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术前查艾滋被指违规 业内人士：应以免费为前提
2011年06月18日 08:59:10 来源： 新华报业网-扬子晚报 编辑：耿健
本报6月15日曾经报道《部分医院手术病人竟被收性病、艾滋病检验费》，省物价局曝光50余项医药卫生服务违法收费行为，被检查的20家大医院“家家有问题”，其中在检查中发现有意愿对需要手术的病人收取乙肝、丙肝、性病和艾滋病的费用。此后，有医生致电本报表示，从医疗安全的角度，艾滋病检查早已经列入术前常规检查，不能算是乱收费。那么术前查艾滋乙肝，究竟算不算是乱收费？
-争议起因
物价局认为术前查艾滋违规
做手术的住院病人被收了艾滋病检验费，手指骨折的病人竟然还收阴道分泌物检验费，医院招标后私下与企业订立现金回扣协议……6月14日的发布会上，省物价局检查分局副局长林京对全省医药卫生服务价格大检查的情况进行阶段性通报：截至目前，国家发改委已按计划抽查了南京市鼓楼医院、江苏省肿瘤医院和苏州大学附属第一医院。省物价局组织的省内检查，4-6月先查了20家大医院，初步查出8大类、50余项违法乱收费行为。
“我们这次检查发现了很多问题，有的医院对住院病人特别是需要手术的病人，进行乙肝、丙肝、性病和艾滋病检验并收取检验费。某医院对治疗手部掌指骨骨折切开复位内固定术的患者还收取阴道分泌物检验费！”
医院： 任何有创检查，都有传染可能性
一名三甲医院的外科专家告诉记者，术前检查艾滋，首先是为了避免交叉感染艾滋病病毒的患者，对其诊疗的安排以及所用器械、物品和代谢物的处理都有别于普通患者。原则上，艾滋病患者不能同普通病人住同一房间，手术时也要安排到特殊感染手术室。携带艾滋病病毒、乙肝、丙肝病毒的患者使用的医疗器械，要使用单独的消毒包，除了一般的消毒流程外还要多次消毒，并进行相关指标的检验。“任何有创检查和手术，都有被感染的可能性，哪怕是做胃镜、拔牙，都有感染的可能。”这位专家说。
除了对病人，医护人员也要进行必要的防护，外科医生直接接触患者的血液，遭受感染的几率会增大。“一般戴一层手套，对艾滋病人手术要戴两层，还要穿特别的防护服，戴防护眼镜。”
另外，就是输血可能带来的隐患，万一病人以后发现感染了艾滋或者乙肝，那怎么判断是否是输血造成的呢？这名专家说，医院很大程度上也是规避风险，目前医疗纠纷实行“举证责任倒置”，患者如果状告医院，医院要证明自己没有错。假如医院手术前没有做这样的检查，日后患者感染了艾滋病或乙肝，回来找医院说是手术感染的，医院根本说不清。而现在外科手术输血的比例依旧非常高，比如绝大多数心脏手术都必须输血，一台普通心脏手术输血量通常在800毫升左右。
但同样，对于术前进行艾滋病检测，许多病人或家属往往难以理解。特别是儿童，手术之前也要进行艾滋病毒的检查，这让很多家长都觉得不可思议。对此专家解释说，即使是孩子，也有可能通过母婴垂直传播造成艾滋病毒感染，而小孩手术同样存在上述风险，所以做这项检查是不分年龄的。
省卫生厅： 术前查艾滋等病不违规
省卫生厅规财处副处长陶红滨表示，2005年《江苏省医疗服务项目价格》中规定收费项目和收费价格，艾滋病也列入其中，至于何种情况需要采取何种治疗或检查，则应该遵循医疗规律。术前医生需要了解患者身体状况，所以，艾滋病、乙肝等都是必须查的。省卫生厅医政处处长李少东也表示，医院术前检查艾滋病、乙肝等都没违反医疗规范。
记者了解到，卫生部于2000年6月1日发布根据《医疗机构临床用血管理办法(试行)》组织专家制定了《临床输血技术规范》，自2000年10月1日起实施。2003年省卫生厅就下发通知，要求医疗机构按照卫生部《临床输血技术规范》，对受血患者受血前应进行乙肝、丙肝、梅毒、艾滋病等项目的检测。
江苏省医学法学会胡晓翔副会长告诉记者，根据临床输血技术规范，医患双方都要签署《临床输血治疗同意书》，这其中术前检查就包含了艾滋等项目。“所以说，手术输血前进行艾滋病的检查是具有法律依据的。“胡晓翔说，医院该不该给患者查艾滋，不是物价部门说了算的。“而如果医院某个项目本该收十元钱，收了十一元，那就是违规了。”
省物价局： 术前查艾滋找不到国家规定
对于卫生部门的质疑，记者昨日向省物价局求证。省物价局相关人士向记者表示，一方面术前检查要包括哪些内容，国家并没有相关的规定，而且省物价局、省卫生厅2005年就发布的《江苏省医疗服务项目价格》的通知中是找不到手术需要查验乙肝、丙肝、性病、艾滋病等要求的。另一方面，不少医院害怕因手术带来医疗纠纷，尤其是前些年一些输血病人在做完手术后发现自己原来没有丙肝的患了丙肝，给医院带来很多官司，所以对输血的手术病人通常会做肝功能的检查，但事实是，大部分手术的病人是不需要输血的。
这位人士表示：“应该说，我们查出来的医院这么多问题是实际存在的，现在不仅是我省在做医药卫生价格大检查，全国自上而下都在做，国家发改委也在检查，我省的检查人员也参加了国家发改委对外省的抽查，都是这么查的，一些问题还是从国家发改委的直接检查中反映出来的。”而省物价局检查分局副局长林京昨日也对记者表示，一些没有做手术的住院病人也被收取了乙肝、丙肝、性病或艾滋病等检查费用，医院不能无视自己的这些乱收费行为。
业内人士建议：强制查艾滋应以免费为前提
记者了解到，国内有一些地区此项收费是由政府埋单的。2007年《浙江省艾滋病防治条例》规定，根据艾滋病预防和控制的需要，经本人同意，免费对孕产妇、手术病人进行产前、手术前艾滋病检测，费用由政府全额埋单。
一位业内人士告诉记者，医院在诊疗中如果严格依据操作规范，可以避免艾滋病的传播，实际上医源性感染艾滋病的几率越来越小。所以给病人施行“强制”检查，其实更多是为了避免以后的医疗纠纷。
那么既然强制检查，首先需要保证患者的知情权，在检查之前，医务人员必须明确告知患者，否则就是侵犯了患者的知情同意权。另外，既然是“强制”检查，那么费用就不应该由患者承担。而换个角度，免费检查也容易得到患者的支持。(于丹丹 毕晓红 石小磊)
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
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Preoperative HIV accused of illegal investigation industry: should be free as a precondition
June 18, 2011 08:59:10 Source: Xinhua Newspaper Network - Yangtze Evening News Editor: Jian Geng
Newspaper had reported on June 15, "part of the surgery patients hit by hospital received sexually transmitted diseases, HIV testing fee", the Provincial Price Bureau exposure more than 50 medical and health services to illegal collection of fees, to be inspected 20 large hospitals, "Every family has its problems." , which are found during inspections will be charged on the need for surgery patients hepatitis B, hepatitis C, sexually transmitted diseases and AIDS costs. Since then, doctors call the newspaper said that from the perspective of medical safety, AIDS testing already included in the preoperative routine examination, can not be overcharged. HIV-hepatitis B before surgery then check whether the count is not arbitrary charges?
- The causes controversy
Pricing that preoperative investigation HIV violation
Surgery patients were received HIV testing fee, even a finger fracture patients also received vaginal inspection fees, after a private hospital tender cash rebate agreement entered into with the company on June 14 ... ... The conference, Provincial Price Bureau check Lin, deputy director of Beijing Branch of the province's medical and health services for the price situation for periodic inspection briefing: As of now, the National Development and Reform Commission has scheduled a sample of the Drum Tower Hospital, Nanjing, Jiangsu Province, Suzhou University Cancer Hospital and the first hospital. Provincial Price Bureau organizations in the province inspection will check the 4-June 20 large hospitals, initially identified eight categories, more than 50 illegal and arbitrary collection of fees.
"We found a lot of problems the inspection, some hospital patients, especially patients who need surgery, for hepatitis B, hepatitis C, sexually transmitted diseases and HIV testing and inspection fees charged. A hospital for treatment of hand metacarpal and phalangeal fractures with open reduction fixation of the patients also received vaginal inspection fees! "
Hospital: Any invasive, has the possibility of infection
A top three hospital surgeons told reporters that preoperative HIV, first, to avoid cross-infection of HIV patients, their treatment of the arrangement and the instruments used, the handling of goods and metabolites are different from ordinary patients. In principle, patients with AIDS can not live in the same room with the general, surgical operating room should be arranged to specific infections. Living with HIV, hepatitis B, hepatitis C virus in patients with medical devices, to use a separate sterile package, in addition to the general disinfection processes but also many foreign disinfection, and associated indicators test. "Any invasive examination and surgery, there is the possibility of infection, even if it is to do endoscopy, tooth extraction, there is the possibility of infection." The expert said.
In addition to patients, medical staff have the necessary protection, the surgeon direct contact with blood, will increase the chance of being infected. "Generally wear a layer of gloves to wear for people with AIDS, two surgery, but also wear special protective clothing, wear protective glasses."
In addition, blood transfusion is a potential risk, if the patient later found to be infected with HIV or hepatitis B, how to determine whether it is caused by blood transfusion? The expert said the hospital also largely avoid the risk, the implementation of the current medical malpractice "burden of proof", the patient sued the hospital if the hospital to prove that he did wrong. If the hospital before surgery did not do such a check, the future of patients infected with HIV or hepatitis B, and comes back surgery, said hospital infections, the hospital does not tell. Now surgery is still a very high proportion of blood transfusions, such as the vast majority of cardiac surgery have to be blood transfusion, a normal blood volume cardiac surgery is usually 800 ml.
But again, for HIV testing before surgery, many patients or their families are often difficult to understand. Especially children, but also for HIV before surgery to check that so many parents think that's incredible. This expert explained that, even children, may also be caused by vertical transmission of HIV infection, but children also exists the risk of surgery, so do the inspection regardless of age.
Provincial Health Department: HIV and other diseases, preoperative investigation is not illegal
Provincial Health Department Deputy Director of Planning and Finance, said Tao Hongbin, 2005, "Jiangsu Province, the price of medical services" fees and charges specified in the price of AIDS was also included, as to what circumstances require treatment or examination, should be medical follow the law. Doctors need to understand the patient preoperative physical condition, so, AIDS, hepatitis B, etc. are necessary investigation. Provincial Health Office of Medical Affairs Director Li Shaodong also said that the hospital preoperative AIDS, hepatitis B and so did not violate medical practice.
Reporters learned that the Ministry of Health on June 1, 2000 issued under the "medical blood for clinical management (tentative)" experts to develop a "clinical transfusion technical specifications", since October 1, 2000 onwards. 2003 Provincial Health Department issued a notice on the next, the medical establishment is in accordance with the Ministry of Health, "Clinical Transfusion technical specifications", by the blood of patients affected by blood should be carried out before the hepatitis B, hepatitis C, syphilis, HIV testing and other projects.
Jiangsu Medical Law Hu Xiaoxiang, vice president, told reporters, according to the technical specifications of clinical blood transfusion, doctors and patients must sign the "consent of clinical blood transfusion", which contains the preoperative HIV and other projects. "Therefore, blood transfusions before AIDS screening is a legal basis." Hu Xiaoxiang, said the hospital the patient should check to HIV, not the final say in the price department. "And if the hospital received a project of the ten dollars, received eleven dollars, and that is a violation."
Provincial Price: HIV patients before the investigation could not find the state
Challenge for the health sector, the provincial price bureau reporter yesterday confirmation. Provincial Price Bureau official told reporters, on the one hand preoperative examination should include what the state did not correlate with the requirements, the Provincial Price Bureau, the Provincial Health Department in 2005 "issued by Jiangsu Province, the price of medical services," the notice can not find the need for operation check of hepatitis B, hepatitis C, sexually transmitted diseases, AIDS and other requirements. On the other hand, many hospitals are afraid to bring medical malpractice due to surgery, especially a few years ago some of the blood transfusion after surgery the patient had not found himself suffering from hepatitis C hepatitis C, many lawsuits brought to the hospital, so the blood transfusion surgery patients usually do check liver function, but the fact is that most surgical patients do not need blood transfusion.
The source said: "It should be said, we check out of the hospital so many questions is real, it is not only the price of our province to do the medical and health inspection of the country from top to bottom are doing, the National Development and Reform Commission also inspection, inspectors also participated in the province of the National Development and Reform Commission checks of foreign province, are of such a check, some of the problems or the direct examination from the National Development and Reform Commission reflected. "The Provincial Price Bureau deputy inspection Secretary Lin told reporters in Beijing yesterday, a number of surgery patients have not been charged hepatitis B, hepatitis C, HIV and other sexually transmitted diseases, or inspection costs, these hospitals can not ignore their own arbitrary collection of fees.
The industry recommendations: mandatory HIV should be free to check the premise
Reporters learned that there are some areas of this country is charged by the government will pay for. 2007 "Zhejiang AIDS Prevention Act," provides, according to the needs of AIDS prevention and control, by consent, free of charge to pregnant women, prenatal surgery patients, HIV testing before surgery, the cost will pay in full by the government.
An industry source told reporters that the hospital treatment, if strictly in accordance with practices, to avoid the spread of AIDS, in fact iatrogenic risk of HIV infection getting smaller and smaller. So to the patients in "mandatory" check, in fact, more to avoid future medical disputes.
Well, since mandatory testing, you first need to ensure the patient's right to know, before the examination, medical personnel must be clear to patients that, otherwise, it is a violation of the patient's informed consent. In addition, since it is "mandatory" check, then the cost should not be borne by the patient. And from another angle, but also easy to get free check-patient support. (In Dandan Bi Xiaohong Shi Xiaolei)
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