Circular of the General Office of the State Council on Issuing the Key Tasks in Deepening the Medical and Health System Reform in 2016
Circular of the General Office of the State Council on Issuing the Key Tasks in Deepening the Medical and Health System Reform in 2016
Circular of the General Office of the State Council on Issuing the Key Tasks in Deepening the Medical and Health System Reform in 2016
Guo Ban Fa [2016] No.26
April 21, 2016
People's governments of all provinces, autonomous regions, and municipalities directly under the Central Government, as well as the relevant departments of the State Council,
These Key Tasks in Deepening the Medical and Health System Reform in 2016, which have been approved by the State Council, are hereby issued to you for your earnest implementation in light of the actual conditions.
Key Tasks in Deepening the Medical and Health System Reform in 2016
Since the launch of a new round of medical reform, different regions and relevant departments have, under the leadership of the Central Committee of the Communist Party of China ("CPC") and the State Council, been working together to advance the reform, constantly improve top-down design, and gradually tackle key issues and difficulties, so that the difficulty in seeking medical treatment and expensive medical expenses have been substantially relieved, and major periodical effect has been achieved in deepening the medical reform. In 2015, the average life expectancy reached 76.34 years old, a rise of 1.51 years old compared to that in 2010; people's health, in general, reached the average level in upper-middle-income countries; the proportion of residents' personal spending on health to total health expenses dropped to below 30%, the lowest level in the recent 20 years. Positive progress and effect achieved in the medical reform lay a solid foundation for the continuous deepening of reform.
The year 2016 marks the start of the 13th Five-year Plan, and is a crucial year in achieving the periodical objective of deepening the medical and health system reform by 2017, and a key year in achieving the objective that everyone will have access to basic medical and health services by 2020.To make a good beginning for the implementation of the reform tasks determined in the medical reform plan during the 13th five-year plan period, ensure greater reform effect, and promote the development of a basic medical and health system covering urban and rural residents, so as to effectively build a healthy China, we shall, by comprehensively implementing the guidelines of the 18th National CPC Congress and the third, fourth and fifth plenary sessions of the 18th CPC Central Committee, conscientiously following the decisions of the CPC Central Committee and the State Council, building and effectively implementing firm development concepts, namely, innovative, coordinated, green, open, and shared development, and adhering to the principles of ensuring basic medical and health care services for the people, improving the services provided at the grass-roots level, and developing sound supporting mechanisms, further highlight key areas and links, intensify reform and innovation, further advance the coordinated reform of medical and health system, medical insurance system, and medicine production and circulation system while strengthening the integrity, systematism, and coordination in the reform, and further improve the execution ability in the reform to implement reform policies.
I. Comprehensively Deepen the Reform of Public Hospitals
1. Consolidate and improve the comprehensive reform of public hospitals at the county level. Classified guidance and demonstration shall be strengthened by carrying out the demonstration of the comprehensive reform of public hospitals at the county level in Qidong City, Jiangsu Province, Tianchang City, Anhui Province, Youxi County, Fujian Province, and Huzhu Tu Autonomous County, Qinghai Province to lead reform improvements entirely. (Responsible by the National Health and Family Planning Commission (NHFPC) and the Ministry of Finance (MOF), with the involvement of the State Commission Office of Public Sectors Reform (SCOPSR), the National Development and Reform Commission (NDRC), the Ministry of Human Resources and Social Security (MOHRSS), and the State Administration of Traditional Chinese Medicine (SATCM), and the first-mentioned department taking the lead, hereinafter the same)
2. Expand the pilot comprehensive reform of urban public hospitals. Pilot cities will be increased by 100 ones to 200 ones nationwide. The central finance will grant a lump-sum subsidy of CNY20 million to each increased pilot city and a subsidy of CNY1 million to each district with public hospitals directly under the governments of all pilot cities. Meanwhile, assessment of the effect of the pilot comprehensive reform of public hospitals shall be carried out, with an assessment results-linked central financial subsidies allocation mechanism developed. The participation of ten hospitals directly under, and under the management by, the NHFPC in the comprehensive reform of public hospitals in their respective jurisdictions shall be promoted first, with a performance appraisal mechanism developed. Efforts shall be made to actively advance the participation of hospitals set up by state-owned enterprises in the reform of public hospitals and study the formulation of guiding documents on the participation of military hospitals in the pilot comprehensive reform of urban public hospitals. (Responsible respectively by the NHFPC, the MOF, the State-owned Assets Supervision and Administration Commission of the State Council (SASAC), and the Health Bureau, Logistics Department of the Central Military Commission, with the involvement of the SCOPSR, the NDRC, the MOHRSS, and the SATCM)
3. Fulfill government responsibilities. Governments of all provinces, cities, and counties shall, in accordance with the Circular of the General Office of the State Council on Issuing the Outlines of the National Medical Health Service System Plan (2015-2020) (Guo Ban Fa [2015] No.14), formulate and implement their respective medical and health resources allocation standards (medical health service system plans), regional health plans, and county-level medical health service system plans, and comprehensively fulfill their responsibilities for the investment in public hospitals. (Responsible respectively by the NHFPC, the NDRC, and the MOF)
4. Improve the reasonable compensation mechanism. We shall cancel medicine commissions (excluding those for traditional Chinese medicine decoction pieces) in all public hospitals in the increased pilot cities while consolidating the reform results achieved in the cancellation of medicine commissions in public hospitals. The multi-party compensation sharing mechanism of adjusting the prices of medical services, increase government subsidies, reforming payment methods, and hospitals strengthening accounting and saving operational costs shall be perfected. The relevant national medical service price adjustment policies shall be implemented to develop a dynamic medical service price adjustment mechanism based on changes in cost and revenue structure. The parity relations between medical institutions at different levels and between medical services shall be gradually straightened out according to the principles of "overall volume control, structural adjustment, price rises and falls, and gradual implementation". Prices of medical services shall be rationalized according to the steps of "room making, structural adjustment, and transition guarantee": Making room for adjustments to the prices of medical services by lowering expenses for drugs, devices, and supplies through centralized purchase, cost control via medical insurance, and standardization of diagnosis and treatment behaviors, and strictly controlling unreasonable examination and inspection expenses; adjusting the prices of medical services step by step, rather than only adjusting the prices of those whose medicine commissions are cancelled, with the adjustments included in the payment scope of medical insurance funds as required; strengthening the coordination and transition of policies on prices of medical services, payment from health insurance funds, medical cost control, and graded diagnosis and treatment, to ensure the sustainable development of medical institutions, affordable health insurance funds, and in general non-increase in the burden on the masses. Adjustments to the prices of medical services shall be made in cities under the pilot reform of public hospitals, with priority given to those in the provinces under the pilot comprehensive medical reform. (Responsible respectively by the NHFPC, the NDRC, the MOHRSS, the MOF, and the SATCM)
5. Perfect the public hospital management system. Guiding documents on the development of a modern hospital management system shall be formulated to determine the autonomy of a public hospital in terms of personnel management, internal distribution, and operation management. Pilot cities shall develop and improve a comprehensive performance appraisal indicators system for public hospitals, introducing third-party performance appraisal. In addition, pilot cities shall promote the professionalization and expertise of presidents by developing mechanisms for the training certification, assessment of target responsibilities during the term of office, and the corresponding incentives and restraints regarding presidents, and strengthen financial budget management by implementing such management in all public hospitals and promoting the implementation of the chief accountant system in Grade 3 public hospitals. (Responsible by the NHFPC, the MOHRSS, the SCOPSR, the MOF, the Ministry of Education (MOE), and the SATCM)
6. Deepen the reform of the staffing system. The total headcount of public hospitals carrying out the comprehensive reform shall be reasonably ratified within the existing total headcount for local regions. The staffing record-filing system shall be gradually implemented by innovating the staffing management methods and perfecting the administrative measures for the record filing of staffing. The pilot reform of the staffing management of public hospitals shall be explored in regions where conditions permit. Overall consideration shall be given to the benefits of staff and non-staff workers in terms of position setting, income distribution, professional title assessment, management and use. The reform of the endowment assurance system shall be pushed forward in accordance with the provisions of the State. Further efforts shall be made to perfect the employment system, position management system, and open recruitment system. The talent urgently needed and high-level talent of hospitals may be recruited by hospitals by examination as required, with the results made public. (Responsible respectively by the SCOPSR, the MOHRSS, the NHFPC, and the MOF, with the involvement of the SATCM)
7. Speed up the development of a remuneration system in line with the characteristics of the medical and health industry. We shall organize and improve the pilot reform of the remuneration system of public hospitals, intensify exploration, and summarize pilot experience in a timely manner. Pilot cities are encouraged to explore and formulate the measures for ratifying the performance payroll of public hospitals and develop a distribution incentive mechanism closely linked with job responsibilities, work performance, and actual contribution, to highlight the technical labor value of medical personnel, standardize the income distribution order, gradually increase the income and benefits of medical personnel, and mobilize their enthusiasm.
......
Guo Ban Fa [2016] No.26
April 21, 2016
People's governments of all provinces, autonomous regions, and municipalities directly under the Central Government, as well as the relevant departments of the State Council,
These Key Tasks in Deepening the Medical and Health System Reform in 2016, which have been approved by the State Council, are hereby issued to you for your earnest implementation in light of the actual conditions.
Key Tasks in Deepening the Medical and Health System Reform in 2016
Since the launch of a new round of medical reform, different regions and relevant departments have, under the leadership of the Central Committee of the Communist Party of China ("CPC") and the State Council, been working together to advance the reform, constantly improve top-down design, and gradually tackle key issues and difficulties, so that the difficulty in seeking medical treatment and expensive medical expenses have been substantially relieved, and major periodical effect has been achieved in deepening the medical reform. In 2015, the average life expectancy reached 76.34 years old, a rise of 1.51 years old compared to that in 2010; people's health, in general, reached the average level in upper-middle-income countries; the proportion of residents' personal spending on health to total health expenses dropped to below 30%, the lowest level in the recent 20 years. Positive progress and effect achieved in the medical reform lay a solid foundation for the continuous deepening of reform.
The year 2016 marks the start of the 13th Five-year Plan, and is a crucial year in achieving the periodical objective of deepening the medical and health system reform by 2017, and a key year in achieving the objective that everyone will have access to basic medical and health services by 2020.To make a good beginning for the implementation of the reform tasks determined in the medical reform plan during the 13th five-year plan period, ensure greater reform effect, and promote the development of a basic medical and health system covering urban and rural residents, so as to effectively build a healthy China, we shall, by comprehensively implementing the guidelines of the 18th National CPC Congress and the third, fourth and fifth plenary sessions of the 18th CPC Central Committee, conscientiously following the decisions of the CPC Central Committee and the State Council, building and effectively implementing firm development concepts, namely, innovative, coordinated, green, open, and shared development, and adhering to the principles of ensuring basic medical and health care services for the people, improving the services provided at the grass-roots level, and developing sound supporting mechanisms, further highlight key areas and links, intensify reform and innovation, further advance the coordinated reform of medical and health system, medical insurance system, and medicine production and circulation system while strengthening the integrity, systematism, and coordination in the reform, and further improve the execution ability in the reform to implement reform policies.
I. Comprehensively Deepen the Reform of Public Hospitals
1. Consolidate and improve the comprehensive reform of public hospitals at the county level. Classified guidance and demonstration shall be strengthened by carrying out the demonstration of the comprehensive reform of public hospitals at the county level in Qidong City, Jiangsu Province, Tianchang City, Anhui Province, Youxi County, Fujian Province, and Huzhu Tu Autonomous County, Qinghai Province to lead reform improvements entirely. (Responsible by the National Health and Family Planning Commission (NHFPC) and the Ministry of Finance (MOF), with the involvement of the State Commission Office of Public Sectors Reform (SCOPSR), the National Development and Reform Commission (NDRC), the Ministry of Human Resources and Social Security (MOHRSS), and the State Administration of Traditional Chinese Medicine (SATCM), and the first-mentioned department taking the lead, hereinafter the same)
2. Expand the pilot comprehensive reform of urban public hospitals. Pilot cities will be increased by 100 ones to 200 ones nationwide. The central finance will grant a lump-sum subsidy of CNY20 million to each increased pilot city and a subsidy of CNY1 million to each district with public hospitals directly under the governments of all pilot cities. Meanwhile, assessment of the effect of the pilot comprehensive reform of public hospitals shall be carried out, with an assessment results-linked central financial subsidies allocation mechanism developed. The participation of ten hospitals directly under, and under the management by, the NHFPC in the comprehensive reform of public hospitals in their respective jurisdictions shall be promoted first, with a performance appraisal mechanism developed. Efforts shall be made to actively advance the participation of hospitals set up by state-owned enterprises in the reform of public hospitals and study the formulation of guiding documents on the participation of military hospitals in the pilot comprehensive reform of urban public hospitals. (Responsible respectively by the NHFPC, the MOF, the State-owned Assets Supervision and Administration Commission of the State Council (SASAC), and the Health Bureau, Logistics Department of the Central Military Commission, with the involvement of the SCOPSR, the NDRC, the MOHRSS, and the SATCM)
3. Fulfill government responsibilities. Governments of all provinces, cities, and counties shall, in accordance with the Circular of the General Office of the State Council on Issuing the Outlines of the National Medical Health Service System Plan (2015-2020) (Guo Ban Fa [2015] No.14), formulate and implement their respective medical and health resources allocation standards (medical health service system plans), regional health plans, and county-level medical health service system plans, and comprehensively fulfill their responsibilities for the investment in public hospitals. (Responsible respectively by the NHFPC, the NDRC, and the MOF)
4. Improve the reasonable compensation mechanism. We shall cancel medicine commissions (excluding those for traditional Chinese medicine decoction pieces) in all public hospitals in the increased pilot cities while consolidating the reform results achieved in the cancellation of medicine commissions in public hospitals. The multi-party compensation sharing mechanism of adjusting the prices of medical services, increase government subsidies, reforming payment methods, and hospitals strengthening accounting and saving operational costs shall be perfected. The relevant national medical service price adjustment policies shall be implemented to develop a dynamic medical service price adjustment mechanism based on changes in cost and revenue structure. The parity relations between medical institutions at different levels and between medical services shall be gradually straightened out according to the principles of "overall volume control, structural adjustment, price rises and falls, and gradual implementation". Prices of medical services shall be rationalized according to the steps of "room making, structural adjustment, and transition guarantee": Making room for adjustments to the prices of medical services by lowering expenses for drugs, devices, and supplies through centralized purchase, cost control via medical insurance, and standardization of diagnosis and treatment behaviors, and strictly controlling unreasonable examination and inspection expenses; adjusting the prices of medical services step by step, rather than only adjusting the prices of those whose medicine commissions are cancelled, with the adjustments included in the payment scope of medical insurance funds as required; strengthening the coordination and transition of policies on prices of medical services, payment from health insurance funds, medical cost control, and graded diagnosis and treatment, to ensure the sustainable development of medical institutions, affordable health insurance funds, and in general non-increase in the burden on the masses. Adjustments to the prices of medical services shall be made in cities under the pilot reform of public hospitals, with priority given to those in the provinces under the pilot comprehensive medical reform. (Responsible respectively by the NHFPC, the NDRC, the MOHRSS, the MOF, and the SATCM)
5. Perfect the public hospital management system. Guiding documents on the development of a modern hospital management system shall be formulated to determine the autonomy of a public hospital in terms of personnel management, internal distribution, and operation management. Pilot cities shall develop and improve a comprehensive performance appraisal indicators system for public hospitals, introducing third-party performance appraisal. In addition, pilot cities shall promote the professionalization and expertise of presidents by developing mechanisms for the training certification, assessment of target responsibilities during the term of office, and the corresponding incentives and restraints regarding presidents, and strengthen financial budget management by implementing such management in all public hospitals and promoting the implementation of the chief accountant system in Grade 3 public hospitals. (Responsible by the NHFPC, the MOHRSS, the SCOPSR, the MOF, the Ministry of Education (MOE), and the SATCM)
6. Deepen the reform of the staffing system. The total headcount of public hospitals carrying out the comprehensive reform shall be reasonably ratified within the existing total headcount for local regions. The staffing record-filing system shall be gradually implemented by innovating the staffing management methods and perfecting the administrative measures for the record filing of staffing. The pilot reform of the staffing management of public hospitals shall be explored in regions where conditions permit. Overall consideration shall be given to the benefits of staff and non-staff workers in terms of position setting, income distribution, professional title assessment, management and use. The reform of the endowment assurance system shall be pushed forward in accordance with the provisions of the State. Further efforts shall be made to perfect the employment system, position management system, and open recruitment system. The talent urgently needed and high-level talent of hospitals may be recruited by hospitals by examination as required, with the results made public. (Responsible respectively by the SCOPSR, the MOHRSS, the NHFPC, and the MOF, with the involvement of the SATCM)
7. Speed up the development of a remuneration system in line with the characteristics of the medical and health industry. We shall organize and improve the pilot reform of the remuneration system of public hospitals, intensify exploration, and summarize pilot experience in a timely manner. Pilot cities are encouraged to explore and formulate the measures for ratifying the performance payroll of public hospitals and develop a distribution incentive mechanism closely linked with job responsibilities, work performance, and actual contribution, to highlight the technical labor value of medical personnel, standardize the income distribution order, gradually increase the income and benefits of medical personnel, and mobilize their enthusiasm.
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