Medical and health system reform

Documents issued by the CPC Central Committee and the State Council in 2009

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The reform of the medical and health system is based on the Opinions of the CPC Central Committee and the State Council on Deepening the Reform of the Medical and Health System (ZF [2009] No. 6, hereinafter referred to as the Opinions). Implement the Scientific Outlook on Development, adhere to the people-oriented principle, and focus on exploration and innovation in response to the growing new needs of the masses, new trends in medical and health development and new challenges facing them. It refers to a series of theoretical exploration and practical measures to adjust and innovate the current public health services, medical services, medical security, drug supply security and corresponding management systems. In 2009, the central government issued the opinion that the general goal of deepening the reform of the medical and health system is to establish and improve the basic medical and health system covering urban and rural residents, and provide medical and health services for the masses.^[5]

From 2009 to 2011, we will focus on five reforms. everything accelerate advance Basic medical security system The second is preliminary establishment National Essential Drug System Third, improve the basic medical and health service system, and fourth, promote Basic public health services Five is to promote gradual equalization Pilot reform of public hospitals 。

Issued by the General Office of the State Council in July 2020《 Key tasks for deepening the reform of the medical and health system in the second half of 2020 》。^[1]

On June 3, 2024, the General Office of the State Council issued the Key Tasks for Deepening the Reform of the Medical and Health System in 2024.^[6]

Chinese name: Medical and health system reform
Issued by: The State Council of the CPC Central Committee

Release time: 2009
Reform time: 2009-2011

catalog

seven Reform achievements
eight Related reports

Current situation of reform

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Since the reform and opening up, we have carried out a series of reforms in the medical and health industry, and also experienced some relatively large reform processes, and made some breakthroughs. For example, for health resources The serious shortage has led to the problem of "difficulty in seeing a doctor, hospitalization and surgery". We encourage multi-channel financing and various forms of medical care, and gradually form a new pattern of public ownership as the main body, and various forms and channels of medical care. Through a series of incentive measures, medical institutions have obviously mobilized the enthusiasm of medical institutions and medical personnel, significantly improved the scale, conditions, level and capacity of medical services in China, and significantly increased the supply of medical and health services, effectively alleviating the "difficult to see a doctor, difficult to be hospitalized, difficult to operate" and other prominent contradictions caused by the shortage of health resources. For another example, in view of the malpractice that the medical insurance for employees is basically covered by the state and enterprises and institutions Labor insurance and medical system Reformed and established Basic medical insurance for urban employees System. At the same time, a new rural cooperative medical system has been gradually established Basic medical insurance system for urban residents and Urban and rural medical assistance system China's medical security system has been initially formed.

However, some deep-seated problems of the medical and health system have not been fundamentally solved, and some new problems have emerged: the development of medical and health services in urban and rural areas and regions is unbalanced, the order of drug production and circulation is not standardized, the hospital management system and operating mechanism are not perfect, the government health investment is insufficient, and the medical expenses are rising rapidly, Medical security system It is not perfect, the scope of security is small, the level of security is low, and the individual burden of residents is too heavy. The problem of "difficult to see a doctor" and "expensive to see a doctor" has emerged in the new situation. At present, China has entered into comprehensive construction a moderately prosperous society At the new stage of the 21st century, the people's living standards are constantly improving, the residents' consumption mode has also stepped onto a new level, and the health demand is increasing rapidly. "Prevention without disease, treatment with disease, and prevention of disability" has become the most concerned, urgent, and realistic interest problem of the masses of the people. The people put forward higher requirements for improving medical and health services. To deepen the reform of the medical and health system, the first is to alleviate the problem of "difficult and expensive medical treatment" strongly reflected by the masses, and reduce the Disease burden We will ensure that all people have access to medical care when they are ill and safeguard their health rights and interests; The second is to cope with the new challenges brought to medical and health work by industrialization, urbanization, population aging, changes in disease spectrum and environmental changes; Third, resolve the deep-seated contradictions formed and accumulated in the medical and health field for a long time, and promote the sustainable and healthy development of medical and health undertakings; Fourth, we will gradually establish a basic medical and health care system in line with national conditions, ensure that everyone has access to basic medical and health services, and constantly improve people's health.

Deepening the reform of the medical and health system is based on a profound summary of previous health reforms, starting from the national conditions, drawing on useful international experience, and guided by the Scientific Outlook on Development, to carefully study and solve major issues such as what kind of system to establish, what kind of development to achieve, what is the purpose of development, and how to develop, Innovation system To solve the deep-seated system, mechanism and structural problems that restrict the scientific development of medical and health undertakings, to achieve the goal of "everyone has access to basic medical and health services" proposed at the 17th National Congress of the Communist Party of China, and to accomplish the major historical tasks of "establishing a basic medical and health system" and "providing medical services for the sick".

Reform opinions

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On June 30, 2006, the 141st executive meeting of the State Council decided to establish an inter ministerial coordination working group to deepen the reform of the medical and health system, led by the National Development and Reform Commission and the Ministry of Health, with 16 departments including the Ministry of Finance and the Ministry of Human Resources and Social Security participating. Over the next two years, the working group has carried out a large number of practical research in various places, made special research on key and difficult issues, widely listened to the opinions of all parties, and entrusted world health organization , Peking University and other well-known institutions at home and abroad Parallel research , and also soliciting proposals online. On this basis, the Opinions on Deepening the Reform of the Medical and Health System was drafted. The State Council held two executive meetings on February 29 and September 10, 2008 to review the Opinions.

On October 23, 2006, General Secretary Hu Jintao the Political Bureau of the Central Committee An important speech was delivered at the 35th group learning meeting, which emphasized the public welfare nature of public health care and pointed out the direction for deepening the reform of the medical and health system. Premier Wen Jiabao presided over two symposiums on deepening the reform of the medical and health system in the middle of April 2008, listened to the opinions of medical workers, experts and scholars, heads of enterprises, employees of enterprises, urban residents, farmers, migrant workers and other representatives from all walks of life, and proposed that medical reform should make people benefit and medical staff be encouraged Make it easy for supervisors to master. Li Keqiang The Vice Premier personally went to the grass-roots level to investigate, presided over several meetings to study the revision and improvement of the Opinions, and proposed the direction and work requirements of the five key reforms in the near future.

According to the deployment of the State Council, the medical reform opinions (draft for comments) were again solicited from the public in September 2008, and the full text was released to the public from October 14 to November 14, asking questions of the people and causing positive responses from all sides. Subsequently, the Working Group carefully sorted out the feedback from all parties and revised the Opinions on the principle of absorption as much as possible, with a total of more than 190 revisions. At the same time, the State Council decided to carry out in-depth research and calculation on the goals and main measures of the recent key reforms around the issues of the greatest concern to the masses, and formed the "Key Implementation Plan for the Recent Reform of the Medical and Health System (2009-2011)".

On January 21, 2009, the 26th executive meeting of the State Council reviewed again. On February 5, the Political Bureau of the Central Committee The Standing Committee deliberated, and the CPC Central Committee and the State Council adopted the Opinions and Implementation Plan in principle. On March 5, Premier Wen Jiabao solemnly stated to the whole country People's Congress The medical reform work was reported. To sum up, under the direct leadership of the CPC Central Committee and the State Council, the Opinions were formed after more than two years of hard work by the working group, repeated demonstration, revision and improvement, and are the crystallization of wisdom from all parties.

Reform tasks

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Issued by the General Office of the State Council on June 10, 2019《 Notice of the General Office of the State Council on Printing and Distributing the Key Tasks of Deepening the Reform of the Medical and Health System in 2019 》The State Council Reform Office held a regular policy briefing on this issue on the 10th. Wang Hesheng, Deputy Director of the National Health Commission and Deputy Director of the Secretariat of the Leading Group for Medical Reform under the State Council, said that the "Key Tasks" closely focused on solving the problem of difficult and expensive access to medical care, deepening the joint reform of medical care, medical insurance and medicine, and unswervingly promoting the implementation of medical reform to achieve results and benefit the people.^[2]

Issued by the General Office of the State Council in July 2020《 Key tasks for deepening the reform of the medical and health system in the second half of 2020 》。^[1]

Reform and innovation

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This reform implements the scientific concept of development, adheres to the people-oriented principle, and focuses on exploration and innovation in response to the growing new needs of the masses, new trends in medical and health development and new challenges facing them. In general, there are five major innovations:

First, on the concept of reform, it is the first time to put forward the concept of "taking the basic medical and health system as public goods To the whole people ". The purpose of the reform is very clear. It is to establish a basic medical and health system covering urban and rural residents, and solve the problem of "difficult and expensive access to medical services", which is widely reported by the masses. The plan always runs through the main line of adhering to the public welfare of public health. The innovation of this concept is not only in line with the law of medical and health development, but also in line with China's basic national conditions, which is of great significance.

Second, on the basic principle of reform, it clearly emphasizes the combination of government leadership and the role of market mechanism, and emphasizes the unity of fairness and efficiency. On the one hand, from the perspective of safeguarding the health rights and interests of the broad masses, it is proposed to strengthen the responsibility of the government in the basic medical and health system and provide public health and Basic medical services The dominant position in. On the other hand, it emphasizes the importance of giving play to the role of the market mechanism, making overall use of the medical and health resources of the whole society, striving to form an efficient drug supply security system, a multi-level medical security system and a diversified medical pattern, promoting orderly competition, improving service quality and efficiency, and meeting the multi-level and diversified needs of the masses.

Third, on the basis of the focus of the recent reform, we should highlight the basic, basic and grass-roots level, and emphasize facing the countryside and benefiting the masses. Based on the national conditions and the characteristics of the primary stage, it is proposed to first solve the problem of fairness, ensure basic needs, and establish a basic medical and health system. It is the first time to propose the establishment of a basic medical security system covering urban and rural residents, that is, universal medical insurance; insist Prevention first The public health service system and the medical service, medical security, and drug supply security system are juxtaposed as the four major systems constituting the basic medical and health system to be strengthened, which is proposed for the first time Equalization of basic public health services To narrow the gap between urban and rural residents in basic public health services; It is the first time to propose preliminary establishment National Essential Drug System We will rectify and improve the drug production and supply security system, standardize drug use behavior, and reduce drug prices and patients' medical expenses; Efforts should be made to strengthen the construction of the grass-roots medical and health service system, so that the majority of urban and rural people can get better basic medical and health services without leaving the countryside and communities. At the same time, according to the basic national conditions, it emphasizes the leading role of county level hospitals in rural disease prevention and treatment, and proposes to comprehensively strengthen the construction of county level hospitals, improve the level and quality of medical services, so as to prevent serious rural diseases from leaving the county.

Fourth, on the basic idea of reform, we should combine far and near, solve the prominent problem of people's medical treatment and establish and improve the basic system. On the one hand, focus on the long-term and highlight Top-level design For the first time, it systematically proposed the basic framework of the basic medical and health system to establish a basic medical and health system with Chinese characteristics, and defined the overall direction and objectives, main tasks, and main policies and measures for deepening the reform, namely, "one goal, four systems, and eight supports". At the same time, based on the current situation, it is proposed that we should focus on five key reforms in the near future, namely, "four basic reforms and one pilot project", to enhance the operability of the reform. The five reforms are interlinked, involving the key links of the medical and health system reform and the most concerned issues of the people.

Fifthly, in terms of the methods and steps of reform, we emphasized that pilot projects should be carried out first and steadily. Because the reform of the medical and health system involves a wide range of areas, is complex, has strong policy orientation, and has large regional differences, some major reforms in the plan should be made clear by the central government with the goal orientation and basic principles, leaving room for local operations, encouraging local pilot exploration to adapt to local conditions, and constantly deepening the reform through summing up and accumulating experience.

In addition, there are many highlights in specific policies and measures, such as the establishment of medical and health information system as an important starting point for reform; Encourage social capital to set up non-profit hospitals, and accelerate the formation of diversified medical management pattern; Propose to establish Standardized training for residents Research and explore the multi-point practice of registered physicians to improve the level and quality of medical services; Cultivate practical health talents for rural areas in poverty-stricken areas through targeted free training and other ways; To carry out medical social work and improve communication between doctors and patients.

Reform focus

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On the basis of fully considering the characteristics of the reform of the medical and health system, combined with the actual situation of China, this medical reform focuses on the five reforms in the near future, starting from solving the problem of "difficult and expensive access to medical services", which is most strongly reflected by the masses.

First of all, the reform of the medical and health system is an arduous and long-term task, which needs to be promoted in stages and with emphasis. At the initial stage of the reform, we first focused on solving the problem of fairness, ensuring the basic needs of the masses for medical treatment, and with the economic and social development, we gradually developed multi-level and diversified medical and health services, improved service efficiency and quality, and met the diverse medical and health needs of the masses.

secondly, Medical security system Imperfect, the public health service institutions' public welfare nature is weakening, the order of drug production and circulation is not standardized, and the price is falsely high. The five reforms are to change the situation that some urban and rural residents have no basic medical security and public health services have been weak for a long time, reverse the trend of public health institutions, and truly return to public welfare, Effectively solve the outstanding problems in the current medical and health field, and lay a solid foundation for comprehensively realizing the long-term goal of medical and health system reform.

Finally, five key reforms have been carried out to address the problem of "difficult and expensive access to medical services", which is widely reported by the public. advance Basic medical security system We will integrate all urban and rural residents into the basic medical security system, and effectively reduce the burden of medical expenses paid by individuals. establish National Essential Drug System We will improve the basic medical and health service system, make it easier for people to get medical treatment, and reduce the price of medical services and drugs. We will promote the gradual equalization of basic public health services so that all urban and rural residents can enjoy basic public health services and prevent disease to the maximum extent. We will promote the pilot reform of public hospitals, improve the service level of public medical institutions, and work hard to solve the problem of people's "optimistic about disease".

system in force

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The basic medical and health system is mainly composed of the public health service system, medical service system, medical security system and drug supply security system covering urban and rural residents Quaternity , complement each other, build supporting facilities and coordinate development. At the same time, we should establish and improve eight systems, mechanisms and conditions for the management, operation, investment, price, supervision, science and technology and talents, information, and legal system of medicine and health, and ensure the effective and standardized operation of four systems in eight aspects, so as to achieve the goal of providing safe, effective, convenient, and inexpensive medical and health services for the masses. Therefore, the basic framework of the basic medical and health system can also be vividly summarized as "four beams and eight pillars". The Opinions clearly put forward the specific contents and main policies and measures for the construction and improvement of "four beams and eight pillars".

What are the time and steps for deepening the reform of the medical and health system?

In the scheme design of this medical reform, we not only focus on the overall design, but also clarify the overall reform direction, objectives and basic framework; It also highlights the key points and strives for obvious results in the near future. The work of medical reform is mainly divided into the short-term and long-term stages. The tasks of these two stages are interlinked to promote the continuous and effective progress of medical and health system reform.

In the near future, it mainly refers to the three years from 2009 to 2011. The focus of reform is to accelerate the construction and preliminary establishment of the basic medical security system National Essential Drug System Improve the basic medical and health service system, promote the gradual equalization of basic public health services, and promote the pilot reform of public hospitals. The goal of the reform is to effectively alleviate the problem of "difficult and expensive access to medical services". The task of this stage is to reform the medical and health system, the basic problems that are most highlighted by the masses and urgently need to be solved, ensure the basic medical and health needs of the masses, make the medical reform take a solid step, and lay a good foundation for the next step of reform. In the Recent Key Implementation Plan of the State Council on the Reform of the Medical and Health System (2009-2011), 20 tasks have been defined for the three years Time node And 23 quantitative indicators. Relevant departments will also formulate a number of supporting documents and implementation rules according to the needs of the reform.

The long-term stage is from now to 2020. The task of reform is to generally establish a relatively complete public health service system and medical service system, a relatively complete medical security system, a relatively standardized drug supply security system, a relatively scientific management system and operation mechanism of medical and health institutions, including four major systems and eight supports. The goal of the reform is to basically establish a basic medical and health system covering urban and rural residents. The reform in this stage is an extension of the previous stage. On the basis that everyone enjoys basic medical and health services, we should adapt to the multi-level medical and health needs of the people, further improve the system, work hard to improve service efficiency and quality, expand the supply of quality services, and improve the health level of the people.

Why is the medical and health system reform a gradual process?

The reform of the medical and health system is a systematic project that involves a wide range of areas and is extremely difficult. Therefore, it is necessary to take the overall situation as a whole and step by step.

First of all, China has a large population, a weak foundation, a low level of economic development, a large gap between urban and rural areas and between regions, and is in the primary stage of socialism for a long time. This basic national condition determines the difficulty and complexity of reform, which requires long-term and arduous efforts.

Secondly, the reform of the medical and health system itself is complex. It includes four fields: public health, medical service, medical security and drug supply security. There are deep contradictions in each field. To solve these contradictions, we must break through the key points and gradually advance them in stages.

Thirdly, the reform of the medical and health system is related to the vital interests of the masses of the people and the well-being of thousands of households. Moreover, different groups have different demands. Therefore, every decision should be made with caution. In order to avoid major decision-making mistakes, many policies need to be piloted before being promoted.

What are the main contents of China's medical security system?

China's medical security system basic medical insurance And urban and rural medical assistance, as well as other forms of Supplementary medical insurance And commercial health insurance.

Basic medical insurance is provided by Basic medical insurance for urban employees 、 Basic medical insurance for urban residents and New rural cooperative medical care The composition covers the urban employed population, urban non employed population and rural population in terms of system. Under the premise of comprehensive consideration of affordability in all aspects, through multi-channel financing with clear and reasonable sharing of responsibilities by the state, employers, collectives, families and individuals Social mutual aid Mutual aid and cost sharing can meet the basic medical security needs of urban and rural residents.

Urban and rural medical assistance is the network base of China's multi-level medical security system, which is mainly funded by the government finance to help urban and rural poor people who are unable to enter the basic medical insurance system and who cannot afford co payment after entering, so that they can enjoy basic medical security as other social members.

Supplementary medical insurance Including commercial health insurance and other forms of supplementary medical insurance. It is mainly to meet the high-level medical needs beyond the basic medical security. The State encourages enterprises and individuals to participate in commercial insurance And various forms of supplementary insurance to address the needs beyond the basic medical security.

In addition, the state provides social welfare and develops charities, establishes and improves medical and health service facilities, expands the source of medical security funds, and better meets the medical security needs of the masses.

Cities and towns in China basic medical insurance System construction What achievements have been made? What problems still exist?

Cities and towns in China Basic medical insurance system include Basic medical insurance for urban employees System and Basic medical insurance system for urban residents 。 At present, the basic medical insurance system for urban employees has been generally established nationwide, and the basic medical insurance system for urban residents is also gradually being piloted. By the end of 2008, the number of urban basic medical insurance participants had exceeded 310 million. In recent years Medical insurance management The department continuously explores in the management, establishes and improves the mechanism, improves the policy specifications, and strengthens the service management. The effect of the urban basic medical insurance system gradually appears:

First, the basic medical needs of the insured have been guaranteed. town Basic medical insurance system Stable operation and basic balance of fund income and expenditure have alleviated the problem of "difficult and expensive medical treatment" of the people to a certain extent.

Second, we have established a basic security mechanism and a cost sharing mechanism in line with China's actual conditions. basic medical insurance Adhere to the principle of basic security, that is, the level of financing should be consistent with the level of economic development, and with the actual payment capacity of units and individuals; The treatment level should not only ensure the basic medical needs of the insured, but also meet the Medical insurance fund The actual ability to pay. The establishment of a cost sharing mechanism has promoted the improvement of the cost constraint mechanism and the enhancement of the sense of self-protection, providing a guarantee for the sustainable development of the system.

Third, a third-party regulatory mechanism for medical services has been initially established. Medical insurance institutions On behalf of the insured, it supervises the medical behaviors of designated institutions, promotes reasonable diagnosis and treatment and rational drug use of medical institutions, thus ensuring the reasonable medical rights and interests of the insured.

Four is to establish Social management The service system reduces the transactional burden of employers and strengthens the public service function of the government. town Basic medical insurance system The smooth implementation and stable operation of State owned enterprise reform And the transformation of the economic system, and played an important role in maintaining the overall situation of reform, development and stability.

Existing problems: First, some prefecture level cities have not started implementation Basic medical insurance system for urban residents ； Some employees of state-owned enterprises in difficulty and retirees from closed and bankrupt enterprises have not yet been insured. Second, various items Medical security system The overall planning mode and compensation mode need to be optimized; The overall level of various insurance systems is relatively low, and it is difficult to achieve the convergence of insurance policies and benefits in the process of personnel mobility and identity transformation. Third, the handling and management service capacity needs to be further improved. To meet the needs of socialized management, we should extend services to streets and communities, innovate management service concepts, and better provide quality and convenient services for the majority of insured people.

What is the goal of improving insurance coverage?

Increasing the coverage rate of insurance is an important measure to improve the ability of people to pay for medical services and solve the problem of "expensive medical services". Basic medical security system The goal of coverage is to achieve full coverage of urban and rural residents, so that everyone can enjoy basic medical security. At present, the primary task to speed up the construction of the basic medical security system is to expand the coverage as soon as possible, and strive to use three years to achieve three goals by 2011: medical insurance for employees, medical insurance for residents and new rural cooperative medical system Basic medical insurance system It covers more than 90% of the total population.

What are the progress and challenges of China's new rural cooperative medical system?

Since 2003, the New Rural Cooperative Medical System System construction Starting from the pilot project, we actively explored and made steady progress, basically achieving full coverage and making remarkable achievements.

First, the coverage continues to expand. By 2008, 2729 counties (cities and districts) had established the new rural cooperative medical system, covering all counties (cities and districts) with agricultural population in the country. More than 800 million farmers participated in the new rural cooperative medical system, with a participation rate of 91.5%. The goal of comprehensive coverage set by the central government was completed two years ahead of schedule.

Second, the level of financing has steadily improved. From 2003 to 2008, the per capita financing standard of participating farmers increased from 30 yuan to 100 yuan, including 80 yuan per capita subsidies from governments at all levels and 20 yuan per capita contributions from individuals; The central government raised the per capita subsidy standard for the farmers in the central and western regions from 10 yuan to 40 yuan, and also gave some subsidies to the farmers in the eastern provinces; The scale of the National New Rural Cooperative Medical Fund increased from 4 billion yuan to more than 70 billion yuan.

Third, farmers are benefiting more and more. By the end of 2008, a total of 1.5 billion people across the country had been compensated by the new rural cooperative medical system, with a total compensation fund of 125.3 billion yuan, of which 110 million people had been compensated for hospitalization, 101.4 billion yuan had been compensated, 1.19 billion people had been compensated for outpatient medical care, and 200 million people had undergone health examinations. The average hospitalization compensation amount of the participating farmers increased from 690 yuan at the beginning of the pilot project to 1066 yuan in 2008, and the actual hospitalization compensation ratio increased from 24.7% to 38%, effectively reducing the economic burden of diseases on farmers.

Fourth, the framework and operating mechanism of the new rural cooperative medical system have been continuously improved. Local governments have gradually established and improved the management and operation mechanism led by the government, headed by health departments, coordinated by relevant departments, operated by agencies, served by medical institutions, and participated by farmers; It has established a financing mechanism that takes families as units to participate voluntarily, takes counties (cities, districts) as units to make overall plans, and combines individual contributions, collective support and government funding; It has established a unified and standardized fund management system throughout the country and a supervision system centered on fund operation, review and payment with the participation of farmers and other relevant parties; A medical assistance system connected with the new rural cooperative medical system has been established.

Practice has proved that the new rural cooperative medical system is in line with China's national conditions, the level of rural economic development, and farmers' economic affordability and medical service needs. The New Rural Cooperative Medical System (NRCMS) is a major institutional innovation in the reform and development of rural health in China, and an important form of realizing the basic medical security for farmers at this stage.

As a basic form of medical security for rural residents, the new rural cooperative medical system is still developing and needs further improvement. This is mainly reflected in: First, the financing level of the new rural cooperative medical system is low, the overall level of farmers' security is not high, and the burden of farmers' personal medical expenses is still heavy. Second, the new rural cooperative medical system has been established, but the specific compensation programs and institutional measures still need to be standardized and improved. Third, with the comprehensive coverage of the new rural cooperative medical system and the improvement of funding standards, the task of ensuring the safe operation of the fund is more onerous. It is urgent to improve the construction of the agency and strengthen the construction of the management capacity of the agency. Fourth, the rural medical and health service capacity is still relatively weak, unable to meet the basic medical needs of farmers; Some medical institutions provide non-standard services and have high medical expenses.

How to further improve the new rural cooperative medical system?

In the future, the focus of the new rural cooperative medical system is to consolidate and improve the system, strengthen supervision and management, and improve the level of security;

First, gradually raise the level of financing. By 2010, ncms The financial subsidy standard should reach 120 yuan per person per year, and the individual payment level of farmers should be appropriately raised.

The second is to adjust and improve the overall compensation plan. According to the principle of fair enjoyment and fair benefit, and on the premise of ensuring the safety of the fund, the level of hospitalization compensation should be gradually improved. Explore and improve the overall planning of outpatient services, appropriately increase outpatient compensation, expand the range of benefits, and enable farmers to benefit from the growth of financing.

Third, we will effectively strengthen Fund supervision 。 Conscientiously implement the new rural cooperative medical fund Financial accounting system To regulate and improve the management and operation of the new rural cooperative medical fund. We will improve the system for publicizing the use and compensation of new rural cooperative medical funds and strengthen social supervision. We will strengthen the investigation and punishment of corruption, misappropriation, fraud and other violations of the New Rural Cooperative Medical Fund to ensure the safety of the fund.

Fourth, strengthen the supervision of designated medical institutions. Standardize the new rural cooperative medicine catalogue and the catalogue of diagnosis and treatment items; The service behavior of designated medical institutions can be effectively constrained by exploring effective medical expense payment methods, strengthening administrative management and other comprehensive measures.

Fifth, strengthen management service capacity building. In line with the principle of simplification and efficiency, improve the management and operation system of the new rural cooperative medical system. Accelerate informatization construction and improve management ability. Actively promote the practice of participating farmers' immediate compensation for medical treatment in designated medical institutions to facilitate farmers' medical treatment.

Sixth, further improve the construction of rural health service system. Improve the service quality and efficiency of rural medical institutions, reform the system and mechanism, and reasonably control medical expenses.

How to make difference Medical security system Connection between?

The connection between different medical security systems includes different Basic medical insurance system Connection between basic medical insurance and medical assistance Linkage between systems and basic medical insurance and Supplementary medical insurance Connection between. To do a good job in these links, we should deal with the following four aspects:

First, we should do a good job in the policy convergence of various basic medical insurance systems. Further coordinate the formulation and improvement of various basic medical insurance policies, accelerate the expansion of coverage, and strive to realize the directory of basic medical insurance for all at an early date; Gradually improve the overall level and security level of basic medical insurance, and narrow the institutional differences.

Second, do a good job in all aspects basic medical insurance Connection in management. Based on the existing medical insurance information management systems, unify the information standards to enable the sharing of various basic medical insurance data information; Overall arrangement Medical insurance system Fixed point management, service standards, and settlement methods. Gradually integrate and handle Manage Resources , improve management service efficiency And provide services for the insured.

The third is to make a good connection between the status change of the insured and the basic medical insurance relationship when they move. Efforts should be made to study the transfer and continuation methods of insurance relations, so as to realize the smooth transfer of basic medical insurance relations. Do a good job in transforming the insured from resident to Employed people The connection between residents' medical insurance and employees' medical insurance; When the insured is transferred from the countryside to the city, the new rural cooperative medical system should be connected with the medical insurance for urban employees (residents); When the insured is transferred across regions, the basic medical insurance relationship should be transferred.

Fourth, improve the multi-level medical security system. perfect Urban and rural medical assistance system We will provide assistance in various forms and at different levels, subsidize people in need and participate in insurance and cooperation, and provide subsidies for basic medical expenses that are difficult for the recipients to bear, so as to ease the medical burden of people in need and strengthen the bottom line of security. We will improve medical subsidies for civil servants, large medical expense subsidies and Enterprise supplementary medical insurance 。 Encourage commercial insurance companies to develop and adapt to the needs of the masses Medical insurance system Connected health insurance products meet the multi-level medical security needs of the masses.

What are the achievements and problems of public health services?

Since the reform and opening up, China has continuously strengthened the construction of the public health service system, and basically completed the disease prevention and control system and emergency medical treatment system covering the whole country's urban and rural areas. Under the correct leadership of the Party and the government, we will ensure that there are no major epidemics after major natural disasters. Major infectious diseases that seriously threaten people's health Endemic Diseases Effectively controlled, filariasis eliminated, and no poliomyelitis , effective response Human infection with highly pathogenic avian influenza Human infection streptococcus suis And other epidemic situations. It is estimated that since 1978 National immunization programme Since then, it has decreased nationwide measles 、 pertussis 、 diphtheria , polio, tuberculosis tetanus A total of 300 million people were affected by six kinds of diseases, and 4 million related deaths were reduced. Since 1992, 80 million people nationwide have been prevented from contracting hepatitis B virus surface antigen The number of carriers decreased by 20 million and hepatitis B was popularized Vaccination The epidemic of hepatitis B was effectively controlled. In 2007, the number of vaccines in the national immunization program increased to 14 and 15 infectious diseases were prevented. AIDS , tuberculosis schistosomiasis Major progress has been made in the prevention and control of major infectious and endemic diseases, the spread of AIDS has been initially curbed, the coverage of tuberculosis control strategies has reached 100%, and the schistosomiasis epidemic has dropped to the lowest level in history. Chronic Non-Communicable Diseases The prevention and control work was gradually standardized, and mental health work was included in the important agenda. Create a national health city (district) and National Health Town (County) activities steadily progressed, rural water and toilet improvement and comprehensive improvement of rural environmental sanitation continued to advance, and urban and rural environmental sanitation further improved. The implementation of tobacco control has been steadily promoted. reduce Maternal mortality And elimination Neonatal tetanus The number of projects has expanded to 1200. The subsidy policy for hospital delivery of pregnant and lying in women in rural areas in central and western China has been fully implemented. In 2009, the scope of the subsidy for hospital delivery of pregnant and lying in women in rural areas will be expanded to the whole country, and the national maternal mortality rate will be reduced from 36.6 per 100000 in 2007 to 34.2 per 100000 in 2008, infant mortality rate From 15.3 ‰ in 2007 to 14.9 ‰ in 2008. The health supervision system has been extended to the grass-roots level, and new progress has been made in the health supervision of food, drinking water, public places, occupations, radiation, schools, infectious disease prevention, medical services and blood safety. However, there are still some problems in China's public health services:

First, the ability of personnel in some areas can not meet the job requirements. Public health service institutions lack the conditions to stabilize and attract talents, the professional quality of health personnel is not high, the structure is not reasonable, and the public's trust in primary health services is not high.

Second, there are great differences in the level and accessibility of public health services between regions and people. There is a large gap in the level of public health services between the eastern region and the central and western regions, as well as between urban and rural areas. The public health services and management model of floating population are still under exploration.

Third, the infrastructure of some public health service institutions is weak and funding is insufficient, which affects the effective development of services.

How to understand Equalization of basic public health services ？

Equalization of basic public health services means that all urban and rural residents, regardless of their gender, age, race, place of residence, occupation and income, have equal access to basic public health services. The equalization of basic public health services can be understood from two perspectives: from the perspective of protecting citizens' health rights, it means that everyone has the same right to enjoy services; From the perspective of service content, it is determined according to the health needs of residents and the financial affordability of the government. There are public health services for people, such as unified establishment Resident health records , health education, etc; There are also individual oriented public health services, such as vaccination, maternal and child health care, elderly health care, etc, AIDS "Four exemptions and one care", tuberculosis schistosomiasis The prevention and treatment of fluorosis etc. Endemic Diseases The project of is aimed at people in epidemic areas. These are basic public health services. However, if a person does not belong to these people, they do not need these services. In this sense, equalization does not mean that everyone must receive the same basic public health services without any differences.

Equalization of basic public health services What is the goal of?

To achieve the equalization of basic public health services, the goal is to ensure that urban and rural residents have access to the most basic and effective basic public health services, narrow the gap between urban and rural residents in basic public health services, so that everyone can enjoy basic public health services, and ultimately make people free from disease, less disease, late disease, and serious disease.

The goal of equalization of basic public health can be divided into short-term goals and long-term goals. The short-term goal is: from 2009, the country will formulate basic public health service projects and increase some major public health service projects to gradually provide urban and rural residents with basic public health services. By 2011, the mechanism to promote the equalization of basic public health services will be basically established, and the gap between urban and rural areas, regions and people in public health services will gradually narrow. The medium and long-term goal is to promote Equalization of basic public health services The mechanism of health care has been improved, the content of basic public health services has been further increased, and major diseases and major health risk factors have been effectively controlled.

What are the contents of basic public health services?

The national basic public health project refers to the national basic public health project Input-output ratio , economic and social development and national financial resources, etc.

Countries at this stage Basic public health services Including disease control, vaccination, epidemic monitoring and reporting, women's and reproductive health care Child health , elderly health care, health education, health information collection report, health risk factor detection and intervention, etc., will be gradually unified throughout the country from 2009 Resident health records And implement standardized management. Regular health examination for the elderly over 65 years old, growth and development examination for infants under 3 years old and pregnant women Antenatal examination And postpartum visits, including hypertension, diabetes Mental illness , AIDS, tuberculosis and other population disease prevention and control to provide guidance services. Strengthen health knowledge publicity and education, set up CCTV health channel, and the central and local media should strengthen health knowledge publicity and education. Relevant departments will formulate corresponding operational documents to clarify specific contents and requirements. With the development of economy and society, it will be timely adjusted National Basic Public Health Service Project To meet the growing needs of the people Public health services We need to improve the health of the whole people.

Are major national public health service projects directly related to the masses?

The State has established and implemented major public health service projects aimed at major diseases and major health risk factors such as infectious diseases and endemic diseases that seriously threaten vulnerable groups such as women, children and the elderly, and residents in some areas. At present, major public health service projects mainly include: National immunization programme The prevention and control of major diseases, hospital delivery of rural women, etc. will also be increased in 2009: re vaccinate people under the age of 15 with hepatitis B vaccine; Eliminate coal burning fluorosis harm; Rural women take folic acid before pregnancy and early pregnancy to prevent birth defect ； Poor cataract patients regained vision; Rural water and toilet improvement projects.

Major public health service projects are directly related to people's health, which can exempt or alleviate the disease threat of specific groups. For example, due to the universal implementation of child immunization programs, China has achieved world health organization "None" proposed poliomyelitis ”The goal of "Children diphtheria ”There has been no reported case for 20 consecutive years; China has strengthened the prevention and treatment of major infectious diseases, and implemented“ Four exemptions and one care ”Policies to implement free treatment for TB patients Modern tuberculosis control strategy （ DOTS ）Major infectious diseases have been initially curbed; For a long time, the prevention and control of endemic diseases has been steadily promoted and basically eliminated Iodine deficiency disease ， Kashin Beck disease 、 Keshan disease And fluorosis.

How to guarantee Equalization of basic public health services Implementation of?

In terms of investment, the first is to increase investment in professional public health. Discipline such as disease prevention and control institutions Public health institutions The personnel funds, development and construction funds, public funds and business funds of government budget Full amount arrangement, service income collection special financial account or included budget management 。 The second is to establish and improve the funding guarantee mechanism for basic public health in urban and rural areas. In 2009, the per capita funding standard for basic public health services was not less than 15 yuan, and in 2011, it was not less than 20 yuan. It provided free health education for urban and rural residents, health examinations for the elderly, infants, pregnant and lying in women, and carried out basic public health services such as guidance on the prevention and treatment of chronic diseases and infectious diseases. Third, we will support the implementation of major public health service projects such as the prevention and control of major diseases, the National Immunization Program, and the hospital delivery of rural women. In 2009, we will increase programs such as hepatitis B vaccination for people under the age of 15. Increase the financial support of the central and provincial governments to poor areas Special transfer payment intensity. central government Mainly for National immunization programme Subsidies will be given for the prevention and control of major infectious diseases across regions.

In terms of construction, the first is to strengthen the capacity of public health services. Focus on improving the facilities and conditions of professional public health institutions such as mental health, maternal and child health, health supervision, family planning, and urban and rural grass-roots medical and health institutions, and improve the ability to respond to major diseases and public health emergencies. Second, actively promote and apply TCM prevention and health care methods and technologies, and give full play to the role of TCM in preventing disease.

In terms of management, the first is to strengthen planning. Reasonably allocate public health service resources according to regional health planning. Second, strengthen performance appraisal 。 Formulate post service specifications, refine assessment contents, standardize assessment procedures and implementation rules, and link personnel income with service performance to improve service quality and efficiency. Third, change the service mode. Institutions undertaking the task of public health services should go deep into grass-roots units and households, and carry out proactive services for the population. Fourth, implement infectious disease hospitals, rat prevention institutions prevention and cure of schistosomiasis The treatment policy for staff engaged in toxic, harmful and infectious posts in institutions and other disease prevention and control institutions.

What are the components and functions of the public health service system?

The public health service system consists of a professional public health service network and the public health service functions of the medical service system. The professional public health service network includes disease prevention and control, health education, maternal and child health care, mental health, emergency treatment, blood collection and supply, health supervision and family planning. The medical service system based on the basic medical and health service network provides daily public health services for the masses. The public health service system is implementing Prevention first It plays an important role in reducing the number of people getting sick as far as possible.

The current situation and problems of the medical service system?

Since 30 years of reform and opening up, China's medical and health care has developed rapidly. At the end of 2007, the total number of medical and health institutions in China was 298408, including 19852 hospitals, Township Health Center 39876, 27069 community health service centers (stations); The total number of health personnel in China is 5907052; The total number of beds is 3.7011 million. In addition, there are 614000 village clinics and 882000 village doctors. China's urban and rural medical service network has basically taken shape. A medical service system linking community health service institutions with urban hospitals (including provincial and municipal general hospitals and specialized hospitals) has initially taken shape in cities, and a three-level medical prevention and health care network at the county, township and village levels has been formed in rural areas. Among them, public hospitals are the backbone of China's medical and health service system, play an important basic role in China's urban and rural medical service system, and play an important role in improving people's health, ensuring social stability and security. At the same time, private medical institutions have also become an integral part of China's medical service system, playing a positive role. Sino foreign joint venture and cooperative medical institutions have also developed to a certain extent.

At present, there are six uncoordinated aspects in China's medical service system: first, the development of health service is uncoordinated with economic development, and health service lags behind the development of economy and other social undertakings for a long time. Second, medical services and medical security are uncoordinated, the development of medical security is lagging behind, and the medical expenses of urban and rural residents are heavier. Third, the medical and health development in urban and rural areas and regions is not coordinated, and the gap in the quality, level and accessibility of medical services between rural and urban areas, central and western regions and eastern regions, as well as between different groups of people is widening. Fourth, hospital management system, operation mechanism and Medical service demand The performance appraisal system needs to be improved. Fifth, the development of traditional Chinese medicine and western medicine is not coordinated, the development of traditional Chinese medicine lags behind, the service field gradually shrinks, and the characteristics and advantages gradually fade away. Sixth, fairness and efficiency are uncoordinated, focusing on mobilizing the enthusiasm of medical personnel and ignoring the public welfare of public health care; It pays attention to improving service efficiency and neglects to maintain medical and health equity.

In the process of realizing that everyone has access to basic medical and health services, what is the role of the grass-roots medical and health service system?

The primary medical and health service system is to provide public health and Basic medical services Is an important carrier of. Grass roots medical and health institutions are close to the residents, familiar with the situation of districts, villages and towns, have certain health service capabilities, prevention first, prevention and control combined, and the service cost is relatively low, which plays an irreplaceable role in providing safe, convenient, high-quality, and inexpensive basic medical and health services for urban and rural residents. At present, primary medical and health institutions mainly carry out public health services such as health education, prevention and treatment of infectious diseases, management of chronic diseases, maternal and child health care, so that residents can increase medical and health knowledge, improve their self-care level, change bad living habits, and get sick as little as possible. At the same time, appropriate medical technologies and essential drugs should be adopted to provide basic medical services for rural and community residents, and diagnosis and treatment services for common diseases, frequently occurring diseases and chronic diseases with clear diagnosis should be widely carried out to facilitate people's medical treatment nearby. Through improving the rural three-level medical and health service network, we should build a new urban service system based on urban community health service institutions, with reasonable division of labor and close collaboration between community health service institutions and hospitals, and prevention and health care institutions, and gradually establish hierarchical medical care, community first diagnosis and two-way referral system And provide safe, convenient, high-quality and inexpensive services for the masses of urban and rural people.

What are the specific measures for the construction of the grass-roots medical and health service system?

Goals by 2011:

First, strengthen the infrastructure construction of grass-roots medical and health institutions. Through the central government's key support for the construction of about 2000 county-level hospitals (including traditional Chinese medicine hospitals), at least one county-level hospital in each county will basically reach the level of standardization, giving play to the leading role of county-level hospitals in the county medical and health service network; 29000 units planned by the central government have been completed Township Health Center On the basis of the construction task, support 5000 central township hospitals to strengthen the construction; Support the construction of village clinics in remote areas and realize that every administrative village has a clinic; Newly built and renovated 3700 urban community health service centers and 11000 Community Health Station 。 We will improve the grass-roots medical and health service network, and strive to ensure that rural residents can get safe, effective, convenient, and economic public health services without going out of the countryside for minor illnesses and urban residents without going out of the community Basic medical services 。

Second, strengthen the construction of grass-roots medical and health service team Primary medical institutions culture General practitioner and Community Nurse We will recruit licensed doctors and registered nurses, train medical personnel, improve the system of urban hospitals' counterpart support to rural areas, implement the policy of urban doctors' service in rural areas, and other measures to gradually standardize the services of grass-roots medical and health institutions, and gradually improve the service level and quality.

Third, improve the input and compensation mechanism and transform the operation mechanism of grass-roots medical and health institutions. The government is responsible for the Township Health Center , City community sanitation service The funds for capital construction, equipment purchase and personnel approved by the center (station) according to the national regulations, drug income is no longer used as a compensation channel for the funds of basic medical and health institutions, and drugs are sold at zero margin to reduce the burden of basic medical and health services for urban and rural residents. For all township hospitals and urban community health service institutions, including those organized by social forces, the government will give subsidies by purchasing services, and give reasonable subsidies to rural doctors for public health services and other tasks.

Fourth, establish hierarchical diagnosis and treatment and two-way referral The division of labor and cooperation mechanism and the transformation of service mode have significantly increased the utilization of basic medical and health services, realized that minor diseases can be found at the basic level and major diseases can be found in hospitals, and alleviated the situation of "difficult registration and medical treatment" in large hospitals.

What is the role of each component of the rural medical and health service system?

China's rural medical and health service system County hospitals For the tap Township Health Center And village clinics. As the 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 the professional and technical guidance for township hospitals and village clinics and the refresher training of health personnel; Township health centers are responsible for providing comprehensive services such as diagnosis and treatment of common and frequently occurring diseases in public health services, and undertaking business management and technical guidance for village clinics; The village clinic is responsible for the public health services and the diagnosis and treatment of common diseases in the administrative village.

Why should we focus on supporting the construction of county-level hospitals and central township hospitals?

The county level hospital is the leader of the rural "three haves" medical and health service network and the hub of urban and rural medical connection. It undertakes the tasks of diagnosing and treating serious diseases in rural areas, guiding township hospitals and village clinics to carry out medical and health services, training rural health personnel, etc Township Health Center The business development of village clinics plays an important role in driving and guiding. Currently, County hospitals The main problems in medical service capacity are critical care, emergency Operation room The facilities, equipment and technical strength of clinical laboratory departments are relatively weak. To strengthen the capacity building of county hospitals, on the one hand, common and frequently occurring diseases in rural areas can be well diagnosed and treated in county hospitals, some severe patients can be diagnosed and treated in time, and people in rural areas can get a higher level of Basic medical services The diagnosis and treatment of most diseases in rural areas can be solved in county-level hospitals, which is of great significance for solving the problem of seeing doctors and seeking medical treatment in rural areas, ensuring that "everyone has access to basic medical services", and achieving the goal of "serious diseases do not leave the county"; On the other hand, compared with urban hospitals, county hospitals charge relatively low fees, which can effectively reduce medical expenses and help alleviate the financial burden of medical care for the people in rural areas.

Township Health Center It is a health institution focusing on prevention and combining prevention and treatment, a hub of the rural three-level health service network, and an important service carrier of the new rural cooperative medical system. Township health centers are divided into general health centers and central health centers according to their functions. Among them, the central health center is the guidance center for prevention, health care and medical technology within a certain region. In addition to the function of a general health center, it is also responsible for assisting the county health institutions to carry out technical guidance for the general health centers in the region. By the end of 2007, there were 39876 township hospitals in China, including 10396 central hospitals. In order to make it convenient for farmers to obtain high-quality medical and health services nearby, it is necessary to further strengthen the construction of central township hospitals, improve the diagnosis and treatment conditions, improve the service level, effectively play the backbone role of central hospitals in the rural three-level network, and drive and promote the development of rural health institutions.

What is the status and role of urban community health services?

First, urban community health services should gradually become the "gatekeeper" of urban residents' health, providing public health services such as disease prevention and control, diagnosis and treatment services for common diseases and frequently occurring diseases, as well as chronic disease management, health education and consultation and rehabilitation services. Second, community health service is the foundation of the new urban medical and health service system. Through the gradual establishment of community first diagnosis, graded medical treatment and two-way referral system To realize the division of labor and cooperation between urban hospitals and community health service institutions will be conducive to improving China's medical service system and guiding health care Rational allocation of resources To facilitate people to see doctors and reduce medical expenses.

What are the objectives and main contents of the drug policy reform?

The goal of national drug policy reform is to establish National Essential Drug System A drug supply guarantee system based on the principle of Safe medication It covers three basic contents: first, establish a national essential drug system to ensure the production and supply of drugs and improve the availability of drugs; Second, improve the drug quality supervision system, promote rational clinical use of drugs, and ensure drug safety; Third, improve the "new drug discovery system" and scientific and technological innovation system, promote the sustainable development of the pharmaceutical industry, and improve the pharmaceutical supply capacity and international competitiveness.

What is the essential drug system? What are the main contents?

“ essential drugs ”The concept of world health organization It was put forward in the 1970s. It refers to drugs that can meet basic medical and health needs, have appropriate dosage forms, ensure supply, can be equipped at the grass-roots level, and can be equitably obtained by the people. The main characteristics are safe, necessary, effective, and inexpensive. China should establish National Essential Drug System It is an important national medical and health policy established by the Party Central Committee and the State Council to safeguard the health of the people and protect the basic drug rights of the public. It is the core of the national drug policy and the foundation of the drug supply guarantee system. The main contents include reasonably determining the varieties of essential drugs, improving the production, supply, use, pricing, reimbursement and other policies of essential drugs, and ensuring people's basic drug use.

Why establish a national essential drug system?

establish National Essential Drug System It is conducive to rectifying the order of drug production and circulation, standardizing medical behavior, promoting rational drug use, reducing the burden of the masses, and realizing that everyone has access to basic medical and health services. At the same time, it is conducive to safeguarding the basic medical and health rights of the people and promoting fairness and justice. China is a vast country with great differences in urban and rural development and regional development essential drugs The system is conducive to improving the accessibility of people to basic drugs, thus ensuring the demand of people for basic drugs and protecting the basic medical and health rights of residents. The establishment of the national essential drug system is also of great significance for promoting the development of health care.

What are the principles, standards and procedures for the selection of national essential drugs?

The selection of essential drugs should adhere to the principles of necessary prevention and treatment, safe and effective, reasonable price, convenient use, and equal emphasis on both Chinese and western medicines, combined with the characteristics of drug use in China and with reference to international experience. First of all, it should adapt to China's public health, basic medical and health services and basic medical security level; It should conform to the characteristics of the disease spectrum in China and meet the needs of grass-roots medical and health institutions for prevention and treatment of common diseases, frequently occurring diseases and infectious diseases; It should be the first choice for clinical use, and the primary medical and health institutions can provide and ensure the availability; It must be approved by the national drug regulatory authority for official listing, and it does not contain national endangered Wildlife Requirements for medicinal materials, etc. The selection procedures of essential drugs include: scientific and fair selection of national essential drugs according to drug safety and other information, in accordance with the procedures of expert consultation and evaluation, multi-party consultation, multi-party demonstration, and review and approval by the expert committee.

How is the price of essential drugs set?

In setting the price of essential drugs, it is necessary to keep the production enterprises reasonably profitable, encourage the production and supply of enterprises, strictly control the circulation costs, and reduce unreasonable price increases. Main measures: First, the country will set a unified retail guide price for essential drugs according to their generic names, and the operators will independently set the actual purchase and sale prices without breaking the relevant government regulations. Second, the provincial people's government, according to the bidding situation, determines the unified purchase price of essential drugs in the region within the range set by the national guidance price, including distribution costs. Third, the basic medical and health institutions run by the government sell essential drugs at zero price difference; Other non-profit medical institutions should gradually eliminate drug markups.

What are the national regulations on the use of essential drugs in medical institutions at different levels?

The state establishes a system of priority selection and rational use of essential drugs to ensure that all primary medical and health institutions run by the government are equipped with and use essential drugs. Other types of medical and health institutions should first choose to equip with essential drugs and use essential drugs as first-line drugs for clinical treatment. The health department will formulate the proportion of essential drugs used by medical and health institutions of different sizes and levels, and regularly check the allocation of essential drugs in medical and health institutions. At the same time, all retail pharmacies and medical institutions should be equipped with and sell national essential drugs, and patients can purchase drugs at retail pharmacies with prescriptions.

What measures are there to encourage medical institutions to use essential drugs rationally?

First, establish and improve the allocation and use system of essential drugs in medical and health institutions, and determine the proportion of essential drugs used by medical and health institutions of different sizes and levels. The second is to formulate guidelines for the clinical application of essential drugs and formularies of essential drugs, and standardize the medication behavior of clinicians. Third, improve the drug administration and prescription review system of medical and health institutions. Give full play to medical institutions and pharmaceutical technicians Role in standardizing clinical medication. Fourth, strengthen medical institutions, especially Primary medical institutions Continuing education and training of medical and health personnel to improve the level of rational drug use. Fifth, establish a monitoring, assessment and evaluation system for the use of essential drugs and rational use of drugs, and regularly check the use and management of essential drugs in medical and health institutions. In view of the problems found, timely intervention measures should be taken to standardize the use of essential drugs.

At the same time, further standardize the purchase and sale of drugs, increase transparency and strengthen the public right to know And give full play to the role of industry supervision, mass supervision and social supervision to ensure the production and supply of essential drugs.

How is the medical insurance reimbursed for essential drugs and non essential drugs?

All drugs included in the basic list of medical insurance reimbursement can be reimbursed in a certain proportion if they are used due to illness and meet the requirements of medical insurance reimbursement. This is true for essential drugs, as well as for non essential drugs.

The differences between essential drugs and non essential drugs in medical insurance reimbursement are as follows: first, all essential drugs are included in the reimbursement list of basic medical security drugs, while only part of non essential drugs are included; Second, the State encourages the use of essential drugs, and the reimbursement rate of essential drugs is significantly higher than that of non essential drugs.

What is the goal of the pilot reform of public hospitals? How to carry out pilot work?

Ensure the public welfare nature and social benefits of public hospitals, improve the quality and efficiency of medical services, and control Medical service cost , is the starting point of the reform of public hospitals. The goal of the pilot reform is to explore the establishment of a more standardized public hospital management system, operation mechanism and supervision mechanism, a more complete public hospital compensation mechanism, and a more reasonable public hospital scale layout and diversified medical management pattern within three years, To form the general idea and main policy measures for the reform of public hospitals and lay the foundation for comprehensively promoting the reform of public hospitals.

The specific steps of the pilot work are as follows: from 2009, develop a pilot program, select a number of cities and public hospitals to carry out the pilot work, make a summary and evaluation in time, form the general idea and main policies of public hospital reform, and gradually push forward in 2011.

How to evaluate the pilot effect of public hospitals?

To evaluate the pilot effect of public hospitals, public hospitals should focus on performing public service functions, maintaining the nature of public welfare, and ensuring service quality, safety and efficiency. The main contents of the evaluation include: First, whether the public hospitals have fulfilled the goals and tasks set by the government to provide safe, effective, convenient and inexpensive Basic medical services ； Second, whether the public hospitals fully implement the relevant government laws and regulations, guidelines and policies, rules and regulations, and service standards, standardize medical service behavior, improve the quality and efficiency of medical services, and ensure the safety of patients; Third, whether the public hospitals conscientiously implement the economic operation, financial management Price management , the use of essential drugs and other relevant policies to reduce the burden on the masses. Fourth, whether the use and distribution of public hospital income comply with relevant national regulations and policies. Relevant parties will study and establish an evaluation index system and method, carry out internal and external evaluation, and play the role of social supervision and mass supervision.

Pilot reform of public hospitals What is the main content of?

The Implementation Plan specifies that the pilot reform of the public hospital system focuses on three aspects: first, reform the management system, operation mechanism and supervision mechanism, explore the separation of politics and affairs Separate management and office The effective forms include improving the hospital corporate governance structure, promoting the reform of personnel and distribution systems, and strengthening Medical service quality management Etc; Second, promote the reform of compensation mechanism and implement public hospitals government grants Policies, promotion Separation of medicine Gradually cancel drug markups, and actively explore various effective forms of separating medicine; Third, accelerate the formation of a diversified medical pattern, actively and steadily promote the transformation of some public hospitals, and encourage private capital to set up non-profit hospitals. Through reform, public hospitals can effectively perform their public service functions, standardize medical service behaviors, improve the efficiency and quality of medical services, and provide safe, effective, convenient, inexpensive and satisfactory medical services for the people.

How to establish an efficient and standardized operation mechanism of public hospitals and maintain the nature of public welfare?

First, establish and improve the hospital corporate governance structure, clarify the responsibilities and rights of owners and managers, and form a mechanism of mutual checks and balances in decision-making, implementation and supervision, which is responsible, incentive, restrictive, competitive and dynamic. Second, promote Separation of medicine And gradually eliminate drug markups. The hospital's income or loss thus reduced will be increased by Pharmacy service fee Adjust the charging standards for some technical services and increase government investment. Actively explore various effective ways to separate medicine. Third, strictly manage hospital budget and revenue and expenditure, and strengthen cost accounting And control, strengthen financial supervision and operation supervision. Strictly control the construction scale, standards and loan behavior of public hospitals. Fourth, reform the personnel and distribution system, and clarify the selection, appointment and Job specification Improve medical staff Professional title evaluation system , Implementation Post performance salary System. Fifth, adhere to the patient-centered approach, optimize service processes, and standardize drug use, inspection, and medical behavior.

How to understand“ Separation of medicine ”？

For a long time, China has implemented the policy of public hospitals to increase the wholesale price of drugs by 15%? 20% to compensate and supplement their own operation and development policies. Hospitals and doctors can obtain benefits by prescribing drugs, and the higher the drug price, the higher the actual markup, and the more profits. This is one of the important reasons why it is expensive for people to see a doctor in the current social environment, and must be thoroughly reformed. The implementation of "separation of medicine and medicine" is to reform the mechanism of medical supplement, cut off the interest relationship between hospitals and drug sales from the system and mechanism, solve the problem of doctors prescribing more drugs and expensive drugs, promote the rational use of drugs, and effectively reduce the drug burden of the masses. This medical reform plan has clearly defined the reform direction of "separating medicine from medicine". It has determined that the basic medical and health institutions organized by the government will implement zero margin sales of essential drugs from 2009. For public hospitals, gradually reform or cancel the drug markup policy, and make it clear that public hospitals will gradually be compensated by service charges Drug addition The three channels of income and financial subsidy are changed into two channels of service charge and financial subsidy, and actively explore Separation of medicine Multiple effective ways. At present, the exploration in some places mainly includes separate accounting of medical revenue and expenditure pharmacy trusteeship , stripping hospital outpatient pharmacy, etc.

Resolve“ Remedy one's illness with medicine ”After the problem, how to improve the compensation mechanism of public hospitals?

After the reform of the mechanism of "supplementing medicine with medicine", the compensation of public hospitals has changed from three channels of service charge, drug plus income and financial subsidy to two channels of service charge and financial subsidy. For the medical losses originally made up by drug plus income, the compensation mechanism of public hospitals will be established and improved to ensure the normal operation of public hospitals. First, provide public hospitals with pharmaceutical care By adding Pharmacy service fee make up. Second, adjust the charging standard of medical services Medical service cost And the value of technical services. Third, implement public hospitals government grants Policy. Gradually increase the government's expenditure and subsidies for public hospital infrastructure and equipment purchase, key discipline development, and retirees in line with national regulations Policy losses Special subsidies will be given for public health services and other tasks undertaken.

How to establish a public hospital that reflects the characteristics of the medical and health industry personnel system ？

First, establish a contract employment mechanism. hold Employment contract As a public hospital personnel management And establish a contract management based employment mechanism. Second, establish a fair competition mechanism to Post management Instead of identity management, post setting management system, open recruitment system and competitive employment system are implemented in public hospitals to realize post setting based on needs Competitive employment Employment by post and contract management. Third, establish and improve performance appraisal Mechanism. Establish an assessment system based on the employment contract and job responsibilities, take the work ability, business level and service satisfaction as the important basis for assessment, and focus on the assessment of work performance. Fourth, reform the internal distribution incentive mechanism. Establish embodiment Job performance Income distribution system. Fifth, establish and improve the supervision and management mechanism.

How to improve the salary system of public hospitals?

Implemented in public hospitals Post performance salary System. Reasonably determine the total wage level of hospital staff and implement total wage control. Post salary It mainly reflects the responsibilities and requirements of the post employed by the staff. The staff shall implement the corresponding post wage standard according to the post employed, and implement the principle of "one post, one salary, post salary change"; merit pay , mainly reflecting the actual performance and contribution of staff. Relevant departments will gradually establish and improve the performance pay distribution method in line with the characteristics of public hospitals in accordance with the overall deployment of the reform of the income distribution system of public institutions and the actual situation of the medical and health industry, so as to link the income of staff with their job responsibilities, work performance and actual contributions.

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On July 22, 2022, the National Health Commission announced at a press conference that the reform of China's medical and health system had achieved remarkable results. First, the difficulty of seeing doctors for the masses was effectively alleviated. Set up 10 national medical centers in professional categories, build 50 national and regional medical centers, and set up 15000 medical consortia. Promote the expansion and sinking of relevant high-quality medical resources. In 2021, the number of cross provincial medical treatment related specialties of the first batch of national and regional medical centers decreased by 9.3% compared with 2019, and the order of medical treatment became more reasonable. Second, the problem of expensive medical services for the masses has been alleviated, and the state has promoted the centralized purchase and use of drug consumables. The average price reduction of seven batches of selected drugs in centralized purchase has exceeded 50%. The average price reduction of centralized purchase of two batches of consumables exceeded 80%, saving about 300 billion yuan in total. In the country, the basic medical insurance is basically coordinated at the prefecture and city level, and the hospitalization and outpatient expenses are directly settled across provinces. The proportion of individual health expenditure fell to 27.7%. Third, the efficiency of the medical and health system continued to improve. In 2020, the outpatient appointment rate of tertiary public hospitals will reach 56.6%, the level of rational drug use will steadily increase, and the proportion of outpatient prescriptions of essential drugs will increase year by year. Fourth, the health centered reform has become more prominent.^[3]

In October 2022, China has built the world's largest medical and health system, with 1.04 billion people covered by basic endowment insurance, and the participation rate of basic medical insurance is stable at 95%. Health care for the sick and the elderly has improved in all aspects. Life expectancy per capita has increased to 78.2 years, and the main health indicators are among the top in high-income countries.^[4]

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In 2022, the reform of the medical and health system will continue to appear in the report of the 20th National Congress of the Communist Party of China. The report of the 20th National Congress of the Communist Party of China further promotes the construction of a healthy China and plans a fuller road map for reform and development. The new concept of "coordinated development and governance of medical insurance, medical treatment and medicine" points out the direction for the next step of medical reform.

Fu Hua, a professor at the School of Public Health of Fudan University, said, "In order to enhance the public's sense of medical access, in addition to the" soul bargaining "seen by everyone, more is to be inclusive, for example, to let chronic diseases such as hypertension be controlled in the community, and to establish an emergency response network for acute stroke in rural areas."; "Strengthen the health management of major chronic diseases, improve the ability of prevention and treatment of diseases and health management at the grass-roots level", "develop and expand the medical and health team, focus on rural areas and communities", "implement the national strategy of actively responding to population aging"; "The sense of access to medical care should be compatible with economic development."^[4]

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