Improve the management, operation, investment, price, and supervision systems and mechanisms of medicine and health, strengthen the construction of science and technology, talent, information, and legal systems, and ensure the effective and standardized operation of the medicine and health system.
(8) Establish a coordinated and unified medical and health management system. Implement localized and industry-wide management. All medical and health institutions, regardless of ownership, investment entities, affiliations and nature of operations, are subject to unified planning, unified access, and unified supervision by the local health administrative department. The central and provincial levels can set up a small number of medical centers or regional medical centers responsible for medical research and teaching functions, as well as specialized hospitals and other medical institutions responsible for the diagnosis and treatment of difficult and difficult diseases nationwide or regionally; counties (cities) are mainly responsible for organizing county-level hospitals and rural health care centers. and community health service agencies; the remaining public hospitals are run by the city.
Strengthen regional health planning. Provincial people's governments formulate health resource allocation standards, organize the preparation of regional health plans and medical institution establishment plans, and clarify the number, scale, layout and functions of medical institutions. Scientifically formulate standards for the construction and equipment configuration of primary medical and health institutions such as township health centers (village clinics), community health service centers (stations), and hospitals at all levels. Make full use of and optimize the allocation of existing medical and health resources, gradually integrate medical institutions that do not meet planning requirements, strictly control the allocation of large-scale medical equipment, encourage independent construction and sharing, and improve the efficiency of medical and health resource utilization. New health resources must comply with regional health plans and focus on weak links such as rural and community health. Strengthen the connection between regional health planning, urban and rural planning, and overall land use planning. Establish a monitoring and evaluation mechanism for regional health planning and resource allocation.
Promote the reform of the public hospital management system. From the perspective of conducive to strengthening the public welfare of public hospitals and effective government supervision, we should actively explore various forms of separation of political affairs and separation of management and operation. To further transform government functions, the health administrative department is mainly responsible for industry management functions such as health development planning, qualification access, standards, and service supervision, while other relevant departments manage and provide services according to their respective functions. Implement the independent legal person status of public hospitals.
Further improve the basic medical insurance management system. The central government formulates the framework and policies of the basic medical insurance system, and local governments are responsible for organizing, implementing and managing the system, creating conditions to gradually improve the overall level of coordination. Effectively integrate basic medical insurance handling resources and gradually realize the unification of urban and rural basic medical insurance administrative management.
(9) Establish an efficient and standardized operating mechanism for medical and health institutions. All revenues and expenditures of public health institutions are included in budget management. In accordance with the responsibilities and tasks assumed, the government shall reasonably determine the staffing, salary levels and funding standards, clarify the job responsibilities of various personnel, strictly enforce personnel access, strengthen performance appraisal, establish an employment system that allows people to enter and leave, and improve work efficiency and service quality. .
Transform the operating mechanism of primary medical and health institutions. Grassroots medical and health institutions such as urban community health service centers (stations) and township health centers run by the government must strictly define their service functions and clearly stipulate the use of appropriate technology, equipment and basic drugs to provide low-cost services to the general public and maintain their public welfare nature. . It is necessary to strictly determine the staffing establishment, implement a personnel recruitment system, and establish a human resources management system that allows entry and exit and effective incentives. It is necessary to clarify the scope and standards of revenue and expenditure, implement financial management methods for approving tasks, approving revenue and expenditure, and performance appraisal subsidies, and explore various measures such as the implementation of two lines of revenue and expenditure, and the total prepayment of public health and medical security funds. Effective management methods, strict budget management of revenue and expenditure, and improve the efficiency of fund use. It is necessary to reform the drug markup policy and implement zero markup sales of drugs. Strengthen and improve internal management, establish an assessment and incentive system with service quality as the core and job responsibilities and performance as the basis, and form a long-term mechanism to ensure fairness and efficiency.
Establish a standardized operating mechanism for public hospitals. Public hospitals must abide by the principles of public welfare and social benefit, insist on being patient-centered, optimize service processes, and standardize medication, examinations, and medical behaviors. Deepen the reform of the operating mechanism, establish and improve the hospital's corporate governance structure, clarify the responsibilities and rights of owners and managers, and form a mechanism with mutual checks and balances in decision-making, execution, and supervision, with responsibility, incentives, constraints, competition, and vitality. Promote the separation of medicines and actively explore a variety of effective ways to gradually reform the mechanism of using medicines to supplement medical care.
Gradually reform or cancel the drug markup policy through various methods such as differential price increases for drug purchases and sales, and the establishment of pharmaceutical service fees. At the same time, measures such as appropriately adjusting medical service prices, increasing government investment, and reforming payment methods will be adopted to improve the public hospital compensation mechanism. Further improve the financial and accounting management systems, strictly manage budgets, and strengthen financial supervision and operational supervision. Local governments can, in light of local realities, pilot various management methods such as "assessment of revenue and expenditure, offsetting expenditure with revenue, turning over excess revenue, subsidy for the difference, and clear rewards and punishments" for qualified hospitals. Reform the personnel system, improve the allocation and incentive mechanism, implement the employment system and position management system, strictly manage total wages, implement comprehensive performance appraisal and job performance salary systems based on service quality and job workload, and effectively mobilize the enthusiasm of medical staff.
Improve the operating mechanism of medical insurance agencies. Improve the internal governance structure, establish a reasonable employment mechanism and distribution system, improve the incentive and restraint mechanism, and improve medical insurance management capabilities and management efficiency.
(10) Establish a government-led diversified health investment mechanism. Clarify the health investment responsibilities of the government, society and individuals. Establish the government's leading position in providing public health and basic medical services. Public health services are provided equally to urban and rural residents mainly through government financing. The cost of basic medical services is reasonably shared by the government, society and individuals. Special medical services are paid directly by individuals or through commercial health insurance.
Establish and improve the government health investment mechanism. Both the central government and local governments must increase investment in health and take into account both the supply side and the demand side. Gradually increase the proportion of government health investment in total health expenditures, so as to effectively reduce the burden of basic medical and health expenses on residents; the growth rate of government health investment should be higher than the growth rate of regular fiscal expenditures, so that the proportion of government health investment in regular fiscal expenditures Gradually improve. The new government health investment will be mainly used to support public health, rural health, urban community health and basic medical security.
Reasonably divide the health investment responsibilities of the central and local governments at all levels according to the principle of graded burdens. Local governments bear the main responsibilities, and the central government mainly provides subsidies for the national immunization program, public health such as the prevention and control of major infectious diseases across regions, basic medical security for urban and rural residents, and the construction of relevant public medical and health institutions. Increase special transfer payments from the central and provincial finances to areas in need.
Improve the government’s investment mechanism in public health. The personnel funds, development construction and business funds of professional public health service institutions shall be fully arranged by the government, and the service income obtained in accordance with regulations shall be turned over to a special fiscal account or included in budget management. Gradually increase per capita public health funding and improve the funding guarantee mechanism for public health services.
Improve the government’s investment mechanism in urban and rural primary medical and health institutions. The government is responsible for the capital construction funds, equipment purchase funds, personnel funds and business funds for public health services that are approved in accordance with national regulations for the township health centers and urban community health service centers (stations) it operates, so that they can operate normally. For all township health centers and urban community health service institutions, including those run by social forces, various localities can adopt methods such as purchasing services to determine government subsidies. Support the construction of village clinics and provide reasonable subsidies to rural doctors for public health services and other tasks.
Implement the government subsidy policy for public hospitals. Gradually increase government investment, mainly used for infrastructure construction and equipment purchase, supporting the development of key disciplines, retiree expenses in line with national regulations and subsidizing policy losses, etc. Special subsidies will be provided for tasks such as public health services. Form a standardized and reasonable government investment mechanism for public hospitals. Investment policies will be tilted toward traditional Chinese medicine hospitals (ethnic hospitals), infectious diseases hospitals, mental hospitals, occupational disease prevention and treatment hospitals, obstetrics and gynecology hospitals, and children's hospitals. Strictly control the construction scale, standards and loan practices of public hospitals.
Improve the government’s investment mechanism in basic medical security. The government provides necessary funds to support the establishment and improvement of new rural cooperative medical care, basic medical insurance for urban residents, basic medical insurance for urban employees, and urban and rural medical assistance systems. Ensure the normal funding of relevant agencies.
Encourage and guide social capital to develop medical and health undertakings. Actively promote the development of non-public medical and health institutions and form a medical system with diversified investment entities and diversified investment methods. We must promptly formulate and improve relevant policies and regulations, standardize the access conditions for social capital, including overseas capital, to run medical institutions, and improve fair and equitable industry management policies.
Social capital is encouraged to establish non-profit medical institutions in accordance with the law. The state formulates guiding opinions on the restructuring of public hospitals and actively guides social capital to participate in various ways in the restructuring and reorganization of some public hospitals, including hospitals run by state-owned enterprises. Steadyly advance the pilot program of public hospital restructuring, moderately reduce the proportion of public medical institutions, and form a pattern in which public hospitals and non-public hospitals promote each other and develop together. Support qualified personnel to open businesses in accordance with the law to facilitate people's medical treatment. Improve classified management policies and preferential tax policies for medical institutions. Strengthen supervision of hospitals run by private entities in accordance with the law.
Vigorously develop medical charity. Formulate relevant preferential policies to encourage social forces to set up charitable medical institutions, or make charitable donations to medical aid, medical institutions, etc.
(11) Establish a scientific and reasonable pharmaceutical price formation mechanism. Standardize medical service price management. Basic medical services provided by non-profit medical institutions are subject to government-guided prices, while the rest are set independently by medical institutions. The central government is responsible for formulating medical service price policies and projects, pricing principles and methods; the provincial or municipal price authorities, together with the health, human resources and social security departments, determine the guiding prices of basic medical services. The price of basic medical services is set based on the service cost after deducting financial subsidies, reflecting the reasonable cost of medical services and the value of technical labor services. Services provided by medical institutions and doctors at different levels are subject to tiered pricing. Standardize the charging items and standards of public medical institutions, and study and explore the reform of charging methods such as charging based on disease type. Establish a system for price monitoring of medical equipment and instruments, cost supervision and review of examination and treatment services, and regular price adjustments.
Reform the drug price formation mechanism. Reasonably adjust the scope of government pricing, improve pricing methods, increase transparency, use price leverage to encourage independent innovation by enterprises, and promote the production and use of national essential drugs. Gradually implement a pre-pricing drug economic evaluation system for new drugs and patented drugs. Implement a low-price pricing system for generic drugs after they are launched to curb low-level duplication of construction. Strictly control the price difference rate in drug circulation links. Pilot projects such as differential price increases and pharmaceutical service fee collection for drugs sold in hospitals will be carried out to guide hospitals to use drugs rationally. Strengthen the control and management of prices in the circulation and use of medical consumables and implantable (interventional) medical devices. Improve the pharmaceutical price monitoring system and standardize the independent pricing behavior of enterprises.
Actively explore the establishment of a negotiation mechanism between medical insurance agencies, medical institutions, and drug suppliers, and give full play to the restrictive role of medical insurance on medical services and drug costs.
(12) Establish a strict and effective medical and health supervision system. Strengthen medical and health supervision. We will improve the health supervision and law enforcement system and strengthen the capacity building of urban and rural health supervision agencies. Strengthen the supervision of medical and health service behavior and quality, improve medical and health service standards and quality evaluation systems, standardize management systems and work processes, accelerate the formulation of unified disease diagnosis and treatment specifications, and improve the medical and health service quality monitoring network. Strengthen the access and operation supervision of medical and health institutions. Strengthen the supervision of social public health such as drinking water safety, occupational hazard prevention and control, food safety, and medical waste disposal. We will severely crack down on various illegal activities that endanger people's health and life safety in accordance with the law.
Improving medical security supervision. Strengthen the supervision of medical insurance handling, fund management and use, and establish an effective use and risk prevention mechanism for medical insurance funds. Strengthen the monitoring role of medical security on medical services, improve the payment system, actively explore the implementation of capitation payment, payment based on disease type, total advance payment, etc., and establish an effective restraint mechanism that pays equal attention to incentives and punishments. Strengthen the supervision of commercial health insurance and promote standardized development.
Strengthen drug supervision. Strengthen government regulatory responsibilities, improve the construction of regulatory systems, and strictly regulate drug research, production, circulation, use, prices, and advertising. Implement quality management standards for pharmaceutical production and strengthen supervision of the production of high-risk varieties. Strictly implement pharmaceutical business management regulations, explore and establish a management model for classifying and grading drug business licenses, and increase supervision and inspection of key varieties. Establish a rural drug supervision network. Strengthen government supervision of drug prices to effectively curb falsely high pricing. Standardize the clinical use of drugs and give full play to the role of licensed pharmacists in guiding rational drug use and drug quality management.
Establish a regulatory system for information disclosure and multi-party social participation. Encourage industry associations and other social organizations and individuals to independently evaluate and supervise the operational performance of government departments, pharmaceutical institutions and related systems. Strengthen industry self-discipline.
(13) Establish a sustainable development mechanism for medical and health science and technology innovation and a talent guarantee mechanism.
Promote medical and health science and technology progress. Make medical and health science and technology innovation the focus of national science and technology development, strive to overcome difficulties in medical science and technology, and provide technical support for people's health. Increase investment in medical scientific research, deepen the reform of medical and health science and technology systems and institutions, integrate superior medical scientific research resources, accelerate the implementation of major medical science and technology projects, encourage independent innovation, strengthen research on major disease prevention and treatment technologies and key technologies for new drug development, and build on the basics of medicine We strive to achieve new breakthroughs in applied research, high-tech research, research on traditional Chinese medicine and integrated traditional Chinese and Western medicine. Develop and produce medical devices suitable for my country's national conditions. Extensively carry out international health science and technology cooperation and exchanges.
Strengthen the construction of medical and health talent teams. Formulate and implement a talent team building plan, focusing on strengthening the training of professional technicians and nursing staff in public health, rural health, and urban community health. Formulate preferential policies to encourage outstanding health talents to serve in rural areas, urban communities, and central and western regions. Appropriate preference will be given to health technicians who have worked at the grassroots level in urban and rural areas for a long time in terms of professional title promotion, professional training, and remuneration policies. Improve the qualification system for general practitioners, improve the on-the-job training system for rural and urban community health personnel, encourage participation in academic education, promote the standardization of rural doctors' practice, and ensure that grassroots medical and health institutions have qualified general practitioners as soon as possible. Strengthen the construction of high-level scientific research, medical care, health management and other talent teams. Establish a standardized training system for residents and strengthen continuing medical education. Strengthen the construction of nursing teams and gradually solve the problem of low proportion of nursing staff. Cultivate and expand the talent team of traditional Chinese medicine. Steadyly promote the rational flow of medical personnel, promote vertical and horizontal exchanges of talents between different medical institutions, and study and explore the multi-site practice of registered physicians. Standardize the employment conditions of hospital managers and gradually form a professional and professional medical institution management team.
Adjust the structure and scale of higher medical education. Strengthen general medical education, improve standardized and normative clinical medical education, and improve the quality of medical education. Increase investment in medical education, vigorously develop higher medical undergraduate and junior college education for rural areas and communities, adopt targeted free training and other methods to cultivate practical medical and health talents for rural areas in poor areas, and create a large number of qualified doctors who take root in rural areas and serve farmers.
Build a healthy and harmonious doctor-patient relationship. Strengthen the construction of medical ethics and medical ethics, attach importance to the cultivation of humanistic qualities and professional quality education of medical personnel, and vigorously promote the spirit of saving lives and helping the wounded. Optimize the practice environment and conditions for medical personnel, protect the legitimate rights and interests of medical personnel, and mobilize the enthusiasm of medical personnel to improve services and increase efficiency. Improve medical practice insurance, carry out medical social work, improve medical dispute resolution mechanisms, and enhance doctor-patient communication. Form a good atmosphere in the whole society of respecting medical science, respecting medical and health workers, and respecting patients.
(14) Establish a practical and shared medical and health information system. Vigorously promote the construction of medical and health informatization. Focusing on promoting the information construction of public health, medical care, medical insurance, drugs, and financial supervision, we will integrate resources, strengthen information standardization and the construction of public service information platforms, and gradually achieve unified, efficient, and interconnected services.
Accelerate the construction of medical and health information systems. Improve the public health information system with the disease control network as the main body, and improve the prediction, early warning and analysis reporting capabilities; focus on establishing resident health files to build rural and community health information network platforms; focus on hospital management and electronic medical records, Promote the construction of hospital informatization; use network information technology to promote cooperation between urban hospitals and community health service agencies. Actively develop telemedicine for rural and remote areas.
Establish and improve the medical security information system. Accelerate the construction of medical security information systems with complex functions such as fund management, expense settlement and control, medical behavior management and supervision, insured unit and individual management services, etc. Strengthen the construction of basic medical insurance for urban employees, basic medical insurance for urban residents, new rural cooperative medical care and medical assistance information systems, realize the connection with the information systems of medical institutions, and actively promote the "all-in-one card" and other methods to facilitate medical treatment for insured persons. Increase transparency in medical services.
Establish and improve the national, provincial and municipal three-level drug supervision, drug inspection and testing, and adverse drug reaction monitoring information networks. Establish a basic drug supply and demand information system.
(15) Establish and improve the medical and health legal system. Improve health laws and regulations. Accelerate the advancement of basic medical and health legislation, clarify the rights and obligations of the government, society and residents in promoting health, and ensure that everyone has access to basic medical and health services.
Establish and improve the health standards system and ensure the connection and coordination of relevant laws and regulations. Accelerate legislation on traditional Chinese medicine. Improve drug supervision laws and regulations. Gradually establish and improve a relatively complete health legal system that is compatible with the basic medical and health system.
Promote administration according to law. Strict and standardized law enforcement will effectively improve the ability of governments at all levels to use legal means to develop and manage medical and health services. Strengthen the popularization of medical and health laws and strive to create a legal environment that is conducive to people's health.