In accordance with the spirit of the 17th CPC National Congress, in order to establish a medical and health system with Chinese characteristics, and gradually realize the goal of basic medical and health care services for all, and to improve the health of the whole population, is now on the reform to put forward the following views.
First, fully understand the importance, urgency and enormity of deepening the reform of the medical and health system, health is the basis for the comprehensive development of people. Medicine and health care is related to the happiness of thousands of families, is a major livelihood issues. Deepen the reform of the medical and health system, accelerate the development of medical and health care, to adapt to the people's growing demand for medicine and health, and constantly improve the quality of people's health, is the implementation of the scientific concept of development, to promote the comprehensive and coordinated sustainable development of the economy and society is an inevitable requirement, is to safeguard the social justice of the important initiatives, is an important symbol of the improvement of the quality of life of the people, is to build a well-off society in all aspects and build a harmonious socialist society is a major task. It is a major task in building a moderately prosperous society and a harmonious socialist society. Since the founding of New China, and especially since the reform and opening up of China, China's medical and health undertakings have made remarkable achievements, with the basic formation of a medical and health service system that covers both urban and rural areas, a growing capacity to prevent and treat diseases, a gradually expanding population covered by medical insurance, a rapid increase in the level of health science and technology, and a marked improvement in the health of the masses of the people, with the main health indicators of the population at the forefront of the developing world. Especially since the major victory against SARS, governments at all levels have increased investment, accelerated the development of public health, rural health care and urban community health, and made breakthroughs in new rural cooperative medical care and basic medical insurance for urban residents, laying a good foundation for the deepening of the reform of the medical and health system. At the same time, it should also be noted that the contradiction between the current level of development of China's medical and health services and the requirements for coordinated economic and social development and the health needs of the people is still relatively prominent. Uneven development of urban and rural and regional medical and health undertakings, the allocation of resources is unreasonable, public **** health and rural, community health care work is relatively weak, the medical security system is not sound, the order of the production and circulation of medicines is not standardized, the hospital management system and operation mechanism is not perfect, the government health investment is insufficient, the cost of medicines is rising too fast, the people's public reaction is relatively strong. From now to 2020, is China's comprehensive construction of a moderately prosperous society in a critical period, medicine and health work shoulders a heavy task. With the development of the economy and the improvement of people's living standards, the masses will have higher demands for improved medical and health services. Industrialization, urbanization, population aging, changes in the disease spectrum and changes in the ecological environment have brought a series of new and serious challenges to medical and health work. Deepening the reform of the medical and health system is a strategic choice for accelerating the development of medicine and health care, an important way to realize the people's *** enjoyment of the fruits of reform and development, and the urgent desire of the general public. Medicine is a wide-ranging, difficult social systems engineering. China's large population, low per capita income level, urban and rural, regional disparities, the basic national conditions of the long-term primary stage of socialism, determines the deepening of the reform of the medical and health system is a very complex and arduous task, is a gradual process, the need for a clear direction and framework on the basis of a long period of painstaking efforts and perseverance in the exploration, in order to gradually establish in line with the conditions of China's medical and health system.
Second, the guiding ideology of the reform of the medical system, the basic principles and overall objectives
(1) Guiding ideology. The guiding ideology of the reform of the medical system is: guided by Deng Xiaoping Theory and the important thought of the "Three Represents", in-depth implementation of the scientific concept of development, starting from China's national conditions, drawing on international experience, focusing on the realization of the goal of basic medical and health services for all, and focusing on solving the people's most concerned about, the most direct, the most realistic interests. Problems. Adhere to the public welfare nature of public **** health care, adhere to the policy of focusing on prevention, focusing on rural areas, and giving equal importance to both traditional Chinese and Western medicine, implement the separation of government affairs, management and operation, medicine, and profit-making and non-profit-making, strengthen the government's responsibility and investment, improve the national health policy, improve the system, strengthen supervision and management, innovate the system and mechanism, and encourage the participation of society, so as to build a basic medical care system that covers both urban and rural residents, and continuously improve the health level of the entire population. system for urban and rural residents, to continuously improve the health of the entire population, and to promote social harmony.
(2) Basic principles. Reform of the medical system should be guided by the following basic principles: adhere to the people-centered, put the protection of people's health rights and interests in the first place. Adhere to the medical and health services for the people's health purposes, to protect the people's health as the center, in order to enjoy basic medical and health services for all as the fundamental starting point and finishing point, from the design of the reform program, the establishment of the health system to the construction of the service system to follow the principle of public welfare, and strive to solve the outstanding problems of the masses, and strive to achieve the whole people have a cure for their illnesses. Adhere to the national conditions and establish a medical and health system with Chinese characteristics. Adhere to the basic national conditions of China, realistically summarize the practical experience of the reform and development of medicine and health, and accurately grasp the laws of development of medicine and health and the main contradictions; adhere to the level of basic medical and health services in coordination with the national economy and social development, and in line with the affordability of the people; give full play to the role of traditional Chinese medicine; and adhere to the local conditions, classify and guide the local initiatives, explore the establishment of a basic medical and health system in line with national conditions. basic medical and healthcare system in line with national conditions. Adhere to the unity of fairness and efficiency, and combine government leadership with the role of market mechanisms. Adhere to the government-led, strengthen the government's responsibility in the basic medical and health system, strengthen the government's responsibilities in the system, planning, financing, services, supervision and other aspects of the maintenance of the public **** public welfare of medical and health care, and promote fairness and justice; at the same time, focus on giving full play to the role of the market mechanism, and promote the formation of an orderly competition mechanism, to improve the efficiency of the operation of medical and health care and the level and quality of service, and to satisfy the people's multi-level and diversified medical and health care needs, diversified healthcare needs of the people. Adhere to a comprehensive approach, combining the improvement of the system with the resolution of current problems. We will take a holistic approach, taking into account the interests of all parties, including the supply side and the demand side, focusing on the integration of prevention, treatment and rehabilitation, and correctly handling the relationship between the government, health organizations, pharmaceutical enterprises, medical personnel and the people. Both focus on the long-term, innovative institutional mechanisms, but also based on the current, efforts to solve the outstanding problems in medicine and health; both focus on the overall design, clear overall reform direction and goals and the basic framework, but also focus on the implementation of step-by-step, and actively and steadily promote the reform.
(C) the overall goal. The overall goal of the reform of the medical system is to establish a basic medical and health care system covering urban and rural residents, to provide safe, effective, convenient and inexpensive medical and health services. By 2020, a basic medical and health care system covering urban and rural residents will have been basically established. The general establishment of a relatively perfect public **** health service system and medical service system, a relatively sound medical security system, a relatively standardized drug supply guarantee system, a more scientific management system and operation mechanism of medical and health institutions, the formation of a multi-dimensional pattern of medical treatment, everyone enjoys basic medical and health services, basically adapted to the people's multi-level health care needs, and the people's health level has been further improved. Third, improve the four major systems of medicine and health, the establishment of a basic medical and health care system covering urban and rural residents to establish a public **** health service system covering urban and rural residents, medical service system, medical security system, drug supply security system of four basic medical and health care system, the four major systems complement each other, supporting the construction and coordinated development.
(d) comprehensively strengthen the public **** health service system. Establish and improve disease prevention and control, health education, maternal and child health care, mental health, emergency treatment, blood collection and supply, health supervision and family planning and other professional public **** health service network, and improve the primary health care service network based on the medical service system of public **** health service function, the establishment of a clear division of labor, information interoperability, resource **** enjoyment, coordinated and interactive public **** health service system. Improve the capacity of public **** health services and the ability to deal with emergencies in the event of public **** health emergencies, and promote the gradual enjoyment of equalized basic public **** health services by urban and rural residents. Determine the scope of public **** health services. Clearly define the national public **** health service program, gradually increase the content of the service, and refine the service and assessment standards. Local governments are encouraged to increase the content of public **** health services on the basis of the centrally stipulated service items, in accordance with the local economic level and prominent public **** health problems. Improving the public **** health service system. Further define the functions, goals and tasks of the public **** health service system, optimize the allocation of personnel and equipment, and explore effective forms of integrating public **** health service resources. It has improved the system of prevention and control of major diseases and the emergency response mechanism for public **** health emergencies, and strengthened the prevention, control and monitoring of infectious, endemic, occupational and chronic diseases that pose a serious threat to people's health. Strengthening the construction of first-aid systems in urban and rural areas. Strengthening health promotion and education. Medical and health institutions and institutions, schools, communities and enterprises should vigorously carry out health education, advocate healthy and civilized lifestyles, and make use of radio, television, the Internet, newspapers and magazines and other media to strengthen the dissemination of knowledge about health, medicine and hygiene, to promote rational nutrition among the public, and to raise the general public's awareness of health and their ability to take care of themselves. Carry out in-depth patriotic health campaigns. It has incorporated rural environmental sanitation and environmental pollution control into the planning for the construction of new socialist countryside, promoted the construction of sanitary cities and civilized villages and towns, and continuously improved the sanitary environment for urban and rural residents in terms of their lives, work and other aspects. Strengthening health supervision services. Vigorous efforts are being made to promote environmental hygiene, food hygiene, occupational hygiene, school hygiene and migrant worker hygiene.
(V) further improve the medical service system. Adhering to the principle of running medical care with non-profit medical institutions as the mainstay and for-profit medical institutions as supplements, and with public medical institutions as the mainstay and non-public medical institutions as the leading ones, the medical service system is being constructed with a reasonable structure, a clear division of labor, a combination of prevention and treatment, appropriate technology, and an orderly functioning system that includes a grassroots health care service network covering both urban and rural areas as well as various types of hospitals. Vigorously developing the rural medical and healthcare service system. Accelerating the establishment of a sound three-tier rural medical and healthcare service network with county-level hospitals as the leader, township health centers as the backbone, and village health centers as the foundation. County hospitals, as medical and health care centers within the county, are mainly responsible for inpatient-based basic medical services and the rescue of critically ill patients, as well as for the business and technical guidance of rural health institutions and the further training of rural health personnel; township health centers are responsible for the provision of public *** health services and the diagnosis and treatment of common and frequent diseases, as well as comprehensive services, and are responsible for the business management of village health offices and technical guidance; Village health offices are responsible for the provision of public **** health services and the diagnosis and treatment of common diseases in administrative villages. Rural villages that are in a position to do so may implement integrated rural management. Accelerating the implementation of plans for the construction and development of rural health service systems, actively promoting the construction of rural health care infrastructure and capacity, with the Government focusing on running county-level hospitals and running a health center in each township, taking various forms of support for the construction of village health offices, and vigorously improving rural health care conditions and the quality of health care services. Improve the new urban medical and health service system based on community health services. Vigorously develop community health services, accelerate the construction of community health service centers as the main body of the urban community health service network, improve the function of community health services, in order to maintain the health of community residents as the center, to provide disease prevention and control and other public **** health services and general common diseases, common diseases, chronic diseases of the primary diagnostic and treatment services. The community health service model is being transformed, with proactive services and door-to-door services, gradually assuming the role of "gatekeeper" of residents' health. Improving the functions and responsibilities of various types of hospitals. Optimize the layout and structure of hospitals, and give full play to the backbone role of urban hospitals in the diagnosis and treatment of acute, critical and difficult illnesses, medical education and scientific research, and the guidance and training of grassroots health personnel. Large hospitals that are in a position to do so may, in accordance with the requirements of regional health planning, promote the rational flow of medical resources through trusteeship and reorganization. Establishment of a mechanism for the division of labor and collaboration between urban hospitals and community health service organizations. Urban hospitals drive the sustainable development of community health through technical support and personnel training. At the same time, comprehensive measures such as improving service capacity, lowering fees and increasing reimbursement rates are being taken to guide the sinking of general treatment to the grassroots level, and to gradually realize community-based first-aid, hierarchical medical care and two-way referrals. Integrate urban health resources, make full use of primary medical resources such as existing first- and second-tier hospitals in cities and medical institutions owned by state-owned enterprises and institutions, and develop and improve community health service networks. Give full play to the role of traditional Chinese medicine, including ethnomedicine, in disease prevention and control, response to public **** health emergencies, and medical services. Strengthen the construction of Chinese medicine clinical research bases and Chinese medicine hospitals, organize and carry out joint research on the prevention and treatment of difficult diseases in Chinese medicine, and vigorously promote appropriate technologies in Chinese medicine in medical and health institutions. Create a favorable policy environment to support the development of Chinese medicine and promote the inheritance and innovation of Chinese medicine. Establish a system for urban hospitals to provide counterpart support for rural medical and health care. Developed regions should strengthen counterpart support for the development of medical and health care in impoverished areas and ethnic minority regions. Large urban hospitals should establish a long-term and stable system of counterpart support and cooperation with county-level hospitals in impoverished and ethnic minority areas, adopting such methods as clinical services, personnel training, technical guidance, and equipment support to help them improve their medical standards and service capabilities.
(VI) Accelerating the construction of a medical security system. Accelerate the establishment and improvement of a multi-level medical security system covering urban and rural residents, with basic medical security as the mainstay, supplemented by other various forms of supplementary medical insurance and commercial health insurance. Establishing a basic medical insurance system that covers urban and rural residents. Basic medical insurance for urban workers, basic medical insurance for urban residents, new rural cooperative medical care, and urban and rural medical assistance*** all make up the basic medical insurance system, covering the urban employed population, the urban non-employed population, the rural population, and the urban and rural populations in difficulty, respectively. Adhering to the principles of broad coverage, basic protection and sustainability, the system starts by focusing on the protection of major illnesses, and gradually extends to minor outpatient illnesses, raising the level of protection. Establishing a multi-channel financing mechanism with clear responsibilities and reasonable burden-sharing among the State, organizations, families and individuals, and realizing mutual social assistance***. With economic and social development, the level of financing and the level of coordination will be gradually raised, narrowing the gap between the levels of protection and ultimately realizing the basic unity of the system's framework. Further improving the basic medical insurance system for urban workers, accelerating coverage of the employed population, and focusing on solving the medical insurance problems of workers and retirees of state-owned enterprises that have closed down and gone bankrupt and enterprises in difficulty, as well as those working in mixed-ownership and non-publicly-owned economic organizations, and flexibly-employed persons; accelerating the promotion of pilot projects for basic medical insurance for urban residents, and rolling them out across the board by 2009, with an emphasis on solving basic medical insurance problems for the elderly and children; and fully implementing the new rural medical insurance system. medical insurance; fully implementing the new rural cooperative medical care system, gradually raising the level of government subsidies, appropriately increasing farmers' contributions, and improving the ability to provide protection. Improving the urban and rural medical assistance system. Subsidies are being provided to people in difficulty for enrolling in insurance and for medical expenses they can hardly afford, so as to build a solid bottom line for medical protection. Areas with the necessary conditions should take a variety of approaches to actively explore the establishment of an integrated urban and rural basic medical insurance management system. Trade unions and other social organizations are encouraged to carry out various forms of mutual medical assistance. Encourage and guide various types of public welfare organizations to develop social charitable medical assistance. The basic medical insurance system for urban workers, the basic medical insurance system for urban residents, the new rural cooperative medical care system and the urban-rural medical assistance system are well connected, and the issue of basic medical insurance for rural migrant workers is properly resolved. Rural migrant workers who have signed labor contracts and have established stable labor relations with their enterprises are to be included in the basic medical insurance system for urban workers in accordance with national regulations that specify the responsibility of the employer to make contributions; other rural migrant workers are to participate in the new type of rural cooperative medical care in the area of their household registration or in the basic medical insurance for urban residents in the area where they are working, according to the actual situation. Rural migrant workers are actively engaged in the connection of policies on the continuation of their medical insurance relationships, medical treatment in other places, and expense settlement services. Actively developing commercial health insurance. Commercial insurance organizations are encouraged to develop health insurance products adapted to different needs, simplify claims procedures for the convenience of the public, and meet diversified health needs. Enterprises and individuals are encouraged to participate in commercial insurance and various forms of supplemental insurance to address needs beyond basic medical protection. Continue to explore ways for commercial insurance organizations to participate in the management of new rural cooperative medical care.
(VII) Establishing and improving the drug supply guarantee system. Based on the establishment of the national basic drug system, and with the cultivation of an internationally competitive pharmaceutical industry, the improvement of the concentration of drug production and circulation enterprises, the standardization of the order of drug production and circulation, the improvement of the drug price formation mechanism, and the strengthening of government supervision as the main contents, the construction of a standardized and intensive drug supply guarantee system, and the continual improvement of the system of practicing pharmacists, to ensure that the masses of the people are safe to use medicines. Establishing a national essential drug system. The central government has uniformly formulated and issued a national list of essential medicines, and reasonably determined the varieties and quantities of essential medicines in China in accordance with the principles of necessity for prevention and treatment, safety and efficacy, reasonable price, ease of use, and equal emphasis on both traditional Chinese and Western medicines, taking into account the characteristics of medicines used in China, and with reference to international experience. To establish a production and supply system for essential medicines, and to give full play to the market mechanism under the government's macro-control, essential medicines will be produced or centrally purchased by the state through bidding, direct distribution, reduction of intermediate links, and the retail price will be uniformly set on the basis of reasonably determining the profit level of the production chain, so as to ensure the supply and production of essential medicines, and to safeguard the public's basic use of medicines. Standardize the use of basic medicines, and formulate specifications for the use of basic medicines and guidelines for their clinical application. Basic medicines should be used in all primary healthcare institutions such as urban community healthcare centers (stations), township healthcare centers, and village healthcare offices, and basic medicines should be used as the first choice of medicines in all other types of healthcare institutions, and the proportion of their use should be determined. Essential drugs are all included in the basic medical insurance system drug reimbursement directory, reimbursement ratio is significantly higher than non-essential drugs to regulate the production and circulation of drugs. Improve the development policy of the pharmaceutical industry and industry development planning, strict market access, strict drug registration and approval, vigorously regulate and rectify the order of production and circulation, promote the optimization and upgrading of the pharmaceutical industry and technological progress, the development of modern logistics and chain management of pharmaceuticals, and promote the integration of drug production and distribution enterprises. It has established a rural drug supply and supervision network that covers a wide range of areas, has a sound system, and is convenient and beneficial to the people and farmers. Supporting the production of special and emergency medicines in small quantities. Improve the drug reserve system. It will standardize drug procurement and resolutely combat commercial bribery in the purchase and sale of medicines. Strengthen the monitoring of adverse drug reactions and establish an early warning mechanism for drug safety and an emergency disposal mechanism. Fourth, improve the institutional mechanism to ensure the effective and standardized operation of the medical and health system to improve the management of medical and health, operation, input, price, regulatory system and mechanism, strengthen science and technology and human resources, information, legal system, to ensure the effective and standardized operation of the medical and health system.
(H) the establishment of a coordinated and unified medical and health management system. In accordance with the principles of separation of government affairs, separation of management and administration, territorialization and industry-wide management, the scope of responsibilities between different levels of government and between the government and the medical and health institutions are reasonably determined, so as to form a management system with clear functions, clear positioning, comprehensive coordination, and unity of authority and responsibility. Implementation of territorialized and industry-wide management. All medical and health institutions, regardless of ownership, subject of investment, affiliation and nature of operation, are subject to unified planning, access and supervision by the local health administrative department. Central and provincial level can set up a small number of medical research, teaching functions of the medical center or regional medical center, undertake national or regional diagnosis and treatment of difficult diseases, such as specialty hospitals and other medical institutions; counties (cities, districts) is mainly responsible for organizing the county hospitals, rural health and community health institutions; the rest of the public hospitals by the municipalities responsible for organizing the district. Strengthening regional health planning. The people's governments at the provincial level formulate standards for the allocation of health resources, organize the preparation of regional health plans and plans for the establishment of medical institutions, and specify the number, size, layout and functions of medical institutions. Scientific formulation of standards for the construction and equipment allocation of grassroots health institutions such as township health centers (village health offices), community health service centers (stations) and hospitals at all levels. Make full use of and optimize the allocation of existing medical and health resources, adjust and optimize the structure and layout, and gradually integrate medical institutions that do not meet the planning requirements, strictly control the allocation of large-scale medical equipment, and encourage *** to build *** to enjoy and improve the efficiency of the use of medical and health resources. New health resources must be in line with regional health planning, focusing on weak areas such as rural and community health. Strengthen the connection between regional health planning and urban development planning and land use planning. Establishing a mechanism for monitoring and evaluating regional health planning and resource allocation. Pushing forward the reform of the management system of public hospitals. From the perspective of helping to strengthen the public welfare of public hospitals and effective government supervision, actively explore various forms of realizing the separation of government affairs and the separation of management and management. To further transform government functions, the health administrative department is mainly responsible for health development planning, qualification access, norms and standards, service supervision and other industry management functions, while other relevant departments manage and provide services in accordance with their respective functions. Implementing the independent legal person status of public hospitals. Further improving the basic medical insurance management system. The central government will uniformly formulate the framework and policies for the basic medical insurance system; local governments will be responsible for organizing, implementing and managing the system; and conditions will be created to gradually raise the level of coordination. Basic medical insurance management resources will be effectively integrated, and the administrative management of basic medical insurance in urban and rural areas will be gradually unified.
(ix) Establishing an efficient and standardized mechanism for the operation of medical and health institutions. Maintaining the public welfare nature of public medical and health institutions as the core, and gradually establish a standardized, scientific, efficient and orderly mechanism for the operation of medical and health institutions. Public **** health institutions all income and expenditure into the budget management. In accordance with the responsibilities and tasks undertaken by the government to reasonably determine the staffing, salary levels and funding standards, to clarify the duties of various types of personnel positions, strict access to personnel, strengthen performance assessment, the establishment of the ability to enter and leave the employment system, improve efficiency and quality of service. Transforming the operating mechanism of primary healthcare organizations. Government-organized urban community health service centers (stations) and township health centers and other primary health care institutions, to strictly define the function of the service, clearly stipulate the use of appropriate technology, suitable personnel, suitable equipment and basic drugs, to provide low-cost services for the general public, to maintain the nature of public welfare. Staffing levels should be strictly authorized, a system of staff employment should be implemented, and a human resources management system that allows for entry and exit and provides effective incentives should be established. It is necessary to clarify the scope and standards of income and expenditure, implement the financial management method of approved tasks, approved income and expenditure, and performance appraisal and subsidies, and explore the implementation of a variety of proven management methods, such as the two lines of income and expenditure, and the total prepayment of public ****sanitation and medical insurance funds, to strictly manage income and expenditure budgets and improve the efficiency of the use of funds. The drug mark-up policy should be reformed, and zero-differential-rate sales of drugs should be implemented. Strengthen and improve internal management, establish a system of assessment and incentives centered on service quality and based on job responsibilities and performance, and form a long-term mechanism to guarantee fairness and efficiency establish a standardized mechanism for the operation of public hospitals. Public hospitals should follow the principles of public welfare and social benefits, adhere to the patient-centered, optimize the service process, standardize the use of medicine and inspection and medical behavior, and deepen the reform of the operating mechanism. Establish and improve the corporate governance structure of hospitals, clarify the responsibilities and rights of owners and managers, and form a mechanism of mutual checks and balances in decision-making, implementation and supervision, with responsibilities, incentives, constraints, competition and vitality. Separate management of pharmaceutical revenues and expenditures is being implemented, and effective ways are being explored to gradually reform the mechanism of compensating doctors with medicines. Gradually reform or abolish the policy of drug markups through the implementation of differential markups for the purchase and sale of medicines, the establishment of medicinal service fees, and other means, while taking measures to improve the compensation mechanism for public hospitals by appropriately adjusting the price of medical services, increasing government investment, and reforming payment methods. The financial and accounting management system should be further improved, budget management should be strictly enforced, and financial supervision and operational oversight should be strengthened. Localities may, in the light of local realities, carry out pilot projects for hospitals that are in a position to do so, using a variety of management methods, such as "approving income and expenditure, offsetting expenditure with income, paying over the excess, subsidizing the difference, and separating rewards and penalties". Reform the personnel system, improve the distribution and incentive mechanism, implement the employment system and job management system, strictly manage the total amount of wages, and implement a comprehensive performance appraisal and job performance pay system based on the quality of service and the workload of the job, so as to effectively mobilize the enthusiasm of medical personnel. Improve the operating mechanism of medical insurance management organizations. Improve the internal governance structure, establish a reasonable employment mechanism and distribution system, improve incentives and constraints mechanism, and improve the management capacity and management efficiency of medical insurance management.