Opinions on deepening the reform of medical and health system
(March 2009 17)
According to the spirit of the 17th National Congress of the Communist Party of China, in order to establish a medical and health system with China characteristics, gradually realize the goal of everyone enjoying basic medical and health services, and improve the health level of the whole people, we hereby put forward the following opinions on deepening the reform of the medical and health system.
First, fully understand the importance, urgency and arduousness of deepening the reform of the medical and health system
Medical and health care is related to the health of hundreds of millions of people and the happiness of thousands of families, and it is a major livelihood issue. Deepening the reform of medical and health system, speeding up the development of medical and health undertakings, adapting to the people's growing medical and health needs, and constantly improving the people's health quality are inevitable requirements for implementing Scientific Outlook on Development and promoting comprehensive, coordinated and sustainable economic and social development, important measures for safeguarding social fairness and justice and improving people's quality of life, and important tasks for building a well-off society in an all-round way and a harmonious socialist society.
Since the founding of New China, especially since the reform and opening up, China's medical and health undertakings have made remarkable achievements. The medical and health service system covering urban and rural areas has basically taken shape, the ability of disease prevention and control has been continuously enhanced, the population covered by medical security has gradually expanded, the level of health science and technology has been rapidly improved, and the people's health level has been significantly improved. The main health indicators of residents rank among the top in developing countries. Especially since the great victory in the fight against SARS, governments at all levels have increased investment, the development of public health, rural medical care and urban community health has accelerated, and the new rural cooperative medical care and basic medical insurance for urban residents have made breakthroughs, laying a good foundation for deepening the reform of the medical and health system. At the same time, we should also see that the contradiction between the development level of China's medical and health undertakings and the people's health needs and the requirements of coordinated economic and social development is still outstanding. The development of medical and health undertakings in urban and rural areas and regions is unbalanced, the allocation of resources is unreasonable, public health and rural and community medical and health work are relatively weak, the medical security system is not perfect, the order of drug production and circulation is not standardized, the hospital management system and operation mechanism are not perfect, the government's health investment is insufficient, the medical expenses are rising too fast, the personal burden is too heavy, and the people reflect strongly.
From now until 2020, it is a crucial period for China to build a well-off society in an all-round way, and medical and health work has a long way to go. With the development of economy and the improvement of people's living standards, the masses will have higher requirements for improving medical and health services. Industrialization, urbanization, aging population, changes in disease spectrum and ecological environment all bring a series of new and severe challenges to medical and health work. Deepening the reform of medical and health system is a strategic choice to accelerate the development of medical and health undertakings, an important way to realize people's enjoyment of the fruits of reform and development, and an urgent desire of the broad masses of the people.
Deepening the reform of medical and health system is a social systematic project involving a wide range and great difficulty. China has a large population, a low per capita income level, a large gap between urban and rural areas and regions, and is in the primary stage of socialism for a long time, which determines that deepening the reform of the medical and health system is a very complicated and arduous task and a gradual process. Through long-term efforts and unremitting exploration, a medical and health system in line with China's national conditions should be established on the basis of a clear direction and framework. Therefore, to deepen the reform of the medical and health system, we should not only make firm determination and make solid progress, but also carefully organize and implement it steadily to ensure the smooth progress of the reform and achieve the expected goals.
Second, the guiding ideology, basic principles and overall objectives of deepening the reform of the medical and health system
(1) The guiding ideology for deepening the reform of the medical and health system. Guided by Deng Xiaoping Theory and Theory of Three Represents, we will thoroughly implement the Scientific Outlook on Development, proceed from China's national conditions and learn from international beneficial experience, and strive to achieve the goal of universal access to basic medical and health services and solve the most concerned, direct and realistic interests of the people. Adhere to the public welfare nature of public health, adhere to the policy of giving priority to prevention, focusing on rural areas, and paying equal attention to traditional Chinese and western medicine, implement separation of government affairs, management, medicine, profit-making and non-profit, strengthen government responsibility and investment, improve national health policy, improve institutional system, strengthen supervision and management, innovate institutional mechanisms, encourage social participation, build a basic medical and health system covering urban and rural residents, and continuously improve the health level of the whole people and promote social harmony.
(2) Basic principles for deepening the reform of the medical and health system. The reform of medical and health system must be based on the national conditions, proceed from reality and adhere to the correct reform principles.
-adhere to the people-oriented principle and give priority to safeguarding people's health rights and interests. Adhere to the purpose of medical and health services for people's health, take the protection of people's health as the center, and take everyone's access to basic medical and health services as the fundamental starting point and foothold. From the design of reform scheme, the establishment of health system to the construction of service system, we should follow the principle of public welfare, provide the basic medical and health system as a public product to the whole people, focus on solving outstanding problems strongly reflected by the masses, and strive to achieve universal medical care.
-Adhere to the national conditions and establish a medical and health system with China characteristics. Adhere to the basic national conditions, sum up the practical experience of medical and health reform and development in a realistic way, and accurately grasp the laws and main contradictions of medical and health development; Adhere to the coordination of basic medical and health services with economic and social development and people's affordability; Give full play to the role of traditional Chinese medicine (ethnic medicine); Adhere to local conditions, classified guidance, give full play to local enthusiasm, and explore the establishment of a basic medical and health system in line with national conditions.
-Adhere to the unity of fairness and efficiency, and combine the role of government-led and market mechanisms. Strengthen the government's responsibility in the basic medical and health system, strengthen the government's responsibility in system, planning, financing, service and supervision, safeguard the public welfare of public medical and health, and promote fairness and justice. At the same time, pay attention to the role of market mechanism, mobilize social forces to participate, promote the formation of an orderly competition mechanism, improve the operational efficiency, service level and quality of medical and health care, and meet the multi-level and diversified medical and health needs of the people.
-Adhere to overall planning, and combine solving current outstanding problems with improving the institutional system. Proceed from the overall situation, coordinate urban and rural and regional development, take into account the interests of all parties such as supply side and demand side, pay attention to the combination of prevention, treatment and rehabilitation, and correctly handle the relationship between the government, health institutions, pharmaceutical enterprises, medical personnel and the people. We should not only focus on the long-term, innovate the system and mechanism, but also focus on solving the outstanding problems in medical and health undertakings based on the current situation. Pay attention to the overall design, define the overall reform direction, objectives and basic framework, highlight key points, implement them step by step, and actively and steadily promote the reform.
(3) The overall goal of deepening the reform of the medical and health system. Establish and improve the basic medical and health system covering urban and rural residents, and provide safe, effective, convenient and cheap medical and health services for the masses.
By 20 1 1, the basic medical security system will cover all urban and rural residents, the basic drug system will be initially established, the urban and rural primary medical and health service system will be further improved, basic public health services will be popularized, breakthroughs will be made in the pilot reform of public hospitals, the accessibility of basic medical and health services will be significantly improved, the burden of medical expenses for residents will be effectively reduced, and the problem of "difficult and expensive medical treatment" will be effectively alleviated.
By 2020, a basic medical and health system covering urban and rural residents will be basically established. We have generally established a relatively complete public health service system and medical service system, a relatively sound medical security system, a relatively standardized drug supply security system, and a more scientific management system and operation mechanism of medical and health institutions, thus forming a diversified medical service pattern. Everyone enjoys basic medical and health services, basically meeting the people's multi-level medical and health needs, and the people's health level has been further improved.
Third, improve the four medical and health systems and establish a basic medical and health system covering urban and rural residents.
We will build a public health service system, medical service system, medical security system and drug supply security system covering urban and rural residents, and form a "four-in-one" basic medical and health system. The four systems complement each other, supporting construction and coordinated development.
(4) comprehensively strengthen the construction of the public health service system. Establish and improve public health service networks such as disease prevention and control, health education, maternal and child health care, mental health, first aid, blood collection and supply, health supervision and family planning, improve the public health service function of the medical service system based on the primary health service network, establish a public health service system with clear division of labor, information exchange, resource sharing and coordination, and improve the level of public health.
Determine the scope of public health services. Clarify the national basic public health service items and gradually increase the service content. Encourage local governments to increase public health services on the basis of the service items specified by the central government according to the local economic development level and outstanding public health problems.
Improve the public health service system. Further clarify the functions, objectives 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. We will improve the prevention and control system for major diseases and the emergency mechanism for public health emergencies, and strengthen the monitoring and prevention of infectious diseases, chronic diseases, endemic diseases, occupational diseases and birth defects that seriously threaten people's health. Strengthen the construction of urban and rural first aid system.
Strengthen health promotion and education. Medical and health institutions and institutions, schools, communities, enterprises, etc. We should vigorously carry out health education, make full use of various media, strengthen the dissemination of health and medical knowledge, advocate a healthy and civilized lifestyle, promote rational nutrition for the public, and improve people's health awareness and self-care ability.
Carry out the patriotic health campaign in depth. Incorporate rural environmental sanitation and environmental pollution control into the construction plan of new socialist countryside, promote the construction of sanitary cities and civilized villages and towns, and continuously improve the sanitary environment for urban and rural residents to live and work.
Strengthen health supervision services. Vigorously promote environmental health, food hygiene, occupational health, school health and migrant workers' health work.
(5) Further improve the medical service system. Adhere to the principle of non-profit medical institutions as the main body, for-profit medical institutions as the supplement, public medical institutions as the leading factor, and non-public medical institutions as the same development, and build a medical service system with reasonable structure covering urban and rural areas.
Vigorously develop the rural medical and health service system. Further improve the rural medical and health service network based on county hospitals, township hospitals and village clinics. As a medical and health center in the county, county hospitals are mainly responsible for basic medical services and the rescue of critically ill patients, and undertake professional technical guidance and further training for health personnel in township hospitals and village clinics; Township health centers are responsible for providing public health services and comprehensive services such as diagnosis and treatment of common diseases and frequently-occurring diseases, and undertaking business management and technical guidance for village clinics; Village clinics undertake public health services and diagnosis and treatment of general diseases in administrative villages. Conditional rural areas implement integrated rural management. Actively promote rural medical and health infrastructure and capacity building, the government focuses on running county-level hospitals, setting up a health center in each township, supporting various forms of village clinic construction, making every administrative village have a village clinic, and vigorously improving rural medical and health conditions and improving service quality.
Improve the new urban medical and health service system based on community health service. Accelerate the construction of urban community health service network with community health service centers as the main body, improve service functions, and provide public health services such as disease prevention and control, basic diagnosis and treatment services for common and frequently-occurring diseases, chronic disease management and rehabilitation services centered on maintaining the health of community residents. Change the mode of community health service, continuously improve the service level, adhere to active service and door-to-door service, and gradually assume the responsibility of "gatekeeper" of residents' health.
Improve the functions and responsibilities of various hospitals. Optimize the layout and structure, and give full play to the backbone role of urban hospitals in the diagnosis and treatment of critical and difficult diseases, medical education and scientific research, and guidance and training of grassroots health personnel. Conditional large hospitals can promote the rational flow of medical resources through trusteeship and reorganization in accordance with the requirements of regional health planning.
Establish a division of labor and cooperation mechanism between urban hospitals and community health service institutions. City hospitals promote the sustainable development of community health services through technical support and personnel training. At the same time, comprehensive measures such as enhancing service capacity, lowering charging standards and increasing reimbursement ratio will be taken to guide the general diagnosis and treatment to sink to the grassroots level, and gradually realize the first consultation in the community, graded medical care and two-way referral. Integrate urban health resources, make full use of existing primary and secondary hospitals, medical institutions affiliated to state-owned enterprises and institutions and medical institutions organized by social forces, and develop and improve the community health service network.
Give full play to the role of traditional Chinese medicine (ethnic medicine) in disease prevention and control, response to public health emergencies and medical services. Strengthen the construction of clinical research bases and hospitals of traditional Chinese medicine, and organize joint research on the prevention and treatment of difficult diseases with traditional Chinese medicine. In the primary medical and health services, vigorously promote the appropriate technology of traditional Chinese medicine. Adopt policies to support the development of traditional Chinese medicine and promote the inheritance and innovation of traditional Chinese medicine.
Establish a system for urban hospitals to support rural medical and health work. Developed areas should strengthen their support for the development of medical and health undertakings in poor areas and ethnic minority areas. Hospitals in big cities should establish a long-term and stable counterpart support and cooperation system with county hospitals, and help county hospitals improve their medical level and service ability through clinical services, personnel training, technical guidance and equipment support.
(6) Accelerate the construction of 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 main body and other forms of supplementary medical insurance and commercial health insurance as supplements.
Establish a basic medical security system covering 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 constitute the basic medical security system, covering urban employed population, urban unemployed population, rural population and urban and rural poor population respectively. Adhere to the principle of wide coverage, basic protection and sustainability, starting from the key protection of serious and serious diseases, and gradually extending to outpatient minor diseases, and constantly improving the level of protection. Establish a multi-channel financing mechanism with clear and reasonable responsibilities of the state, units, families and individuals to realize social mutual assistance and economic assistance. With the development of economy and society, we will gradually improve the level of financing and overall planning, narrow the gap in the level of security, and finally realize the basic unity of the institutional framework. Further improve the basic medical insurance system for urban workers, speed up the coverage of the employed population, and focus on solving the basic medical insurance problems for employees and retirees such as state-owned closed and bankrupt enterprises and difficult enterprises, as well as employees of non-public economic organizations and flexible employees; In 2009, comprehensively promote the basic medical insurance for urban residents, focusing on solving the basic medical insurance problems for the elderly, the disabled and children; Fully implement the new rural cooperative medical system, gradually increase the level of government subsidies, appropriately increase farmers' contributions, and improve the security capacity; We will improve the urban and rural medical assistance system, subsidize the people who have difficulties in participating in insurance and the medical expenses they cannot afford, and build a solid medical security bottom line. Explore the establishment of a basic medical security management system that integrates urban and rural areas.