卫生部:2012年各地加强医药费用控制情况

2012-11-05 卫文 卫生部

  近日,卫生部办公厅通报了关于2012年各地加强医药费用控制有关情况,如下:   一、控制医药费用增长情况   (一)控整体,优化医疗资源结构布局,提高医疗服务体系效率。各地在加强基层医疗卫生机构能力建设的同时,探索采取托管、建立医疗集团(联合体)、院办院管等方式,在医院与基层医疗卫生机构之间建立相对紧密的分工协作机制,逐步构建分级诊疗、双向转诊的就医格局,降低医疗费用。如江苏镇江市组建医疗

  近日,卫生部办公厅通报了关于2012年各地加强医药费用控制有关情况,如下:

  一、控制医药费用增长情况

  (一)控整体,优化医疗资源结构布局,提高医疗服务体系效率。各地在加强基层医疗卫生机构能力建设的同时,探索采取托管、建立医疗集团(联合体)、院办院管等方式,在医院与基层医疗卫生机构之间建立相对紧密的分工协作机制,逐步构建分级诊疗、双向转诊的就医格局,降低医疗费用。如江苏镇江市组建医疗集团,促进医疗资源下沉;武汉市第五医院对社区卫生服务中心进行人、财、物等统一管理和调配,建立“直管”的紧密型分工协作模式,提升区域医疗服务整体水平和绩效。

  (二)抓源头,降低医疗服务要素成本。一是建立健全药品和耗材集中招标采购制度。充分利用现代化物流手段,提高配送效率,降低流通环节成本。同时严肃查处医药购销领域的不正之风。二是鼓励优先使用基本药物和适宜技术。鼓励遴选国产优质药品和器材,取代进口产品,降低费用。山东省对二级以上医疗机构基本药物配备使用的范围、比例、采购配送等提出明确要求,促使公立医院优先配备使用基本药物。三是严格大型医疗设备准入和二、三类医疗技术临床应用准入管理,重点加强对高风险、高费用技术的准入管理。江苏、上海等地加强对心血管疾病介入诊疗、肿瘤治疗、关节置换等技术准入,从源头上保障质量安全,同时避免不合理使用。

  (三)管终端,控制单体医疗机构医药费用。在外部监管方面,各部门通力合作,规范诊疗行为,推动适宜技术的使用,抓好关键科室和关键环节的控费工作。一是卫生行政部门加强对医疗机构用药及控费情况的监管。通过开展抗菌药物专项整治,规范医疗机构和医务人员对抗菌药物的使用;通过对关键科室和重点病种的费用加强监测,有的放矢地控制费用。部分地区卫生行政部门还将控费情况纳入医院评审评价中,对未达到控费目标的医疗机构实行“一票否决制”。二是医保部门积极推进基本医保支付方式改革。上海、镇江等地结合医疗联合体、医疗集团的建立,推进总额预付,促进医疗机构自觉下转病人;北京市试点按疾病分组(DRGs)付费;吉林省、河南省在部分县级公立医院探索按病种付费。三是办医主体将控费工作纳入对公立医院和院长的综合目标管理、绩效考核。四是建立社会广泛参与的控费监督机制,完善医疗服务信息公示制度。

  在内部管理方面,公立医院普遍加强内部管理,创新服务方式。一是通过优化服务流程、开展日间手术、建立多学科会诊中心、提供“一站式”服务等方式,在保障医疗质量安全的前提下,科学缩短平均住院日,提高服务效率。北京大学第三医院以缩短平均住院日为切入点,从内部管理挖掘潜力,平均住院日已降至6.87天;上海交通大学附属仁济医院全面推行日间手术,目前涵盖74种手术,手术数量占总手术量的25%,以甲状腺良性肿瘤手术为例,平均住院天数降低到1.35天。二是规范诊疗行为。加强临床路径管理、开展处方点评、动态监测抗菌药物使用等。三是控制运行成本。加强成本核算、预算管理等,强化医院成本控制,减少浪费,控制费用。

  二、控费工作下一步安排

  我部于2011年印发了《卫生部办公厅关于各地开展医药费用控制有关工作情况的通报》(卫办医管发〔2011〕165号),对控费工作提出明确要求,各地在认真落实这些要求的基础上,要进一步提高对控费工作的认识,逐步建立控费工作的长效机制。

  (一)加强医院内部管理,提高医院运行效率。创新服务方式,通过优化服务流程、开展日间手术、建立多学科会诊中心、延伸护理服务等,缩短平均住院日,提高服务效率,降低医药费用。优先配备、使用基本药物,广泛使用适宜技术,实行同级医疗机构检查、检验结果互认,减少患者就医成本。加强财务管理,实行成本核算与控制,减少医院运行中的“跑冒滴漏”现象,杜绝不必要的浪费。建立激励约束机制,将成本和费用控制纳入医务人员绩效考核,促使医务人员自觉控费。

  (二)强化医院外部监管,抓好控费关键环节。加强对关键环节和费用较高病种的监测,对费用增长速度较快的疾病诊疗行为进行重点监控。及时查处不合理用药、用材和检查以及重复检查行为。完善药品和耗材集中招标采购制度,严格大型医疗设备和二、三类医疗技术临床应用准入管理,重点加强对高风险、高费用技术的准入管理。

  要继续配合有关部门,推进医保支付方式改革。建立社会广泛参与的控费监督机制,完善医疗服务信息公示制度,定期向社会公布门诊、住院平均费用变化等信息。发挥社会各方监督作用。

  (三)以控费工作为抓手,促进公立医院体制创新和机制转换。积极探索建立促进医疗资源纵向流动的办医体制,形成公立医院与基层医疗卫生机构之间相对紧密的分工协作机制,做好疾病康复和延伸服务,逐步形成分级诊疗、双向转诊、急慢分治的就医格局,提高区域整体医疗服务效率,降低医疗费用。

  完善医院发展机制,建立现代医院管理制度。将控制医疗费用与控制医院单体规模紧密结合,引导医院转变发展模式和管理方式,通过加强内涵建设,完善以岗位管理为核心的人事管理制度,提高医院管理水平和运行效率。建立健全内部收入分配机制,提高人员经费支出占业务支出的比例,将调动医务人员的积极性转化为人民群众的健康效益,降低群众看病负担。



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    2013-05-26 pcw115
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    2012-11-07 cathymary
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    2012-11-07 bshuang