浅谈对医药分开核算、分别管理的思考

背景 20世纪90年代，医疗费用持续增长，超过GNP的增长速度。医疗费用上升中药品费用占很大比重。原因分析 医疗财政补偿持续不足，药品市场管理混乱，卫生系统的行业形象下降，社会要求卫生系统进行改革，为了解决药品费用上涨过快的问题，卫生部门尝试医药分开核算、分别管理政策。讨论 医药分开核算、分别管理不同于医药分业，也不等于医药分家。政策实行后有引发许多新的问题：（1）医院补偿依然乏力；（2）病人的负担有增无减；（3）医疗质量保证难度加大等等。因此首先必须加强领导组织协调。

Thinking of Separation of Accounting and Management of Medical Service and Pharmaceuticals Sales

Background. Medical expense is rising continuously and goes beyond the increase speed of GNP in 1990s'. The proportion of pharmaceutical expense in increase of medical expense is large. Reason analysis. 1) Economic compensation to hospital is continuously inadequate; 2) pharmaceutical market management is disordered; 3) credit of health system is decreasing; and 4) the health system is required to conduct reform by the society. To solve the problems of pharmaceutical expense rising too fast, the Ministry of Health tried to conduct a policy of separation of accounting and management of medical service and pharmaceuticals sales. Discussion. Separation of accounting of medical service and pharmaceutical is different from division of specialty between physician and pharmacist, and also different from changing pharmaceutical operation with hospital characteristics to pharmaceutical operation with enterprise characteristics. The policy probably brings potential benefits. Meanwhile,many new problems are probably induced after implementing the policy, which are: 1) economic compensation to hospital is still inadequate; 2) the burden of patients will not decrease; and 3) it would be more difficult to control medical quality, and so on. Therefore, the first thing to be done is to strengthen organization and coordination.