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西药费55万，诊疗费357元：「孤儿药」太贵怪医护头上了？

2021-09-07 梅斯医学 MedSci原创

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近日，一张医院发票引起热议。

近日，一张医院发票引起热议。
 
这是一名小女孩（化名小花）住院费用收据。收据上显示，小花住院共4天，花费 55 万余元。其中药费为550177.2 元，其余有床位费620元、化验费930元、治疗费157元、护理费80元、检查费1555元、诊查费120元。
 
此票据一出，立刻在网上引起轩然大波，该院瞬间成为网友口诛笔伐的对象，医生和护士也成为众矢之的。
 
 
“药物符合指南，家属已签署知情同意”
 
2个月前，小花的母亲发现不满2岁的小花四肢无力、运动明显落后，于是母女二人来到西安交通大学第二附属医院儿童病院就医。
 
进行基因诊断后，小花最终被确诊为脊髓性肌萎缩症（SMA）。这个病目前仅有一种特效药，但其价格十分昂贵，目前一针55万人民币。医生团队在与其母亲商量并取得同意后，为小花使用了诺西那生纳，也就有了后来“住院4天55万”的收据单。
 
接下来，无良媒体带节奏、善良网友被诱导，“医院有没有人监管了”“这是救命还是害命”等等声音陆续出现在网上，一副不揪出幕后黑手绝不罢休的样子。
 
9月4日，该医院出面澄清，于官方公众号发表科普文章称：院方所开药物符合《脊髓性肌萎缩的临床实践指南》，且患者家属已签署知情同意，并且该医院为公立医院，实行药品零加成。
 
                                                               图片来源：西安交大二附院官方公众号
 
随后，小花的母亲也通过健康时报发声，表示希望大家不要捕风捉影。并且称“拿一生病的孩子当炒作工具，不负责的行为已经影响到一个普通家庭的正常生活”。
 
 
脊髓性肌萎缩症 & 诺西那生纳
 
根据报道，小花得的病是脊髓性肌萎缩症（SMA），该病属于罕见的常染色体隐性遗传病，一般是由于运动神经元存活基因1 （SMNl）突变，而导致缺乏SMN蛋白，神经细胞不能正常发挥功能，导致衰弱，甚至可以导致致死性肌无力 。因此，小花若是得不到及时的救治，会逐渐出现多系统功能受损，最终会出现呼吸衰竭，生命随时有终止的可能。
 
                         脊髓肌肉萎缩会导致肌肉萎缩和失去控制，通常从婴儿期开始，病情严重后会瘫痪、甚至死亡
 
而新闻中出现的药物“诺西那生钠注射液”，则是目前唯一上市用于治疗SMA的药物。诺西那生钠，英文名Nusinersen，通过改变SMN2前mRNA的剪接，从而增加完整长度SMN蛋白的产生。
 
2016 年 12 月 23 日，诺西那生纳在美国经食品药品监督管理局（ FDA） 批准上市，成为第一个治疗 SMA 的药物。然而，如同其他的孤儿药一样，其价格昂贵地令人却步：
 
在美国，诺西那生纳的定价为 12.5 万美元/针（约合人民币 86 万），首年费用 75 万美元，之后每年花费 37.5 万美元。
 
在中国，价格由2 年前的70 万元/针，降到了现在 55 万元一针。除此以外，根据SMA患者援助活动：对于符合条件的患儿，无论每年打多少针，只需支付一针的药物费用。也就是说，在中国，目前诺西那生纳的花费最低为每年55 万元人民币。
 
医院乱收费？不要再让医护人员背锅了！
 
医院的回应中提到，该医院为公立医院，实施“药品零加成”。也就是说，药品实行零差率销售，多少钱进的药，多少钱卖出去。在这其中，无论是运输储存、药物折损、还是药师服务的费用，都要由医院自己拿钱。
 
也就是说，医院不仅没有多收一分药品钱，反而在自己往里搭钱！
 
而对于医务人员的指责就更令人无奈。小花住院的4天里，有儿童病院神经专家团队制定详细治疗方案，有护士进行精心护理。到最后的收费账单上，仅有护理费80元、诊查费120元、治疗费157元是给医生和护士的。若是平均给每人每天，怕是只有几十块而已。
 
在55万的药费面前，这几百块的“人工费”不免让人心酸，十年寒窗苦读，最后只能自嘲一句“廉价劳动力”。要能看病，还得会沟通。要会临床，还要搞科研。见患者、写报告、加夜班、持续学习……还要在仅仅一点风吹草动的时候，被某些媒体推到风口浪尖……
 
 
进入医保万事大吉？未必
 
每次高价药的新闻一出，总有人高呼“纳入医保”。那么，纳入医保可行吗，纳入后就万事大吉了吗？
 
首先，医保预算有限。
 
一针 Spinraza要55万元，以2020年我国城乡居民医保人均筹资标准550 元为例，一针Spinraza就花掉 1000 位城乡居民一年的医保费，而这些钱，可能本来够几十个患者一年的药物费用了。
 
再者，医保要是纳入了Spinraza，要不要纳入其他天价药呢？全都纳入，又哪里有那么多钱。
 
资源有限，合理分配就非常重要。一些非常昂贵的药进医保后，却未必能便捷医生，造福患者。甚至有时起到反效果——患者找遍各大医院，却根本买不到药了！
 
为什么会存在这样的情况？这就不得不谈到药占比考核、医保控费。
 
药占比和医保控费在一定程度上确实限制了“以药养医”。但是，却也造成了一个新的问题：药物入医保后，医生要担心药占比超标，同时又不能让医院亏本运营，因此不得不在开高价医保药时思量再三。这也是为什么，有的医生好不容易下了班，却还在办公室里披星戴月算药占比。
 
那么天价药到底怎么办呢？目前来说，唯一的方法是让药企适当降价。
 
诚然，药企前期研发成本高，号称每个上市药需要“十年十个亿”的成本。但是，诺西那生纳真的需要一针55万元人民币，才能挣回本钱吗？据数据统计，该药在2019年进入中国时，其年全球销售额高达20亿美元！也就是说，诺西那生纳在中国上市前，其成本早已收回，55万元每针的价格几乎是纯利润。
 
鉴于我国近年来医保财政压力一路上升，很多受众更广泛的药物尚未纳入医保，在此背景下，通过谈判让药厂适当降价让利，看来是目前最好的办法了。
  
参考资料：
 
1. 《警惕！两岁以下婴幼儿“头号罕见遗传病杀手”，致残、致死率高~~~ 》西安交大二附院
2. 《200 元一针进口药国内卖 70 万？别上来就骂药厂黑心，显得那么外行 》丁香园
3. 《4天花55万药费，患儿家长：用药是我同意的，医院没多收一分钱》健康时报
4. 《“婴儿住院4天花55万药费”，这种热点新闻背后到底有什么玄机？》烧伤超人阿宝

评论区 (8)
#插入话题
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    2021-09-09 bshuang

    #药费#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1446250, encodeId=1f12144625060, content=<a href='/topic/show?id=f8cb8e958ae' target=_blank style='color:#2F92EE;'>#药费#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87958, encryptionId=f8cb8e958ae, topicName=药费)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=0Yy1x0ia6yKWyKUaG6Ja0UA&s=100&t=1564295847, createdBy=646f5195679, createdName=bshuang, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555631, encodeId=5aaa1555631bf, content=<a href='/topic/show?id=dcd89053994' target=_blank style='color:#2F92EE;'>#西药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90539, encryptionId=dcd89053994, topicName=西药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4014636852, createdName=minzju5057, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015374, encodeId=a92510153e487, content=药品比例扣费的话，估计一年不用领奖金了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02f55506212, createdName=ms9000000062740836, createdTime=Tue Sep 07 15:04:30 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015307, encodeId=6d29101530e39, content=此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09475597318, createdName=ms4000001926991513, createdTime=Tue Sep 07 10:18:23 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015304, encodeId=0f741015304bf, content=这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=366c5447718, createdName=喝了多少杯, createdTime=Tue Sep 07 10:07:26 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015297, encodeId=9dde101529ecb, content=罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be445463446, createdName=ms6000001020103110, createdTime=Tue Sep 07 09:51:56 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015292, encodeId=8035101529235, content=医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIPTO688x0Oejg1w8ar0XwRPI6msp72K4d2mzY3LJvzzYLEOTvSYVUgjRc9TgPibiaVfn3Y15SSjKcw/132, createdBy=5cfd1936440, createdName=黄河后浪, createdTime=Tue Sep 07 09:41:14 CST 2021, time=2021-09-07, status=1, ipAttribution=)]
    2021-09-09 minzju5057

    #西药#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1446250, encodeId=1f12144625060, content=<a href='/topic/show?id=f8cb8e958ae' target=_blank style='color:#2F92EE;'>#药费#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87958, encryptionId=f8cb8e958ae, topicName=药费)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=0Yy1x0ia6yKWyKUaG6Ja0UA&s=100&t=1564295847, createdBy=646f5195679, createdName=bshuang, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555631, encodeId=5aaa1555631bf, content=<a href='/topic/show?id=dcd89053994' target=_blank style='color:#2F92EE;'>#西药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90539, encryptionId=dcd89053994, topicName=西药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4014636852, createdName=minzju5057, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015374, encodeId=a92510153e487, content=药品比例扣费的话，估计一年不用领奖金了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02f55506212, createdName=ms9000000062740836, createdTime=Tue Sep 07 15:04:30 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015307, encodeId=6d29101530e39, content=此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09475597318, createdName=ms4000001926991513, createdTime=Tue Sep 07 10:18:23 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015304, encodeId=0f741015304bf, content=这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=366c5447718, createdName=喝了多少杯, createdTime=Tue Sep 07 10:07:26 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015297, encodeId=9dde101529ecb, content=罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be445463446, createdName=ms6000001020103110, createdTime=Tue Sep 07 09:51:56 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015292, encodeId=8035101529235, content=医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIPTO688x0Oejg1w8ar0XwRPI6msp72K4d2mzY3LJvzzYLEOTvSYVUgjRc9TgPibiaVfn3Y15SSjKcw/132, createdBy=5cfd1936440, createdName=黄河后浪, createdTime=Tue Sep 07 09:41:14 CST 2021, time=2021-09-07, status=1, ipAttribution=)]
    2021-09-07 ms9000000062740836

    药品比例扣费的话，估计一年不用领奖金了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1446250, encodeId=1f12144625060, content=<a href='/topic/show?id=f8cb8e958ae' target=_blank style='color:#2F92EE;'>#药费#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87958, encryptionId=f8cb8e958ae, topicName=药费)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=0Yy1x0ia6yKWyKUaG6Ja0UA&s=100&t=1564295847, createdBy=646f5195679, createdName=bshuang, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555631, encodeId=5aaa1555631bf, content=<a href='/topic/show?id=dcd89053994' target=_blank style='color:#2F92EE;'>#西药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90539, encryptionId=dcd89053994, topicName=西药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4014636852, createdName=minzju5057, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015374, encodeId=a92510153e487, content=药品比例扣费的话，估计一年不用领奖金了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02f55506212, createdName=ms9000000062740836, createdTime=Tue Sep 07 15:04:30 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015307, encodeId=6d29101530e39, content=此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09475597318, createdName=ms4000001926991513, createdTime=Tue Sep 07 10:18:23 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015304, encodeId=0f741015304bf, content=这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=366c5447718, createdName=喝了多少杯, createdTime=Tue Sep 07 10:07:26 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015297, encodeId=9dde101529ecb, content=罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be445463446, createdName=ms6000001020103110, createdTime=Tue Sep 07 09:51:56 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015292, encodeId=8035101529235, content=医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIPTO688x0Oejg1w8ar0XwRPI6msp72K4d2mzY3LJvzzYLEOTvSYVUgjRc9TgPibiaVfn3Y15SSjKcw/132, createdBy=5cfd1936440, createdName=黄河后浪, createdTime=Tue Sep 07 09:41:14 CST 2021, time=2021-09-07, status=1, ipAttribution=)]
    2021-09-07 ms4000001926991513

    此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。

    1

    展开1条回复
  5. [GetPortalCommentsPageByObjectIdResponse(id=1446250, encodeId=1f12144625060, content=<a href='/topic/show?id=f8cb8e958ae' target=_blank style='color:#2F92EE;'>#药费#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87958, encryptionId=f8cb8e958ae, topicName=药费)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=0Yy1x0ia6yKWyKUaG6Ja0UA&s=100&t=1564295847, createdBy=646f5195679, createdName=bshuang, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555631, encodeId=5aaa1555631bf, content=<a href='/topic/show?id=dcd89053994' target=_blank style='color:#2F92EE;'>#西药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90539, encryptionId=dcd89053994, topicName=西药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4014636852, createdName=minzju5057, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015374, encodeId=a92510153e487, content=药品比例扣费的话，估计一年不用领奖金了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02f55506212, createdName=ms9000000062740836, createdTime=Tue Sep 07 15:04:30 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015307, encodeId=6d29101530e39, content=此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09475597318, createdName=ms4000001926991513, createdTime=Tue Sep 07 10:18:23 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015304, encodeId=0f741015304bf, content=这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=366c5447718, createdName=喝了多少杯, createdTime=Tue Sep 07 10:07:26 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015297, encodeId=9dde101529ecb, content=罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be445463446, createdName=ms6000001020103110, createdTime=Tue Sep 07 09:51:56 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015292, encodeId=8035101529235, content=医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIPTO688x0Oejg1w8ar0XwRPI6msp72K4d2mzY3LJvzzYLEOTvSYVUgjRc9TgPibiaVfn3Y15SSjKcw/132, createdBy=5cfd1936440, createdName=黄河后浪, createdTime=Tue Sep 07 09:41:14 CST 2021, time=2021-09-07, status=1, ipAttribution=)]
    2021-09-07 喝了多少杯

    这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1446250, encodeId=1f12144625060, content=<a href='/topic/show?id=f8cb8e958ae' target=_blank style='color:#2F92EE;'>#药费#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87958, encryptionId=f8cb8e958ae, topicName=药费)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=0Yy1x0ia6yKWyKUaG6Ja0UA&s=100&t=1564295847, createdBy=646f5195679, createdName=bshuang, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555631, encodeId=5aaa1555631bf, content=<a href='/topic/show?id=dcd89053994' target=_blank style='color:#2F92EE;'>#西药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90539, encryptionId=dcd89053994, topicName=西药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4014636852, createdName=minzju5057, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015374, encodeId=a92510153e487, content=药品比例扣费的话，估计一年不用领奖金了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02f55506212, createdName=ms9000000062740836, createdTime=Tue Sep 07 15:04:30 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015307, encodeId=6d29101530e39, content=此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09475597318, createdName=ms4000001926991513, createdTime=Tue Sep 07 10:18:23 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015304, encodeId=0f741015304bf, content=这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=366c5447718, createdName=喝了多少杯, createdTime=Tue Sep 07 10:07:26 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015297, encodeId=9dde101529ecb, content=罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be445463446, createdName=ms6000001020103110, createdTime=Tue Sep 07 09:51:56 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015292, encodeId=8035101529235, content=医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIPTO688x0Oejg1w8ar0XwRPI6msp72K4d2mzY3LJvzzYLEOTvSYVUgjRc9TgPibiaVfn3Y15SSjKcw/132, createdBy=5cfd1936440, createdName=黄河后浪, createdTime=Tue Sep 07 09:41:14 CST 2021, time=2021-09-07, status=1, ipAttribution=)]
    2021-09-07 ms6000001020103110

    罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1446250, encodeId=1f12144625060, content=<a href='/topic/show?id=f8cb8e958ae' target=_blank style='color:#2F92EE;'>#药费#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87958, encryptionId=f8cb8e958ae, topicName=药费)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/g?b=oidb&k=0Yy1x0ia6yKWyKUaG6Ja0UA&s=100&t=1564295847, createdBy=646f5195679, createdName=bshuang, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555631, encodeId=5aaa1555631bf, content=<a href='/topic/show?id=dcd89053994' target=_blank style='color:#2F92EE;'>#西药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90539, encryptionId=dcd89053994, topicName=西药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4b4014636852, createdName=minzju5057, createdTime=Thu Sep 09 00:09:56 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015374, encodeId=a92510153e487, content=药品比例扣费的话，估计一年不用领奖金了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=02f55506212, createdName=ms9000000062740836, createdTime=Tue Sep 07 15:04:30 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015307, encodeId=6d29101530e39, content=此药应该纳入国家医保报销之内，不应该是少数人群就拒之门外。他们更应该有活下去的理由。, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09475597318, createdName=ms4000001926991513, createdTime=Tue Sep 07 10:18:23 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015304, encodeId=0f741015304bf, content=这种病患者是少数，应该进医保。如果没有，对于普通人来说，基本放弃治疗。, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=366c5447718, createdName=喝了多少杯, createdTime=Tue Sep 07 10:07:26 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015297, encodeId=9dde101529ecb, content=罕见病患者数量极少，有研究计算罕见病纳入医保，对医保基金影响很小。况且谁能保证自己不得罕见病？药企目的是盈利，越多越好，不可能指望药企做慈善，那么以后不会有人研发新药！改善民生医疗保障只能靠国家！别甩锅！, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=be445463446, createdName=ms6000001020103110, createdTime=Tue Sep 07 09:51:56 CST 2021, time=2021-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015292, encodeId=8035101529235, content=医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIPTO688x0Oejg1w8ar0XwRPI6msp72K4d2mzY3LJvzzYLEOTvSYVUgjRc9TgPibiaVfn3Y15SSjKcw/132, createdBy=5cfd1936440, createdName=黄河后浪, createdTime=Tue Sep 07 09:41:14 CST 2021, time=2021-09-07, status=1, ipAttribution=)]
    2021-09-07 黄河后浪

    医保还需进一步完善，某些特殊群体不应该因为人群数量少就被忽视

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