f24149e19485, content=<a href='/topic/show?id=82b440848a4' target=_blank style='color:#2F92EE;'>#国家医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40848, encryptionId=82b440848a4, topicName=国家医保局)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82569313637, createdName=雕雕, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1649066, encodeId=59cd164906671, content=<a href='/topic/show?id=edab350166e' target=_blank style='color:#2F92EE;'>#医疗服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35016, encryptionId=edab350166e, topicName=医疗服务价格)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2bd723724308, createdName=jiangfeng5075, createdTime=Mon Jun 10 01:15:00 CST 2019, time=2019-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2027330, encodeId=52c5202e330b3, content=<a href='/topic/show?id=765660e2236' target=_blank style='color:#2F92EE;'>#服务价格#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=60722, encryptionId=765660e2236, topicName=服务价格)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b505306, createdName=医生2394, createdTime=Wed May 15 07:15:00 CST 2019, time=2019-05-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1925071, encodeId=bfa819250e1de, content=<a href='/topic/show?id=92e233124eb' target=_blank style='color:#2F92EE;'>#动态调整#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33124, encryptionId=92e233124eb, topicName=动态调整)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=322359, createdName=bioon3, createdTime=Fri Oct 12 18:15:00 CST 2018, time=2018-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1280424, encodeId=07741280424d7, content=<a href='/topic/show?id=1bd3338451e' target=_blank style='color:#2F92EE;'>#医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33845, encryptionId=1bd3338451e, topicName=医保局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0cd7162, createdName=nakerunner, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1303575, encodeId=0af613035e597, content=<a href='/topic/show?id=90fa35013c4' target=_blank style='color:#2F92EE;'>#医疗服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35013, encryptionId=90fa35013c4, topicName=医疗服务)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da20314, createdName=lfcmxl, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1409675, encodeId=2ffa14096e564, content=<a href='/topic/show?id=2c1c35262a9' target=_blank style='color:#2F92EE;'>#医药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35262, encryptionId=2c1c35262a9, topicName=医药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=36f62754598, createdName=cathymary, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497194, encodeId=7f24149e19485, content=<a href='/topic/show?id=82b440848a4' target=_blank style='color:#2F92EE;'>#国家医保局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40848, encryptionId=82b440848a4, topicName=国家医保局)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=82569313637, createdName=雕雕, createdTime=Sun Sep 23 01:15:00 CST 2018, time=2018-09-23, status=1, ipAttribution=)]
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    2018-09-23 cathymary
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