Opinions of Deepening the Reform of the Medical and Health Care System

 2018-07-03  25


· Document Number:No. 6 [2009] of the CPC Central Committee

· Level of Authority: Group Provisions

· Date issued:03-17-2009

· Effective Date:03-17-2009

· Status: Effective

· Issuing Authority: Central Committee of the Communist Party of China State Council

 

Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical and Health Care System
(March 17, 2009 No. 6 [2009] of the CPC Central Committee)
According to spirits of the 17th National Congress of the Communist Party of China (CPC), for purposes of establishing a medical and health care system with Chinese characteristics, gradually realizing the objective of providing universal coverage of basic medical and health care services, and improving the level of people's health, we hereby put forward the following opinions on deepening the reform of the medical and health care system.
I. Fully understanding the importance, urgency and difficulty of deepening the reform of the medical and health care system
The medical and health care cause is a major livelihood issue which concerns the health of hundreds of millions of people and the well-being of millions of households. To deepen the reform of the medical and health care system, speed up the development of the medical and health care cause, meet the increasingly growing demands of the people for medicine and health care and continuously improve the health of the people are the inevitable requirements of implementing the scientific development view and promoting the comprehensive, coordinated and sustainable economic and social development, are the important measures for maintaining social fairness and justice and improving the life quality of the people, and are a major task in building a well-off and harmonious socialist society on a full scale.
Since the founding of the new China, especially since the reform and opening-up to the outside world, China's medical and health care cause has witnessed remarkable achievements. For example, a medical and health service system covering both urban and rural areas has been formed basically, the ability of disease prevention and control has increased continuously, the population covered by the medical security has expanded gradually, the level of health science and technology has risen rapidly, the level of people's health has been improved significantly, and the main health indicators of residents are at the forefront of the developing countries. In particular, since the significant victory in the fight against SARS, the governments at all levels have appropriated more funds for medicine and health care, the development of public health, rural medical and health care and urban community health care has been accelerated, and breakthroughs have been made in the development of new-typed rural cooperative medical care and basic medical insurance for non-working urban residents, laying a good groundwork for deepening the medical and health care system. At the same time, it should be noted that the current development level of China's medical and health care cause still obviously does not meet the health demands of the people and requirements of the coordinated economic and social development. The people are greatly concerned about the uneven development of the medical and health care cause in urban and rural areas, unreasonable allocation of resources, relatively weak work on public health and rural and community medicine and health care, incomplete medical security system, nonstandard order of the production and distribution of medicine, imperfect management system and operation mechanisms of hospitals, inadequate health funds appropriated by governments, rapid increase in medical costs and excessive burdens on individuals.
From now on to 2020 is a critical period for China to build a well-off society on a full scale, and the medical and health care tasks are heavy. With the economic development and the rise of the people's living standard, the people will have higher requirements for improving medical and health care services. Industrialization, urbanization, aging population, disease spectrum changes and changes of ecological environment all have brought about a series of new stern challenges to medical and health care work. To deepen the reform of the medical and health care system is a strategic choice for accelerating the development of the medical and health care cause, is an important way for the people to share the fruits of reform and development, and is an urgent hope of the people.
To deepen the reform of the medical and health care system is a broad-based difficult social system project. The basic national conditions of China, i.e. a large population, low average income per capita, big gaps between urban and rural areas and between regions and being in the primary stage of socialism for a long time, determine that to deepen the medical and health care system is a very complicated and arduous task and is a gradual process, and a medical and health care system corresponding to China's national conditions could be gradually established only on the basis of a clear direction and framework and through a long period of hard work and persistent exploration. Therefore, to deepen the reform of the medical and health care system, we should not only have a firm determination to lose no time in carrying forward the reform, but also make elaborate arrangements and steady implementation, so as to ensure the smooth progressing of reform and achieve the desired objectives.
II. Guiding ideology, basic principles and overall objective for deepening the reform of the medical and health care system
(1) Guiding ideology for deepening the reform of the medical and health care system. We shall follow the guidance of Deng Xiaoping theory and the important idea of “Three Represents”, thoroughly implement the scientific development view, start from China's national conditions, learn from international useful experience, focus on achieving the objective of providing universal coverage of basic medical and health care services, and endeavor to resolve the interest issues which the people are most concerned with, which are most direct and which are most practical. We shall insist that public medicine and health care are for the public good, adhere to guidelines of giving priority to prevention, focusing on rural areas and stressing both traditional Chinese medicine and western medicine, separate government administration from public institutions, government management from business operations, medical treatment from drugs and for-profit operations from nonprofit operations, strengthen the government's responsibility, increase investment, improve the national health policies, perfect the system of rules, strengthen supervision and management, innovate in systems and mechanisms, encourage public participation, and establish a basic medical and health care system covering both urban and rural residents, so as to continuously improve the level of national health and promote social harmony.
(2) Basic principles for deepening the reform of the medical and health care system. The reform of the medical and health care system must be based on our national conditions, start from reality in every respect, and adhere to correct reform principles.
-- We shall adhere to the people-first concept, and give top priority to safeguarding the health rights and interests of the people. We shall adhere to the tenet that the medical and health care cause should serve the people's health, center on protecting the people's health, take the provision of universal coverage of basic medical and health care services as the fundamental starting point and foothold, follow the principle of public good in terms of design of reform program, establishment of health system and construction of service system, provide the basic medical and health care system as a public product to all the people, focus on resolving the problems that the people are greatly concerned about, and strive to realize the provision of medical services for all the people who need medical attention.
-- We shall adhere to establishing the medical and health care system with Chinese characteristics based on our national conditions. We shall start from our basic national conditions, realistically sum up practical experience from the medical and health care reform and development, and accurately grasp the law and main contradictions of the medical and health care development; adhere to the harmonization between the level of basic medical and health care services and that of the economic and social development and the consistency between it and the affordability of the people; give full play to the traditional Chinese medicine (ethnic medicine); adhere to the adjustment of measures to local conditions and the categorized guidance, accentuate the local initiatives, and explore the ways to establish a basic medical and health care system in line with our national conditions.
-- We shall insist on unifying fairness and efficiency, and combining the leading role of government with the role of market mechanism. We shall strengthen the responsibility of government in the basic medical and health care system, increase the functions of government in development of rules, planning, financing, services, supervision, etc., maintain the public nature of the public medical and health care, and promote fairness and equity. At the same time, we shall pay attention to the role of market mechanism, mobilize social forces to participate, and promote the formation of an orderly competition mechanism, and improve the operating efficiency, service level and quality of medical and health care, so as to satisfy multi-level and diversified demands of the people for medical and health care.
-- We shall insist on the overall planning with all factors being considered, and combine resolving the prominent problems for the time being with improving the system of rules. We shall start from the overall situation, coordinate the urban-rural and regional development, take into account interests of all parties including suppliers and demanders, focus on the combination of prevention, treatment and rehabilitation, and properly handle the relations among government, health institutions, pharmaceutical enterprises, medical workers and the people. We shall not only innovate in systems and mechanisms by looking forward, but also resolve the prominent issues existing in the medicine and health care system for the time being. We shall not only underscore the overall design to clarify the overall direction, objectives and basic framework of reform, but also highlight the key points and implementation step by step to actively and steadily push forward the reform.
(3) Overall objectives for deepening the reform of the medical and health care system. We shall establish and improve a basic medical and health care system covering both urban and rural residents, which provides safe, effective, convenient and affordable medical and health care services for the people.
By 2011, a basic medical security system will have covered both urban and rural residents, a basic drug system will have been initially established, the grassroots medical and health service system in urban and rural areas will have been further improved, the universal access to basic public health services will have been realized, the pilot reform of public hospitals will have seen breakthroughs, the accessibility of the basic medical and health care services will have been significantly raised, the burden of medical costs on residents will have been effectively reduced, and the “difficulty in obtaining medical services and high medical expenses” will have been effectively eased.
By 2020, the basic medical and health care system covering both urban and rural residents will have been basically established. A relatively complete public health service system and medical service system, a relatively sound medical security system, a fairly standard drug supply safeguard system, and a relatively scientific management system and operation mechanism for medical and health institutions will have been established universally. A medical business layout with diversified participants will have been formed, a universal coverage of the basic medical and health care services will have been provided, the multi-level needs of the people for medical and health care will have been basically met, and the level of the people's health will have been further improved.
III. Improving the four major systems of medicine and health care and establishing a basic medical and health care system covering both urban and rural residents
We shall build a public health service system, a medical service system, a medical security system and a drug supply safeguard system covering both urban and rural residents, and form a four-in-one basic medical and health care system. The four systems shall supplement each other, be built in relation to each other and develop in a coordinated way.
(4) We shall strengthen the building of the public health service system on a full scale. We shall establish and improve the professional public health service network of disease prevention and control, health education, maternal and child health, mental health, first aid, blood collection and supply, health supervision, family planning, etc., improve the public health service functions of the medical and health service system based on the grassroots medical and health service network, establish a public health service system with a clear division of work, information exchange, resource sharing, coordination and interaction, improve the capacities to provide public health services and respond to and dispose of public health emergencies, and promote the equal access for urban and rural residents to basic public health services step by step.
We shall determine the scope of public health services. We shall clarify the items of national basic public health services, and gradually increase the contents of services. Local governments shall be encouraged to increase the contents of public health services according to the local level of economic development and conspicuous public health issues and on the basis of service items as prescribed by the central government.
We shall improve the public health service system. We shall further clarify the functions, objectives and tasks of the public health service system, optimize the allocation of personnel and equipment, and explore the effective forms of integration of the public health service resources. We shall improve the grave disease prevention and control system and the public health emergency response mechanism, strengthen the monitoring, prevention and control of infectious diseases, chronic diseases, endemics, occupational diseases, birth defects and other diseases that seriously threat the people's health, and strengthen the building of an urban and rural first aid system.
We shall strengthen health promotion and education. Medical and health care institutions, state organs, schools, communities, enterprises, etc. shall vigorously carry out health education, make full use of various media to enhance the dissemination of knowledge on health, medicine and health care, advocate a healthy and civilized lifestyle, promote reasonable nutrition of the people, and improve the health awareness and self-care ability of the people.
We shall carry out an in-depth patriotic health campaign. We shall bring the rural environmental health and environmental pollution control into the construction planning of the new socialist countryside, promote the construction of health cities and civilized villages and towns, and continuously improve the health environment in living, work, etc. of urban and rural residents.
We shall strengthen health supervision services. We shall vigorously promote the environmental health, food hygiene, occupational health, school health, as well as the health work of moving population such as rural migrant workers.
(5) We shall further improve the medical service system. We shall adhere to the following principles for running medical services: taking nonprofit medical institutions as the mainstay and for-profit medical institutions as the supplement and letting the public medical institutions take the lead and the non-public medical institutions develop together, and build a medical service system with a reasonable structure and covering both urban and rural areas.
We shall vigorously develop the rural medical and health service system. We shall further improve the rural medical and health service network under the leadership of county-level hospitals and based on health clinics in townships and towns and infirmaries in villages. County-level hospitals, as the medical and health care centers in counties, shall be mainly responsible for the basic medical services and the rescue of critically ill or acute patients, and undertake the operational and technical guidance of health clinics in townships and towns and infirmaries in villages and training of health personnel. Health clinics in townships and towns shall be responsible for providing public health services and comprehensive services such as diagnosis and treatment of common or frequently-occurring diseases, and undertake the business management and technical guidance of infirmaries in villages. Infirmaries in villages shall undertake the public health services, diagnosis and treatment of common diseases, etc. in the administrative villages. Where conditions permit, rural areas shall adopt the integrated management of townships and villages. We shall actively promote the medical and health care infrastructure and capacity buildup in rural areas. The government shall focus on building county-level hospitals and well operate a health clinic in each town or township; take various measures to support the construction of infirmaries in villages so that each administrative village will have a village infirmary. We shall vigorously improve the medical and health care conditions in rural areas and enhance the service quality.
We shall improve a new type of urban medical and health service system based on community health service. We shall accelerate the construction of an urban community health service network that takes the community health service centers as the mainstay, improve service functions, and aiming at the health protection of community residents, provide public health services including disease prevention and control, primary diagnosis and treatment services for common diseases and frequently-occurring diseases, chronic disease management and rehabilitation services. We shall transform the mode of community health services, continuously raise the service level, insist on active service and doorstep service, and gradually fulfill their role of “gatekeeper” of the health of residents.
We shall improve the functions and responsibilities of all kinds of hospitals. We shall optimize the layout and structures, and give full play to the key roles of urban hospitals in the diagnosis and treatment of critical and acute illnesses as well as intractable diseases, medical education, scientific research, guidance and training of health personnel at the grassroots level, etc. Where conditions permit, large hospitals may promote the reasonable movement of medical resources in such manners as trusteeship and reorganization according to the requirements of regional health planning.
We shall establish the work division and coordination mechanism for urban hospitals and community health service institutions. Urban hospitals shall promote the sustainable development of community health services in such manners as technical support and personnel training. At the same time, we shall take such comprehensive measures as enhancing the service capability, lowering standards for charges and raising the proportion of cost reimbursement to guide the general diagnosis and treatment to descend to the community level, and gradually realize the initial diagnosis at the community level, graded medical services and two-way referral. We shall integrate urban health resources and make full use of existing urban primary and secondary hospitals, medical institutions subordinated to state-owned enterprises and public institutions, medical institutions operated by social forces and other resources to develop and improve community health service network.
We shall give full play to the role of traditional Chinese medicine (ethnic medicine) in disease prevention and control, response to public health emergencies and medical services. We shall strengthen the construction of clinical research bases of traditional Chinese medicine and traditional Chinese medicine hospitals, and organize the project cooperation in using traditional Chinese medicine to prevent and control intractable diseases. We shall vigorously promote the appropriate technologies of traditional Chinese medicine in grassroots medical and health services. We shall adopt policies supporting the development of traditional Chinese medicine to promote the inheritance and innovation of traditional Chinese medicine.
We shall establish a system of urban hospitals' one-on-one assistance in rural medical and health care work. Developed regions shall increase the one-on-one assistance in poor and ethnic minority areas in developing their medical and health care cause. Urban large hospitals shall establish a long-term stable practice of one-on-one assistance and cooperation with county-level hospitals, and take approaches such as clinical services, personnel training, technical guidance and equipment support to help them improve their medical and service capabilities.
(6) We shall speed up the building of the medical security system. We shall speed up the establishment and improvement of a multi-level medical security system focusing on the basic medical security, supplemented by other various forms of supplementary medical insurance and commercial health insurance and covering both urban and rural residents.
We shall establish a basic medical security system covering both urban and rural residents. Basic medical insurance for urban workers, basic medical insurance for non-working urban residents, the new-typed rural cooperative medical care and urban-rural medical assistance, which respectively cover urban employed population, urban non-employed population, rural population and people in hardship in urban and rural areas, jointly constitute the basic medical security system. We shall adhere to the principles of wide coverage, basic security and sustainable development, start from the security for serious illnesses, gradually expand it to the outpatient minor illnesses, and continuously improve the level of security. We shall establish a multi-channel fundraising mechanism with clear responsibilities and reasonable sharing among the state, entities, families and individuals to achieve social mutual assistance. With the economic and social development, we shall gradually raise the level of fundraising and overall planning level, narrow the gap between levels of security, and ultimately achieve a basically unified systematic framework. We shall further improve the basic medical insurance system for urban workers, accelerate the coverage of employed population, and focus on solving the basic medical insurance issues concerning employees and retirees of closed or bankrupt state-owned enterprises or financially strained enterprises, employees in non-public economic organizations and personnel with flexible employment arrangements; in 2009, shall extensively promote the basic medical insurance for non-working urban residents, and give weight to addressing the basic medical insurance issues concerning the elderly, the disabled and children; shall fully implement the new-typed rural cooperative medical care system, gradually increase the level of government subsidies, and appropriately increase payments by farmers to enhance the security capacity; shall improve the urban-rural medical assistance system, provide subsidies for people in hardship to get insurance and for their unaffordable medical costs, and reinforce a strong bottom line for medical security. We shall explore the establishment of an urban-rural integrated basic medical security management system.
We shall encourage trade unions and other social organizations to carry out various forms of medical mutual aid activities. We shall encourage and guide various types of organizations and individuals to develop charitable social medical assistance.
We shall do a good job in the interconnection of the basic medical insurance system for urban workers, basic medical insurance system for non-working urban residents, new-typed rural cooperative medical care system and urban-rural medical assistance system. We shall actively do a good job in the transfer connection of basic medical insurance relationship by focusing on rural migrant workers moving between urban and rural areas, and improve the settlement services for non-local medical services by focusing on retirees resettled in different areas. We shall properly resolve the issue of basic medical insurance for rural migrant workers. Rural migrant workers who have concluded labor contracts and established stable labor relations with enterprises shall be covered by the basic medical insurance system for urban workers, and the payment responsibility of employers shall be clarified according to the state provisions; other rural migrant workers shall, as the case may be, participate in the new-typed rural cooperative medical care at the places of their registered permanent residences or the basic medical insurance for non-working urban residents at the places where they work.
We shall actively develop commercial health insurance. We shall encourage commercial insurance institutions to develop health insurance products meeting different needs, simplify claims procedures, provide convenience to the people, and satisfy the diversified health needs. We shall encourage enterprises and individuals to meet their needs outside the basic medical security through participating in commercial insurance and various forms of supplementary insurance. Under the premise of ensuring funds safety and effective supervision, we shall advocate the manner of purchasing medical security services by the government, and explore the entrustment of qualified commercial insurance institutions with the management services of all types of medical security.
(7) We shall establish and improve a drug supply safeguard system. We shall speed up the establishment of a drug supply safeguard system based on the national basic drug system to ensure the drug safety of the people.
We shall establish a national basic drug system. The central government shall formulate and promulgate a unified catalogue of national basic drugs, and reasonably determine the varieties and quantities, on the principles of necessity for prevention and control, safety and effectiveness, reasonable price, ease in use and emphasis on both traditional Chinese medicine and western medicine, in consideration of Chinese characteristics in drug use and by referring to international experiences. We shall establish a production and supply safeguard system for basic drugs, give full play to the role of market mechanism under the government's macro-control, implement public bidding for procurement of basic drugs, and conduct uniform distribution to reduce intermediate links and ensure the use of basic drugs by the people. The state shall formulate the guiding retail prices for basic drugs, and the people's governments at the provincial level shall, within the extent of the guiding prices, determine the unified procurement prices within their respective administrative regions in light of the bidding conditions. We shall standardize the use of basic drugs, and formulate a guide to the clinical application of basic drugs and a collection of prescriptions of basic drugs. Urban and rural grassroots medical and health care institutions shall be fully equipped with and use basic drugs, and other types of medical institutions shall take basic drugs as the preferred drugs and determine the use ratio. Basic drugs shall be fully covered by the basic medical security drug catalogue for cost reimbursement, and the proportion of cost reimbursement shall be significantly higher than that of non-basic drugs.
We shall regulate the production and circulation of drugs. We shall improve the pharmaceutical industry development policies and industry development planning, strictly control the market access and drug registration approval, vigorously regulate and straighten up the production and distribution order, promote the improvement of the independent innovation capacity of pharmaceutical enterprises and the optimization and upgrading of the pharmaceutical industrial structure, develop modern logistics and commercial chains of drugs, and promote the integration of pharmaceutical production and distribution enterprises. We shall establish a rural drug supply network which is convenient and beneficial to the people in rural areas. We shall improve the drug reserve system. We shall support the production of special drugs and first-aid drugs which are used in small quantities. We shall regulate drug procurement, and investigate and punish without mercy commercial briberies in the purchase and sale of medicine. We shall strengthen the monitoring of side effects of drugs, and establish the drug safety alert and emergency response mechanisms.
IV. Improving systems and mechanisms to ensure the effective and standard operation of the medical and health care system
We shall improve systems and mechanisms for the medical and health care management, operation, investment, pricing and supervision, and strengthen the development of science and technology, talents, information and legal system, so as to ensure the effective and standard operation of the medical and health care system.
(8) We shall establish a coordinated and unified medical and health management system. The geographic and industry-wide administration shall be applied. All medical and health institutions, regardless of ownership, investors, affiliation and nature of business, shall be subject to the unified planning, market access management and supervision by the local health administrative departments. At the central and provincial levels, a few medical science centers or regional medical centers undertaking the medical research and teaching functions may be set up, as well as other medical institutions such as specialist hospitals undertaking the diagnosis and treatment of national or regional intractable diseases; the governments at the county (city) level shall be mainly responsible for organizing the establishment of county-level hospitals and rural health and community health service institutions; other public hospitals shall be run by governments at the city level.
We shall strengthen the regional health planning. The people's governments at the provincial level shall formulate standards for health resource allocation, organize the preparation of regional health planning and planning for the setup of medical institutions, and determine the quantity, scale, layout and functions of medical institutions. We shall scientifically formulate the standards for the construction and equipment allocation for grassroots medical and health institutions such as health clinics in townships and towns (infirmaries in villages) and community health service centers (stations) and hospitals at all levels. We shall make full use and optimize the allocation of the existing medical and health resources, gradually reorganize medical institutions that do not meet the requirements of the planning, strictly control the allocation of large-scale medical equipment, encourage joint construction and sharing, and improve the use efficiency of medical and health care resources. The new health resources must conform to the regional health planning, and be mainly invested in the weak links such as rural and community health care. We shall strengthen the interconnection between the regional health planning and the urban and rural planning, overall land use planning, etc. We shall establish the mechanism for supervising and evaluating the regional health planning and resource allocation.
We shall push forward the reform of management system of public hospitals. We shall, from the standpoint of strengthening the public nature of public hospitals and the effective government supervision, actively explore multiple ways for realizing the separation of government administration from public institutions and separation of government management from business operations. We shall further transform the government functions. The health administrative departments shall be mainly responsible for health development planning, qualifications for market access, specifications and standards, service supervision and other industry management functions, and other relevant departments shall conduct administration and provide services according to their respective functions. The independent corporate status of public hospitals shall be ensured.
We shall further improve the basic medical insurance management system. The central government shall formulate the uniform framework and policies for the basic medical insurance system, and local governments shall be responsible for organizing the implementation of management. We shall create conditions to escalate the level of overall planning. We shall effectively integrate the basic medical insurance agency resources to gradually realize the unified administration of basic medical insurance in urban and rural areas.
(9) We shall establish efficient and standard operating mechanisms for medical and health care institutions. All revenue and expenditures of public health institutions shall be subject to budget management. The governments shall reasonably determine the staffing, wage levels and funding standards according to the functions and tasks of the institutions, clarify the job responsibilities of all kinds of personnel, strictly control personnel access, strengthen the performance assessment, and establish a personnel management system stressing personnel movement, so as to increase work efficiency and service quality.
We shall transform the operating mechanisms for grassroots medical and health institutions. Urban community health service centers (stations), health clinics in townships and towns and other grassroots medical and health institutions operated by governments shall strictly define their service functions, clearly require the use of appropriate technology, appropriate equipment and basic drugs, provide low-cost services for the people, and maintain the nature for the public good. We shall strictly determine the staffing, implement the recruitment system, and establish an incentive and effective human resources management system stressing personnel movement. We shall clarify the scope and standards of revenue and expenditures, implement the financial management measures featuring task approval, revenue and expenditure approval and subsidies based on performance assessment, explore multiple effective management measures such as management of income and expenditures along two lines and prepayment of the total funds for public health and medical security, strictly carry out the budget management of revenue and expenditures, and improve the use efficiency of funds. We shall reform the policy of adding a certain percentage to the drug prices, and implement the policy of “zero-difference” sale of drugs. We shall strengthen and improve the internal management, establish the assessment and incentive systems which take the service quality as a core and are based on the job responsibilities and performance, and form a long-term effective mechanism that ensures fairness and efficiency.
We shall establish standard operating mechanisms for public hospitals. Public hospitals shall be run for the public goods, follow the principle of social benefits, center round the patients, optimize service processes, and standardize the drug use, examination and medical treatment. We shall deepen the reform of operating mechanisms, establish and improve the hospital corporate governance structure, and clarify functions and powers of owners and managers so as to form responsible, incentive, restrictive, competitive and viable mechanisms featuring checks and balances among decision-making, execution and supervision. We shall boost the separation of medical care from drugs, and actively explore various effective ways for gradually reforming the mechanism of subsidizing medical services through drug sales. We shall gradually reform or eliminate the policy of adding a certain percentage to drug prices in various ways such as adopting the pricing based on differences between drug purchase and sale and setting a dispensing service fee, and at the same time, improve the mechanism of compensating public hospitals through appropriately adjusting prices of medical services, increasing government input, reforming payment methods and other measures. We shall further improve the financial and accounting management system, strictly carry out the budget management, and strengthen financial supervision and operating supervision. At the local level, according to actualities, various pilot administrative measures such as “income and expenditure approval, offset of income toward expenditures, turning in the surplus of income, subsidy for the difference, and clear rewards and punishments” may be implemented for qualified hospitals. We shall reform the personnel system, improve the distribution incentive mechanism, promote the recruitment system and post management system, strictly carry out the total wage management, and implement the comprehensive performance assessment and post performance wage systems which rely mainly on the service quality and post workload so as to effectively arouse the initiative of health workers.
We shall improve the operating mechanisms for medical insurance agencies. We shall improve their internal governance structure, establish a reasonable personnel mechanism and distribution system, improve the incentive and restraint mechanisms, and improve the management capacity and efficiency of medical insurance agencies.
(10) We shall establish a government-led multi-source health investment mechanism. We shall clarify the responsibilities of government, society and individuals in health investment. We shall establish the leading role of the government in the provision of public health and basic medical services. We shall provide both urban and rural residents with equal access to public health services mainly through government funding. The cost of basic medical services shall be reasonably shared by the government, society and individuals. The cost of medical services for special needs shall be paid by individuals directly or paid by commercial health insurance.
We shall establish and improve a government health investment mechanism. Both the central government and the local governments shall increase the health investment, and take into account both suppliers and demanders at the same time. We shall gradually increase the proportion of government health investment to the total health cost in order to effectively reduce the burden of costs of basic medical and health care services on residents. The growth rate of government health investment shall be higher than that of recurrent financial expenditures so as to gradually raise the proportion of government health investment to the recurrent financial expenditures. The new government health investment shall be mainly used for supporting public health, rural health, urban community health and basic medical security.
The responsibilities of health investment of the central government and local governments at all levels shall be reasonably divided according to the principle of graded burden sharing. Local governments shall undertake the main responsibilities, and the central government shall mainly provide subsidies for the national immunization planning, public health such as prevention and control of cross-regional major infectious diseases, basic medical security for both urban and rural residents, construction of relevant public medical and health institutions, etc. The central and provincial public finance departments shall increase the specialized transfer payments for financially strained regions.
We shall improve the mechanism of government investment in public health. The personnel funds and funds for development, construction and business of specialized public health service institutions shall be arranged by the government in full, and the service income obtained according to the relevant provisions shall be turned in to the special fiscal account or brought into budget management. We shall gradually increase the public health fund per capita, and improve the mechanism for safeguarding the public health service funds.
We shall improve the mechanism of government investment in grassroots medical and health institutions in urban and rural areas. The governments shall be responsible for the infrastructure funds, equipment purchase funds, personnel funds and business funds for the provided public health services of their health clinics in townships and towns and urban community health service centers (stations), as approved according to the state provisions, so as to ensure their normal operation. For all health clinics in townships and towns and urban community health service institutions including those sponsored by social forces, all places may approve government subsidies through service purchase and other channels. We shall support the construction of infirmaries in villages, and provide reasonable subsidies for village doctors who assume the public health service and other tasks.
We shall implement the policy of providing government subsidies for public hospitals. We shall gradually increase the government investment, which shall be mainly used for the infrastructure construction, equipment procurement, development of key disciplines, cost for retirees in line with the state provisions, subsidies for policy-related loss, etc., provide special subsidies for the assumed public health services and other tasks, and form a standard and reasonable mechanism of government investment in public hospitals. We shall have preferential investment policies for traditional Chinese medicine hospitals (ethnic hospitals), hospitals for infectious diseases, mental hospitals, hospitals for the prevention and control of occupational diseases, maternity hospitals, children's hospitals, etc. We shall strictly control the construction scale and standards and loans of public hospitals.
We shall improve the mechanism of government investment in basic medical security. The government shall provide necessary financial support for the establishment and improvement of the new-typed rural cooperative medical care, basic medical insurance for non-working urban residents, basic medical insurance for urban workers, and urban-rural medical assistance system. We shall ensure the normal funds for the relevant agencies.
We shall encourage and guide social capital in developing the medical and health care cause. We shall actively promote the development of non-public medical and health institutions, and form a medical business system with diversified investors and investment manners. We shall lose no time in formulating and improving the relevant policies and legislation, standardize the market access conditions for social capital including overseas capital to establish medical institutions, and improve fair and just industry management policies. We shall encourage social capital to set up non-profit medical institutions according to law. The state shall formulate guiding opinions on the restructuring of public hospitals to actively guide social capital to participate in a variety of ways in the restructuring and reorganization of some public hospitals including those run by state-owned enterprises. We shall steadily boost the pilot restructuring of public hospitals, appropriately reduce the proportion of public medical institutions, and form a pattern of mutual promotion and development of public hospitals and non-public hospitals. We shall support qualified personnel in starting their own businesses according to law to provide convenient medical services for the people. We shall improve the categorized management policy and preferential taxation policies for medical institutions. We shall strengthen the supervision over medical institutions run by social forces according to law.
We shall vigorously develop medical charity. We shall formulate the relevant preferential policies to encourage social forces to set up charitable medical institutions or make charitable donations to medical assistance institutions, medical institutions, etc.
(11) We shall establish a scientific and reasonable medical pricing mechanism. We shall standardize the price management of medical services. The basic medical services provided by nonprofit medical institutions shall be subject to government-guided pricing, and others shall be priced by medical institutions independently. The central government shall be responsible for formulating price policies and items and pricing principles and methods for medical services; the competent price departments at the level of province or city shall, jointly with the departments of health and human resources and social security, ratify the guiding prices for basic medical services. Prices for basic medical services shall be formulated on the basis of the service costs with fiscal subsidies being deducted, and reflect reasonable costs of medical services and the value of technical services. The services provided by medical institutions and doctors at different levels shall be subject to tiered pricing. We shall regulate the charge items and standards of public medical institutions, and study and explore the reform of charge methods such as charges by disease type. We shall establish the systems of medical equipment and instrument price monitoring, supervision over the service costs of medical examination and treatment, and regular price adjustment thereof.
We shall reform the drug pricing mechanism. We shall reasonably adjust the scope of government pricing, improve the pricing method, increase the transparency, make use of price leverage to encourage enterprises to make independent innovations, and promote the production and use of national basic drugs. New and patented drugs shall be gradually subject to the pre-pricing drug economic evaluation system. Generic drugs shall be subject to the low pricing system when they enter the market, so as to control low-level redundant construction. We shall strictly control the price difference ratio in the distribution of drugs. We shall adopt the pilot differential pricing for drugs sold in hospitals, dispensing service fees, etc. to guide the reasonable drug use by hospitals. We shall strengthen the price control and management of medical consumables and medical devices used for implantation (intervention) in the stages of distribution and use. We shall improve the medical price monitoring system and regulate the behaviors of independent pricing of enterprises.
We shall actively explore the establishment of a negotiation mechanism between medical insurance agencies and medical institutions and medical suppliers, and give play to the role of medical security in restricting the medical service and drug costs.
(12) We shall establish a strict and effective medical and health care supervision system. We shall strengthen the medical and health care supervision. We shall improve the health supervision and law enforcement system, and strengthen the capability construction of urban and rural health supervision bodies. We shall strengthen the supervision over the behaviors and quality of medical and health care services, improve the standards and quality evaluation system of medical and health care services, regulate the management system and work procedures, accelerate the formulation of unified norms for disease diagnosis and treatment, and improve the quality monitoring network of medical and health care services. We shall strengthen the supervision over the market access and operation of medical and health institutions. We shall strengthen the monitoring of drinking water safety, prevention and control of occupational hazards, food safety, medical waste disposal and other aspects of public health. We shall, according to law, strictly crack down on various illegal behaviors endangering the people's health and life safety.
We shall improve the supervision over medical security. We shall strengthen the supervision over medical insurance handling, fund management and use, etc., and establish a mechanism for the effective use of medical insurance funds and risk prevention and control. We shall strengthen the role of medical security in monitoring medical services, improve the payment system, actively explore the adoption of such methods as per capita payment, payment by disease type and prepayment of total amount, and establish an effective restriction mechanism stressing both incentives and punishments. We shall strengthen the supervision over commercial health insurance to promote the standard development thereof.
We shall strengthen the supervision over drugs. We shall strengthen the regulatory responsibilities of government, improve the building of the regulatory system, and strictly supervise the drug research, production, distribution, use, pricing and advertisement. We shall put into practice the management rules on the production quality of drugs, and intensify the supervision over the production of high-risk varieties of drugs. We shall strictly implement the management rules on drug business operation, explore the management modes of categorized and graded drug business permits, and strength the supervision and spot inspection on key varieties of drugs. We shall establish a supervision network of drugs in rural areas. We shall strengthen the government supervision over drug prices, and effectively control the price bubbles. We shall regulate the clinical use of drugs, and give play to the roles of licensed pharmacists in guiding reasonable drug use and managing drug quality.
We shall establish a supervision system with open information and multi-party participation. We shall encourage trade associations and other social organizations and individuals to conduct independent evaluations and supervision on the operating performances of government departments, medical institutions and the relevant systems. We shall strengthen the industry self-discipline.
(13) We shall establish a sustainable development mechanism for science and technology innovations in medicine and health care and a talent safeguard mechanism. We shall promote the advancement of science and technology in medicine and health care. We shall take the science and technology innovations in medicine and health care as a focus of the national science and technology development, endeavor to crack difficulties in pharmaceutical science and technology, and provide a technical safeguard for the people's health. We shall increase the investment in medical research, deepen the reform of the medical and health science and technology system and institutions, consolidate the predominant medical research resources, speed up the implementation of major specialized projects of pharmaceutical science and technology, encourage independent innovations, strengthen the research on technologies for the prevention and control of major diseases and key technologies for development of new drugs, and seek breakthroughs in medical basis and applied research, high-tech research, traditional Chinese medicine study, combined study of traditional Chinese medicine and western medicine, etc. We shall develop and produce medical equipment suitable to our national conditions. We shall extensively carry out international cooperation and exchange in health science and technology.
We shall strengthen the development of medical and health care talents. We shall formulate and implement a development program for talents, and focus on strengthening the fostering and training of professionals and paramedics in public health, rural health and urban community health. We shall make preferential policies to encourage outstanding health talents to serve in rural areas, urban communities and the central and western regions of China. We shall provide appropriate preferential policies for the professional title promotion, business training, treatments, etc. of health technicians who have longtime worked at the community level in urban and rural areas. We shall improve the office qualification system of general practitioners, perfect the in-service training system for rural and urban community health workers, encourage their participation in academic education, and promote the standardization of practice of village doctors so as to realize as soon as possible that all grassroots medical and health institutions have qualified general practitioners. We shall strengthen the development of talents engaging in high-level scientific research, medical care, health management, etc. We shall establish a standardized training system for resident physicians and strengthen the continued medical education. We shall strengthen the development of paramedics, and gradually solve the problem of a too low ratio of paramedics. We shall train and expand the traditional Chinese medicine talents. We shall steadily promote the reasonable movement of health workers, promote vertical and horizontal exchange of talents among different medical institutions, and study and explore the multiple-site practice of registered medical practitioners. We shall standardize the position-taking conditions for hospital managers, and gradually form a professional and specialized managerial team for medical institutions.
We shall adjust the structure and scale of higher medical education. We shall strengthen the general medical education, improve the standardized clinical medical education, and raise the quality of medical education. We shall increase the investment in medical education, vigorously develop bachelor's and associate degree medical education for rural areas and communities, foster practical medical and health personnel for poor rural areas in various methods such as orientated training free of charge, and bring up a large number of qualified doctors who take root in rural areas and serve farmers.
We shall build a sound and harmonious physician-patient relationship. We shall strengthen the medical ethnics, pay attention to the humanistic quality training and professional quality education of health workers, and vigorously carry forward the spirit of “healing the wounded and rescuing the dying.” We shall optimize the practicing environment and conditions for health workers, protect the legitimate rights and interests of health workers, and arouse the initiative of health workers to improve services and efficiency. We shall improve the medical practice insurance, carry out medical social work, perfect the mechanism for handling medical disputes, and enhance the physician-patient communication. We shall form a good atmosphere of respecting medical science, respecting medical and health workers and respecting patients in the whole society.
(14) We shall establish a practical and sharing medical and health information system. We shall vigorously boost the medical and health care computerization. We shall focus on boosting the computerization in such aspects as public health, medical care, medical insurance, drugs and financial supervision, integrate resources, strengthen the development of information standardization and public service information platforms, and gradually realize unification, high efficiency, networking and intercommunication.
We shall speed up the building of the medical and health information system. We shall improve the public health information system which takes the disease control network as the mainstay, and enhance the capabilities of forecasting, early warning, analysis and reporting; focus on the establishment of health files of residents to build the health information network platforms of villages and communities; focus on hospital management and electronic medical records to boost the computerization of hospitals; and use network information technology to promote the cooperation between urban hospitals and community health service institutions. We shall actively develop the remote medical services for rural and outlying areas.
We shall establish and improve a medical security information system. We shall speed up the building of the multi-functional medical security information system covering fund management, settlement and control of costs, management and supervision of medical behaviors and management services for entities and individuals participating in insurance programs. We shall strengthen the building of information systems for the basic medical insurance for urban workers, basic medical insurance for non-working urban residents, new-typed rural cooperative medical care and medical assistance, realize the connection with the information system of medical institutions, actively promote the “all-in-one card” and other ways for facilitating the insurance (cooperative medical care) participants' receipt of medical services, and increase the transparency of medical services.
We shall establish and improve the three-level (state, province and city) information networks of drug supervision, drug inspection and testing and monitoring of side effects of drugs. We shall establish a supply and demand information system of basic drugs.
(15) We shall establish and improve a legal system of medicine and health care. We shall improve health laws and regulations. We shall accelerate the basic medical and health legislation, clarify the rights and obligations of the government, society and residents in health promotion, and safeguard the universal coverage of basic medical and health care services. We shall establish and improve a health standards system, and do a good job in the connection and coordination of the relevant laws and regulations. We shall speed up the legislation on traditional Chinese medicines. We shall improve the laws and regulations on drug regulation. We shall gradually establish and perfect a relatively complete health legal system appropriate for the basic medical and health care system.
We shall promote the administration according to law. We shall ensure strict and standard law enforcement, and tangibly enhance the abilities of governments at all levels to use legal means to develop and administer the medical and health care cause. We shall strengthen the publicity of law on medicine and health care, and try to create a legal environment favorable to the people's health.
V. Focusing on reforms in five key areas, and striving to achieve obvious results in the near future
To obtain reform results as soon as possible, ensure the public nature of medical and health care services, and giving weight to safeguarding the basic demands of the people for medical services, we shall focus on the reforms in five key areas from 2009 to 2011 according to the requirements of benefiting the people, encouraging health workers and allowing easier control on the part of regulators.
(16) We shall accelerate the building of the basic medical security system. The basic medical security system shall cover both urban and rural residents, and the rates of insurance (cooperative medical care) participation in the basic medical insurance for urban workers, basic medical insurance for non-working urban residents and new-typed rural cooperative medical care shall all reach 90% or above within three years; the urban-rural medical assistance system shall cover all families in hardship in China. We shall focus on enhancing the security for in-patient and outpatient treatment of serious diseases, and gradually increase the levels of fundraising and security. The subsidy standard for the basic medical insurance for non-working urban residents and new-typed rural cooperative medical care provided by the public finance departments at all levels shall have increased to 120 yuan per capita a year by 2010. We shall do a good job in the transfer connection of medical insurance relationship and the settlement services for receiving medical services at different places. We shall improve the systems and mechanisms of medical security management. We shall effectively reduce the burden of personal medical expenses on urban and rural residents.
(17) We shall initially establish a national basic drug system. We shall establish a relatively complete system for the selection, production, supply and use of basic drugs and medical insurance reimbursement. In 2009, we shall promulgate the catalogue of national basic drugs; regulate the procurement and distribution of basic drugs; and reasonably determine the prices for basic drugs. From 2009, all government-run grassroots medical and health institutions shall be equipped with and use basic drugs, all other types of medical institutions must also use basic drugs according to the relevant provisions, and all retail pharmacies shall be equipped with and sell basic drugs. We shall improve the policy of medical insurance reimbursement for basic drugs. We shall ensure the affordability, safety and effectiveness of basic drugs for the people, and reduce the burden of costs of basic drugs on the people.
(18) We shall improve the grassroots medical and health service system. We shall speed up the construction of rural three-tier medical and health service network and urban community health service institutions, give play to the leading role of county-level hospitals, and build a relatively complete grassroots medical and health service system within 3 years. We shall strengthen the development of grassroots medical and health care talents, especially the fostering and training of general practitioners, and focus on improving the service level and quality of grassroots medical and health institutions. We shall transform the operating mechanisms and service modes of the grassroots medical and health institutions, and improve the compensation mechanisms. We shall gradually establish a system of graded diagnosis and treatment and two-way referral, and provide convenient and low-cost basic medical and health care services for the people.
(19) We shall gradually promote the equal access to basic public health services for all. The state shall decide basic public health service projects, and from 2009, gradually provide the urban and rural residents with uniform basic public health services such as disease prevention and control, maternal and child health and health education. We shall implement state major public health service projects, effectively prevent and control major diseases and risk factors thereof, and further improve the capacity of handling major public health emergencies. We shall improve the urban and rural public health service system, and perfect the fund safeguard mechanism for public health services. In 2009, the standard for the basic public health service fund per capita shall not be less than 15 yuan, and will not be less than 20 yuan by 2011. We shall strengthen the performance assessment, and improve the service efficiency and quality. We shall gradually narrow the gap between the basic public health services for urban and rural residents, and try to reduce the illnesses of the people.
(20) We shall boost the pilot reforms of public hospitals. We shall reform the management system, operating mechanisms and supervision mechanisms of public hospitals, and actively explore the effective ways for separating government administration from public institutions and separating government management from business operations. We shall improve the corporate governance structure of hospitals. We shall promote the reform of the compensation mechanism for public hospitals, increase government investment, improve the policy of economic compensation for public hospitals, and gradually solve the issue of “subsidizing medical services through drug sales”. We shall speed up the formation of a diversified medical business pattern, and encourage the private sector to operate nonprofit hospitals. We shall make great efforts to improve the internal management of public hospitals, optimize the service processes, regulate the behaviors of diagnosis and treatment, arouse the initiative of health workers, improve the service quality and efficiency, significantly shorten the waiting time of patients, achieve the mutual recognition of testing results of medical institutions at the same level, and try to let the people receive satisfying medical services.
VI. Actively and steadily pushing forward the reform of the medical and health care system
(21) We shall raise awareness and strengthen leadership. Party committees and governments at all levels shall fully understand the importance, urgency and difficulty of the deepening reform of the medical and health care system, raise awareness, strengthen confidence, tangibly strengthen organizational leadership, put the solving of problems concerning people's receiving medical services on the important agenda as a key to improving people's livelihood and expanding domestic demand, clarify the division of tasks, and realize the government's responsibilities for public medical and health care. We shall establish a leading group for deepening the reform of the medical and health care system of the State Council to conduct the overall organization and implementation of the deepening reform of the medical and health care system. The relevant departments of the State Council shall earnestly perform their duties and closely cooperate with each other to form a concerted force, and strengthen the supervision and assessment. Local governments shall, according to the requirements of these Opinions and the implementation scheme, formulate specific implementation schemes and effective measures with proper adjustments to the local conditions, make elaborate arrangements, promote the orderly progressing of the reform, and ensure that the results of the reform will benefit all the people.
(22) We shall highlight the key points and implement the reform step by step. Since the establishment of a basic medical and health care system covering both urban and rural residents is a long-term task, we shall adhere to the combination of recent and future situations, and start from the basics and the grassroots level. Recently, we shall focus on the reform in five areas including the basic medical security system, the national basic drug system, the grassroots medical and health service system, the equal access to basic public health services for all and the pilot reform of public hospitals. We shall lost no time in formulating the operational documents and specific schemes, making further detailed policies and measures, clarifying implementation steps, doing a good job in coordination and connection, and coordinating and promoting various reforms.
(23) We shall gradually deploy the reform based on pilot reform projects. The reform of the medical and health care system is comprehensive, complex and of a strong policy nature, and we shall carry out pilot projects for some major reforms. The leading group for deepening the reform of the medical and health care system of the State Council shall be responsible for formulating the principles and policy framework for the pilot projects and coordinating and guiding the overall pilot work across the country. All provinces, regions and municipalities shall formulate specific pilot programs and organize the implementation thereof. We shall encourage local governments to carry out various forms of pilot projects in line with their actualities, actively explore effective ways for achieving the expected results, timely sum up experience and gradually deploy the reform.
(24) We shall strengthen the publicity and provide correct guidance. To deepen the reform of the medical and health care system needs the understanding, support and participation of all walks of life. We shall adhere to the correct direction of public opinions, widely publicize the great significance of the reform and the major policies and measures for the reform, actively guide the social anticipation, reinforce the confidence of the people, win the universal support for this significant reform which benefits all the people, and create a good public opinion environment for deepening the reform.