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<section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section powered-by="gulangu"><section><section><section><section><p><p><img src="image/20201014/86b79d371e9862b01189f0252a03b2cd_1.png" /></p></p></section><section><section><span><strong></strong></span></section><p><span>医疗器械媒体报道先锋</span></p><p><span>分享专业医疗器械知识</span></p></section><section><section><section><span>关注</span></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section></section><section data-role="paragraph" data-color="rgb(182, 228, 253)" data-custom="rgb(182, 228, 253)"><section><br /></section><section powered-by="gulangu"><section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><span>疫情之下，互联网医疗再迎政策红利，“首诊”有望被纳入互联网医疗。</span></p></section></section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><br /></section><p><img src="image/20201014/aa3111ec9c7060e698ed2550a661879b_2.png" /></p></section></section></section></section></section></section><section powered-by="gulangu"><section><br /></section></section><section powered-by="gulangu"><p><span>近日，国家发改委、中央网信办联合印发《关于推进“上云用数赋智”行动 培育新经济发展实施方案》（以下简称《方案》），首次提出了“互联网医疗医保首诊制”的内容，突破了以往只允许进行常见病、慢性病的线上复诊政策！</span></p><p><br /></p><p><span>《方案》中具体指出：以国家数字经济创新发展试验区为载体，在卫生健康领域探索推进互联网医疗医保首诊制和预约分诊制，开展互联网医疗的医保结算、支付标准、药品网售、分级诊疗、远程会诊、多点执业、家庭医生、线上生态圈接诊等改革试点、实践探索和应用推广。</span></p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><strong><span>探索推进互联网医疗医保首诊制<br /></span></strong></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><strong><span>6省市或将率先试点</span></strong></p></section></section></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><span>这是国家层面首次提出将首诊纳入互联网医疗、医保，不过，这个政策是“<strong>以国家数字经济创新发展试验区为载体</strong>”。也就是说按照以往先试点再推广的惯例来看，6个国家数字经济创新发展试验区有可能率先试点互联网医疗医保首诊制。</span></p><p><br /></p><p><span>据悉，</span><strong><span>浙江省、河北省(雄安新区)、福建省、广东省、重庆市、四川省</span></strong><span>这6个省市去年10月接受了“国家数字经济创新发展试验区”授牌，正式启动试验区创建工作。也就是说，这6个省市，将有可能率先试点互联网医疗医保首诊制。</span></p><p><br /></p><p><span>而在上述6个地区中，<strong>浙江、四川</strong>可能会优先试行。这六个城市都已经根据《互联网医院管理办法》和国务院26号文的要求建立了省级监管平台，互联网诊疗服务已经发展成一定的规模和总结了经验，对互联网医疗服务业的痛点、难点理解得更清晰，具备先行先试的基础。其中，浙江、四川还是国家“互联网+医疗健康”示范省，有可能会先行先试，因为这两个省有更好的基础。”</span></p><p><br /></p><p><span>而在优先落地的首诊科室上，<strong>皮肤科</strong>被公认为最有可能率先进行尝试的科室。</span></p><p><br /></p><p><span>值得注意的是，本次探索互联网医疗医保首诊制和预约分诊制，文件发布主体为国家发展改革委和中央网信办，并不是与互联网医疗、互联网医保相关主管部委国家卫健委、国家医保局联合印发，这对于互联网医疗监管、互联网诊疗项目医保支付的监管政策都带来了一定不确定性，而从“探索推进”的用词上看，目前尚未有具体的政策出台，但文件选择全国六大国家数字经济创新发展试验区为突破口，应该还是有可能先进行试点的。</span></p><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><strong><span>疫情期间<br /></span></strong></section></section></section><section><section powered-by="gulangu"><section><p><strong><span><strong>互联网医疗复诊打通医保支付</strong></span></strong></p></section></section><section powered-by="gulangu"><section><br /></section></section></section></section></section></section><section powered-by="gulangu"><section><p><span>疫情的推动，今年2月以来各地相继出台关于互联网诊疗、医保报销、网上续方等多项相关指导文件和政策细则，快速推动了互联网医疗的全国范围普及。</span></p><p><br /></p><p><span>而在此之前，政策层面一直对线上首诊严令禁止。早在2018年9月，国家卫健委、国家中医药管理局印发了《互联网诊疗管理办法（试行）》、《互联网医院管理办法（试行）》、《远程医疗服务管理规范（试行）》等3份文件。</span></p></section></section><section powered-by="gulangu"><section><p><br /></p></section></section><section powered-by="gulangu"><section><p>其中指出，互联网医院有两种形式：</p></section></section><section powered-by="gulangu"><section><table width="657"><tbody><tr opera-tn-ra-comp="_$.pages:0.layers:0.comps:18.classicTable1:0" powered-by="gulangu"><td colspan="1" rowspan="1" opera-tn-ra-cell="_$.pages:0.layers:0.comps:18.classicTable1:0.td@@0" width="8.0000%"><section powered-by="gulangu"><section><p>■</p></section></section></td><td colspan="1" rowspan="1" opera-tn-ra-cell="_$.pages:0.layers:0.comps:18.classicTable1:0.td@@1" width="92.0000%"><section powered-by="gulangu"><section><p>第一类是实体的医疗机构，可以自建互联网医院平台或与互联网企业合作搭建平台；</p></section></section></td></tr><tr opera-tn-ra-comp="_$.pages:0.layers:0.comps:18.classicTable1:1" powered-by="gulangu"><td colspan="1" rowspan="1" opera-tn-ra-cell="_$.pages:0.layers:0.comps:18.classicTable1:1.td@@0" width="8.0000%"><section powered-by="gulangu"><section><p>■</p></section></section></td><td colspan="1" rowspan="1" opera-tn-ra-cell="_$.pages:0.layers:0.comps:18.classicTable1:1.td@@1" width="92.0000%"><section powered-by="gulangu"><section><p>第二类是第三方来申请创办的互联网医院，必须要跟一家实体医疗机构来建立紧密的合作。</p></section></section></td></tr></tbody></table></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><span>推出这一政策，主要是为了方便管理，尤其是在发生医疗纠纷的时候。在线、云端这种纯虚拟的互联网医院，没有办法去监管。而实体医院和第三方合作举办互联网医院，首先要承担相应的监督责任。<br /></span></p><p><br /></p><p><span>另外 ，按照《互联网诊疗管理办法（试行）》第十六条规定，<strong>不得对首诊患者开展互联网诊疗活动</strong>，只能对部分常见病、慢性病患者提供复诊服务。</span></p><p><br /></p><p><span>在线开展复诊并且开具处方的时候，医师一定要掌握患者相应的一些病历资料，明确患者在实体医疗机构已经就一种病或者几种病有过明确的诊断了，那么可以针对已经明确诊断的疾病提供复诊的服务。如果是一个初诊的病人，查询不到任何病历资料的话，那么就只能建议他到实体医疗机构就诊。</span></p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><p>但如何界定在线疾病咨询和在线疾病诊疗是个难题。疾病在线咨询不属于互联网诊疗的范围，互联网诊疗是医生对疾病下诊断的结论，并且要提出治疗方案，要按照互联网诊疗的管理办法进行管理。</p></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><span>除此之外，对于患者来说，他们最关心的是在互联网上进行的医疗行为，是否可以与医保报销进行衔接？从今年开始，特别是疫情期间，互联网医疗的配套鼓励政策接连下发，原来关紧的闸正在一步步松开。</span></p><p><br /></p><p><span>今年2月初，国家卫健委连续下发文件，鼓励开展互联网诊疗进行疫情防控，要求针对发热患者组织呼吸科、感染科、急诊医学科、重症医学科、精神卫生科及全科医生，通过互联网为人民群众提供优质便捷的诊疗咨询服务。</span></p><p><br /></p><p><span>今年3月2日，国家医保局、国家卫健委日前联合印发《关于推进新冠肺炎疫情防控期间开展“互联网+”医保服务的指导意见》，<strong>明确要求：常见病、慢性病患者在互联网医疗机构复诊可依规进行医保报销</strong>。</span></p><p><br /></p><p><span>这意味着处方外流道路上的<strong>医保支付得以打通</strong>，不仅参保者的个人账户，甚至还包括统筹账户都将纳入到互联网医疗服务中支付，无疑对拉动患者上线就诊起到了很大促进作用。</span></p><p><br /></p><p><span>目前已有<strong>上海、浙江、江苏、天津、四川、广东、北京</strong>等地区相继将定点医疗机构的常见病、慢性病纳入在线医保。</span></p><p><br /></p><p><span>从线上复诊、接通医保到如今探索互联网医疗医保首诊制，互联网医疗的步子迈得越来越快，也越来越大。</span></p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><strong><span>促进互联网医疗发展<br /></span></strong></section></section></section><section><section powered-by="gulangu"><section><p><strong><span>配套政策仍待完善</span></strong></p></section></section></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><span>长远来看，互联网首诊的一个好处是，完全可以解决医疗资源与实际需求间的错配，将一线大城市的优质医疗资源覆盖到基层、偏远地区。其实，这个鸿沟一直都在，一直被批评，但一直没有得到有效解决。在这次的疫情面前，这个鸿沟被放大了。<br /></span></p><p><br /></p><p><span>然而若开放互联网首诊，降低风险的关键是严格控制医生资质。因为通过网上问诊能否掌握患者的病情，能否做出线上诊断、开出线上处方，医生才是最有发言权。一个资质合格、经验丰富的医生，才可以正确判断在什么情况下可以线上诊疗，什么情况下必须线下面诊。因此需对医生的职称设一些门槛（如副主任医师以上）。</span></p><p><br /></p><p><span>当然，承认互联网医疗并让他们可以实际发挥作用，还需要配套政策，包括符合要求的互联网首诊、复诊的医疗费用可以使用医保支付，首诊和复诊开具的处方可以在实体药房或互联网上购买药品，允许大城市的医生可以多点执业、自由执业等等。</span></p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><p>本次发改委的文件是方向性的指导，没有对医疗机构形成指令性要求，未来还要根据发改委的建议进行系统地落地。在确定首诊的科室、首诊流程等方面，由于专业性较强，还需要与国家卫建委、国家医保局等进行跨部门的协同。</p></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><span>来源：国务院办公厅官网、经济观察报、时代周报、北京市医保局等，筑医台资讯综合整理。</span></p></section><section><br /></section></section><section data-role="outer" label="Powered by gulangu"><section data-role="paragraph" data-color="#757576"><section data-role="paragraph"><section><section><section data-brushtype="text"><strong>相关阅读</strong></section></section></section><section><section><br /></section></section><section data-width="100%"><section><section><section><section data-width="100%"><section data-tools="gulangu" data-id="87578" data-color="#6aa9ad" data-custom="#59c3f9"><section><p><img src="image/20201014/2aac877ff9233ba5a66e7a5ff3a4febf_3.gif" /></p></section><section data-brushtype="text">戳一下，更有料！</section></section><section data-tools="gulangu" data-id="87578" 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发表于 2020-10-14 12:28:37