The central committee of the communist party of China general office of the state council on forwarding

The deepening medical and health system reform leading group of the state council on further promote deepening medical and health system reform experience of several opinions"

The national health and family planning commission of the People's Republic of China

The 2016-11-08

Recently, the general office of the central committee of the communist party of China and the state council on forwarding the deepening medical and health system reform leading group of the state council on further promoting the deepening medical and health system reform experiences of the several opinions, and issued a circular, urged all localities departments combined with real earnest implementation.

The deepening medical and health system reform leading group of the state council on further promoting the deepening medical and health system reform experience several opinions of the full text is as follows.

We will deepen reform of the medical and health system is a major decision made by the CPC central committee and the state council, is comprehensively deepen reform and important task to build a well-off society in an all-round way. In order to further consolidate and expand health reform achievements, are promoting we will deepen reform of the medical and health system experience is put forward the following opinions.

Major progress was made in a, deepen reform and obvious effect

Launch a new round of reform at the 18th party congress in particular, each region of the relevant departments of the implementation of the CPC central committee and the state council decision deployment earnestly, adhere to the basic medical and health care system as public products provided to the core concept, adhere to the basic, strong base, the basic principles of building mechanism, adhere to the overall arrangement, highlight the key, the basic path of gradual and overcome difficult, to advance reform, deepen the reform made significant progress and obvious effect. Mainly displays in: basic to establish universal health care system, the basic medical insurance rates steady at 95% above, covered with a population of more than 1.3 billion people, 2016 urban and rural residents health fiscal subsidy standard per capita 420 yuan, implemented a serious illness insurance, urban and rural residents improved security level. Public hospital reform deepening continuously, the country's 1977 counties (cities) implemented at the county level public hospital reform, public hospital comprehensive reform pilot cities to expand to 200, the scientific management system and operational mechanism is formed. Grassroots medical and health service system constantly improved, the basic realization of cultural station institutes, village village clinic, obviously improve the service ability. The degree of equalization of basic public health service, the implementation of 12 kinds of 45 national basic public health services, covering the whole process of residents' life, benefit hundreds of millions of people. Further improved drug supply security system, implement the national system for basic drugs, promote open and transparent public medical institutions and drug centralized purchasing online, at the provincial level gradually establish take the market as the leading drug price formation mechanism. Accelerate the construction of hierarchical diagnosis system across the country more than half of the county (city) to carry out the pilot first option at the grass-roots level, the county JiuZhenLv within reach more than 80%. Personal health spending accounts for the proportion of the total health expenses continues to decline, fell to 40.4% from 40.4% in 2008 to the following; Basic medical and health services accessibility improved significantly, 80% of residents 15 minutes to reach the medical institution; Significantly improve people's health level, the highest average life expectancy at 76.34 years of age, 1.51 years higher than that of 2010, the people's health level, on the whole, better than average level of high-income countries, achieved higher health performance with less investment. Practice has proved that deepening the reform of medical system in the right direction, clear path, powerful measures, reform achievements widely benefit the people, to deal with the problem of hospital and improve the quality of people's health, safeguard social fairness and justice, and promote economic and social development plays an important role in such aspects.

Under the strong leadership of the CPC central committee and the state council, deepening the reform step by step consists a good foundation to improve quality, formed by the framework to the system construction, from the individual breakthrough to system integration and integrated propulsion, continuously improve the top-level design, to enhance local initiative and creativity, gradually break through the difficult problem, emerge a batch of dare to face tough, courageous enough to probe into the innovation of the typical regions, formed a group of practical, can copy can promote the experience of practice.

At present, the deepening health reform has entered the deep waters and GongJianQi, benefit adjustment is more complex, institutional contradictions. In the critical period of reform climbing over icahn, summed up to promote early deepening health reform to create good practice and ripe experience, and give full play to the typical experience of the reform of the global demonstration, breakthrough and leading role, is conducive to further unify thoughts, firm faith, overcome difficult, systems and mechanisms conducive to innovation and breakthrough interests barriers, beneficial to improve the basic medical and health system, realize the goal of everyone will have access to basic medical and health services, to promote the health of China construction and lay a solid foundation to build a well-off society in an all-round way.

Second, using the typical experience, to promote the further development of reform

(a) set up the system of strong leadership and medical treatment, health care, medicine, "3 d" joint operation mechanism, organization guarantee for deepening the reform

1. Strengthen the leadership of party committee and government on health reform. Deepening the reform work shall be the responsibility of the local party and government charge. By the party committee and government is mainly responsible for comrades or a is mainly responsible for comrades to reform leading group leader, give full play to the leading group for reform of overall coordination effect, earnestly implement the leadership responsibility of the government on health reform, guarantee responsibility, management responsibility, supervision and responsibility.

2. Establish and improve the propulsion mechanism. Stresses the responsibility division of labor mechanism, establish a system reform task parameter, blame layer upon layer in place. Implementing supervision mechanism and specific inspection key reform task, as the important basis of the annual appraisal. Catch assessment accountability mechanism, reform task completion included in the government performance appraisal comprehensively deepen reform and target management performance evaluation, serious lack of accountability reforms to promote regional and individual commendation and reward for positive innovation, effective area and individuals.

(2) break with medicine cure, establishing and perfecting the public hospital operation mechanism

3. According to the empty, structure, cohesion between the basic path of making medical service prices gradually. Actively yet prudently proceed with medical service price reform, in ensuring that public hospital benign operation, affordable medical insurance fund, the burden of the masses under the premise of the overall increase, according to the total amount control, structural adjustment, mixed, gradually in place, classification guidance straighten out different level medical institutions and medical service price comparison between relations. All public hospitals cancelled drug addition, as a whole consideration of the local government determine the compensation policy, pricing precision measurement, synchronous adjustment of medical service prices. By regulating the behavior of diagnosis and treatment, and reduce drug, consumables, etc. Make room, dynamic adjustment of medical service prices. Price adjustment should focus on improving the medical personnel technical services value in the diagnosis and treatment, surgery, nursing, rehabilitation and medical projects such as the price of traditional Chinese medicine, to lower the price of large medical equipment examination treatment and inspection, etc, and with health care payments, classification of diagnosis and treatment, such as cost control policy to connect each other. Through comprehensive ShiCe, gradually increasing the income of medical services (excluding medicines and chemical reagents, consumables, inspect and test income) in the hospital the proportion of total, establish a public hospital operation mechanism.

4. The implementation of public hospital drug procurement classification. Distinguish different drugs, through tendering, negotiation, hanging net, fixed-point production directly form a reasonable purchase price. Adhere to the principle of concentration belt quantity purchase, for clinical use, the purchase amount is high, the enterprise production and a number of essential drugs and generic drugs, centralized bid procurement by provincial drug procurement agencies. Public hospital comprehensive reform pilot cities can take in the city on the provincial drug centralized purchasing platform to purchase. Encourage the cross-regional joint procurement and joint procurement specialist hospital. Practice the medical consumables procurement sunshine, to carry out the high value medical consumables, inspection detection reagent and centralized purchasing large medical equipment. For part of patent medicine, the sole drug production, establish a transparent, participating mechanism of price negotiation. Negotiation result on national drug supply security integrated management information platform, hospital drug procurement according to the negotiation result. With health care payment policy of cohesion, in accordance with the provisions, will conform to the conditions of drugs into the compliance costs of medical insurance.

5. Public hospital drug procurement gradually implement the "two votes". Around to adjust measures to local conditions, gradually implementing public medical institutions and drug purchase "two votes" (production enterprise to open an invoice of enterprises and circulation enterprises to open an invoice) of medical institutions, encourage other medical institutions to implement the "two votes", reduce the drug circulation of the intermediate links, improve circulation enterprises concentration, hit "money laundering", lower drug prices artificially high, purifying the circulation environment. By integrating pharmaceutical trading enterprises, warehousing and transportation resources, speed up the development of pharmaceutical logistics, encourage regional drug distribution of urban and rural integration, to promote the "two votes" to provide basic conditions. Build system of commercial bribery enterprise blacklist, rake-off of commercial bribery of pharmaceutical production and circulation enterprises, cancel the qualification of suppliers.

6. The standard diagnosis and treatment behavior. Using informatization technology to all outpatient treatment behavior and expenses, hospitalization medical institutions to carry out the entire monitoring and intelligent audit, be warned, matter controls, afterwards audits. Carry out prescription reviews, strengthen information disclosure and social supervision. Strengthen the rational use of drugs and adverse drug reactions monitoring, the price is high, large dosage, non drug establish monitored directory, such as auxiliary treatment for tracking monitoring, early warning. Key drugs may purchase a filing, clear purchase quantity, the doctor prescribed, after the head of the examination and approval by the medical institutions to drug purchase department for the record. Strictly control the scale of public hospital too fast growth.

7. Implement the responsibilities for government investment. The full implementation of government policy on the investment of public hospitals. In accordance with the relevant regulations, and gradually public hospital long-term debt repayment and resolve of provisions.

(3) play a fundamental role health care, to strengthen the external restriction of medical services

8. In order to strengthen the management of orgnaization of health care functions. Integration of urban and rural residents basic medical insurance system, to achieve coverage, financing policy, to ensure treatment, medical insurance directory, fixed management, fund management, and other "six unity". Straighten out management system, unified basic medical insurance agency management, can carry out the establishment of medical insurance fund management center, undertake fund pays and management, medicines procurement and payment, the payment standard negotiations, the designated agency agreement management and settlement functions, give full play to medical care for medicine production and circulation enterprises, hospitals and doctors supervision function, the gripper for linkage reform. After the unification of insurance agency orgnaization to more efforts to promote the reform of medical insurance payment methods, further play to health care to control the medical expense unreasonable growth role.

9. The comprehensive advance payment reform. Gradually reduce pay by project, perfect the medical insurance payment total amount control, carry out mainly by macro-reforms, capitation payment, pay by bed, and total prepaid the compound payment method of combining a variety of payment methods to pay according to the disease diagnosis related group (DRGs), medicare payment reform gradually cover all medical institutions and medical services. Conditional region points method can be combined with budget management, according to macro-reforms, promote orderly competition between medical institutions and rational allocation of resources. Establish balance retention, reasonable overruns share the incentive constraints mechanism, stimulate medical institutions regulating behavior, control the cost of endogenous power.

10. Basic orgnaization of health care service pattern innovation. According to the principle of tube separated, promote the orgnaization of agency of health care professional. On the premise of ensuring the safe and effective supervision of the funds, the way the government purchasing service with qualifications entrusted by the orgnaization of business insurance institutions and other social forces to participate in the basic health care services, to undertake a serious illness insurance, urban and rural residents to introduce competition mechanism, improve the efficiency of orgnaization of health management service and quality. Encourage the development of commercial health insurance.

(4) promote the separating, tube separated, to establish modern hospital management system

11. A government-run medical system. Around to adjust measures to local conditions, explore effective organization form, perform the duty of a government as a whole.

12. The implementation of public hospital operation management autonomy. Transform government functions, the competent administrative departments at all levels from direct management of public hospitals to industry management, strengthen the policy laws and regulations, industry planning, formulation of standards and regulations and the supervision and guidance. Improve public hospital corporate governance structure, implement internal personnel management, organization setup, income distribution, deputy recommendation, appointment or dismissal of cadres in the middle, such as annual budget execution autonomy. Improve public hospital internal decision-making and restriction mechanism, strengthen management, play to the staff and workers' congress function, strengthen the democratic management.

13. The implementation of public hospital performance evaluation. Evaluation system, set up public welfare oriented function orientation, duties to perform, social satisfaction, cost control, performance index, financial management, etc. Organize regular public hospital performance appraisal and dean annual and term target responsibility appraisal. The assessment results and hospital financial aid, medical insurance pay, merit pay total and dean, appointment, rewards and punishments, etc., to establish the incentive constraints mechanism.

14. Strengthen the management of public hospital refinement. Improve the medical quality and safety management system and the quality monitoring evaluation system, promote the clinical pathway management, promote the medical quality continuous improvement. Implements the comprehensive budget management, to carry out cost accounting, the balance of the overall analysis, budget implementation, cost efficiency and solvency, etc., as the important basis of hospital operation management decisions. Implementation of the third party accounting audit supervision system, strengthen the regulation of economic operation of the state-owned assets, to the hospital.

(5) establish the personnel salary system in accordance with industry characteristics, arouse the enthusiasm of the medical staff

15. To establish a flexible mechanism of choose and employ persons. Innovation of public hospital management mode, perfect management method, actively explore trial preparation of management reform of public hospitals will be carried out. Within the total local existing establishment, determine the total public hospital preparation, records and shall be gradually practised in some large and medium cities third rate reform of public hospitals to carry out the preparation of management, personnel management pilot. Implement recruitment system, post management system, personnel management system such as the open recruitment system. Simplify the process of professional and technical personnel recruitment, shortage of professional and technical personnel to hospital or high-level personnel can adopt the method of inspection shall be in accordance with the provisions, the hospital recruitment. Increase the grassroots health institutions, senior positions in proportion, broadening the medical staff career development space.

16. The reform of salary system. Where can be combined with the actual, according to the relevant provisions of the reasonable public hospital compensation levels, gradually improve staff spending accounts for the proportion of business spending. To work outside of time more labor, high-level medical talents converging, public welfare goal task heavy, signing the family doctor service public medical institutions, will be tilted during the performance of the approved total payroll. To strengthen the long-term incentive of medical personnel, the establishment of public welfare oriented performance evaluation mechanism, compensation in maintaining moderate growth based on the current level of implementation. Merit pay total amount of the approved public medical institutions according to the assessment results of autonomous performance wage distribution. Total compensation for approval and distribution of personal merit pay not with medical institutions of medicines and chemical reagents, consumables, large medical examination and other business income, salary distribution of posts, risk, technical content contribution, etc., it is strictly prohibited to medical staff set revenue targets. Grassroots medical institutions can be approved in accordance with regulations of the financial system in balance of payments to extract the worker welfare funds and rewards.

(6) by signing the family doctor service and medical association as main fulcrum, accelerate the construction of the classification system

17. To promote the family doctor service signing. To form a family doctor as the core, provide the technical support specialist contract service team, provide residents with long-term continuous public health and basic medical and health management service. Optimize the signing service connotation, in medical treatment, referral, medicine, health care and other aspects of signing residents adopted a policy of differentiation, promote the first option at the grass-roots level. Sound on the basis of the standardized work performance appraisal system. Can guide residents or family at the same time of signing with the family physician team, choice a secondary hospital, a tertiary hospital, to establish the combination of "1 + 1 + 1" signing service mode, within residents can be combined in contract signing select a medical institution, if to the outside of the combination of visits by the family doctor referral, guide residents to change habits, form a reasonable medical treatment order.

18. A medical association. According to the government leading, voluntary association, regional coordination, the principle of convenient to the masses, sharing resources and talent sinking oriented, establish the longitudinal association of medical resources, promote grass-roots service ability. Within the medical association clear urban tertiary hospital, secondary hospital and has relations of the basic medical and health institutions, and two-way referral agreement, and improve the mechanism of related management, operation and examination etc. Promote the health technical personnel county township, township Guan Village, establish flexible talent flow mechanism, take turns to the service. Intensify counterpart aid, accurate support grassroots health institutions specialized subject construction and talents training, promote balanced urban and rural medical resources allocation. Relying on the counterpart support channels, and integration of medical resources, increase the old revolutionary base areas, ethnic minority areas, border areas and poor areas of medical and health undertakings support, further completes the xinjiang medical talent "author" Tibet work.

19. Giving full play to the advantages of Chinese medicine service. Strengthen grass-roots medical institutions of traditional Chinese medicine library construction, and promote comprehensive service mode of traditional Chinese medicine, widely use of traditional Chinese medicine appropriate technology, give full play to their role in the prevention and control of common disease, frequently-occurring disease and chronic disease of traditional Chinese medicine. In improving medical service price, manifest the value of technical services of traditional Chinese medicine of traditional Chinese medicine, on the basis of reasonable standards of traditional Chinese medicine press disease to pay. For grassroots service system is not sound, weak ability of Chinese medicine in the area, will the doctor of traditional Chinese medicine hospital outpatient medical services into the first option in TCM and meet the needs of the people first option to see the traditional Chinese medicine. The innovation of traditional Chinese medicine diagnosis and treatment patterns.

20. Improve the classification diagnosis and supporting policies. Reasonable division and carry out the duties of medical institutions at all levels diagnosis and treatment, the clear referral procedures and standards, carrying out responsibility system of first diagnosis and referral system of examination and approval. Give play to the role of health policy adjustment, the medical institutions to carry out the clinical duties and referral linked to performance appraisal and allocated medical insurance fund. Explore collaboration (such as medical association pattern of vertical cooperation total medicare pay, guide the two-way referral. Improve the level of different medical institutions differentiation to pay for health care policy, promote the first option at the grass-roots level. For the referral of patients, according to regulations on the reimbursement policy to tilt.

(7) make full use of Internet technology, improve the masses go to a doctor

21. To strengthen the construction of health information infrastructure. Build mutual sharing and business collaboration of national, provincial, city and county level 4 population health information platform, improve the residents to electronic health records, electronic medical records, electronic prescription based database as the core, through all kinds of medical and health institutions channel data resources sharing, and improve the classification based on the technology of Internet, big data medical information system, to achieve continuous, coordination and integration of medical and health services to provide technical support.

22. The push for the convenience of huimin service. Optimization of diagnosis and treatment process, improve the medical environment, overall arrangement booking, inspection, diagnosis and treatment, referral, payment and settlement, promote the Internet booking triage, mobile payment, clinic and settlement, and the results query applications. Perfect inspection results mutual recognition mechanism, enlarge high quality resources radiation effect, convenient masses to the nearest hospital. Using mobile client, the Internet of things, such as technology, doctor-patient communication platform, for health consultation, and patient feedback provide convenience, health management, etc. Make full use of informatization technology, remote medical service, first opened 834 counties of remote medical system. Promoting residents' health card, social security card application integration, such as activating residents electronic health records applications, strengthen information publishes, connectivity, to promote prevention, treatment, rehabilitation and health management of electronic health services. Reasonable allocate health resources, science and number of various professional consultation of doctors, ensure physician examined have plenty of time, improve the quality of medical services.

(eight) development and standardize social do medical, meet the demand of diversified medical services

23. Promote social do medical development level. Regional health planning and the planning of the establishment of medical institutions do medical leave enough space for the society, priority for non-profit medical institutions. Optimize social do medical development environment, promote the public medical institutions and the public medical institutions in market access, social insurance, key specialty construction, title evaluation, academic communication, grade evaluation, technical access to the same treatment. Support social do medical chain operation, build brand, group development, to provide high-end services, and shortage of rehabilitation, aged care and other services. Encourage social forces according to the relevant provisions of the establishment of an independent medical examination, medical imaging diagnosis, disinfection supply and blood purification.

24. Strengthen the standard management. Pushing local administrator, strengthen the industry regulation, all medical institutions unified planning, unified access, unified supervision, in accordance with the standard social do medical organizations working behavior. To crack down on illegal practice medicine. In accordance with the relevant "pipes" reform requirement, simplifying access of optimization of examination and approval procedures, strengthen the supervision of things after the event. Strengthen the nonprofit social do medical institutions property rights, financial operation and supervision over the use of capital surplus management, promote the development of social do medical health.

Third, strengthen promotion, strengthen the deepening health reform initiative and creativity

(a) attaches great importance to the promotion. Party committees and governments at all levels must fully understand the importance of promoting deepening health reform experience, serious organizational learning reform experience, in-depth study comprehends the reform train of thought, steps and methods, to promote the related reform measures listed as priority in our region, strengthen the reform of concentration, intensify reform. To form on the reformer, reformers, under the guidance of choose and employ persons, to advance reform, to ensure the reform experience to take root, to produce real results.

(2) adjust measures to local conditions to explore innovation. To closely around the combinative oneself is actual, respect the initiative at the grassroots level system innovation as the core mission, around key links and key areas, further emancipate the mind, bold innovation, to explore the effective implementation of the reform path, clear internal logic and reform policy combination, the elaborating management reform, encourage regional linkage. With highly responsible spirit emphasizing target tasks, precise landing, explore innovation, tracking efficiencies and mechanism guarantee, nurture more can copy can promote the reform of the experience.

(3) strengthen the supervision of promotion. Departments concerned to implement the new delegate requirements, in accordance with the responsibility to strengthen the guidance and policy support. The deepening medical and health system reform leading group office of the state council jointly with relevant departments to strengthen supervise and analysis to solve the problems in time, prevent the experience in promotion of randomness and uncertainty. Further summarizes the creation around the ripe experience, and in a timely manner to rise to the policy, summarizes the fruits of reform, consolidate the good and good development.

(4) to do propaganda work earnestly. Continue to strengthen the reform experience of typical mining and propaganda, reflect the reform practice and progress of fresh, strengthen confidence, building consensus. Adhere to the correct public opinion direction, timely response to social concern, a reasonable guide social expectations, to deepen reform and create a good environment for public opinion. (source: xinhua Beijing on November 8)