The General Office of the State Council has recently issued the "Five Key Reforms of the Medical and Health Care System 2011 Main Work Arrangements," which accelerates the construction of the basic medical insurance system, initially establishes the national basic drug system, improves the medical and health care system, promotes the gradual equalization of the basic public ****health services, and actively and steadily promotes the reform of public hospitals in five aspects. The reform of public hospitals to promote five aspects of the 17 specific tasks, and delineated the responsibility for the task of the department.
The Working Arrangement puts forward 17 specific tasks in five areas as follows:
Accelerating the construction of the basic medical security system
1. Consolidating and expanding the coverage of basic medical security, and basically realizing universal medical insurance.
--The number of participants in basic medical insurance for employees (hereinafter referred to as employee medical insurance) and basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) has reached 440 million, with the rate of participation rising to over 90%. The participation rate has been raised to over 90%. The issue of insurance coverage for retirees of closed and bankrupt enterprises and for employees of enterprises in difficulty has been properly resolved. All university students were included in the scope of urban residents' medical insurance. Actively promoting the participation of employees of non-public economic organizations, flexibly employed persons and rural migrant workers in employees' medical insurance. Promoting the participation of unemployed persons in insurance. Implementing the policy of selective participation by flexibly employed persons and migrant workers who have not established labor relations.
--Further consolidate the coverage of the New Rural Cooperative Medical Care (hereinafter referred to as the New Rural Cooperative Medical Care), with the participation rate continuing to stabilize at over 90 percent.
2. Comprehensively upgrading the level of basic medical protection and strengthening the protection capacity.
--Further raising the standard of financing, the government's subsidy standard for both the New Rural Cooperative and the urban residents' health insurance has been raised to 200 yuan per person per year, and the standard of individual contributions has been raised appropriately.
--Expanding the scope of implementation of outpatient co-ordination, universally carrying out outpatient co-ordination for urban residents' health insurance and the new rural co-operation, and including in the scope of payment, in accordance with the regulations, medicines in the health insurance catalog used by primary health care institutions and the general diagnosis and treatment fees they charge; and actively exploring the co-ordination of outpatient services under the employees' health insurance scheme.
Significantly raising the level of protection. The proportion of hospitalization expenses paid within the policy scope of urban residents' medical insurance and the New Farmers' Cooperative strive to reach about 70%. The maximum payment limit of the integrated fund within the policy scope of employee health insurance, urban residents' health insurance and the new rural cooperative in all integrated areas has reached more than six times the annual average salary of local employees, the annual disposable income of local residents and the annual per capita net income of farmers nationwide, respectively, with none of them being less than 50,000 yuan.
-Actively carrying out pilot projects to raise the level of medical protection for major diseases, and launching pilot projects to raise the level of protection for children's leukemia and congenital heart disease on a provincial (autonomous regions and municipalities) basis, as well as increasing the types of pilot diseases and expanding the scope of pilot areas on the basis of summarizing and evaluating the situation. The government is also urgently studying policies and measures to provide the necessary support for the treatment of opportunistic infections in AIDS patients in terms of medical insurance and assistance.
-- Comprehensively raising the level of medical assistance. Subsidize the participation of people in difficulty in insurance, and expand the scope of subsidies from low-income insurance recipients and five-guarantee households to low-income patients with serious illnesses, people with severe disabilities, the elderly from low-income families, and other special groups in difficulty. Outpatient assistance is being provided. The starting line for medical assistance has been gradually lowered and abolished, and the proportion of assistance for out-of-pocket expenses for hospitalization within the scope of the policy is in principle no less than 50%. Exploring the development of a pilot program to provide assistance for particularly serious illnesses. Encourage social forces to make charitable donations to medical assistance, and broaden funding channels.
3. Improving the level of basic medical insurance administration and management, and facilitating the public's medical settlement.
-Continuing to promote the "one-card" approach to medical care, basically realizing instant settlement of medical expenses within the integrated area of the insured (or settlement, the same below). Strengthen the capacity building of settlement of medical expenses in other places, carry out instant settlement of medical expenses in other places within provinces (autonomous regions and municipalities), and explore the instant settlement of medical expenses in other places, focusing on retirees resettled in other places. It will do a good job of transferring and continuing the basic medical insurance relationship of migrant workers and other mobile employed persons, and study issues related to the cumulative calculation of years of contribution.
--Strengthening the budgetary management of the revenues and expenditures of the medical insurance fund, setting up a system for analyzing the fund's operation and risk warning, controlling the fund's balance, and improving the efficiency of its use. Areas with excessive fund balances in the employee medical insurance and urban residents' medical insurance funds should gradually reduce their balances to a reasonable level; the balance rate of the New Farmers' Cooperative Coordination Fund for the current year should be controlled at 15% or less, and the cumulative balance should be no more than 25% of the Coordination Fund for the current year. Areas where the fund's current income does not cover expenditures should take practical and effective measures to ensure the smooth operation of the fund.
--To give full play to the role of medical insurance in guiding the supply and demand of medical services and in restraining medical costs. For those who go to primary medical and health care institutions, the proportion of payment for medical insurance will be tilted. Reforming the payment method of medical insurance, vigorously implementing capitation, payment by type of disease, and total prepayment. It is actively exploring the establishment of a negotiation mechanism between medical insurance organizations and medical institutions and drug suppliers.
--Strengthening the supervision of medical services by medical insurance. It has strengthened the dynamic management of designated medical institutions and designated retail pharmacies, established and perfected a system for evaluating the level of integrity of medical insurance, implemented the hierarchical management of designated medical institutions, and further standardized the service behaviors of designated medical institutions and designated pharmacies. It is studying the gradual extension of the supervision of medical institutions' medical services by medical insurance to the supervision of medical personnel's medical service behaviors. Increase penalties for fraudulent insurance behavior in accordance with the law.
-Employee health insurance and urban residents' health insurance have basically realized municipal (prefecture)-level coordination, and localities are encouraged to explore provincial-level coordination. Areas in a position to do so are further raising the level of coordination of the New Farmers' Cooperative Program. Accelerating the promotion of urban and rural integration of basic medical insurance, and steadily advancing the integration of administrative and management resources. The policies and management of the various basic medical security systems are well connected, and information*** is being shared to avoid duplication of coverage. It is actively exploring the commissioning of qualified commercial insurance organizations to handle various types of medical insurance management services.
--Supporting the development of commercial health insurance, encouraging enterprises and individuals to address their needs beyond basic medical security by participating in commercial insurance and various forms of supplementary insurance.
Preliminarily establishing a national basic drug system
4. Expanding the scope of implementation of the national basic drug system to achieve full coverage at the grassroots level.
--Expanding the scope of implementation of the basic drug system, implementing the national basic drug system in all government-run primary medical and healthcare institutions, and realizing zero-differential-rate sales of medicines.
--Studying and improving the national essential drug list (for use at the grassroots level), standardizing the addition of medicines in all provinces (autonomous regions and municipalities), and taking into account the needs of adults and children in the use of medicines, so as to better adapt to the basic needs of grassroots in the use of medicines. Synchronize the implementation of the basic drug health insurance payment policy.
5. Establishing a standardized procurement mechanism for basic medicines, and reshaping the grass-roots drug supply guarantee system.
--To implement centralized procurement and uniform distribution on a provincial (regional and municipal) basis for basic drugs (including additional varieties by provinces, autonomous regions and municipalities) used by government-run primary medical and healthcare institutions implementing the basic drug system, so as to ensure that the basic drugs are safe, effective, of good quality, reasonably priced, and supplied in a timely manner.
--Preparing the centralized procurement plan for essential drugs, determining the specific dosage forms, specifications and quality requirements for the procurement of essential drugs, specifying the quantity to be procured, and implementing the volume-price linkage. Provinces (autonomous regions and municipalities) that are unable to determine the quantity to be procured for the time being carry out procurement through a single-source commitment.
-Insisting on quality first, reasonable price, and encouraging localities to adopt a "double-envelope" bidding system, only the economic and technical bid evaluation of qualified enterprises to enter the business bid evaluation, business bid evaluation by the lowest price winners.
--The implementation of the combination of bidding and purchasing, the signing of purchase and sales contracts. Purchasing agencies authorized or entrusted by the primary health care institutions and drug suppliers to sign purchase and sales contracts and is responsible for the implementation of the contract, the primary health care institutions of basic drugs payment for the unified payment, in principle, from the delivery of acceptance to payment shall not exceed 30 days.
--Establishing and improving the dynamic adjustment mechanism of the guideline price of essential drugs, classifying and managing the retail guideline price of essential drugs, and exploring the implementation of unified national pricing for exclusive varieties of essential drugs and varieties whose prices have been basically stabilized and sufficiently supplied by repeated centralized purchasing.
--Developing and improving policies for the provision and use of basic medicines at the grassroots level, and ensuring that government-run primary medical and healthcare organizations are fully equipped with and use basic medicines.
--Guaranteeing the production and supply of basic medicines. The supplying enterprises independently choose the operating enterprises for distribution or their own distribution. Encourage the development of modern logistics and other means to improve distribution efficiency. Promote drug production and distribution enterprises to optimize the structure and achieve scale of operation.
--To fully implement the new national quality standards for essential drugs. Strengthening the supervision of essential drugs, accelerating the construction of an informatization system, conducting sampling tests covering all varieties of essential drugs and electronic supervision of all varieties, and improving the ability to trace the entire process of essential drugs from production to circulation.
6. Comprehensive reform of primary medical and health care organizations will be comprehensively pushed forward, and a new operating mechanism will be established.
-Adjustment of fees and medical insurance payment policies for primary medical and healthcare institutions, combining the original registration fee, consultation fee, injection fee, and pharmacy service cost of primary medical and healthcare institutions into the general consultation and treatment fee. Reasonably formulate and adjust the fees for general consultation and treatment, and on the premise of not increasing the existing personal burden on the public, reasonably determine the proportion of payment by health insurance.
--Establishing a stable and long-term multi-channel compensation mechanism for primary medical and healthcare organizations. The government will implement special subsidies for primary medical and health care institutions and subsidies for the difference between recurring revenues and expenditures, and will implement the "two lines of income and two lines of expenditure" in areas where the conditions are favorable.
-Improving the management of establishment. Accelerate the completion of the formulation of staffing standards for primary medical and health care organizations. Innovative ways of organization management, county (city, district) as a unit to implement the total amount of staffing control, co-ordinated arrangements, dynamic adjustment.
--Deepening the reform of the personnel system. Promote the implementation of the localities to set up a fixed number of posts, the full establishment of personnel employment system and job management system, the implementation of the need to set up a post, bidding for a post, according to the post employment, contract management, the establishment of performance assessment, superiority and elimination of the fittest, able to go up, able to go down, able to enter, able to go out of the employing mechanism. Competitive recruitment of grass-roots medical personnel to complete, the localities combined with the actual proper streaming and resettlement of non-recruited personnel, to ensure social stability.
--Improving the performance appraisal mechanism, based on the quantity and quality of work, as well as the satisfaction of service recipients and the improvement of residents' health status and other indicators, the primary health care institutions and medical personnel to carry out a comprehensive quantitative assessment, the results of the assessment is linked to the subsidies of primary health care institutions and the income level of medical personnel.
--Improve the distribution incentive mechanism. Full implementation of performance pay, to ensure that the reasonable level of income of primary medical personnel will not be reduced. Insisting on more work, more pay, excellent performance and pay, appropriately widen the gap between the income of medical personnel, and to the key positions, business backbone and make outstanding contributions to the key tilt, mobilize the enthusiasm of medical personnel.
--Encouraging regions with the conditions to include village health offices and non-government-organized primary medical and health care institutions in the implementation of the basic drug system, and to provide reasonable compensation through the purchase of services and other means. Subsidies and support policies for village doctors are being implemented.
--The central government continues to provide incentives and subsidies to localities for the implementation of the national basic drug system and the comprehensive reform of primary medical and healthcare institutions through the method of awarding subsidies in lieu of rewards.
China News Network, February 17 - The General Office of the State Council recently issued the "five key reforms of the medical and health system in 2011 the main work arrangements," from accelerating the construction of the basic medical security system, the initial establishment of the national essential drugs system, improve the health care service system, promote the gradual equalization of basic public ****health services, and actively and steadily push forward the reform of public hospitals, five aspects of the clear 17 Specific tasks, and delineated the responsible departments to undertake the tasks.
The 17 specific tasks in the five areas proposed by the Work Arrangement are as follows:
Accelerating the construction of the basic medical security system
1. Consolidating and expanding the coverage of the basic medical security, and basically realizing the universal medical insurance.
--The number of participants in basic medical insurance for employees (hereinafter referred to as employee medical insurance) and basic medical insurance for urban residents (hereinafter referred to as urban residents' medical insurance) has reached 440 million, with the participation rate rising to over 90%. The participation rate has been raised to over 90%. The issue of insurance coverage for retirees of closed and bankrupt enterprises and employees of enterprises in difficulty has been properly resolved. All university students were included in the scope of urban residents' medical insurance. It is actively promoting the participation of employees of non-public economic organizations, flexibly employed persons and rural migrant workers in employees' medical insurance. Promoting the participation of unemployed persons in insurance. Implementing the policy of selective participation by flexibly employed persons and migrant workers who have not established labor relations.
--Further consolidate the coverage of the New Rural Cooperative Medical Care (hereinafter referred to as the New Rural Cooperative Medical Care), with the participation rate continuing to stabilize at over 90 percent.
2. Comprehensively upgrading the level of basic medical protection and strengthening the protection capacity.
--Further raising the standard of financing, the government's subsidy standard for both the New Rural Cooperative and the urban residents' health insurance has been raised to 200 yuan per person per year, and the standard of individual contributions has been raised appropriately.
--Expanding the scope of implementation of outpatient co-ordination, universally carrying out outpatient co-ordination for urban residents' health insurance and the new rural co-operation, and including in the scope of payment, in accordance with the regulations, medicines in the health insurance catalog used by primary health care institutions and the general diagnosis and treatment fees they charge; and actively exploring the co-ordination of outpatient services under the employees' health insurance scheme.
Significantly raising the level of protection. The proportion of hospitalization expenses paid within the policy scope of urban residents' medical insurance and the New Farmers' Cooperative strive to reach about 70%. The maximum payment limit of the integrated fund within the policy scope of employee health insurance, urban residents' health insurance and the new rural cooperative in all integrated areas has reached more than six times the annual average salary of local employees, the annual disposable income of local residents and the annual per capita net income of farmers nationwide, respectively, with none of them being less than 50,000 yuan.
-Actively carrying out pilot projects to raise the level of medical protection for major diseases, and launching pilot projects to raise the level of protection for children's leukemia and congenital heart disease on a provincial (autonomous regions and municipalities) basis, as well as increasing the types of pilot diseases and expanding the scope of pilot areas on the basis of summarizing and evaluating the situation. The government is also urgently studying policies and measures to provide necessary support for the treatment of opportunistic infections in AIDS patients in terms of medical insurance and assistance.
-- Comprehensively raising the level of medical assistance. Subsidize the participation of people in difficulty in insurance, and expand the scope of subsidies from low-income insurance recipients and five-guarantee households to low-income patients with serious illnesses, people with severe disabilities, the elderly from low-income families, and other special groups in difficulty. Outpatient assistance is being provided. The starting line for medical assistance has been gradually lowered and abolished, and the proportion of assistance for out-of-pocket expenses for hospitalization within the scope of the policy is in principle no less than 50%. Exploring the development of a pilot program to provide assistance for particularly serious illnesses. Encourage social forces to make charitable donations to medical assistance, and broaden funding channels.
3. Improving the level of basic medical insurance administration and management, and facilitating the public's medical settlement.
-Continuing to promote the "one-card" approach to medical care, basically realizing instant settlement of medical expenses within the integrated area of the insured (or settlement, the same below). Strengthen the capacity building of settlement of medical expenses in other places, carry out instant settlement of medical expenses in other places within provinces (autonomous regions and municipalities), and explore the instant settlement of medical expenses in other places, focusing on retirees resettled in other places. It will do a good job of transferring and continuing the basic medical insurance relationship of migrant workers and other mobile employed persons, and study issues related to the cumulative calculation of years of contribution.
--Strengthening the budgetary management of the revenues and expenditures of the medical insurance fund, setting up a system for analyzing the fund's operation and risk warning, controlling the fund's balance, and improving the efficiency of its use. Areas with excessive fund balances in the employee medical insurance and urban residents' medical insurance funds should gradually reduce their balances to a reasonable level; the balance rate of the New Farmers' Cooperative Coordination Fund for the current year should be controlled at 15% or less, and the cumulative balance should be no more than 25% of the Coordination Fund for the current year. Areas where the fund's current income does not cover expenditures should take practical and effective measures to ensure the smooth operation of the fund.
--To give full play to the role of medical insurance in guiding the supply and demand of medical services and in restraining medical costs. For those who go to primary medical and health care institutions, the proportion of payment for medical insurance will be tilted. Reforming the payment method of medical insurance, vigorously implementing capitation, payment by type of disease, and total prepayment. It is actively exploring the establishment of a negotiation mechanism between medical insurance organizations and medical institutions and drug suppliers.
--Strengthening the supervision of medical services by medical insurance. It has strengthened the dynamic management of designated medical institutions and designated retail pharmacies, established and perfected a system for evaluating the level of integrity of medical insurance, implemented the hierarchical management of designated medical institutions, and further standardized the service behaviors of designated medical institutions and designated pharmacies. It is studying the gradual extension of the supervision of medical institutions' medical services by medical insurance to the supervision of medical personnel's medical service behaviors. Increase penalties for fraudulent insurance behavior in accordance with the law.
-Employee health insurance and urban residents' health insurance have basically realized municipal (prefecture)-level coordination, and localities are encouraged to explore provincial-level coordination. Areas in a position to do so are further raising the level of coordination of the New Farmers' Cooperative Program. Accelerating the promotion of urban and rural integration of basic medical insurance, and steadily advancing the integration of administrative and management resources. The policies and management of the various basic medical security systems are well connected, and information*** is being shared to avoid duplication of coverage. It is actively exploring the commissioning of qualified commercial insurance organizations to handle various types of medical insurance management services.
--Supporting the development of commercial health insurance, encouraging enterprises and individuals to address their needs beyond basic medical security by participating in commercial insurance and various forms of supplementary insurance.
Preliminarily establishing a national basic drug system
4. Expanding the scope of implementation of the national basic drug system to achieve full coverage at the grassroots level.
--Expanding the scope of implementation of the basic drug system, implementing the national basic drug system in all government-run primary medical and healthcare institutions, and realizing zero-differential-rate sales of medicines.
--Studying and improving the national essential drug list (for use at the grassroots level), standardizing the addition of medicines in all provinces (autonomous regions and municipalities), and taking into account the needs of adults and children in the use of medicines, so as to better adapt to the basic needs of grassroots in the use of medicines. Synchronize the implementation of the basic drug health insurance payment policy.
5. Establishing a standardized procurement mechanism for basic medicines, and reshaping the grass-roots drug supply guarantee system.
--To implement centralized procurement and uniform distribution on a provincial (regional and municipal) basis for basic drugs (including additional varieties by provinces, autonomous regions and municipalities) used by government-run primary medical and healthcare institutions implementing the basic drug system, so as to ensure that the basic drugs are safe, effective, of good quality, reasonably priced, and supplied in a timely manner.
--Preparing the centralized procurement plan for essential drugs, determining the specific dosage forms, specifications and quality requirements for the procurement of essential drugs, specifying the quantity to be procured, and implementing the volume-price linkage. Provinces (autonomous regions and municipalities) that are temporarily unable to determine the quantity to be procured conduct procurement through a single-source commitment.
-Insisting on quality first, reasonable price, and encouraging localities to adopt the "double-envelope" bidding system, only the economic and technical bid evaluation of qualified enterprises to enter the business bid evaluation, business bid evaluation by the lowest price winners.
--The implementation of the combination of bidding and purchasing, the signing of purchase and sales contracts. Purchasing agencies authorized or entrusted by the primary health care institutions and drug suppliers to sign purchase and sales contracts and is responsible for the implementation of the contract, the primary health care institutions of the basic medicines payment for the unified payment, in principle, from the delivery of acceptance to payment shall not exceed 30 days.
--Establishing and improving the dynamic adjustment mechanism of the guideline price of essential drugs, classifying and managing the retail guideline price of essential drugs, and exploring the implementation of unified national pricing for exclusive varieties of essential drugs and varieties whose prices have been basically stabilized and sufficiently supplied by repeated centralized purchasing.
--Developing and improving policies for the provision and use of basic medicines at the grassroots level, and ensuring that government-run primary medical and healthcare institutions are fully equipped to use basic medicines.
--Guaranteeing the production and supply of basic medicines. The supplying enterprises independently choose the operating enterprises for distribution or their own distribution. Encourage the development of modern logistics and other means to improve distribution efficiency. Promote drug production and distribution enterprises to optimize the structure and achieve scale of operation.
--Comprehensively implement the new national quality standards for essential medicines. Strengthen the supervision of essential medicines, accelerate the construction of an information system, conduct sampling tests covering all varieties of essential medicines and electronic supervision of all varieties, and enhance the ability to trace the entire process of essential medicines from production to circulation.
6. Comprehensive reform of primary medical and health care organizations will be comprehensively pushed forward, and a new operating mechanism will be established.
-Adjustment of fees and medical insurance payment policies for primary medical and healthcare institutions, merging the original registration fee, consultation fee, injection fee and pharmacy service cost of primary medical and healthcare institutions into the general consultation and treatment fee. Reasonably formulate and adjust the fees for general consultation and treatment, and on the premise of not increasing the existing personal burden on the public, reasonably determine the proportion of payment by health insurance.
--Establishing a stable and long-term multi-channel compensation mechanism for primary medical and healthcare organizations. The government will implement special subsidies for primary medical and health care institutions and subsidies for the difference between recurring revenues and expenditures, and will implement the "two lines of income and two lines of expenditure" in areas where the conditions are favorable.
-Improving the management of establishment. Accelerate the completion of the formulation of staffing standards for primary medical and health care organizations. Innovative ways of organization management, county (city, district) as a unit to implement the total amount of staffing control, co-ordinated arrangements, dynamic adjustment.
--Deepening the reform of the personnel system. Promote the implementation of the localities to set up a fixed number of posts, the full establishment of personnel employment system and job management system, the implementation of the need to set up a post, bidding for a post, according to the post employment, contract management, the establishment of performance assessment, superiority and elimination of the fittest, able to go up, able to go down, able to enter, able to go out of the employing mechanism. Competitive recruitment of grass-roots medical personnel to complete, the localities combined with the actual proper streaming and resettlement of non-recruited personnel, to ensure social stability.
--Improving the performance appraisal mechanism, based on the quantity and quality of work, as well as the satisfaction of service recipients and the improvement of residents' health status and other indicators, the primary health care institutions and medical personnel to carry out a comprehensive quantitative assessment, the results of the assessment is linked to the subsidies of primary health care institutions and the income level of medical personnel.
--Improve the distribution incentive mechanism. Full implementation of performance pay, to ensure that the reasonable income level of primary medical personnel will not be reduced. Adhering to the principle of "more work, more pay" and "better performance, better pay", the income gap between medical personnel has been appropriately widened, and key positions, business backbone and outstanding contributions have been tilted to mobilize the enthusiasm of medical personnel.
--Encouraging regions with the conditions to include village health offices and non-government-organized primary medical and health care institutions in the implementation of the basic drug system, and to provide reasonable compensation through the purchase of services and other means. Subsidies and support policies for village doctors are being implemented.
--The central financial authorities will continue to provide incentives and subsidies to localities for the implementation of the national basic drug system and the comprehensive reform of primary medical and healthcare institutions through the method of awarding subsidies in lieu of reimbursement.