对实施“医药分开核算分别管理”制度几个问题的思考

Separation of Pharmacy from Hospital

《关于城镇医药卫生体制改革的指导意见》提出了对医院药品收入进行“医药分开核算分别管理”制度,这个制度的实施对于有效控制医药费用的上涨会产生良好的效果,但如果把“医药分开核算分别管理”作为控制医药费用的惟一手段,不可能达到预期效果,甚至会造成药品支出的失控。作者从药品费用上涨的原因、控制药品费用环节以及实施“医药分开核算分别管理”制度应注意的问题等几个方面进行了思考,提出政府应从宏观上采取措施对药厂、经销商、医院三方面进行控制的观点,并指出医院在进行“医药分开核算分别管理”后应加强对医生的监控,继续发挥控制药费的关键作用。

After both managerial and economic separation of pharmaecy from hospital, physicians continue to have central, principal, esential roles in these functions: treat patients, especially in serious and complicated cases; differentiate those who may have somewhat altered absorption, distribution, metabolism of certain drugs, or who have atypical presentations of common diseases, special syndromes, complex pharmacologic meeds, or need methodical and regular functional assessment; guide which drug classes to avoid and which ones to use; choose different mechanisms of action and different profiles of interaction for individual patients; ensure optimization of benefite of medication.