过期淘汰的医疗设备就“下乡”，怎能保障基层医疗？

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                    <h2 style="line-height: 25.6000003814697px; white-space: normal; max-width: 100%; color: rgb(62, 62, 62); box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; color: rgb(136, 136, 136); font-size: 14px; line-height: 1.6; box-sizing: border-box !important; word-wrap: break-word !important;"><img data-type="gif" data-ratio="0.23125" data-w="480" width="auto" src="http://mmbiz.qpic.cn/mmbiz/5ibOsxlAbVbOibGzk1rPuLuA79GCcwBDiblW2XoiaapPtJFIpNcTeqFYNYvDrn8OEGga69f4APajc1GskNibaAr974Q/0?wx_fmt=gif" style="box-sizing: border-box !important; word-wrap: break-word !important; width: auto !important; visibility: visible !important;"  /></span></h2><p><span style="max-width: 100%; color: rgb(136, 136, 136); font-size: 14px; line-height: 1.6; box-sizing: border-box !important; word-wrap: break-word !important;">来源：梅斯医学 &nbsp; 作者：孟庆远</span></p><section class="e7editor" data-id="391" data-color="rgb(30, 155, 232)" data-custom="rgb(30, 155, 232)" style="max-width: 100%; color: rgb(62, 62, 62); line-height: 25.6000003814697px; white-space: normal; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section style="margin: 1.5em 1em 1em; max-width: 100%; box-sizing: border-box; border: 0px rgb(30, 155, 232); border-image-source: none; line-height: 25px; display: inline-block; word-wrap: break-word !important;"><section style="margin-left: -0.5em; max-width: 100%; box-sizing: border-box; line-height: 1.4; word-wrap: break-word !important;"><section style="padding: 3px 8px; max-width: 100%; box-sizing: border-box; border-color: rgb(0, 0, 0); border-radius: 4px; color: rgb(255, 255, 255); font-size: 1em; display: inline-block; word-wrap: break-word !important; background-color: rgb(30, 155, 232);"><span class="e7brush" data-brushtype="text" style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">医疗设备</span></section></section><section class="e7brush" data-style="line-height:24px;color:rgb(89, 89, 89); font-size:14px" style="margin-top: -24px; padding: 22px 16px 16px; max-width: 100%; box-sizing: border-box; border: 1px solid rgb(30, 155, 232); color: rgb(0, 0, 0); font-size: 14px; word-wrap: break-word !important;"><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; line-height: 24px; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="max-width: 100%; color: rgb(89, 89, 89); font-size: 16px; line-height: 25.6px; box-sizing: border-box !important; word-wrap: break-word !important;">医疗器械直接关乎人的身体健康甚至生命安全，对基层医疗机构的分级诊疗发挥重要作用。</span></p></section></section></section><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">尤其是大型检查医疗设备，通过提高疾病诊断正确率，对实现“90%”目标有极大的保障作用。但由于基层财政、医疗机构实力及群众的承受能力等原因，许多基层医疗机构尤其是边远贫困地区医疗机构，考虑城市大医院“超期服役”医疗设备“下乡”已司空见惯，而实际上，<strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">基层患者的高消费并未得到他们预想中的“高精医疗”服务，</strong>“看病贵”反而有所加重。</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">按医疗器械的规范管理规则，医疗器械在使用了一定年限或达不到质量安全要求的情况下，必须进行报废处理。然而现实中，许多医疗机构为了投入的回收，要么继续使用，要么转手别的医疗机构，特别是基层农村医疗机构，成了“超期服役”甚至报废医疗器械“下乡”的主要场地。</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">河南省原阳县5家二级医院和2家中型私立医院的8部CT，<strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">有6部为省市医院淘汰的双排螺旋CT，其中一家县级医院的CT阳性率只有65%，与三甲医院64排螺旋CT结果相符率只有60%，其它如核磁共振、DR、彩超等，报废退役使用率80%。</strong>一家县级医院2015年诊断正确率只有75%，转院率高达21%（新农合），全院检查量负增长，其中双排螺旋CT下降12%，DR下降16%。一定程度上，不能排除报废退役大型医疗设备的检查失信是主要原因之一。据了解，目前有2家县级医疗机构已报请购置最新乙型大型医疗设备。</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">据了解，因为医疗器械种类繁多，不同产品的技术标准、工作原理、应用材料、使用频率、制造工艺、功能、性能等各有差异，使用寿命有长有短，折旧和报废的年限、标准难以统一定性，因此目前国家还没有制定统一的医疗器械使用年限规定和报废标准。这也自然成为城市医疗机构大型医疗设备更新换代后，让报废或退役医疗器械（主要是大型医疗设备）有偿“下乡”的理由而无人制止。</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><br  /></span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">有专家及行业人士提出，一般医疗设备折旧年限一般为<strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">5</strong>年；光学仪器及窥镜、医用超声仪器、医用磁共振设备、医用X线设备、医用核素设备、消毒设备等折旧年限一般为<strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">6</strong>年；高能射线设备折旧年限一般为<strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">6～8</strong>年。达到或超过规定年限且无修复使用价值的仪器设备，结构陈旧、性能落后、严重丧失精度，不能满足使用要求且无法修复的仪器设备，继续使用将会引起事故危险的仪器设备，应彻底报废入库，如果 “下乡”“超期服役”“带病作业”，既可能为临床用械安全埋下了巨大隐患，也让基层患者花高价得不到精准医疗，加重他们“看病贵”。</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">因此，笔者认为必须加强大医院报废或“超期服役监”医疗设备的<span style="max-width: 100%; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">监管力度：</strong></span></span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><br  /></p><section class="e7editor" data-id="44423" data-color="rgb(239, 112, 96)" data-custom="rgb(239, 112, 96)" style="max-width: 100%; color: rgb(62, 62, 62); line-height: 25.6000003814697px; white-space: normal; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><p style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; min-height: 1em; white-space: pre-wrap; word-wrap: break-word !important;"><span style="max-width: 100%; color: rgb(255, 255, 255); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span class="e7brush" data-bcless="darken" data-brushtype="text" style="margin-right: 7px; margin-bottom: 11px; padding: 5px 10px; max-width: 100%; border-radius: 3px; line-height: 36px; text-align: center; border-color: rgb(212, 43, 21); box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(239, 112, 96);">一</span></strong></span><span style="max-width: 100%; line-height: inherit; box-sizing: border-box !important; word-wrap: break-word !important;">需要建立健全和完善医疗器械管理相关法律政策，让医疗器械的管理（包括单位主体责任）明确、明朗、规范化，管理有法可依，依法堵住报废及超期医疗器械“下乡”。</span></p></section><section class="e7editor" data-id="44423" data-color="rgb(239, 112, 96)" data-custom="rgb(239, 112, 96)" style="max-width: 100%; color: rgb(62, 62, 62); line-height: 25.6000003814697px; white-space: normal; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><p style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; min-height: 1em; white-space: pre-wrap; word-wrap: break-word !important;"><span style="max-width: 100%; color: rgb(255, 255, 255); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span class="e7brush" data-bcless="darken" data-brushtype="text" style="margin-right: 7px; margin-bottom: 11px; padding: 5px 10px; max-width: 100%; border-radius: 3px; line-height: 36px; text-align: center; border-color: rgb(212, 43, 21); box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(239, 112, 96);">二</span></strong></span><span style="max-width: 100%; line-height: inherit; box-sizing: border-box !important; word-wrap: break-word !important;">明确监管主体，让卫生、质监、药监（主管或监管）或有关部门对大医院的大型医疗设备进行严格的备案制度及规范监管，建立医疗器械监督管理信息平台，定期抽检查处，对报废大型医疗设备必须入库，个别到期但功能运转状况良好的，经行业技术质量部门的审查验收，确有一定使用价值的可以继续使用，但必须加大加强管理维修维护，发现异常，必须立即停止运转。</span></p></section><section class="e7editor" data-id="44423" data-color="rgb(239, 112, 96)" data-custom="rgb(239, 112, 96)" style="max-width: 100%; color: rgb(62, 62, 62); line-height: 25.6000003814697px; white-space: normal; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><p style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; min-height: 1em; white-space: pre-wrap; word-wrap: break-word !important;"><span style="max-width: 100%; color: rgb(255, 255, 255); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span class="e7brush" data-bcless="darken" data-brushtype="text" style="margin-right: 7px; margin-bottom: 11px; padding: 5px 10px; max-width: 100%; border-radius: 3px; line-height: 36px; text-align: center; border-color: rgb(212, 43, 21); box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(239, 112, 96);">三</span></strong></span><span style="max-width: 100%; line-height: inherit; box-sizing: border-box !important; word-wrap: break-word !important;">基层卫生主管部门，必须对基层医疗机构使用大医院“下乡”大型医疗设备进行严格审查，严禁自行购买使用；建议基层医疗机构购置使用国产大型医疗设备，维修维护方便，投入少，收费价格低；四是执法部门通过网络、中介公司、熟人介绍、非法经销商等渠道，对非法销售国外淘汰医疗器械的案件进行严厉打击。</span></p><p style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; min-height: 1em; white-space: pre-wrap; word-wrap: break-word !important;"><span style="max-width: 100%; line-height: inherit; box-sizing: border-box !important; word-wrap: break-word !important;"><br  /></span></p></section><section class="e7editor" data-id="44423" data-color="rgb(30, 155, 232)" data-custom="rgb(30, 155, 232)" style="max-width: 100%; color: rgb(62, 62, 62); line-height: 25.6000003814697px; white-space: normal; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section style="margin-top: 10px; margin-bottom: 10px; max-width: 100%; box-sizing: border-box; word-wrap: break-word !important;"><span style="max-width: 100%; color: rgb(255, 255, 255); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span class="e7brush" data-bcless="darken" data-brushtype="text" style="margin-right: 7px; margin-bottom: 11px; padding: 5px 10px; max-width: 100%; border-radius: 3px; line-height: 36px; text-align: center; border-color: rgb(15, 95, 145); box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(30, 155, 232);">编辑寄语：</span></strong></span></section></section><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">也许我们所想做的，就是尽可能的保障在生命面前，人是平等的，医疗资源是合理共享的，而不是淘汰制的。</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 25.6000003814697px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; color: rgb(136, 136, 136); box-sizing: border-box !important; word-wrap: break-word !important;">此文来自作者投稿，作者：孟庆远，欢迎投稿~~</span></p><p><br  /></p><section style="line-height: 25.6000003814697px; white-space: normal; max-width: 100%; color: rgb(62, 62, 62); font-family: 微软雅黑; border: 0px; text-align: center; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><section style="max-width: 100%; display: inline-block; box-sizing: border-box !important; word-wrap: break-word !important;"><section class="135title" style="margin: 0em 0.5em 0.1em; max-width: 100%; font-size: 1.8em; color: rgba(51, 120, 255, 0.992157); line-height: 1; font-weight: inherit; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="max-width: 100%; font-size: 20px; box-sizing: border-box !important; word-wrap: break-word !important;"><strong class="135brush" data-brushtype="text" style="padding-right: 50px; padding-bottom: 3px; padding-left: 50px; max-width: 100%; border-bottom-style: solid; border-bottom-width: 1px; border-color: rgb(2, 2, 2); display: block; line-height: 28px; box-sizing: border-box !important; word-wrap: break-word !important;">梅斯医学（MedSci）</strong></span></section><section class="135brush" data-brushtype="text" style="margin: 0.5em 1em; max-width: 100%; font-weight: inherit; text-align: inherit; text-decoration: inherit; color: rgba(51, 120, 255, 0.992157); box-sizing: border-box !important; word-wrap: break-word !important;"><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="max-width: 100%; font-size: 16.3636360168457px; line-height: 16.3636360168457px; box-sizing: border-box !important; word-wrap: break-word !important;">改善医疗质量</span></p><p style="max-width: 100%; min-height: 1em; white-space: pre-wrap; font-size: 1em; line-height: 1; box-sizing: border-box !important; word-wrap: break-word !important;"><img title="medsci.jpg" data-type="jpeg" data-ratio="1" data-w="200" width="200px" src="http://mmbiz.qpic.cn/mmbiz/5ibOsxlAbVbNrYgd0x6A2wbEXots7X5xLE5rBd14oUb6ZYbtiaCrRRE3ickuDaS9Dm23c0HmIAlbCYJUibTkZA1JCQ/640?wx_fmt=jpeg" style="box-sizing: border-box !important; word-wrap: break-word !important; width: 200px !important; visibility: visible !important;"  /></p></section><span style="padding: 0.3em; max-width: 100%; font-size: 1em; border-radius: 0.3em; color: rgb(255, 255, 255); display: inline-block; font-weight: inherit; text-align: inherit; text-decoration: inherit; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgba(51, 120, 255, 0.992157);">微信号：medsci_cn</span></section></section>