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医生被“托”之困境何以破

2016-01-25 廖新波 廖新波新浪博客

医改从何破局?我们已经探讨多年,实验多年,但几无成效,原因何在?平心而论,三明已经做得不错,难为他们了!虽然这样,但我依然认为没有从制度上和法理上将医改固化下来,因而形成“不可复制”的“论断”。本文并非讨论三明如何,而是在经过多年多地的各种试点,顶层还处于一个“试点”思维模式下,或者在“什么是中国特色的医疗制度”还没有准确说法的情况下,探讨医学、医疗、医生中的医生行医状态——如何使医生的知识价

医改从何破局?我们已经探讨多年,实验多年,但几无成效,原因何在?平心而论,三明已经做得不错,难为他们了!虽然这样,但我依然认为没有从制度上和法理上将医改固化下来,因而形成“不可复制”的“论断”。本文并非讨论三明如何,而是在经过多年多地的各种试点,顶层还处于一个“试点”思维模式下,或者在“什么是中国特色的医疗制度”还没有准确说法的情况下,探讨医学、医疗、医生中的医生行医状态——如何使医生的知识价值在市场规律下回归原本的价值。

医生的技术价值只能通过“托”而体现

为什么我国会出现“黄牛党”炒号的现象?首先要从医生的定价来思考。 “黄牛”倒号,各地价格不一,基本上是根据当地的经济水平“报价”,最低120元,一般两三千元,最高五六千元,而专家的“合法”价格在7-15元之间。如今,公立医院已有一些“天价”特诊,一般在三五百元上下。有人认为医生现在的收入并不低,也许是!但他们的主要收入来自哪里呢?在药费、检查费等“创收”上。从某一种角度看,低年资医生的创收能力并不比高年资的低,甚至高于高年资的。而“黄牛党”给出的专家号价格,挤去“恶炒”的水分之后,才是专家真正得到社会认可的价值。

我们再看看名医“走穴飞刀”。有医院管理者说,医生“走穴飞刀”所得的报酬是在医院收入的一半以上,而飞刀的时间只占工作时间的1/5。值得注意的是,一方面是时间与报酬的比例问题,另一方面是这些报酬与医生所开的检查、药品的收入没有半毛钱关系,也可以说是其技术价值、社会价值较好的体现。

“炒号”已然成为中国的一门职业,而且随着“互联网+”的热潮,“炒号”工作模式已经从街边模式转到“互联网+”模式了,形形色色的APP公司应运而生……深谙中国医疗体制的商家们也看到,只要他们控制了医院的现金流、药品流、卫生材料流,甚至检查检验,他们完全可以把医生养起来。因此,互联网要颠覆传统的医疗模式不是不可能的!

不少媒体把“黄牛党”炒号看成是“看病贵、看病难”的根本原因,但是他们并没有看到医生的价值没有得到公正客观的体现,反而把打击“黄牛党”作为打击炒号的重点。其实,专家的价值连医院的清洁工、保安都知道,而我们却视而不见,岂不可悲?作为冤大头的医生,收到的只是可怜的十几元,成为了“黄牛党”的摇钱树,岂不更加可悲?

可见,谁都知道医生的价值潜力很大,“可托”的利润空间很大。唯独我们的支付制度,一直没有把医生真正的价值通过服务价格的调整体现出来。

让医生价值回归,通过市场无形的手配置医生资源和推进分级诊疗

首先可以断定,儿科医生的短缺实际上是中国医生问题的一个缩影。儿科医生短缺是全世界的现象,但中国儿科医生短缺具有明显的中国特色。我国的儿科医生除了承担其职业责任、社会责任外,由于医患之间的不信任,承受患者家属非理性要求的压力远远大于其他专科。此外,在非市场非政府的支付制度下,儿科医生与其他强势科室(赢利机会大的科室)相比,他们“惨淡经营”(确实与其他专业一样在经营)。儿科医生短缺折射出来的问题正是目前我国医生的窘迫境遇——医生的价值得不到合理的定价与体现。所以,儿科医生是我国医生群体的一个缩影。

其次,分级诊疗是一个好政策,但也是一个伪命题。国外也有分级诊疗,但是国外的分级诊疗完全是一种市场行为而不是政策行为。即使公众可以自由看病,但是也不得不遵循一个制度的安排——首诊在社区。而中国推行的分诊医疗虽有“制度的安排”,但是非常无力,根本原因就是没有真正体现医生的价值,并且医生的价值随服务的场所不同而不同,往往在大医院才有更好的体现。因而,医生的服务平台只能在医院,而且是大医院!医生形成一种从“坝下”往“坝上”走的趋势,“坝上”的资源不断堆积,但即使“坝上”的水满了,也不会轻易让它漫出来流到下游,所以会不断地“扩坝蓄流”,加之政策的逆推动,“坝下”的“民工”根本就无用武之地……

由此,人们“凡有病到大医院”的就医习惯和观念随之自然形成——大医院才有大专家,看病就必须找大专家。但事实上,很多常见病、慢性病诊疗以及康复治疗是不需要去大医院的。我国最大、最好医院的院长曾抱怨:80%的病人根本不需要跑到北京来看病。

目前,政府采取各种措施加强基层医疗机构建设,提高基层医疗机构的服务能力,比如建立医联体,甚至(不痛不痒地)改革支付制度,鼓励社会力量办医等,以期形成分级诊疗的秩序。可惜,一直不能奏效。为什么分级诊疗在国外不是问题,在我国就成问题了呢?为什么分级医疗一直推行不下去呢?根本在于:医生没有流动——医生被圈养或愿意被圈养。这是各项分诊医疗政策不力的主因。

我们现在正在走市场机制的路子,如何落实“政府引导,市场推动”呢?我们可以探讨美国医生行医方式的过去、现在与未来趋势,为我们医改提供一点启迪。

医生要走出“被托”的困境,只能通过解锁、剪链。

为什么会存在这种“托”?很多人提出,要解决“托”的问题,首先该解决医生的服务价格问题,尤其是优质资源的定价问题。很可惜,医改到今天依然没有对医生劳动价值的合理定价达成共识。最近,我在一篇三明医改的报告中看到:三明医改提高了服务价格,而有的“善良”医生却认为“太高”。另外,由于提升医疗服务价格,重庆爆发了示威游行。这是多么令人可怜、可悲的事情呀!民众不理解医生的价值情有可原,但连我们医生自己也不认可自己,依然沉浸在旧体制下,盲目地通过检查、药品等创收和“薄利多销”来获取并非价值所在的报酬,不是更加令人扼腕叹息吗?何况,这种不易得来的报酬也是在多种压力下“铤而走险”。

那么,医生的价值该如何回到一个合理的定价,走出被“托”的困境呢?就是要建立起“医院是为医生提供服务的平台,医生是为患者提供服务的主体”的新格局。也就是说,医院要做的是“筑巢引凤”,使医生能够“良禽择木而栖”;病人要选的是医生,而不是医院。实现这个新格局可以从“解锁”和“剪链”入手。

“解锁”——解开医生“单位人”的枷锁。在顶层设计方面,实现医生从单位人向自由执业转变,实际上顶层已经在做一些解锁措施,如医生福利社会化,政府职能转变,专业自治力度不断加大,严控公立医院规模,逐步放开技术准入,推动医师多点执业,鼓励多渠道办医等。这些外部的推动既给医院管理者带来外部压力,也带来应变的动机。医院要根据自身的发展需求,设计一个为医生、专家提供能力发挥的平台,而不是面面俱到,通过粗犷的扩张方式来留住人才。

“剪链”——是剪断医生与其它服务的利益链。在现行制度下,医生的价值充其量是如何利用设备与药品和高值卫生材料;科主任的管理思维就是如何“创收”,获得医院的“二次分配”——奖金激励。上级部门虽然要求医院不得将医院收入指标分解到各科室,不得将医务人员收入与科室收入直接挂钩,而实际上在这种支付制度下,这根本就是一句空话,医院不“创收”靠什么活?既然医院、医生无法改变这种格局,也只能换一个说法,煲的是同一锅汤。

要使医生的知识价值回归,必须从支付制度下手,使医生的收入与药品、检查检验脱钩,让医生对症施治,而不是“利益分成”。具体来说,支付方可从四个方面支付:医生服务、医院服务、药品服务和检查检验服务。这四个方面各自独立核算、独立支付,不是“以药养医”,也不是“以医养药”。

医生提供的是技术服务,根据其经验值、专业特点、疾病系数来核定价格;

医院服务就是医院的后勤补给、医疗管理、护理管理、信息管理、医疗安全保障等等的总和,按病种等因素核定服务价格;

医院的舒适度与服务的费用有关,与投入的成本有关。如此,医院的基本医疗服务标准就建立了,医院不可能随意增加“额外”的服务,患者也会“看菜吃饭”。因为医院服务的运行成本直接与医院的经济效益挂钩,也与患者的自付比例有关,所以医院也不可能大小通吃,不可能通过住院或接受一些轻病号来填充和相抵“医保限额”,特别是能够实行按DRGs付费之后。相反,可以促使更多手术在日间手术室完成,居民常见病、多发病在社区诊疗,更多康复到二级以下的医疗机构、康复机构和护理院等。患者也因医院报销标准之限(部分自付或完全自付)而选择合适的住院或门诊。这样,不仅可以把基本医疗与非基本医疗区分开来,把分级医疗做实,还可以把营利性医院和非营利性医院分开,更加合理地利用医疗资源。

检查检验分开支付不仅有利于避免大检查,更有利于资源的综合利用,使第三方检查检验更加专业化。目前,可以在临床应用的检验过万种,很多不能开展是因为成本问题。如果整合到一个中心,成本大大降低,精准诊断与治疗就成为可能。

药品管理成本也单独成本核算,而不是简单的一个“零加成”蔽之。因为药师、药房运作以及药品安全管理都需要费用,但这种费用的核算必须是合理的,合理到它仅成为医院的成本中心而不是利润中心,使医院感觉到卖药与不卖药没有什么不同。有些国家的医院为什么不青睐药品的“销售”呢?因为销售药品给医院带来的利润微乎其微,所以不值得“经营”。慢慢地,药房等都可以社会化,检查检验由第三方提供,医院从众多的成本中心中解脱出来,只专注于医疗。

如此分账支付的制度,使医生不管在什么场所服务,价值都不变。民众将来找的不完全是医院,更不是大医院,而是“医生”——由找“庙”变为找“和尚”。

我多次说过,医生多点执业不要拘泥在“多点”上,应该在医生的身份改变和医生与医院的关系上。 目前,政策上允许医生自由开业,实际上“寸步难行”,而医生工作室和医生—医院合作伙伴关系(PHP)的行医模式没有任何法律上和审批上的障碍,应该开展起来,因为都是医生流动的最好形式。医生—医院合作伙伴关系是以市场为导向,效率高、质量保证、成本低。从医生角度来看,医院能为医生提供稳定的收入来源,可以保持生活和医疗工作之间的平衡,更灵活地支配时间,避开自行创业中资金、法律、人事等繁琐事物。从医院角度来考虑,可以避免医院收益和医生收入之间的竞争,能提升医生的忠诚度,解决医生资源短缺与分布不均的问题。

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#插入话题
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  2. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-27 vinson820801

    悲哀

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-26 xi.xiong

    分析很到位

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-26 doctording1

    市场的畸形发展

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-26 文医生

    去外国看看才知道什么叫看病难

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-25 sword20000

    看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-25 长春碱

    黄牛党无处不在。

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1707191, encodeId=d84b1e0719170, content=<a href='/topic/show?id=fedc406085d' target=_blank style='color:#2F92EE;'>#困境#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40608, encryptionId=fedc406085d, topicName=困境)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0a4631370697, createdName=ms2536978994064944, createdTime=Tue Sep 13 00:53:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=60402, encodeId=4bf660402ba, content=悲哀, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d5b91683812, createdName=vinson820801, createdTime=Wed Jan 27 09:39:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59610, encodeId=f81959610de, content=分析很到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=151, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c6dc1665697, createdName=xi.xiong, createdTime=Tue Jan 26 16:08:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59548, encodeId=2b7b59548e1, content=市场的畸形发展, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 14:57:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59384, encodeId=120a59384f2, content=去外国看看才知道什么叫看病难, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e4371683642, createdName=文医生, createdTime=Tue Jan 26 13:46:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59186, encodeId=0eb55918655, content=看病没有看猴贵,房价高也不是因为建筑工人。挂号费12,这还叫看病贵, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLAibgOibuZnfdFE64hJHibbD6WwEgyaXx7DtibMOSicJ6JZoLEAIdAdkhDmHWO7P7OXg2tkTicZy9libryicw/0, createdBy=aa991670466, createdName=sword20000, createdTime=Mon Jan 25 13:55:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59178, encodeId=dbb2591e8cb, content=黄牛党无处不在。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTISUH3xzQIz5VrIhTmepRL6oa3EYnPT61ll2ibYJAy3oeB7oJiaBAWF6opwu9Rod4yHsju1JmHroUOw/132, createdBy=23c71654813, createdName=长春碱, createdTime=Mon Jan 25 13:06:00 CST 2016, time=2016-01-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59174, encodeId=32c1591e4c6, content=分析到位, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuK9CDibOwszLoEBg36ZXqzB5NDasNV9GTfFDmBicM1V8hUS4OtTicG3IiaFIKq4wqD23LUxORRJXqjVs/0, createdBy=00e81647535, createdName=I come, createdTime=Mon Jan 25 13:02:00 CST 2016, time=2016-01-25, status=1, ipAttribution=)]
    2016-01-25 I come

    分析到位

    0

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