Deepen the plan for the reform of medical and health system during the "Twelfth Five-Year Plan" and implementation plan

Deepening the reform of the medical and health system is a major practice in implementing the scientific development concept and accelerating the transformation of economic development methods. It is an important measure for building a modern country, ensuring and improving people's livelihood, and promoting social fairness and justice. It is a comprehensive reform that runs through the economic and social fields. The period of the "12th Five-Year Plan" is a crucial period for deepening the reform of the medical and health system, and is also a critical period for establishing a basic medical and health system. In order to consolidate and expand the achievements of the previous phase of reform and achieve the established goals for all people to enjoy basic medical and health services by 2020, the "Twelfth Five-Year Plan for National Economic and Social Development of the People's Republic of China" and "The CPC Central Committee and State Council on Deepening Pharmaceuticals Opinions on the Reform of the Health System (No. 6 (2009)) to prepare this plan. This plan mainly defines the stage goals, reform priorities and major tasks of the 2012-2015 medical and health system reform, and is the guiding document for deepening the reform of the medical and health system in the next four years.

First, planning background

Since the implementation of the deepening reform of the pharmaceutical and health system in April 2009, under the leadership of the Party Central Committee and the State Council, all regions and relevant departments have conscientiously implemented the decision-making and deployment of the Central Government, and in accordance with the basic principles of ensuring basic, strong grass-roots and building mechanisms, Policies, sound systems, increased investment, and coordinated advancement of the five key reforms have achieved significant progress and initial results, and achieved phased goals. The basic medical insurance system covering all urban and rural residents (hereinafter referred to as basic medical insurance) has taken shape. The basic medical insurance for employees (hereinafter referred to as "employee medical insurance"), urban residents' basic medical insurance (hereinafter referred to as "urban residents' medical insurance") and new rural cooperative medical care (hereinafter referred to as The number of people participating in the New Rural Cooperatives (NRCs) reached 1.3 billion, and the level of funding and protection was significantly improved. The scope of coverage extended from serious illnesses to outpatients and minor medical ailments, and the urban and rural medical assistance efforts continued to increase. The national basic pharmaceutical system was initially established, the government-run basic medical and health institutions implemented zero sales of essential drugs, and drug safety was significantly strengthened. The comprehensive reform of primary medical and health institutions, centered on the elimination of the "drug-for-medicine" mechanism, was promoted simultaneously. It began to form a new mechanism for maintaining public welfare, mobilizing enthusiasm, and ensuring sustainability. The basic medical and health service system covering urban and rural areas has basically been completed. More than 2,200 county-level hospitals and more than 33,000 primary and secondary medical and health institutions in urban and rural areas have been transformed and improved. The service capacity of Chinese medicine has gradually increased, and the establishment of the general practitioner system has started. The level of equalization of basic public health services continues to increase, and basic public health services in 10 countries are provided free of charge for both urban and rural residents, and major national public health service projects are fully implemented. Public hospital reform pilots were actively promoted, with institutional and institutional separation surrounding separation of government and affairs, separation of management and management, separation of pharmaceuticals, profit-making, and non-profit (hereinafter referred to as “four separates”). Steady progress. Governments at all levels have clearly improved their understanding and execution of medical and health work. Their practical experience and practices have been continuously enriched. The social atmosphere supporting the reform of the medical and health system is being formed. The three-year reform practice has proved that the direction of the reform of the medical and health system is correct, the path is clear, and the measures are effective. Especially at the grass-roots level, obvious results have been achieved. The people's access to medical services has improved the fairness, accessibility, and convenience of access to medical services. With ease, the role of the reform of the medical and health system in promoting economic and social development has become increasingly important.

The reform of the medical and health system is a long-term and arduous and complicated systematic project. It is necessary to soberly realize that there are still some prominent contradictions and problems in the reform of the current medical and health system, especially as the reform advances in depth, the interest pattern is profoundly adjusted, and deep-seated contradictions, such as institutional and structural, have been exposed. The difficulty is obviously increased. The construction of the medical security system needs to be further strengthened, and the basic drug system needs to be consolidated and improved. The reform of public hospitals needs to be deepened and expanded, and efforts to promote medical services by social forces still need to be intensified. The total and structural contradictions of the talent team are still outstanding, and the change in government functions needs to be accelerated. Pace, the task of building regulations and systems is even more urgent. At the same time, as the economy and society enter a new stage of development, the process of industrialization, urbanization, agricultural modernization, economic globalization, and population aging are accelerating, and the health needs of urban and rural residents continue to increase and present a multi-level and diversified character, which further exacerbates health resources. Contradictions between supply constraints and growing health needs; changes in disease spectrum, medical technology innovation, prevention and control of major infectious diseases, and rapid increase in health costs, etc., to optimize resource allocation, expand service provision, change service models, reasonably control costs, and improve Management capabilities and so on have put forward higher requirements. To solve these problems and challenges, we must continue to promote reforms.

After the "Twelfth Five-Year Plan" period in the process of deepening the reform of the medical and health system, we must earnestly sum up experience, further strengthen organization and leadership, give full play to institutional advantages, and seize the favorable opportunity for major progress in grass-roots comprehensive reform to achieve sustained and rapid economic development. , Constantly agglomerate and expand social consensus, continuously push reforms deeper, and lay a solid foundation for basically building a basic medical and health system that meets China’s national conditions and achieving universal access to basic medical and health services.

Second, the overall requirements and main objectives

(a) General requirements. Guided by the Deng Xiaoping Theory and the important thinking of the "Three Represents" and deeply implementing the scientific concept of development, it closely follows the spirit of the "Opinions of the CPC Central Committee and State Council on Deepening the Reform of the Pharmaceutical Health System" (Zhongfa [2009] No. 6) and insists on The basic medical and health system, as the core concept of providing public products to all citizens, adheres to the basic principles of protecting basic, strong grass-roots, and building mechanisms, and adheres to the principle of prevention, rural-focused, and equal emphasis on Chinese and Western medicine in order to maintain and promote the health of all people. With the aim of building a basic medical and health system, we will make overall arrangements, highlight key points, advance in an orderly manner, further deepen comprehensive reforms in areas such as medical security, medical services, public health, drug supply, and regulatory systems, and strive to build basic medical insurance for the entire people. Consolidate and improve the pharmaceutical system and public hospitals to achieve major breakthroughs in reform, enhance the basic role of basic medical insurance for all people, strengthen the public service of medical services, optimize the allocation of health resources, reconstruct the order of drug production and circulation, improve the efficiency of medical and health system, accelerate Forming the masses of the people Medical services "system of protection, and continuously improve the health of all the people, the people share in the fruits of reform and development.

(b) The main objective. The basic medical and health care system has been accelerating, and the multi-level medical security system with the basic medical insurance as the main body has been further improved. Through reforms such as the payment system, the security and management levels have been significantly improved; the basic medicine system has been continuously consummated and the basic medical and health institutions have been operating The mechanism effectively operated, and the basic medical and public health service capabilities increased simultaneously; the county-level public hospitals achieved periodic progress in reforms; the reform of urban public hospitals was carried out in an orderly manner; the allocation of health resources continued to be optimized, and social forces had made active progress in medical treatment; The construction of a highly talented team has been strengthened, the grassroots talent shortage has been effectively improved, the service capacity of Chinese medicine has been further enhanced, the level of drug safety has been continuously improved, the pharmaceutical production and circulation order has been gradually standardized, and the pharmaceutical price system has been gradually streamlined; With the improvement, the supervision system has been continuously improved, and the supervision of medical and health care has been strengthened.

By 2015, basic medical and health services will be more fair and accessible, service levels and efficiency will be significantly improved, total health expenditures will be reasonably controlled, government health investment growth will be higher than that of regular fiscal expenditures, and government health investment will account for current fiscal expenditures. The proportion has gradually increased, the burden on the masses has been significantly reduced, and the proportion of personal health expenditures to total health expenditure has fallen below 30%. It is difficult to see a doctor and expensive problems have been effectively alleviated. The average life expectancy reached 74.5 years, the infant mortality rate fell below 12‰, and the maternal mortality rate dropped below 22/100,000.

Third, speed up the improvement of the universal health insurance system

We will give full play to the basic role of basic medical insurance for the entire people, with emphasis shifted from expanding the scope to improving quality. Through the reform of the payment system, the responsibility for controlling excessive growth of medical expenses by medical insurance agencies and medical institutions has been increased. On the basis of continuing to increase the rate of basic medical insurance participation, we will steadily increase the level of basic medical insurance and focus on strengthening management services to effectively solve the problem of medical expenses for patients with severe diseases.

(a) Consolidate and expand coverage of basic medical insurance. The three basic medical insurance rates for the employees' medical insurance, urban residents' medical insurance and the new rural cooperative medical insurance increased by three percentage points on the basis of 2010. Focus on migrant workers, employees of non-public economic organizations, flexible employment, and closure of retirees of bankrupt companies and employees in difficult enterprises.

(b) Raise the level of basic medical insurance. By 2015, the urban residents' medical insurance and the new rural cooperative government subsidy standard will be raised to more than RMB 360 per person per year, and the level of personal payment will increase accordingly. Explore the establishment of a funding mechanism that is compatible with the level of economic development. The proportion of hospitalization fees paid by the employees' medical insurance, urban residents' medical insurance, and the new rural cooperative medical insurance policy reached about 75%, and the gap between the proportion of hospitalization expenses paid was obviously narrowed and the maximum payment limit was further raised. The urban residents' medical insurance and the new rural cooperative medical clinics co-ordinated coverage of all co-ordinated areas, and the payment ratio was raised to more than 50%; the medical insurance outpatient clinics were steadily promoted.

(C) improve the basic medical insurance management system. Accelerate the establishment of an overall basic medical insurance management system for both urban and rural areas, explore the integration of medical insurance for employees, medical insurance for urban residents, and the management functions and resources of the new rural cooperative medical system. Areas with conditions to explore the establishment of urban and rural residents' basic medical insurance system. In accordance with the principle of separate management and management, improve the basic medical insurance management and operation mechanism, clearly define the responsibilities, further implement the legal autonomy of the medical insurance agency, and improve the handling capacity and efficiency. Under the premise of ensuring the safety and effective supervision of the fund, it encourages government-purchased services to entrust competent commercial insurance agencies to handle various kinds of medical security management services.

(d) Improve the level of basic medical insurance management services. Accelerate the prompt settlement of basic medical insurance and medical assistance, so that the patients only need to pay for their own expenses, and the remaining expenses are directly settled by the medical insurance agency and the medical institution. The establishment of a medical treatment settlement system in other places will enable the real-time settlement of medical expenses within the region and within the province at the same time in 2015. The initial realization of cross-provincial medical expenses will be settled immediately; the convergence between basic medical insurance and medical assistance will be completed. We will improve the transfer and follow-up policies for medical insurance relations, basically realize the transfer and continuity of employees within the medical insurance system, and promote the convergence of various basic medical insurance systems. Accelerate the establishment of a medical insurance information system with multiple functions such as fund management, cost settlement and control, and medical behavior management and supervision, and realize the interface with the fixed point medical institution information system. Actively promote medical insurance for medical “one card” to facilitate the insured personnel to seek medical treatment.

Strengthen the management of basic medical insurance fund income and expenditure. If the balance of employees’ medical insurance funds is excessive, the balance should be reduced to a reasonable level. The urban residents' medical insurance and the new rural cooperative fund should adhere to the principle of balance of payments in the current year. Excessive balances can be combined with actual priorities to increase the level of high-level medical expenses. Strengthen the basic health insurance fund's mutual aid and anti-risk capabilities, achieve city-level overall planning, gradually establish a provincial risk adjustment fund system, and actively promote provincial-level overall planning. We will improve the basic medical insurance fund management supervision and risk prevention mechanism to prevent overdrafts of basic medical insurance funds and safeguard the safety of funds.

(e) Reform and improve the health insurance payment system. Intensify the reform of medical insurance payment methods, combine the implementation of disease clinical pathways, and actively promote disease-based payment, per-person payment, and total advance payment throughout the country to enhance the incentives and constraints of medical insurance on medical behavior. Set up a restriction mechanism for Medicare to co-ordinate the growth of medical expenses in the region, formulate the overall control targets for Medicare funds and decompose them into fixed-point medical institutions, and include the control of the average (illness) medical expenses growth and individual burden quota control of medical institutions into the medical insurance classification. Evaluation System. Actively promote the establishment of negotiation mechanisms for medical insurance agencies and medical institutions, drug suppliers, and payment mechanisms for purchasing services. The medical insurance payment policy is further tilted toward the grassroots, encourages the use of Chinese medicine services, guides the people from minor illnesses to primary care, and promotes the formation of a hierarchical diagnosis and treatment system. The non-public medical institutions and retail pharmacies that met the qualification criteria were included in the scope of medical insurance coverage, and gradually extended the medical insurance supervision of medical institutions to the supervision of the medical services of medical personnel. Strengthen the supervision of designated medical institutions and retail pharmacies, and increase penalties for fraud insurance fraud.

(6) Improve the urban and rural medical aid system. Increase the investment in rescue funds and establish the bottom line of medical protection. Financial support for households with low-income families, five-guarantee households, severely handicapped people, and low-income families in urban and rural areas participated in urban residents' medical insurance or new rural cooperative medical insurance. The cancellation of the medical assistance deduction line and the increase of the ceiling line will increase the proportion of hospitalized self-insured medical expenses within the scope of the salaries policy to more than 70%. On the basis of pilots, we will comprehensively promote the relief of major diseases and increase the rescue efforts for serious diseases. The cost of emergency medical care for unsupported patients is resolved through medical assistance funds and government subsidies. Encourage and guide social forces to develop charity medical assistance. Encourage trade unions and other social groups to carry out various forms of medical mutual assistance activities.

(7) Actively develop commercial health insurance. Improve the commercial health insurance industry policy, encourage commercial insurance institutions to develop health insurance products beyond basic medical insurance, and actively guide commercial insurance institutions to develop long-term care insurance and special serious illness insurance to meet diversified health needs. Encourage enterprises and individuals to participate in commercial health insurance and various forms of supplementary insurance, and implement relevant taxation and preferential policies. Simplify claims procedures to facilitate settlement by the people. Strengthen the supervision of commercial health insurance and promote its standardization and development.

(8) Exploring the establishment of protection mechanisms for major diseases. Give full play to the synergies and complementarities between basic medical insurance, medical assistance, commercial health insurance, various forms of supplementary medical insurance, and charitable charity, and effectively solve the problem of poverty caused by severe diseases. On the basis of raising the maximum payment limit for basic medical insurance and the proportion of high-cost medical expenses, we will coordinate policies for basic medical insurance and commercial health insurance, actively explore the use of basic medical insurance funds to purchase commercial major illness insurance or establish supplementary insurance, etc., in order to effectively increase serious diseases. Protection level. Strengthen the connection with the medical assistance system and increase the rescue efforts for patients with low-income patients.

IV. Consolidate and improve the basic drug system and new mechanisms for the operation of primary health care institutions

We will continue to expand the effectiveness of grass-roots pharmaceutical and health system reforms, consolidate and improve the national basic medicine system, deepen comprehensive reforms in the management systems, compensation mechanisms, medicine supply, and personnel distribution at the primary health care institutions, continue to strengthen grassroots service network construction, and accelerate the establishment of general practitioners. The system promotes the comprehensive development of grassroots medical and health institutions.

(1) Deepening the comprehensive reform of primary health care institutions. We will improve the overall reform measures in the establishment of management, compensation mechanisms, personnel distribution, etc. in grass-roots medical and health institutions to consolidate the effectiveness of grass-roots reforms. Improve the stable and long-term multi-channel compensation mechanism for grass-roots medical and health institutions. Local governments must incorporate special subsidies for basic medical and health institutions and regular rebate subsidies into the fiscal budget and implement them in full and on time. The central government shall establish a comprehensive drug system. After the implementation of the local recurring subsidy mechanism and into the budget; speed up the implementation of general medical treatment and medical insurance payment policy to ensure the normal operation of primary health care institutions. Improve the performance evaluation and assessment mechanism. On the basis of the stable implementation of performance-based wages, qualified regions can appropriately increase the proportion of reward-based performance-based wages, adhere to the principle of more work, more rewards, and pay more attention to key positions and backbone businesses. The contribution of staff tilted, rationally opened the income gap, mobilize the enthusiasm of medical staff.

(b) Expand the scope of implementation of the basic drug system. We will consolidate the achievements of the government's basic medical and health institutions in implementing the basic medicine system, and implement the policies for the use of all essential medicines and medical insurance payment policies. Orderly implementation of the basic medicine system in village clinics, implementation of basic medicine system policies, and simultaneous implementation of various subsidies and support policies for rural doctors. For non-government-funded grass-roots medical and health institutions, local governments can, in combination with reality, adopt the method of purchasing services and incorporate them into the implementation of the basic drug system. Encourage public hospitals and other medical institutions to give priority to the use of essential medicines.

(3) Improve the national basic medicine list. According to the use of basic medicines in various regions, the types and categories of basic drugs should be optimized, chronically ill children should be appropriately added, drug types used for children should be appropriately increased, drugs with low use rates and low coincidence rates should be reduced, and reasonable quantities of essential drugs should be maintained to better meet the basic needs of the people. In 2012, the national essential drug list was adjusted and announced in due course. Gradually standardize basic drug standards, specifications and packaging. The basic medicines shall be supplemented by the provincial people's government, and the supplemental authority shall not be delegated to the city, county or grassroots medical and health institutions. It is necessary to reasonably control the number of supplemental drugs.

(D) regulate the basic drug procurement mechanism. Adhere to the basic drugs in the province as a unit of online centralized procurement, the implementation of the integration of recruitment, price-linked, double envelope system, centralized payment, full monitoring and other procurement policies. Adhere to the priority of quality and reasonable prices, and further improve the basic drug quality evaluation criteria and evaluation methods, it is necessary to reduce the high drug prices but also to avoid low-cost vicious competition to ensure that basic drugs are safe and effective, timely supply. Establish a centralized procurement and use management system for basic medicines that is based on the province as a unit to significantly improve the supervision and control of essential drug use. Basic pricing for exclusive products and basic medicines that have been repeatedly stabilized and the market supply is adequate has been piloted by the government for unified pricing. For basic medicines with a small amount and clinical necessity, the supply can be ensured through fixed-point production through tenders. For generic drugs that have reached the international level, support is provided in pricing and bidding procurement to encourage companies to improve the quality of essential drugs. Improve the production technology level of essential drugs and supply support capabilities, and improve the basic drug reserve system. Strengthen the supervision of essential drug quality, and all essential drug production and operating companies must be incorporated into electronic surveillance.

(5) Improve the service capabilities of primary health care institutions. In accordance with the principle of filling in and filling up, we will continue to support the standardization of village clinics, township hospitals, and community health service organizations. In 2015, the primary health care institutions reached the standard rate of more than 95%. We will continue to strengthen the training of grass-roots workers, and focus on implementing targeted and practical training programs that have the characteristics of general medicine and promote the use of essential medicines. Further standardize the drug use behavior of primary health care institutions. Encourage grass-roots medical and health institutions to adopt active services, on-site services, etc., to launch medical tours, promote service focus, and transform service content into basic medical services and basic public health services. Establish and improve the system of grading diagnosis and treatment, two-way referral, and actively promote the pilot system for the first-level diagnosis and treatment system at the basic level. Significantly increase the proportion of outpatient and emergency departments in primary health care institutions to the total number of emergency departments.

Build a rural medical and health service network. Improve rural doctors' compensation and pension policies. Strengthen the training of rural doctors and reserve forces, gradually promote the transition of rural doctors to practicing (assistant) physicians, and encourage qualified regions to strengthen the capacity building of rural doctors through targeted training, academic qualifications, and job training. Actively promote integrated management of township health centers and village clinics.

(6) To promote the establishment of a general practitioner system. The establishment of the general practitioner system as a key measure for strengthening the general grassroots level, strengthening the contingent of general practitioners through standardized training, job transfer training, recruitment of practicing physicians, and setting up special posts, and training of 150,000 general practitioners for primary health care institutions by 2015 Above the name, there are 2 or more general practitioners for every 10,000 city residents, and every general hospital has a general practitioner. Actively promote family contract doctor service model, and gradually establish the service relationship between general practitioners and residents, and provide residents with continuous health management services.

(seven) promote the flow of talent to the grassroots. Further improve relevant policies and measures and encourage the guidance of medical personnel to grassroots services. Establish a talent cooperation and exchange mechanism between higher-level hospitals and grass-roots medical and health institutions, explore the flexible flow of talents in counties (cities, districts), and promote county-township talent linkage. To develop free medical students' orientation training, implement the special doctors' special post program, and enrich the grassroots talent team. Strict implementation of the policy of doctors in urban hospitals and disease prevention and control institutions before serving in rural areas before the promotion of senior professional titles for more than one year. Encourage retired doctors in large hospitals to practice at the grass-roots level and in rural areas. Medical personnel who have served in grass-roots medical and health institutions in hard-to-reach and remote areas shall implement the subsidy policy or provide necessary subsidies.

(8) Accelerate the advancement of informatization of primary health care institutions. On the basis of pilots, with the province as the unit, establish a basic medical and health information system that covers functions such as basic drug supply and use, residents' health management, basic medical services, and performance assessment, and improve basic medical and health services. By 2015, basic medical and health information systems will basically cover township health centers, community health service agencies, and qualified village clinics.

V. Actively promote the reform of public hospitals

Adhere to the public welfare nature of public hospitals, and in accordance with the requirements of “four separates”, break the “remedy for medicine” mechanism as the key link, focus on county-level hospitals, and coordinate the management system, compensation mechanism, personnel distribution, medicine supply, and price The comprehensive reforms in the areas of mechanism and other aspects have shifted from partial pilots to comprehensive advancement, vigorously carried out services to facilitate the people and benefit the people, and gradually established new mechanisms for maintaining the public welfare, mobilizing enthusiasm and ensuring sustainable public hospital operation.

(a) Implement the responsibility of the government for medical treatment. Insist on public hospitals to provide basic medical and health services to urban and rural residents, and further clarify the purpose of the government's public hospitals and the duties that should be performed to reverse the behavior of public hospitals for profit. Further implement the government's investment policy on the basic construction of public hospitals and equipment purchases, the development of key disciplines, public health services, retirees' expenses in line with national regulations, and policy-based loss subsidies. Reasonably determine the number and layout of public hospitals (including hospitals owned by state-owned enterprises), and strictly control construction standards, scale, and equipment. It is forbidden to build public hospital debt.

(B) to promote the reform of compensation mechanism. Eliminating the “medicine-supplementing” mechanism as the key link, promoting the separation of medicines, gradually eliminating the drug addition policy, and changing the public hospital compensation from service charge, drug addition income, and financial subsidy to service charge and financial subsidy. Channels. The hospital's medicines and high value medical supplies are subject to centralized purchasing. Government-invested public hospitals purchase large-scale equipment for public hospitals to set inspection prices at the cost after depreciation. Large equipment purchased through loans or fund-raising is, in principle, bought back by the government. Repurchases are difficult to check prices for a limited period. The inspection of medical institutions is open to the society. Inspection equipment and technical personnel should meet statutory requirements or have legal qualifications to achieve mutual recognition of inspection results. As a result of the above-mentioned reforms, reasonable revenues or losses that have been reduced are compensated by adjusting the prices of medical technology services and increasing government investment. Raise the charges for medical treatment, surgery, and nursing care to reflect the reasonable cost of medical services and the value of medical personnel's technical and labor services. The charges for medical technology services are included in the scope of medical insurance payment as required. The increased government investment will be subsidized by the central government. The local government will adjust the expenditure structure according to the actual situation and increase the investment.

(c) Control the growth of medical expenses. Medical insurance agencies and health supervision agencies must strengthen the supervision of medical service behaviors and stop large prescriptions, repeated inspections, and abuse of drugs. Strengthen the monitoring role of medical insurance for medical services, adopt comprehensive payment methods such as total advance payment, per capita payment, and pay per case, guide medical institutions to actively control costs, strengthen supervision, standardize diagnosis and treatment behaviors, and improve service quality; and gradually implement the plan Institutions and public hospitals negotiate the scope of services, payment methods, payment standards, and service quality requirements; they strictly check the utilization rate of basic medical insurance products and the control rate of self-pay drugs.

Strengthen the supervision and control of medical expenses by the health department, incorporate the control and management objectives of the average cost and total cost growth rate, hospital bed days, and the ratio of medicines into the objective management responsibility system of public hospitals as an important indicator of performance assessment. The irrational use of drugs, materials, inspections, and repeated inspections of economic interests. Strengthen the monitoring of the rapid increase in the cost of disease diagnosis and treatment, and control public hospitals to provide non-basic medical services. The competent pricing department should strengthen the charges for medical services and the supervision and inspection of drug prices.

(D) to promote the separation of government affairs, management and separation. Strengthen the whole industry management functions such as planning, access, and supervision of the health administrative department. Research and exploration will adopt a variety of formalities such as the establishment of a special management agency to determine the government-run medical institutions. They will perform the functions of the government’s public hospitals and be responsible for the asset management, financial supervision, performance assessment, and appointment of key hospital officials in public hospitals. The heads of health administrative departments at all levels must not concurrently assume the leading positions in public hospitals and gradually cancel the administrative level of public hospitals.

(e) Establish a modern hospital management system. Explore the establishment of corporate governance structures in various forms of public hospitals such as the council, clarify the responsibilities of the council and the dean, and exercise the powers of public hospitals such as functional orientation, development planning, and major investments by government-run medical institutions or councils. The establishment of the responsibility system for the president’s responsibility system and term of office, the implementation of public hospitals for personnel autonomy, the implementation of on-demand posts, competition for posts, employment by post, contract management, and the socialization of social security services such as public hospital medical staff pensions. Establish a public hospital performance appraisal system centering on the nature of public welfare and operational efficiency, improve the internal distribution mechanism centering on service quality, quantity, and patient satisfaction, increase the ratio of personnel expenditures to business expenditures, and improve the treatment of medical personnel. And the remuneration of the hospital management shall be determined by the government-run medical institution or the authorized council. It is forbidden to link the personal income of medical staff with the hospital's medicines and inspection income; to improve the financial accounting system of public hospitals and to strengthen the accounting and control of expenses.

(six) to carry out hospital management service innovation. Deepen the patient-centered service concept, continuously improve the medical quality management and control system, and continuously improve the level of hospital management and medical service quality. Simplify procedures such as registration, visits, inspections, charges, and medications to facilitate people's medical treatment. Vigorously promote the clinical pathway, carry out quality control of single disease, and standardize medical behavior. Promote the use of essential drugs and appropriate technologies, and regulate the clinical use of antibacterial drugs and other drugs. Taking the hospital management and electronic medical record as the core, we will promote the informationization of public hospitals. Full implementation of measures to facilitate the benefit of the people, vigorously promote high-quality care, optimize the service model and service flow, carry out “first treatment, after settlement” and volunteer services. Actively promote the construction of a regional unified appointment registration platform, generally implement appointment clinics, improve the medical environment, and significantly shorten the waiting time for patients. Development of remote diagnosis and treatment systems for rural grassroots and remote areas.

(7) Promoting the reform of county-level public hospitals in an all-round way. County-level public hospitals are the leading three-tiered medical and health service network in rural areas. During the “Twelfth Five-Year Plan” period, we must put the reform of public hospitals at the county level in a prominent position to eliminate the mechanism of “remedy for medicine” as the key link, and coordinate the promotion of management systems, compensation mechanisms, personnel distribution, procurement mechanisms, and price mechanisms. Comprehensive reforms: Strengthen capacity building with personnel, technology, and key specialties as the core, consolidate and deepen the long-term cooperation and assistance mechanism for deepening urban hospital counterparts to support county-level hospitals. After approval, special posts can be set up at county-level hospitals to bring in urgently needed high-level talents. We will strive to increase the rate of visits within the county to around 90%, basically achieving no serious illnesses. In 2015, it is necessary to realize the goal of staged reform of county-level public hospitals.

(8) To deepen and deepen the reform of urban public hospitals. In accordance with the principles of up and down linkage, internal vitality, and external thrust, we will accelerate the pilot reforms of urban public hospitals, expand the content of deepening pilots, innovate institutional mechanisms, improve service quality and operational efficiency, and form the basic path for reform as soon as possible and gradually promote it throughout the country. . Cities with abundant resources in public hospitals can guide social capital to participate in restructuring and reorganization of some public hospitals, including hospitals run by state-owned enterprises, in various ways. Encourage social capital to carry out various forms of public welfare investment in some public hospitals. Participation in restructuring through joint ventures and cooperation must not change the nature of nonprofits. In the restructuring process, we must strengthen the management of state-owned assets and safeguard the legitimate rights and interests of employees.

Sixth, coordinating the reform of related fields

To further enhance the synergy of various policies for the reform of the medical and health system, continue to promote the equalization of basic public health services, optimize the allocation of health resources, accelerate the development of personnel training and informationization, strengthen the reform of the pharmaceutical production and distribution and medical and health supervision systems, and give full play to policy superposition. effect.

(I) Improve the level of equalization of basic public health services. Gradually increase the per capita basic public health expenditure standard, reaching RMB 40 in 2015, providing health records, health education, vaccination, infectious disease prevention, child care, maternal health care, elderly health care, hypertension and other chronic diseases free of charge for urban and rural residents Management, heavy mental illness management, and health supervision and other national basic public health services. Strengthen health promotion and education, implement the national health action plan, and integrate health education into the national education system. The main media should strengthen the promotion of health knowledge. Promote a healthy lifestyle, guide science to seek medical care and use drugs safely and rationally. By 2015, the standardized electronic archive rate of urban and rural residents' health records will reach 75%; the standardized management rate of hypertension and diabetes patients will reach 40%.

Gradually increase major national public health projects, continue to carry out national immunization programs, prevention of major communicable diseases such as AIDS and tuberculosis, schistosomiasis, rural childbirth and childbirth subsidies, and inspection of “two cancers” (cervical cancer, breast cancer) for women of the right age. Specialized in health services, the maternal hospital delivery rate in rural areas was stable at over 96%. Focus on food safety (including food and beverage, drinking water hygiene), occupational health, mental health, prevention and control of chronic diseases, prevention and control of major endemic diseases, health emergency and other public health services that have a major impact on the health of residents.

We will improve professional public health service networks for prevention and control of major diseases, family planning, and maternal and child health care, and strengthen capacity building for health supervision, emergency treatment in rural areas, prevention of mental illness, and monitoring of food safety risks. Improve disease surveillance, prevention, control capabilities and emergency public health emergency response capabilities. Deeply carry out patriotic health campaigns. Strengthen the public health services and prevention and control of major infectious diseases among the floating population, rural left-behind children and the elderly, and increase the availability of public health services. Strictly carry out performance appraisal and effect evaluation to improve the effectiveness of public health services. Establish a division of labor and cooperation mechanism for public health and medical and health service systems. Professional public health agency funds are included in the budget and arranged in full.

(B) promote the optimization of medical resources structure and layout adjustment. Scientifically formulate regional health plans, clarify the allocation standards for health resources at the provincial, municipal, and county levels, and give priority to social capital for new health resources. If the number of beds per thousand resident population of medical and health institutions reaches four, in principle, the scale of public hospitals will no longer be expanded. The central and provincial levels can set up a small number of medical centers or regional medical centers that undertake medical research and teaching functions. Encourage all localities to integrate inspection and inspection resources within their jurisdiction and promote the co-construction and sharing of large-scale equipment resources. We will strengthen the establishment of weak links in the medical service system and prioritize support for the lack of regional development of medical resources at the grass-roots level, as well as the old and young. Each county focuses on 1 to 2 county-level hospitals (including county hospitals). We will continue to support the establishment of clinical specialties in medical institutions. We will strengthen the construction of women and children in provincial-level women's and children's specialist hospitals and county-level hospitals. Promote the construction of comprehensive hospitals in remote and regional areas. Encourage the development of rehabilitation medicine and long-term care.

Give full play to the role of Chinese medicine in disease prevention and control and medical services. Strengthen the capacity building of TCM medical services with the focus on the urban and rural grassroots, and by 2015, strive to achieve 95% of community health service centers, 90% of township health centers, more than 70% of community health service stations and more than 65% of village clinics. Provide Chinese medicine services. Encourage retail pharmacies to provide Chinese medical services. Actively promote appropriate technologies for Chinese medicine. Strengthen the protection of traditional Chinese medicine resources, research and development and rational use.

(C) vigorously develop non-public medical institutions. Relaxation of social capital to facilitate the admission of medical institutions, encourage powerful social enterprises, charitable organizations, foundations, commercial insurance institutions and other foreign investors to organize medical institutions and encourage qualified personnel (including Hong Kong, Macao and Taiwan) Open a private clinic in accordance with the law. Further improve the practice environment, implement policies on pricing, taxation, medical insurance, land, key discipline construction, and job title assessment, give preferential support to all kinds of social capital to organize non-profit medical institutions, and encourage non-public medical institutions to a high level and scale. Large-scale medical group development. Actively develop the medical service industry, expand and enrich the medical resources of the whole society. In 2015, the number of beds and services of non-public medical institutions reached around 20% of the total.

(D) innovative health personnel training system. We will deepen the reform of medical education, attach importance to the cultivation of humanistic literacy and professional quality education, accelerate the establishment of a standardized training system for residents and improve the continuing medical education system. Increase the training of nurses, elderly care workers, pharmacists, pediatricians, and mental health, pre-hospital emergency, health emergency, health supervision, hospitals and medical insurance management personnel who need urgent shortage of specialized talents and high-level talents. Promoting medical practitioners to practice more, encourage qualified medical personnel to apply for practice in multiple locations, improve the registration, record keeping, assessment, evaluation, and supervision policies of practicing physicians, and establish physician management files. Establish and improve medical practice insurance and medical disputes handling mechanism.

(5) To promote reforms in the field of pharmaceutical production and circulation.改革药品价格形成机制，选取临床使用量较大的药品，依据主导企业成本，参考药品集中采购价格和零售药店销售价等市场交易价格制定最高零售指导价格，并根据市场交易价格变化等因素适时调整。完善进口药品、高值医用耗材的价格管理。加强药品价格信息采集、分析和披露。

完善医药产业发展政策，规范生产流通秩序，推动医药企业提高自主创新能力和医药产业结构优化升级，发展药品现代物流和连锁经营，提高农村和边远地区药品配送能力，促进药品生产、流通企业跨地区、跨所有制的收购兼并和联合重组。到2015年，力争全国百强制药企业和药品批发企业销售额分别占行业总额的50％和85％以上。鼓励零售药店发展。完善执业药师制度，加大执业药师配备使用力度，到“十二五”期末，所有零售药店法人或主要管理者必须具备执业药师资格，所有零售药店和医院药房营业时有执业药师指导合理用药。严厉打击挂靠经营、过票经营、买卖税票、行贿受贿、生产经营假劣药品、发布虚假药品广告等违法违规行为。

落实《国家药品安全“十二五”规划》，提高药品质量水平，药品标准和药品生产质量管理规范与国际接轨。全面提高仿制药质量，到“十二五”期末，实现仿制药中基本药物和临床常用药品质量达到国际先进水平。实施“重大新药创制”等国家科技重大专项和国家科技计划，积极推广科技成果，提高药品创新能力和水平。加强药品质量安全监管，全面实施新修订的药品生产质量管理规范，修订并发布实施药品经营质量管理规范，实行药品全品种电子监管，对基本药物和高风险品种实施全品种覆盖抽验，定期发布药品质量公告。

（六）加快推进医疗卫生信息化。发挥信息辅助决策和技术支撑的作用，促进信息技术与管理、诊疗规范和日常监管有效融合。研究建立全国统一的电子健康档案、电子病历、药品器械、医疗服务、医保信息等数据标准体系，加快推进医疗卫生信息技术标准化建设。加强信息安全标准建设。利用“云计算”等先进技术，发展专业的信息运营机构。加强区域信息平台建设，推动医疗卫生信息资源共享，逐步实现医疗服务、公共卫生、医疗保障、药品监管和综合管理等应用系统信息互联互通，方便群众就医。

（七）健全医药卫生监管体制。积极推动制定基本医疗卫生法，以及基本医保、基本药物制度、全科医生制度、公立医院管理等方面的法律法规，及时将医药卫生体制改革的成功做法、经验和政策上升为法律法规。推动适时修订执业医师法。完善药品监管法律制度。

加强卫生全行业监管。完善机构、人员、技术、设备的准入和退出机制。建立科学的医疗机构分类评价体系。强化医疗卫生服务行为和质量监管。依法严厉打击非法行医，严肃查处药品招标采购、医保报销等关键环节和医疗服务过程中的违法违规行为。建立信息公开、社会多方参与的监管制度，鼓励行业协会等社会组织和个人对医疗机构进行独立评价和监督。强化医务人员法制和纪律宣传教育，加强医德医风建设和行业自律。

七、建立强有力的实施保障机制

（一）强化责任制。地方各级政府要把医药卫生体制改革作为一项全局性工作，加强对规划实施的组织领导，建立健全责任制和问责制，形成政府主要领导负总责，分管常务工作和卫生工作的领导具体抓，各有关部门分工协作、密切配合、合力推进的工作机制，确保规划顺利实施。各地区、各部门要围绕规划的总体目标和重点任务细化年度任务，制定工作方案，落实责任制，把规划的重点任务落到实处。建立规划实施动态监测、定期通报制度，开展规划实施评估。

（二）增强执行力。“十二五”时期是医药卫生体制改革攻坚阶段，医药卫生系统是医药卫生体制改革的主战场，要发挥医务人员改革主力军作用，调动医疗机构和医务人员积极性，维护医务人员合法权益。要充分发挥好政治优势、组织优势，充分发挥基层党组织在医药卫生体制改革中的核心作用，加强思想政治工作，统一思想认识，形成改革攻坚合力。各级政府都要加强医药卫生体制改革工作队伍建设，提高推进改革的领导力和执行力，确保医药卫生体制改革的各项规划措施落到实处。

（三）加大政府投入。地方各级政府要积极调整财政支出结构，加大投入力度，转变投入机制，完善补偿办法，落实规划提出的各项卫生投入政策，切实保障规划实施所需资金。加大中央、省级财政对困难地区的专项转移支付力度。各级政府在安排年度卫生投入预算时，要切实落实“政府卫生投入增长幅度高于经常性财政支出增长幅度，政府卫生投入占经常性财政支出的比重逐步提高”的要求。各级财政部门在向政府汇报预决算草案时要就卫生投入情况进行专门说明。“十二五”期间政府医药卫生体制改革投入力度和强度要高于2009-2011年医药卫生体制改革投入。基本医保政府补助标准和人均基本公共卫生服务经费标准要随着经济社会发展水平的提高相应提高。加强资金监督管理，提高资金使用效益，切实防止各种违法违规使用资金的行为。

（四）实行分类指导。医药卫生体制改革政策性强、情况复杂、涉及面广，各地要在中央确定的医药卫生体制改革原则下根据实际情况，因地制宜地制定具体实施方案，创造性地开展工作。鼓励地方大胆探索、先行先试，不断完善政策，积累改革经验。各有关部门要加强对地方医药卫生体制改革工作的指导，及时总结推广成功经验。注重改革措施的综合性和可持续性，推进改革持续取得实效。

（五）加强宣传培训。坚持正确的舆论导向，做好医药卫生体制改革政策的宣传解读，及时解答和回应社会各界关注的热点问题，大力宣传医药卫生体制改革典型经验和进展成效，合理引导社会预期，在全社会形成尊医重卫、关爱患者的风气，营造改革的良好氛围。广泛开展培训，不断提高各级干部医药卫生体制改革政策水平，确保改革顺利推进。