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维护公立医院公益性

来源: 南方日报网络版     时间: 2019年08月18日 16:51:28
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(  中)(新)(社)(北)(京)(5月)(17日)(电)((记)(者)(董)(子)(畅)()中)(国)(国)(务)(院)(办)(公)(厅)(17日)(发)(布)(了)(《关)(于)(城)(市)(公)(立)(医)(院)(综)(合)(改)(革)(试)(点)(指)(导)(意)(见)(》(以)(下)(简)(称)(《指)(导)(意)(见)(》)。医)(药)(卫)(生)(体)(制)(改)(革)(是)(一)(项)(长)(期)(复)(杂)(的)(系)(统)(工)(程)(,公)(立)(医)(院)(改)(革)(又)(是)(医)(改)(的)(重)(中)(之)(重)(,广)(为)(社)(会)(各)(界)(关)(注)(。  北)(京)(协)(和)(医)(学)(院)(公)(共)(卫)(生)(学)(院)(院)(长)(刘)(远)(立)(指)(出)(,公)(立)(医)(院)(系)(统)(是)(中)(国)(整)(个)(医)(疗)(体)(系)(的)(“主)(力)(军)(”。2013年)(,公)(立)(医)(院)(床)(位)(数)(占)(全)(国)(医)(疗)(卫)(生)(机)(构)(总)(床)(位)(数)(的)(比)(例)(是)(87.8%,入)(院)(人)(数)(占)(全)(国)(的)(64.1%,诊)(疗)(人)(次)(数)(占)(全)(国)(的)(33.6%。“因)(此)(,公)(立)(医)(疗)(体)(系)(布)(局)(和)(运)(行)(是)(否)(合)(理)(、公)(立)(医)(院)(服)(务)(是)(否)(良)(好)(、行)(为)(是)(否)(规)(范)(,直)(接)(关)(系)(到)(老)(百)(姓)(的)(生)(命)(健)(康)(和)(就)(医)(感)(受)(。”  中)(央)(全)(面)(深)(化)(改)(革)(领)(导)(小)(组)(第)(十)(一)(次)(会)(议)(强)(调)(,要)(坚)(持)(公)(立)(医)(院)(公)(益)(性)(的)(基)(本)(定)(位)(。对)(此)(,中)(华)(医)(学)(会)(党)(委)(书)(记)(饶)(克)(勤)(指)(出)(,完)(善)(补)(偿)(机)(制)(是)(公)(立)(医)(院)(改)(革)(的)(核)(心)(问)(题)(之)(一)(。  饶)(克)(勤)(说)(,中)(国)(医)(疗)(费)(用)(结)(构)(异)(化)(,主)(要)(表)(现)(为)(,政)(府)(投)(入)(不)(到)(位)(,财)(政)(补)(助)(约)(占)(公)(立)(医)(院)(收)(入)(的)(8%;医)(疗)(服)(务)(价)(格)(严)(重)(扭)(曲)(,即)(使)(城)(市)(大)(医)(院)(,教)(授)(或)(主)(任)(医)(师)(门)(诊)(诊)(疗)(费)(仅)(为)(4—10元)(人)(民)(币)(/人)(次)(;药)(品)(和)(医)(疗)(耗)(材)(费)(用)(严)(重)(虚)(高)(,一)(些)(药)(品)(价)(格)(高)(出)(香)(港)(公)(立)(医)(院)(同)(种)(药)(品)(的)(十)(倍)(,“以)(药)(补)(医)(”导)(致)(部)(分)(医)(务)(人)(员)(行)(为)(扭)(曲)(;没)(有)(建)(立)(制)(衡)(的)(激)(励)(与)(约)(束)(机)(制)(,医)(务)(人)(员)(没)(有)(参)(与)(改)(革)(的)(积)(极)(性)(。  此)(次)(《指)(导)(意)(见)(》再)(次)(重)(申)(了)(公)(立)(医)(院)(改)(革)(的)(三)(个)(核)(心)(目)(标)(和)(策)(略)(:“维)(护)(公)(益)(性)(,调)(动)(积)(极)(性)(,保)(障)(可)(持)(续)(”。  “三)(者)(环)(环)(相)(扣)(,维)(护)(公)(益)(性)(的)(目)(标)(不)(能)(靠)(牺)(牲)(公)(立)(医)(院)(及)(其)(从)(业)(者)(的)(利)(益)(而)(实)(现)(,而)(必)(须)(要)(通)(过)(建)(立)(起)(符)(合)(行)(业)(特)(点)(、体)(现)(其)(劳)(动)(价)(值)(的)(人)(事)(薪)(酬)(制)(度)(等)(手)(段)(来)(调)(动)("主)(力)(军)("参)(与)(医)(改)(的)(积)(极)(性)(。”刘)(远)(立)(说)(,因)(此)(,调)(动)(积)(极)(性)(是)(维)(护)(公)(益)(性)(的)(必)(要)(条)(件)(。与)(此)(同)(时)(,由)(于)(维)(护)(公)(益)(性)(和)(调)(动)(积)(极)(性)(都)(是)(有)(成)(本)(的)(,而)(资)(源)(又)(是)(有)(限)(的)(,所)(以)(,公)(立)(医)(院)(的)(改)(革)(也)(要)(考)(虑)(可)(持)(续)(性)(,避)(免)(掉)(进)(以)(政)(府)(财)(政)(“债)(台)(高)(筑)(、难)(以)(为)(继)(”为)(突)(出)(表)(现)(的)(“福)(利)(社)(会)(”的)(陷)(阱)(。  目)(前)(,中)(国)(普)(遍)(实)(施)(的)(支)(付)(方)(式)(是)(按)(项)(目)(、按)(药)(品)(加)(成)(率)(付)(费)(。由)(于)(缺)(乏)(监)(督)(机)(制)(,处)(方)(大)(小)(、检)(查)(多)(少)(与)(科)(室)(绩)(效)(、医)(生)(收)(入)(挂)(钩)(,缺)(点)(暴)(露)(尤)(为)(充)(分)(。  《指)(导)(意)(见)(》提)(出)(今)(后)(公)(立)(医)(院)(要)(建)(立)(以)(按)(病)(种)(付)(费)(为)(主)(,按)(人)(头)(、按)(服)(务)(单)(元)(等)(复)(合)(型)(付)(费)(方)(式)(,逐)(步)(减)(少)(按)(项)(目)(付)(费)(。  刘)(远)(立)(认)(为)(,公)(立)(医)(院)(改)(革)(抓)(住)(了)(支)(付)(制)(度)(改)(革)(就)(是)(抓)(住)(了)(整)(个)(医)(改)(的)(“牵)(牛)(鼻)(子)(”工)(程)(,只)(有)(纠)(正)(了)(“扭)(曲)(的)(支)(付)(制)(度)(”后)(,包)(括)(公)(立)(医)(院)(法)(人)(治)(理)(结)(构)(改)(革)(在)(内)(的)(其)(它)(一)(系)(列)(改)(革)(措)(施)(才)(能)(奏)(效)(。  长)(期)(以)(来)(,政)(府)(在)(公)(立)(医)(院)(发)(展)(方)(向)(、资)(源)(配)(置)(等)(重)(大)(决)(策)(以)(及)(院)(长)(聘)(任)(、资)(产)(和)(运)(行)(监)(管)(等)(方)(面)(没)(有)(完)(全)(承)(担)(起)(责)(任)(。公)(立)(医)(院)(的)(部)(分)(重)(大)(决)(策)(权)(由)(医)(院)(管)(理)(层)(实)(际)(掌)(控)(,且)(权)(力)(的)(使)(用)(缺)(乏)(制)(衡)(,成)(为)(公)(立)(医)(院)(过)(度)(追)(求)(经)(济)(利)(益)(,公)(益)(性)(淡)(化)(主)(要)(原)(因)(之)(一)(。但)(同)(时)(,政)(府)(又)(在)(不)(同)(程)(度)(上)(通)(过)(行)(政)(手)(段)(直)(接)(干)(预)(医)(院)(的)(经)(营)(管)(理)(事)(务)(,不)(仅)(影)(响)(到)(公)(立)(医)(院)(的)(管)(理)(效)(率)(和)(效)(果)(,也)(因)(权)(责)(扭)(曲)(而)(难)(以)(问)(责)(。  “推)(进)(现)(代)(医)(院)(管)(理)(制)(度)(是)(实)(现)(改)(革)(目)(标)(的)(主)(要)(路)(径)(之)(一)(,其)(核)(心)(是)(落)(实)(政)(府)(的)(办)(医)(职)(责)(,并)(在)(此)(基)(础)(上)(建)(立)(法)(人)(的)(治)(理)(结)(构)(和)(治)(理)(机)(制)(。”北)(京)(大)(学)(医)(学)(部)(公)(共)(卫)(生)(学)(院)(教)(授)(吴)(明)(告)(诉)(记)(者)(,治)(理)(结)(构)(和)(治)(理)(机)(制)(建)(立)(的)(目)(的)(是)(建)(立)(决)(策)(、执)(行)(、监)(督)(相)(互)(分)(工)(、相)(互)(制)(衡)(的)(权)(力)(运)(行)(机)(制)(,落)(实)(公)(立)(医)(院)(独)(立)(法)(人)(地)(位)(,即)(公)(立)(医)(院)(院)(长)(要)(有)(独)(立)(的)(经)(营)(管)(理)(权)(,但)(在)(分)(权)(的)(同)(时)(一)(定)(要)(有)(制)(衡)(机)(制)(。  吴)(明)(指)(出)(,《指)(导)(意)(见)(》再)(次)(强)(调)(推)(进)(现)(代)(医)(院)(管)(理)(制)(度)(,并)(更)(加)(明)(确)(了)(相)(应)(改)(革)(措)(施)(。首)(先)(调)(整)(或)(整)(合)(政)(府)(部)(门)(之)(间)(的)(权)(责)(,其)(次)(是)(调)(整)(政)(府)(和)(公)(立)(医)(院)(院)(长)(之)(间)(的)(权)(责)(。总)(的)(来)(说)(,现)(代)(医)(院)(管)(理)(制)(度)(是)(通)(过)(影)(响)(院)(长)(的)(权)(责)(,影)(响)(医)(院)(的)(运)(行)(机)(制)(,从)(而)(影)(响)(医)(院)(的)(行)(为)(。
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