Great achievements have been made in health care reform in China, but there are also some problems in this process. We must "take the essence and discard the dross" to welcome the spring of health undertakings in China.
1. Achievements of health reform in China
From the early days of the founding of the People's Republic of China to the present, the health service in China has undergone profound changes and made remarkable achievements. This is mainly manifested in five aspects:
First, the people's health level is constantly improving. According to the standards set by the World Health Organization, there are three main indicators to measure a country's people's health level: one is life expectancy per capita, the other is infant mortality rate, and the third is maternal mortality rate. In the early days of the People's Republic of China, the average life expectancy in China was 35 years, and now it has increased to 71.8 years (77 years, 6l years and 49 years in the United States, India and Nigeria respectively); the infant mortality rate was 2% in the early days of the People's Republic of China, and now it has dropped to 25.5%. (7%o, 3%o and 112%o in the United States, India and Nigeria, respectively); The maternal mortality rate was 15 million/1, in the early days of the People's Republic of China, and now it has dropped to 5.2/1, (the United States, India and Nigeria are 8/1,, 4.1/1, and 7 million/1, respectively). The changes of these three indicators indicate that the health level of China citizens has reached a higher level in developing countries.
second, basically establish a medical and health service system covering both urban and rural areas. After decades of efforts, there are nearly 3, medical and health institutions at all levels covering urban and rural areas in China, such as medical treatment, prevention, health care and supervision, which basically meet the medical and health needs of urban and rural residents. In 26, the number of beds in various medical institutions reached 3.27 million, with an average of 3.1 beds per worker;
The total number of health workers is 5.25 million,
There are 1.5 medical practitioners per worker. In addition, there are 88, rural doctors and health workers.
Third, the medical insurance system for urban workers was initially established, and a new rural cooperative medical system was launched. After 1 years' efforts, the basic medical insurance, supplementary medical insurance, free medical care and commercial medical insurance, which are suitable for China's national conditions, have been basically established, and the number of participants is 16 million. Since 23, a pilot project of the new rural cooperative medical system has been carried out in some counties (cities, districts) in China, in which the central finance, local finance and farmers voluntarily participate in financing, with serious illness subsidies as the main part. By the end of September, 26, 1,433 counties (cities, districts) had carried out the pilot project of the new rural cooperative medical system, accounting for 5.1% of the total number of counties (cities, districts) in China. 46 million farmers participated in the new rural cooperative medical system, accounting for 45.8% of the national agricultural population, and the participation rate reached 8II).5CI/; 14 million farmers in China have benefited from the new rural cooperative system. On the whole, the new rural cooperative medical system is running smoothly and gradually standardized, and the health service level is improved.
fourth, significant progress has been made in the prevention and treatment of major infectious diseases. In the history of China, infectious diseases used to be a serious threat to people's health and life safety. In the 195s, infectious diseases and parasitic diseases ranked first among the causes of death in China, but now they have dropped to the ninth place. It took the lead in eradicating major infectious diseases such as smallpox and polio in developing China countries. China is a country with frequent natural disasters, but for many years, it has successfully achieved no major epidemic after major disasters. In 23, we defeated the SARS epidemic and successfully controlled the spread of avian influenza to human beings. The central government invested 26.9 billion yuan to establish and improve the prevention and control system and medical treatment system for AIDS, tuberculosis and hepatitis B.
Fifth, the level of health care for women and children has been further improved. Women and children are the focus of a country's health care, and their health level represents the overall health status of the population. China has always attached importance to and cared about the health problems of women and children. The traditional fertility model with high fertility rate and high mortality rate formed in the history of China has been changed, and a virtuous circle of low fertility rate and low mortality rate has been realized.
II. Problems in Development
The achievements of China's health undertakings are universally recognized. The World Health Organization once praised China for protecting the health of the largest population in the world at the lowest cost. However, if we re-examine China's health undertakings with "people-oriented" and Scientific Outlook on Development, we will find that the development of health undertakings lags behind the development of economy and other social undertakings, and the contradiction between the health care service system and the people's growing health needs is still quite prominent, and the development of health undertakings is incomplete and uncoordinated. To sum up, there are the following aspects:
First, health resources are generally insufficient, and health development lags behind economic development. China has a population of 1.3 billion, accounting for 22% of the world's total population, while the total health expenditure accounts for only 2% of the world's total health expenditure. In the past, we used to say that China's health undertakings are low-input, high-output, low-cost and high-efficiency. However, from the perspective of Scientific Outlook on Development, this is at the expense of affecting the interests of the masses and increasing the burden on medical and health personnel, especially excellent medical personnel.
Second, the allocation of medical and health resources is unreasonable, and the situation of lack of medical care and medicine in rural and urban communities has not completely changed. China's medical and health services should be low-cost and wide-coverage. The allocation of medical and health resources should be pyramid-shaped, but at present it is inverted pyramid-shaped. High-tech and excellent health talents are basically concentrated in big hospitals in big cities. It is difficult for the masses to seek medical treatment effectively in the local area. Going to other places and big hospitals for medical treatment not only increases the burden of big hospitals, but also increases the economic burden of patients.
Third, the medical security system is not perfect, and a considerable number of people rely on their own expenses for medical treatment. Although the medical security system for urban workers has been established, the coverage is too small. There is no medical security for laid-off workers, unemployed people and low-income people in cities. At present, the pilot project of the new rural cooperative medical system has benefited more than 4 million people, but the fund-raising efforts are small, generally only 5 yuan per person per year, and the guarantee is not strong. Nearly half of the urban population and rural population have no medical security and rely on their own expenses to see a doctor.
Fourth, the medical and health management system does not meet people's health needs. A sound medical and health system in a country should include medical and health service system, basic medical security system, medicine and medical equipment supply system, medical expense price management system, financial fund guarantee system and health supervision and management system. Proceeding from China's national conditions, these tasks cannot be managed by only one department, nor can they be managed well. Need to strengthen the coordination between departments, form a joint force, and pay close attention to * * *.
Fifth, the production and circulation of drugs and medical equipment are disordered and the prices are too high. The production and circulation enterprises in China are large in number, small in scale and difficult to supervise, so it is difficult to implement effective supervision for various reasons.
Sixth, it is difficult for social funds to enter the medical and health field, and the corresponding laws, regulations and policies are not perfect, and the pattern of running hospitals through multiple channels has not been formed. Medical and health undertakings should be developed through multi-channel financing by the government, society and individuals. However, after years of medical service system reform, the pattern of multi-channel medical service has not yet formed.
some of the above problems have been long-standing and unresolved, some are unavoidable at this stage, and some are emerging in development. These problems have affected people's interests, social harmony and the development of health undertakings, and should be solved step by step with the concerted efforts of Qi Xin.
III. Future development trend of China's health undertakings
To develop and promote China's health undertakings, we must proceed from China's national conditions, learn from foreign beneficial experience, explore the road of health development with China characteristics, and strive to achieve the goal of basic health care services for all and build the following four basic systems in accordance with the Decision of the Central Committee on Several Major Issues in Building a Harmonious Socialist Society (hereinafter referred to as the Decision).
(1) There are no four basic systems
First, a basic health care system covering urban and rural residents should be built. China has a large population, and its per capita economic level and fiscal revenue are low. This basic national condition determines that the health security system in China must start with the most basic health care. It is a health security system organized by the government to provide public health services to all residents free of charge and basic medical services at cost. This system aims at the basic health care for everyone, with public health institutions, rural health institutions and urban community health institutions as the main service bodies, adopting appropriate medical technology and basic drugs, and the government will bear the personnel expenses and operational expenses. Adhere to prevention first, combine prevention with treatment, and pay attention to fairness and efficiency.
second, build a multi-level medical security system to meet the medical needs of people at different levels. This requires a social medical insurance system to resist risks. Due to the low level of urbanization in China, the large income gap among residents, and the large agricultural population and informal employment population, it is difficult to establish a unified social insurance system that integrates urban and rural areas for a long time. Only according to the actual situation of urban and rural areas and the income of different groups of people can we establish different forms of mixed medical insurance system.
Third, establish a national system of essential drugs. Medicine is a special product and an important means to safeguard people's health. The special properties of drugs determine that the production and circulation of drugs have certain social welfare nature and cannot be completely regulated by the market. According to the experience of more than 9 countries in the world, the national essential drug system should be the core of the national drug policy. Its main contents are as follows: the state formulates the list of essential drugs according to the principles of safety, effectiveness, necessity and low price. The State organizes the production, procurement and distribution of national essential drugs through bidding, and gradually standardizes the names and prices of the same drugs, so as to ensure the basic drugs, strictly manage the use and reduce the drug costs.
Fourth, establish a scientific and standardized management system for public hospitals. In accordance with the requirements of separation of government affairs, management and administration, medicine and for-profit and non-profit, we will deepen the reform of the management system, operation mechanism and financial guarantee mechanism of medical institutions, promote the localization and industry-wide management of medical institutions, straighten out the medical and health administration system, strengthen the public service function of public hospitals, and correct the tendency of one-sided pursuit of economic benefits.
(II) In 27, we should focus on the following nine tasks
The first one, and actively promote the construction of the basic health care system
It will take several years of efforts to build the basic health care system. This year's focus is on promoting the construction of three systems, namely: strengthening the construction of public health system; Strengthen the construction of rural health service system; Accelerate the development of urban community health services. The above work is led by the government, increasing financial investment.
Second, accelerate the new rural cooperative medical system
The Central Economic Work Conference proposed that the new rural cooperative medical system should cover about 6 million farmers in 8% counties (cities, districts) in China this year. This is a new requirement put forward by the central government to adapt to the construction of new socialist countryside and the construction of new rural cooperative medical system, which is in line with the wishes of governments at all levels and farmers. During the "Eleventh Five-Year Plan" period, the central and central and western regions planned to invest 21.68 billion yuan, and with the arrangement of the eastern coastal governments, the total investment in rural health construction exceeded 3 billion yuan.
third, further strengthen hospital management. This year, we will continue to carry out the activities of Hospital Management Year, focusing on the following tasks:
First, adjust the resources of urban medical services. Starting from the health needs of residents and the construction of basic health care system, some public hospitals will be transformed into community health institutions.
the second is to enrich the connotation of hospital management. Adhere to people-oriented, pay attention to people's all-round development, and strengthen the construction of loyal service spirit and humane service culture.
Third, increase the management responsibility of hospital directors. To improve hospital management, the dean is the first responsible person. Hospital directors must have high political quality and management ability, adhere to Scientific Outlook on Development and correct political outlook, and improve comprehensive management ability.
Fourth, strict access to medical technology and personnel qualifications, safeguarding patient safety, and prohibiting unlicensed practice and out-of-range practice.
Fifth, the scope of medical services should be strictly controlled, and reasonable examination, medication and treatment should be adhered to to improve the quality of medical services.
Sixth, standardize hospital income management and reform inappropriate economic incentive mechanism.
Seventh, reform the personnel system of public hospitals according to the general idea of the reform of public institutions.
Eighth, fully implement the hospital affairs disclosure system, disclose relevant information to the society, accept the supervision of the masses, and listen to their opinions.
Nine is to optimize the medical practice environment and build a harmonious doctor-patient relationship.
fourth, explore a long-term mechanism to control commercial bribery. Focus on strengthening ideological and moral education, ideals and beliefs, improve the concept of obeying the law, and enhance the ability to fight corruption and prevent change.
fifth, do a good job in Chinese medicine. It is necessary to strengthen the inheritance and innovation of traditional Chinese medicine and give full play to the advantages and characteristics of traditional Chinese medicine and ethnic medicine in community health, rural health and treatment of major diseases.
sixth, strengthen the construction of health legal system. Actively do a good job in the legislation of the Primary Health Care Law, the Mental Health Law and the Chinese Medicine Law.
Seventh, strengthen the construction of health talents. According to the needs of rural and urban community health services, we should train qualified personnel, strengthen the training of preventive medicine, family medicine, rehabilitation medicine and nursing personnel, improve the knowledge structure, improve the quality of personnel and enhance the service ability.
eighth, vigorously promote the openness of government affairs. This year, the hospital affairs publicity system was generally implemented in hospitals above the second level in the country. Projects and contents closely related to the interests of the masses should be truthfully disclosed and subject to social supervision.
Ninth, study and formulate the reform plan of medical and health system. The new medical reform plan that has attracted much attention is being accelerated. In order to brainstorm and ensure the scientificity and rationality of the plan, the medical reform coordination group decided to entrust six independent and parallel research institutions at home and abroad to participate in the formulation of the medical reform plan. The six research institutions are: the State Council Development Research Center, Peking University and Fudan University; At the same time, it includes three overseas independent institutions, the World Bank, the World Health Organization and McKinsey, an international consultancy. The purpose of the medical reform coordination group is to improve the scientific and democratic decision-making scheme through this open working method. On the basis of comprehensive comparison of these six alternatives, a new medical reform scheme with the widest knowledge and operability is put forward.