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left;">近日，重庆市政府发布《关于完善公立医院药品集中采购工作的通知》明确规定，医院药品采购价低于医保支付标准或限额的部分奖励给医院，高于医保支付标准或限额的部分由医院承担。(12月29日《每日经济新闻》)</p><p style="text-indent: 2em; text-align: left;">相对医保支付标准，采购价越低医院获得的奖励越多，反之医院的亏损越大，重庆出台这一规定，目的就是为了激励医院在采购时积极压价的动力，也即是鼓励医院二次议价。应该说，目的不错，也相信这一规定能促使医院在采购时倾向价格低的药品。但医改并非仅仅降低药价了之，而是试图通过挤掉药价中虚高的成分，来解决看病贵等问题，并且还得保证医疗效果不因此打折。</p><p style="text-indent: 2em; text-align: left;">换言之，不是药价降下来了，医改的目的就达到了。医院从来都有逐利的冲动，这也是当前的医疗方式、医院饱受诟病的一大原因。激励医院采购低价药未必能抵制医院的逐利冲动，而结果就可能是医院为了利润，会尽量选择价格低于标准的药品，这样一来，就可能减少医院对药品疗效的重视。或者，在必须考虑药品效果时，选择补贴少的药品，但是通过增加用量来获利。如果使用的药品高于医保支付标准，那么就有可能助长收红包、开过多检查等老问题。</p><p style="text-indent: 2em; text-align: left;">总之，鼓励医院二次议价其实是另一种形式的“以药养医”，而当前取消药品加成等改革措施，恰恰是为了废除以药养医这一模式，如此就有走回头路之嫌。当然，这一方法并非完全不可行，但前提是有相应完善的制度来约束医院的逐利冲动，使其更具专业精神，能设身处地的为患者着想，然而，这恰恰也是医改的目的之一，这样无形中形成了一个“死循环”。要想病人看病不难不贵，更应在理顺医疗机制这一关键上下工夫。</p><p style="text-indent: 2em; text-align: left;">毛忠斌</p><p><br style="text-indent: 2em; text-align: left;"/></p> </div> <p class="Editor">编辑：赵彦 </p> <div id="i2i2jyu4k" 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