First step (2008~2010): set the budget and build the framework
The first step could be to formulate a Health Law first, to determine the proportion of government investment and the proportion of government sharing at all levels; to accelerate the construction of the current composite medical insurance system, and to increase the government's investment in it. At the end of 2008, the new rural cooperative medical care basically covers all rural
(1) Formulate the Health Law, determine the proportion of government input and the proportion of government sharing at all levels. There is legislation for education, and also in the document to determine the proportion of government budget and other inputs to GDP. Health involves everyone, the input should be more, can be clearly from the current government budget health expenditure of 0.85% of GDP step by step increase to 5%.
(2) Accelerate the construction of the current composite medical insurance system, increase government investment, and by the end of 2008, the new rural cooperative medical care will basically cover all rural areas. By the end of 2010, the basic medical insurance for urban workers, the basic medical insurance for urban residents, and the medical aid system will cover all urban residents (rather than the "full rollout" of the basic medical insurance for urban residents that is now projected for this time). At present, the focus of the new rural cooperative system should be shifted from expanding coverage to increasing the proportion of government payments and reimbursements; otherwise, the incentive for farmers, especially poor farmers, to participate in the new rural cooperative system because of their inability to pay out of their own pockets will be sharply reduced, and the system, which was initially set up in the past few years, will be put at risk. Similarly, more subsidies should be given to the demand side of the urban community, so that the community medical institutions and equipment that have been initially set up cannot be left vacant, and less subsidy to the supply side is possible as long as there are patients. These reforms can be solved through the national debt, the central government transfer payments and local government supporting methods, to draw a minimum line, the conditions of good places can be more subsidies, poor places by subsidies to reach the basic line.
(2) public **** health system approved staffing, projects, to achieve full financial allocations, make full use of the central and provincial transfers to achieve part of the project free of charge system, such as production, some chronic diseases, major diseases and infectious diseases.
(3) The establishment of specialized medical institution management committees under the people's congresses at all levels to manage public hospitals in the region, and the leadership and finances of public hospitals are determined by the committees and are accountable to the standing committees of the people's congresses. Health administrative agencies at all levels have transformed their functions and strengthened their supervisory responsibilities; financial allocations for non-profit medical institutions, etc., are no longer passed through health administrative agencies or investors, and a hearing system for medical service price adjustments has been established.
(4) Reform the tax system, increase the proportion of direct taxes in local finance, and reduce the proportion of indirect taxes. That is, to reduce the local government's dependence on the turnover tax of a large number of pharmaceutical enterprises, but to guide them to focus on corporate profits, and thus to fundamentally integrate the current extraordinary number of pharmaceutical enterprises, but the efficiency is not high, and innovation is insufficient.
(5) The basic drug system, the appraisal system of non-profit hospitals, and the adjustment of the health insurance payment and restraint mechanism should also be gradually established or deepened at this stage.
(6) Reduce the government's direct pricing and procurement, and reform the current system of designated production of essential medicines and unified procurement of medical devices. 2007, the State Food and Drug Administration designated the production of "urban community, rural essential medicines," the enterprise, the health authorities to recover the right to purchase medical equipment. However, this system may not work well because, on the one hand, under government pricing, even if companies are willing to produce because of preferential treatment, the cost of unified distribution is very high, which will result in the unavailability of these essential medicines in many places, and the price of other medicines may rise further, and if the pricing is too low, fewer and fewer of these essential medicines will be produced; on the other hand, it is difficult for the government to standardize cost criteria and identify manufacturers, and market fairness may be compromised. On the other hand, it is difficult for the government to standardize cost standards and identify manufacturers, and market equity may be broken. In addition, the health administrative department to recover the right to purchase medical equipment seems to deal with the market high kickbacks and disorder, in fact, it is likely to exacerbate the arbitrary procurement of public hospitals (because basically still by them to report the procurement application), the increase in the cost of medicine procurement, the transfer of the real interests to the industry management of the health sector, and then more unclear responsibilities, management and operation of the difficult to separate. And all these will aggravate the institutional obstacles to health care reform.
In fact, the production of essential medicines can be fully encouraged to have production approval number of enterprises to compete, not fixed-point production. At the same time can gradually increase the proportion of medical insurance to pay for the cost of essential drugs. And the industry supervision of medical equipment in addition to centralized procurement, more important is the rational allocation of regional health resources and public hospital financial system reform. Can not let these government departments in charge of the industry and then arbitrarily intervene in business and market behavior, otherwise it is good intentions are likely to bring bigger and more complex problems. The government is responsible for procurement decision-making and supervision; implementation is entrusted to enterprises and institutions. Government officials are not allowed to participate in the implementation to prevent the use of power for personal gain.
Step 2 (2011~2013): Opening up the market and improving the law
(1) While the government continues to strengthen funding for the composite medical insurance system, it strongly encourages the participation of various types of social insurance organizations, striving to make the proportion of total health costs shared by the government, the society, and the individual 25%, 35%, and 40% (the current proportions are 18%, 30%, and 52 percent). In particular, it is vigorously increasing the proportion of government contributions to the protection of non-employed urban residents and rural residents in the central and western regions.
(2) Reform the public health care system, appropriately reduce the proportion of government contributions to those in need, and increase individual contributions. Change the current situation that 1/4 of the government's health budget is used for publicly-funded medical care, making it partially over-consumed. The reduced contribution is used for the above part.
(3) People's congresses at all levels form specialists to formulate health resource planning by regional integration and initially designate the proportion of existing public hospitals to be retained, e.g., 70% to be retained and become non-profit hospitals, 15% to be converted into community health institutions, and 15% to be licensed for merger and integration by social capital. And confirm by law and regulations, etc., the minimum financial input of governments at all levels and in all places to this part of the non-profit hospitals, and ensure that it grows year by year.
(4) the implementation of prepayment system and total control of non-profit medical institutions, at all levels of the National People's Congress, under the leadership of the management committee of the specialized medical institutions scientifically approved the scale of hospital income and expenditure, rather than just under the government's supervision of the two lines of income and expenditure. For tertiary hospitals with too large a scale of income and expenditure to reduce the size of their operational income and expenditure at the beginning of the year in the approved budgetary income and expenditure; for community health service centers and service stations with too small a scale of income and expenditure to expand the size of their operational income and expenditure at the beginning of the year in the approved budgetary income and expenditure; for second-level hospitals to be transformed in accordance with the model of the beneficent hospitals, and second-level hospitals undergoing the transformation can be approved with a larger number of operational expenditures and a smaller number of operational incomes, and the approved The difference between income and expenditure is subsidized by the government budget.
If the actual operating income is greater than the approved operating income, the over-recovery part of the national treasury; if the actual operating income is less than the approved operating income, the government has no responsibility to subsidize; if in the case of the actual operating income is equal to or less than the approved operating income, the actual operating expenditures are less than the approved operating expenditures, after the income and expenditure linkage check is reasonable, and reduce the part of the expenditure to stay in hospitals to use without having to pay.
(5) the realization of the main public **** health projects free system.
Joint point: "the devil is in the details"
To determine by law the proportion of public **** health and basic health care expenditure that should be borne by all levels of government for a certain period of time, to prevent softening of the implementation process. If only a number of departments issued documents, and the documents are different ideas of different interest departments, the final document may "cut the feet to fit the shoes"
The work currently underway and our recommendations above, there are the following joints must pay attention to:
1. At present, there are still about 400 million urban and rural residents are not included in the The health insurance system, while insisting on the current expansion of coverage, must speed up government investment and reduce the proportion of personal burden, otherwise the initially established urban and rural health insurance system faces a crisis.
2. Although some achievements have been made in the past few years in the new rural cooperative and community health construction, but the "squeeze" effect on health resources is limited, efforts should be made to carry out institutional reform step by step without delay.
3. Through the reform of departmental budgeting system to promote the separation of government and enterprise and management. The personnel and financial power of public hospitals from the health administrative agencies to separate out, the country has made some exploration, not through the health administrative agencies to appoint the leadership of public hospitals and do not obtain financial allocations is the fundamental solution, should now deepen the departmental budgeting system, this part of the funds from the budget of the administrative departments of the health sector to separate out. At present, the separation of some of the pilot hospital management company and the health sector is actually two tables, a team, the effectiveness of this approach is worth discussing.
4. For program immunization, maternal and child health, health supervision, health education and other routine projects can be based on the number of service recipients to prepare the budget; for infectious diseases and other sudden projects can be set up a special reserve fund to be supported, such as medical aid fund and public **** health risk prevention reserve. The shift from "supporting people to do things" to "supporting people to do things" reduces the cost of providing public **** health and medical services and maximizes the efficiency of funding.
5. To determine by law the proportion of public **** health and basic health care expenditure that should be borne by all levels of government within a certain period of time, to prevent softening in the implementation process. It is reported that the "two sessions" representatives have repeatedly suggested that it should be determined as soon as possible through the National People's Congress process. If only a number of departments to issue documents, and documents are different interests of different departments with different ideas, departmental coordination policy with compromises, and finally out of the document may be "cutting the foot to fit the shoe".
Several relevant documents of the central government in 1997 and 2000 and the spirit of the 7th Plenary Session of the 16th Central Committee and the 17th National Congress are the basis of the health law, including how medical services are provided, what system is in place, what kind of structure the hospitals have, what kind of relationship there is between the structures, and what kind of competition there is among them, as well as what is the referral system like. It also includes how to finance, basic medical insurance and commercial insurance, who will run, what regulations, what rights and responsibilities of various departments, especially the responsibilities of all levels of government and the proportion of the burden of financing, there is an urgent need to be put into practice in the form of a law.
6. There is an urgent need to deepen the reform of the public *** financial system and the sub-provincial financial system. The result of financing health funds in each province is very uneven, which is related to the current tax system, indirect tax-based tax system is not related to the amount of income of the population, but closely related to the level of consumption of the population, the ability to raise funds by the grades and amount of consumption in each place directly affected. The result is that, although poor families do not spend as much on health as rich families in absolute terms, they have a much higher proportion of household income than rich families. From this perspective, the local tax system must gradually shift from being dominated by indirect taxes to being dominated by direct taxes. On the other hand, after the reform of the tax system in 1994, the financial system below the provincial level basically continues the previous package system, and the number of tasks directly affected by the higher level of government, which not only creates economic contradictions between the central and local levels, and often due to the responsibilities and powers are not willing to take on their own function of providing public **** products, and some localities even appear GDP and fiscal revenue is high, and a certain aspect of the increase in the per capita increase in the number of public **** products decline in the state. State.
7. Appropriate increase in medical prices have the inevitability, but its premise should be aimed at distorting the basic completion of the institutional reform and the basic completion of the reform of the state institutions, or else either as a number of local pilot as difficult to implement, or ultimately unable to achieve the goal of resolving the difficult and expensive to see a doctor.
8. The health care industry is highly specialized, and the experience of developed countries shows that it is not easy to control the rapid growth of costs even with strong government supervision. Various forms of health care industry associations should play a better balancing and self-regulatory role, just from the health care reform program debate, the role of the industry associations to play is still very limited.
Can health care reform be a breakthrough for a new approach to economic growth?
In 2008, in the global economy and China's economic uncertainty increased in the environment, although the resistance to reform still exists, but the reform of the health care system must be deepened, it can also become a new period of China's economic growth mode change and public **** product offerings to enhance a driving force and breakthrough
The current reform of the health care system, both favorable and unfavorable aspects of the existence of, the favorable aspects of In the financial and other funds are relatively sufficient, health care reform to form a certain *** knowledge, leadership understanding calm and adequate; adverse aspects of the various sectors, all sectors of the interests of the solidification and polarization of the trend, the social expression mechanism is not yet smooth, irrational voices from time to time over-exaggerated, on how to maintain the continuity of the policy and the coordination of the ability to be insufficient, and so on.
People's good intentions is naturally the more government subsidies the better, but a short-term subsidies to increase the rate of growth is difficult to significantly increase, and subsidies are not a free lunch, there is bound to be a cost, there is bound to be a financial source, and ultimately still the people's money. Therefore, fill the demand side should not only pay attention to the distribution of health costs, but also to fundamentally change China's economic growth and distribution pattern as soon as possible, reversing the current low cost of labor, capital and resource prices in exchange for high profits, and then more reliance on exports and investment growth in an undesirable way. So that the national income distribution to the people's share of the increase, which can also change the over-reliance on government funds investment system, promote industrial upgrading, for the government to invest more financial resources to health and other public **** products pave the way for the system. This is also fundamentally in line with the scientific outlook on development and the strategy of transforming the mode of economic growth put forward by the central government.
In essence, China's long-term health care supply shortage is also closely linked to the above economic development mode, not only the fiscal expenditure is biased towards industrial investment, for example, many of our national bond projects will also be a large amount of funds biased towards lagging transportation, energy and other infrastructure, this is a realistic choice, the achievement is not small, but on the one hand, these areas of the long term have a clear benefit, can be taken to the market or socialized operations Completion, on the other hand, leading to a serious lack of investment in health, education and other social public **** cause. In fact, health, education is a country's most profitable areas, can greatly promote a country's domestic demand to improve and social development, and the people's access to health care and the right to education is also the basic responsibility of the government.
Health care reform is a worldwide problem, it is difficult to find the ideal model, is bound to be a long-term gradual process, another way to look at it, health care reform is actually part of the reform of the Chinese government's administrative system and the construction of the public **** financial system, as well as the establishment of a complete social policy system. The primary issues at hand are, first, the government's clear public responsibility through law, second, the government's support for and formulation of "market-functioning expansionary policies", and, third, its efforts to avoid sectoral interests and to increase coordination and transparency mechanisms. At present, the direction of health care reform and the basic path has been set or continue to move, more attention needs to be paid to one is the program can be rethinking and then argumentation, adding more rational and in-depth views, and the second is the 2008 "Two Sessions" after the government departments of the specific policy direction, and sometimes the details determine success or failure.
In 2008, in the global economy and China's economic uncertainty increased environment, although the resistance to reform still exists, but we have reason to believe that the reform of the health care system must be deepened, it can also become the new period of China's economic growth mode of change and the provision of public *** products to enhance the impetus and breakthrough. We do not hope for a package solution, but undeniably, in the existing material, manpower and wisdom, in line with the highly responsible attitude towards history and the people, should be able to achieve the right direction, co-ordination of the right way, the right strategy, or small steps, or can be a big step when not hesitate.