医联体建设高潮将至,药企如何未雨绸缪?

2017-05-05 许雷 米内微信  

4月26日,《国务院办公厅关于推进医疗联合体建设和发展的指导意见》(国办发〔2017〕32号,以下简称“32号文”)文件发布。这对于我国医疗机构未来的发展方向做出了革命性的再布局,影响极为深远。作为医药产品销售的最大终端,药品生产企业自然需要提早预估其影响,以便调整今后的营销规划。

4月26日,《国务院办公厅关于推进医疗联合体建设和发展的指导意见》(国办发〔2017〕32号,以下简称“32号文”)文件发布。这对于我国医疗机构未来的发展方向做出了革命性的再布局,影响极为深远。作为医药产品销售的最大终端,药品生产企业自然需要提早预估其影响,以便调整今后的营销规划。

虽然32号文要求今年所有三级公立医院都参与医疗联合体(以下简称“医联体”)的建设,并且把医联体建设的全面推进时间划在2020年,但其实这一变革要早于很多人的感受。

一、医联体如何一路走来

1999年

据某医药自媒体整理的内容显示,国内最早的医联体尝试早在1999年就开始了,始于当年上海瑞金医院推行集团化改革,通过资产重组、管理输出、技术协作等方式,与五家医疗机构进行了跨地区、跨级别、跨部门的医院重组。

2013年

医联体建设全面铺开则是由原卫生部部长陈竺在2013年初全国卫生工作会议上提出的。

2017年

在32号文发布前半个月的国新办新闻吹风会上,国务院医改办主任、国家卫生计生委副主任王贺胜透露:截至2016年底,全国共有205个地级以上城市(占地级以上城市总数的60.8%)开展医联体试点。

另据《中国卫生》2017年第4期《四种模式的探索之路》一文介绍,目前全国2000 余家三级医院中, 参与医联体建设的医院已达到50%左右。

估计很多人听到这些数字会很吃惊吧:为什么医联体建设已经有这么长的历史,而且已经有这么大的规模,但在实际营销工作中却感觉不深呢?

首先要明白一点:医联体从根子上讲并不是“药品采购联合体”,而是医疗技术、资源的整合体。其出发点是解决我国优质医疗资源分布不均、患者终日拥堵于三甲医院、而基层医疗机构水平低吃不饱、从而产生出的“看病难”这一现象,其内含的策略是“分级诊疗”。

通观32号文,绝大部分篇幅都聚焦于在不同水平、特长、层级的医疗机构间系统性搭建顺畅的协作机制,几乎没有涉及现有药品器械采购政策如何与医联体对接的内容。仅有的一句涉及药品采购的话“探索建立医联体内统一的药品招标采购、管理平台“也是针对医联体内部的协作机制。

其次,由于此前缺乏32号文这样的纲领性文件指引,受制于行政管理架构约束,医联体建设缺乏共享共建与利益分配的机制,模式上“松散”多于“紧密”,即便是有技术上的协作,药品采购的主体也没法统一到一起,还是“各吃各的饭”多些。因此药品企业人士对医联体的建设“无感”并不奇怪。

二、药企如何未雨绸缪?

32号文件出台后形势会怎么变化?医联体带来的会是机遇还是挑战?药品企业如何未雨绸缪做准备呢?

首先可以预期的是,由于32号文件这么一个纲领性指导意见的出台,未来医联体通过资产重组与托管、建立理事会和法人治理结构、制定章程和签订合作协议等多种手段,将从过去松散为主的组织形式走向紧密联系。而牵头单位权威的影响力与联合体各单位利益的统一也会促使以医联体为单位的药品统一采购成为现实。

从当前的药品器械招采政策来看,根据《国务院办公厅关于完善公立医院药品集中采购工作的指导意见》(国办发〔2015〕7号),目前我国采取的是“分类采购”原则,针对不同类型的药品器械分别采取集中采购、价格谈判、定点生产、挂网自采和维持旧法等不同办法。

其中对于市场竞争比较充分、多家企业生产、临床用量大的非专利药品,实行以省为单位集中招标采购的办法,且原则上不允许二次议价。从实践上看这类品种虽然采购金额大,但是品规有限,未来医联体可能会从中筛选符合自身医疗技术方向的品种目录。因此相关企业应当积极与牵头单位进行沟通,避免被踢出局。

而在集采之外,还有大量有待谈判\议价的品种(从数量上看可达集采品种的十倍以上),结合新医改取消药品加成的政策,可以预判在这一方面医联体是有动力进行集体谈判\议价采购的。而企业需要考虑的是针对不同医联体的组织模式、用药特点、品规组合、采购数量等,结合全国市场维护综合考虑谈判策略,要有舍取意识、切忌因小失大。

三、四种“国家推荐版”医联体谁更有合作潜力?

由于医联体有四种“国家推荐版”,因此我们也不妨从这个角度探究一下谁家更有合作潜力,以便确定工作重点。

第一种是城市医疗集团,在设区的市级以上城市,由三级公立医院或者业务能力较强的医院牵头,联合社区卫生服务机构、护理院、专业康复机构等组成,基本上就是“三甲医院当大哥说了算、基层医疗机构当小弟跟着干”的架构。其覆盖人口较多、用药量大、配送方便、资金实力有保障,但药品种类复杂,不同层级间医疗机构用药组成差异大,医保报销政策有差异、有待完善,同时医联体议价能力较强、拖欠药款的底气也更足。

第二种是县乡医疗共同体,以县级医院为龙头、乡镇卫生院为枢纽、村卫生室为基础进行县乡一体化管理。这种模式覆盖的地域较广,用药量较大、各级医疗机构间用药差异不如城市集团那么大,普药、输液、慢性病用药可能是主流,配送成本高。未来随着分级诊疗制度的落实,就诊量和用药量会有较大上升空间。

第三种是跨区域专科联盟。根据不同区域医疗机构优势专科资源,以若干所医疗机构特色专科技术力量为支撑,充分发挥国家医学中心、国家临床医学研究中心及其协同网络的作用,以专科协作为纽带,组建区域间若干特色专科联盟,形成补位发展模式。此模式对药企最有吸引力,因为病种专一用药针对性强、直接覆盖全国区域、用药量大,如果共同采购能实现,用“得联盟者得天下”来形容也不为过。但是一个潜在的大问题就是能否找到具有独立法人资格的采购主体,以及联盟成员间缺乏绝对权威,因此对共同采购的认同度有多高、执行力有多强需要甄别。

第四种是远程医疗协作网,这种模式更多是技术指导,由于组织松散、对象分散不太具有商业合作可能,因此不再讨论。

此外还要指出两点:一是,国家级和省级公立医院除参加属地医联体外,可跨区域与若干医联体建立合作关系,这更凸显了以三甲医院为代表的传统优势医疗机构在未来医联体中的话语权地位;

二是,32号文要求对纵向合作的医联体等分工协作模式实行医保总额付费等多种付费(控费)方式,再结合临床路径推广、处方点评等新医改政策来看,对药品的临床有效性、药物经济性提出了很高的要求。综合这两点可以推论:企业基本可以放弃面向二级以下医疗机构的学术推广,而要集中精力针对承担了医联体主要牵头工作的三甲医院展开工作,同时需要匹配有力的学术依据、足够的资源,才能说服担当“话事者”角色的三甲医院中的大咖选择自己的产品。
最重要的是:由于营销对象范围急剧缩小到三甲医院,现在就要着手转型了!

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    2017-05-08 明天会更好!

    我们都拭目以待吧!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=2054302, encodeId=d848205430282, content=<a href='/topic/show?id=6fa835259a8' target=_blank style='color:#2F92EE;'>#医联体建设#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35259, encryptionId=6fa835259a8, topicName=医联体建设)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Dec 05 18:50:00 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195372, encodeId=e0571953e29d, content=我们都拭目以待吧!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Mon May 08 11:10:48 CST 2017, time=2017-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335562, encodeId=2207133556207, content=<a href='/topic/show?id=8d7a3525ed0' target=_blank style='color:#2F92EE;'>#医联体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35257, encryptionId=8d7a3525ed0, topicName=医联体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9de22500104, createdName=1249894fm73暂无昵称, createdTime=Sun May 07 13:50:00 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194808, encodeId=ee2319480878, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sun May 07 06:36:52 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194521, encodeId=9924194521f9, content=医改方方面面,千头万绪!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 10:14:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194502, encodeId=a13e19450206, content=拭目以待吧!看看能成什么样子, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 09:55:05 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194499, encodeId=9c09194499a3, content=医疗改革总是新闻不断, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sat May 06 09:50:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194457, encodeId=fa1319445e3a, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Sat May 06 08:22:28 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194444, encodeId=2ed6194444bc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/udqvoAsWtvRVficPKOpMh4M31O9bJ8jMiaUHAheeNpIqMapC8mUnBWfEskrcVjofbicWU4icRD6vFvVeEYlPmSbXELickazEGVFYO/0, createdBy=24741603767, createdName=医艺依意, createdTime=Sat May 06 07:52:07 CST 2017, time=2017-05-06, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=2054302, encodeId=d848205430282, content=<a href='/topic/show?id=6fa835259a8' target=_blank style='color:#2F92EE;'>#医联体建设#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35259, encryptionId=6fa835259a8, topicName=医联体建设)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Dec 05 18:50:00 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195372, encodeId=e0571953e29d, content=我们都拭目以待吧!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Mon May 08 11:10:48 CST 2017, time=2017-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335562, encodeId=2207133556207, content=<a href='/topic/show?id=8d7a3525ed0' target=_blank style='color:#2F92EE;'>#医联体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35257, encryptionId=8d7a3525ed0, topicName=医联体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9de22500104, createdName=1249894fm73暂无昵称, createdTime=Sun May 07 13:50:00 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194808, encodeId=ee2319480878, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sun May 07 06:36:52 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194521, encodeId=9924194521f9, content=医改方方面面,千头万绪!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 10:14:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194502, encodeId=a13e19450206, content=拭目以待吧!看看能成什么样子, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 09:55:05 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194499, encodeId=9c09194499a3, content=医疗改革总是新闻不断, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sat May 06 09:50:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194457, encodeId=fa1319445e3a, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Sat May 06 08:22:28 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194444, encodeId=2ed6194444bc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/udqvoAsWtvRVficPKOpMh4M31O9bJ8jMiaUHAheeNpIqMapC8mUnBWfEskrcVjofbicWU4icRD6vFvVeEYlPmSbXELickazEGVFYO/0, createdBy=24741603767, createdName=医艺依意, createdTime=Sat May 06 07:52:07 CST 2017, time=2017-05-06, status=1, ipAttribution=)]
    2017-05-07 龙胆草

    学习了,谢谢分享

    0

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    2017-05-06 130****4638

    医改方方面面,千头万绪!

    0

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    2017-05-06 130****4638

    拭目以待吧!看看能成什么样子

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2054302, encodeId=d848205430282, content=<a href='/topic/show?id=6fa835259a8' target=_blank style='color:#2F92EE;'>#医联体建设#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35259, encryptionId=6fa835259a8, topicName=医联体建设)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Dec 05 18:50:00 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195372, encodeId=e0571953e29d, content=我们都拭目以待吧!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Mon May 08 11:10:48 CST 2017, time=2017-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335562, encodeId=2207133556207, content=<a href='/topic/show?id=8d7a3525ed0' target=_blank style='color:#2F92EE;'>#医联体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35257, encryptionId=8d7a3525ed0, topicName=医联体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9de22500104, createdName=1249894fm73暂无昵称, createdTime=Sun May 07 13:50:00 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194808, encodeId=ee2319480878, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sun May 07 06:36:52 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194521, encodeId=9924194521f9, content=医改方方面面,千头万绪!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 10:14:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194502, encodeId=a13e19450206, content=拭目以待吧!看看能成什么样子, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 09:55:05 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194499, encodeId=9c09194499a3, content=医疗改革总是新闻不断, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sat May 06 09:50:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194457, encodeId=fa1319445e3a, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Sat May 06 08:22:28 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194444, encodeId=2ed6194444bc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/udqvoAsWtvRVficPKOpMh4M31O9bJ8jMiaUHAheeNpIqMapC8mUnBWfEskrcVjofbicWU4icRD6vFvVeEYlPmSbXELickazEGVFYO/0, createdBy=24741603767, createdName=医艺依意, createdTime=Sat May 06 07:52:07 CST 2017, time=2017-05-06, status=1, ipAttribution=)]
    2017-05-06 1ddf0692m34(暂无匿称)

    医疗改革总是新闻不断

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2054302, encodeId=d848205430282, content=<a href='/topic/show?id=6fa835259a8' target=_blank style='color:#2F92EE;'>#医联体建设#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35259, encryptionId=6fa835259a8, topicName=医联体建设)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Dec 05 18:50:00 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195372, encodeId=e0571953e29d, content=我们都拭目以待吧!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Mon May 08 11:10:48 CST 2017, time=2017-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335562, encodeId=2207133556207, content=<a href='/topic/show?id=8d7a3525ed0' target=_blank style='color:#2F92EE;'>#医联体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35257, encryptionId=8d7a3525ed0, topicName=医联体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9de22500104, createdName=1249894fm73暂无昵称, createdTime=Sun May 07 13:50:00 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194808, encodeId=ee2319480878, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sun May 07 06:36:52 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194521, encodeId=9924194521f9, content=医改方方面面,千头万绪!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 10:14:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194502, encodeId=a13e19450206, content=拭目以待吧!看看能成什么样子, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 09:55:05 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194499, encodeId=9c09194499a3, content=医疗改革总是新闻不断, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sat May 06 09:50:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194457, encodeId=fa1319445e3a, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Sat May 06 08:22:28 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194444, encodeId=2ed6194444bc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/udqvoAsWtvRVficPKOpMh4M31O9bJ8jMiaUHAheeNpIqMapC8mUnBWfEskrcVjofbicWU4icRD6vFvVeEYlPmSbXELickazEGVFYO/0, createdBy=24741603767, createdName=医艺依意, createdTime=Sat May 06 07:52:07 CST 2017, time=2017-05-06, status=1, ipAttribution=)]
    2017-05-06 榄枷檬

    谢谢分享

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=2054302, encodeId=d848205430282, content=<a href='/topic/show?id=6fa835259a8' target=_blank style='color:#2F92EE;'>#医联体建设#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35259, encryptionId=6fa835259a8, topicName=医联体建设)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Dec 05 18:50:00 CST 2017, time=2017-12-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=195372, encodeId=e0571953e29d, content=我们都拭目以待吧!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160914/IMG57D82E721DB581755.jpg, createdBy=4fc81933929, createdName=明天会更好!, createdTime=Mon May 08 11:10:48 CST 2017, time=2017-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335562, encodeId=2207133556207, content=<a href='/topic/show?id=8d7a3525ed0' target=_blank style='color:#2F92EE;'>#医联体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35257, encryptionId=8d7a3525ed0, topicName=医联体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=9de22500104, createdName=1249894fm73暂无昵称, createdTime=Sun May 07 13:50:00 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194808, encodeId=ee2319480878, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sun May 07 06:36:52 CST 2017, time=2017-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194521, encodeId=9924194521f9, content=医改方方面面,千头万绪!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 10:14:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194502, encodeId=a13e19450206, content=拭目以待吧!看看能成什么样子, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=00501987275, createdName=130****4638, createdTime=Sat May 06 09:55:05 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194499, encodeId=9c09194499a3, content=医疗改革总是新闻不断, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sat May 06 09:50:30 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194457, encodeId=fa1319445e3a, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Sat May 06 08:22:28 CST 2017, time=2017-05-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=194444, encodeId=2ed6194444bc, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=13, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/udqvoAsWtvRVficPKOpMh4M31O9bJ8jMiaUHAheeNpIqMapC8mUnBWfEskrcVjofbicWU4icRD6vFvVeEYlPmSbXELickazEGVFYO/0, createdBy=24741603767, createdName=医艺依意, createdTime=Sat May 06 07:52:07 CST 2017, time=2017-05-06, status=1, ipAttribution=)]
    2017-05-06 医艺依意

    学习了,谢谢分享

    0

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