The State Council Office of health care reform published answers to the reporters on "Twelfth Five-Year Plan"

Addtime：Mar.22, 2012      Source：admin

(State distributing [2012] No. 11, hereinafter referred to as the "health plan"in abbreviation) has been released to the public. Thus, the responsible person from The State Council Office of health care reform answered the reporters’ questions.

Why to make "Health reform plan"? How to join the "Health reform plan" , reform ideas and three years implementation scheme?

   The reform is related to billions of people's well-being, also affects the overall system reform of economic society, and it is a long-term and arduous process. A distinctive feature of the reform is the basic concept of taking the basic medical and health care system as a public product to provide to the public, the basic principles of securing the essential, strengthening the base, establishing the system , and the basic pathof the overall arrangement, emphasizing the key point and gradual advance, top design and overall consider medical and health far development, make clear the guiding ideology of the health reform, overall goal, basic frame and policy measures.

According to < Central Committee of Communist Party of China, the State Council about deepening the medical and health system reform opinion>( hereinafter referred to as "opinion" in abbreviation), by 2020, the basic medical health system will has been basically established covering both urban and rural residents, achieving universal access to basic medical and health services. To achieve this goal, the reform must be phased and advanced step by step.

The first three years when the health care reform launched, namely 2009-2011, is the health care reform initial stage, focusing on the protection of basic level, and proceeding with reform from the base. Thus, the State Council promulgated (hereinafter referred to as the "implementation plan" in abbreviation), and made clear three-year target and five key reform tasks.

Through the efforts, the basic framework of the basic medical insurance system for the people has been formed, the national essential drug system has preliminary been built, the basic medical and health service system has gradually been perfected, the equalization of basic public health services was significantly improved, and the public hospital reform has actively been advanced. The reform has achieved significant progress and apparent effect, especially in the primary have a more obvious effect, health care equity, accessibility, convenience for the people have got bigger improvement, that medical treatment is difficult and expensive has been alleviated somewhat, promote the people's livelihood guarantee and improvement, create good condition for the expansion of domestic demand and stimulation of the economy development. But the reform also faces a lot of difficulty and challenges, and the difficulty of reform further focuses, only by advancing, the reform effect can be expanded. Therefore, to develop "reform plan", consolidating is very important in expanding the achievements of the reform and achieving 2012 long-term goal. Only by defining the 2012-2015 medical and health system reform target, reform focus and main task can we further gather consensus, look for accurate breach, promote the health reform to continue to be effective.

"Health reform plan" is a programmatic document to guide medical and health reform during the “ 12^th Five-year Plan”, make specific arrangement and executive plan, on the basis of comprehensive summary the previous three years health care reform , according to the new situation and new requirements that new period faces , put forward for the next four years to implement  "opinions", aimed to highlight the focus of reform and the operability, "opinion" and "implementation plan" come down in one continuous line.

   How is the "12^th Five-plan" health reform plan formed?

The Party Central Committee and the State Council attaches great importance to the medical reform, deploy basic work , taking formulating “medical reform program” as overall advancement of next health reform, and incorporate the “Twelfth Five-Year Plan” national key special planning. In May, 2011, the ninth session of the State Council reform leading group put forward, the State Council health office took the lead in formulating . To do this important work well, medical office developed a program, set up a planning leading group, the drafting group and the expert advisory group and set the planning organization. Jointly with member units like the Ministry of Health, Ministry of Finance and Ministry of Human Resources and Social Security, in combination with three-year health care reform project mid-term evaluation, comprehensively sum up the progress and result since the health reform, find and analize the problem, and accurately grasp the planning background. At the same time, tease out 25 major system difficult problems needed to breakthrough during the "12th Five-Year Plan", commission the domestic and foreign experts and research institutions to carry out parallel study, and put forward policy recommendations.

After thorough research, serious discussion and repeated coordination, form a planning draft,

ask for the opinions from the province (district, city),  deputy provincial capital city, and the Xinjiang production and Construction Corps, hold the meeting of the State Council medical expert advisory committee to listen to their advice and undertake the revisions. In November 2011 , and  February 2012, the plan was approved in principle by the Tenth Plenary Meeting of the State Council medical reform leading group and discussed by the excutive session of the State Council.

And on March 21, it is officially issued by the State Council.

Why to say "Twelfth Five-Year Plan" period is to deepen reform phase of assault fortified positions, and also the critical period to establish a basic medical and health care system?

   During the "12th Five-Year Plan", in the process of deepening medical and health system reform, take what our forebears have left us but as a departure for new inventions, for the reform of this stage, that whether success or failure is related to whether the early reform can expand or not, and also directly decide whether the medical reform long-term goal can be realized smoothly.

From the point of view of system construction, through the first three year five focus reform, the policy framework of basic medical and health service system has been basically formed, basic medical security system covers both urban and rural residents, the basic drug system has been preliminary established in the base, weak status in the basic service system has been improved significantly. A lot of work needs to be done in system construction before the basic medical and health care system really works. Through the system perfection to enhance the immanent connection between the reform, make basic medical and health care system and solve the people's medical treatment of long-term institutional arrangement.

From the point of reform advancing, the medical reform has taken the propulsion strategy from bottom to top, from outside to inside, gradually through, sustained assault. The first three years saw the key of the reform in grass-roots units, improving the weak link by the combination  of increasing the investment and building a new system, establishing new system the basic medical institutions run, enhancing fairness and availability of the basic medical service. At the period of the "12th Five-Year Plan", the emphasis of the reform gradually goes upward from the base up to the public hospitals, becoming more complex related to the problem of system reform. This is the deep water area in the adjustment of interest pattern, deep-seated contradictions the medical and health system accumulated for long exposed in this period, and needed to be solved individually. Consolidating the first three-year reform achievements and continuing to solve new problems is mutual connection. Consolidate basic level reform achievements and lay the foundation in order to further promote the reform of public hospitals, actively promote the reform in public hospitals, especially the county hospitals, which is conducive to the consolidation of grassroots health effect. Therefore, the "Twelfth Five-Year Plan" period is the critical period to establish a basic medical and health care system.

 What are the focuses of health care reform during the period of the"Twelfth Five-Year Plan"? Why to put forward three key reforms?

"Health reform plan" puts forward clearly that during the period of "12th Five-Year Plan", key breakthrough is to be made in three aspects: accelerate and improve national health care system, perfect the system of essential drugs and basic running new system, actively promote the public hospitals reform, and at the same time, promote overall the reform in other fields. Taking the three aspects as the focus of the reform during the "12th Five-Year Plan" is both inheritance and development of the five focus reform and the development and deepening performed according to the new situation, marking the period characteristics of carrying on the past heritage and opening up the future and overcoming the difficulty during the "12th Five-Year Plan", embodying the core tasks of building new system and perfecting the system.

Promote the three key reforms, deepen and develop the connotation of basic medical and health system with Chinese characteristic. Establishing a basic medical and health care system is a great system innovation of from concept to the system for China's health cause development, and also the long-term goal of health reform. During the first three-year reform, basic medical care and health connotation gradually clears and has basically covered all urban and rural residents, that is, ensure everyone to have a basic medical security, and easily enjoy basic medical and public health services.

The "12th Five-Year Plan" will focus on the problem of how to provide to the whole nation as a basic system, system the basic medical and health care services by advancing the three focus reform, so that the basic medical security system truly becomes safeguard network for the people's medical treatment, making the basic medical and health institutions to be the preferred medical treatment, making public hospital reform find a basic way and lay the system foundation for  everyone with access to basic medical and health service.

Basic protection, strong base and system building need to be carried out from beginning to end during the reform and gathering the strength to advance the three focus reforms is specific reflect to practise this basic principle during the "12th Five-Year Plan". From five key reforms to three aspects breakthrough, the difficulty and the focus further focus and inner link and the logical relations become more clear. Universal health care is the foundation of a basic medical and health system, perfecting the system of essential drugs and basic level running new system is key to sustained "strong grassroots", and the core of public hospital reform is the gradual establishment of maintenance of public welfare, mobilization of the enthusiasm, safeguard of the sustainable operation of new system. At the same time, the emphasis of the reform is changing. The basic medical insurance changes from expanding the scope to enhancing the quality of priority, the grass-roots medical institutions from gluten bone health to develop in the round, the reform of public hospitals from the local pilot to comprehensive promotion,  the construction of medical service system from hardware to focusing on service, revealing reform policy and internal requirements in the new stage.

   By promoting three key reforms, seize the crucial link of "difficult to see a doctor, expensive to see a doctor ". The establishment of universal coverage of basic medical insurance system is to  solve the problem for the masses not to be affordable to see a doctor, from the system, gradually eliminate the poverty due to illness, and effectively reduce the burden of the individual. Basic medicine system reverses the operating system for the grassroots medical and health institutions, and have a deep effect on the base’s service function and service mode, and it is the radical measures to improve medical service accessibility and convenience, and makes the base the health doorkeepers for the masses health. Public hospital reform is the focus of the community, now also has a clear path, and gradually breaks the system of “ medicine compensated by drugs” by the comprehensive reform, make the public hospitals play the important role in medical and health service system. At the same time, continue to promote the equalization of basic public health services, optimize the medical and health resources allocation, accelerate the talent foster and strengthen information construction, strengthen the system reform of production and marketing of medicines,and medicine and health supervision, further enhance the coordination of the reform policy, and play policy superposition effect.

  In what aspect is the basic function of national basic medical insurance reflected and how to advance the construction of this important system?

  National basic medical insurance is closely related with medical service system, the public health system and drug supply system, which not only provides the important guarantee for the people medical treatment, but also plays an important role in restricting the behavior of the medical system and controlling the increase of the medical costs. For the worldwide, currently there are more than 130 countries to have established the medical insurance system to solve the problem of the residents’ medical treatment. Most developed countries have established universal health coverage system. This medical reform takes it as its important content of basic medical health system to build universal health coverage system and build a social safety net, through the first three years’ reform, medical insurance for urban workers, new rural cooperation system and urban residents medical insurance system have been further improved, the urban and rural medical assistance system has also been improved, the commercial medical insurance system is explored, constitute the basic medical insurance system frame, which indicates that our country has preliminarily already implemented basic medical insurance. During the “12th Five-year Plan”, continue the innovation of system and constantly improve the basic medical insurance for the whole nation.

   On one side, on the basis of continuing to improve security level, importantly better the security system for the most serious and special illness and special group of people. Continuously consolidate and expand the coverage of the basic medical insurance, raise the security level, urban residents and government allowance standard for the new rural cooperation system will be increased to 360 yuan per person annually , the cost ratio for being in hospital within the three basic policy on average counts for about 75%, try to narrow the gap of actual hospital costs expenditure ratio, expand the coverage of the outpatients service, raise the level of expenditure and practically lessen the burden of the mass. Importantly explore to establish the security system for the most serious and special illness and the first aid for the patients without spending ability, through various ways like purchasing commercial insurance or building complementary medical insurance, lessen the burden for the mass with serious illness; through several channels raise funds to collect the salvage money to solve the problem of the first-aid costs for the unaffordable patients, thus in system relieve and progressively eliminate the problem of leading to poverty just because of being ill and returning to poverty due to illness.   

   On the other side, actively carry forward the reform of the way of expenditure, allround strengthen the role of stimulating and restraining to the medical institutes from the basic medical insurance. Improve continuously medical insurance management level, actively spread one-card system for medical insurance and medical treatment, haste the immediate closing account for the basic medical insurance, improve the relationship of medical relationship and transfer closing policy, push forward the link between each basic medical insurance system, strengthen the management of the income and expenditure for the basic medical insurance, provide convenience for the people with the insurance to receive medical treatment and closing account. Further improve the system of medical insurance expenditure system, throughout the nation, actively push forward the reform of the way of expenditure to pay according to the variety of sickness( group of sickness), pay according to the number of people and prepay totally,

establish the restraint system of medical insurance to medical expenditure increase within the planning area as a whole, list the medical costs and the control of individual expenditure into medical insurance grading evaluation system, push to tilt the medical expenditure system to the base, control the medicine expenses, standard the service behavior and guide the reasonable medical treatment.

Why to strengthen and improve basic medicine system and on-going system in the base? What are the measures?

Take the basic medicine system as the starting point, generally push the integrated reform, establishing the on-going new system in the base medical and health institutes is  the focus and and highlight for the first three-year reform, and meantime, it is also a key task needed to be continuously strengthened and improved. On one side, the basic medicine system is a totally new system, covering the selection of the basic medicine, production, price fixing, bidding, matching and delivering and using , and an essential change for medicine supply security system in the base medical and health system, and meanwhile have a deep influence on the medical institutes and the massive patients’ medicine-using behavior. Now this system has realized the whole coverage in the base, but it needs to be further ensured and strengthened. On the other hand, the new processing system is essentially established in the base medical and health institutes, but it is still in the key stage of being further improved. Therefore, take it as the key point to improve the basic medicine system and process the new system, ensure each policy and measure to be on the right point, for the new problems that appear in the reform, immediately improve the policy and push the establishment of long-term system.

 Firstly, deepen the integrated reform in the base medical and health institutes. Better the long-term and multi-channel compensating system, establish the constant allowance system of central finance to the local after the overall implementation of basic medicine system, make sure each policy of financial allowance, wholly implement the policy of general treatment costs and medical insurance expenditure to ensure the normal working of the base medical and health institutes. Deepen the reform of on-record personnel and personnel affairs, complete the system of performance evaluation and appraisal, insist on more pay for more work, excellent pay for good achievements, on the basis of steadily processing the performance pay, it will be OK to raise the performance salary as rewards if possible, focus on tilting to the important post, the outstanding workers with special achievements to raise the enthusiasm of the medical staff.

Secondly, improve the basic medicine system. On the basis of strengthening the government’ building the base medical and health institutes to implement the basic medicine system, step by step carry forward the implementation of basic medicine system in the clinics of the country, synchronously make sure each allowance and supporting policy; by the way of purchasing the service, take non-government-run base medical and health institutes into the implementation scope of the basic medicine system. Devoted to strengthening the purchasing system of the basic medicines, insist on the policy of taking the biding and buying as one, the amount and price as the link, double-envelope system, paying unitarily and monitoring for the whole process, for the only-one variety of the basic medicine, after buying for many times with the stable price, try to carry the idea of the state-fixed price, and for those with little usage, the urgent varieties in clinical need, produce in the fixed place by bidding to ensure the supply. Research, stimulate and better the list of national basic medicine, strengthen the supervision of the basic medicine quality, and meet the basic need for the masses.

Thirdly, raise the service ability of the base medical and health institutes. Continue to support the standard construction of the base medical and health institutes, push the information construction of the base medical and health institutes, and raise the standardized service ability of the base. Take the system-establishing of all-round doctors as the key measure, by way of standardized training, training on different posts, advertising for the professional doctors and setting up the special posts, strengthen the team construction of all-round doctors, actively push the mode of family-contract doctors to provide for the inhabitants the continuous health management service. By 2015, one in ten-thousand inhabitants have over 2 all-round doctors, and there will be the all-round doctors in the clinics in each village and town. Further improve the related policy and measure to encourage the talents to work in the base, establish the system of talents exchanging and cooperating and flexible exchanging system, encourage the retired doctors to work in the base and country. For those working in the base medical and health institutes in the remote areas, make sure of the allowance policy or provide the essential aid. Continue to strengthen the training for the staff on the post and make strong the service net of the country medical and health service.

What is the thought of public hospital reform? What steps will be taken to advance it ?

Public hospital is the main body of the medical and health service system, and also the focus  of the community. Through nearly three-year reform, the path for the public hospital reform is becoming clear. During the "Twelfth Five-Year Plan" period, adhere to the public nature of public hospitals, in accordance with the "four separation" requirement, take getting rid of the system of “Medicine compensated by drugs”as a key link, the county hospital as focus, promote the overall development of the management system, compensation system, personnel distribution, drug supply, the price system and other aspects of the comprehensive reform, gradually establish and maintain public interest, arouse enthusiasm, and safeguard the sustainable public hospitals running system.

Firstly, adopt comprehensive means and linkage policy like adjusting medicine price, reforming the style of payment of medical insurance and implementing the government to manage the medical payment responsibility to break the system of “Medicine compensated by drugs”. Change the public hospital compensation channel to the two channels of service charges and government subsidies, the reduction of the reasonable income and the formation of loss should be compensated by way of adjusting the medical technology services prices and increasing government investment. Phase out the drug price addition policy, reduce inspection price, raise the charging standard of the treatment costs, operation costs and nursing fees, embody medical service reasonable costs and medical staff technical service value. At the same time, according to the disciplne, the medical technology services shoule be incorporated into medicare payment policy, promoting the reform of the medical insurance payment pattern, enhance the consciousness of medical institutions, actively controlling the medical expenses and medical costs. Implement the duty of the government to manage the medicine, determine reasonably the quantity and layout of the public hospitals (including the state-owned enterprise hospitals), and strictly control the construction standard, size and equipment. Prohibit the public hospitals to build with debt.

Secondly, promote the administration service separation and the separation of management and running. Implement public hospital management autonomy and establish modern hospital management system. Explore various ways like setting up a special management institution to define the government running medical organizations, which will perform the function of government running public hospitals. Try to establish various public hospital cooperating governance structure like the Council, establish the system of president in charge term goal responsibility system, implement the public hospital autonomy and promote public hospital medical staff pension and other social security service socialization. Establish the public hospital performance and evaluation system of taking the public welfare nature and efficiency as the core, perfect the internal distribution system of taking the service quality, quantity and patient satisfaction as the core, improve the staff benefits, and prohibit to link the medical staff personal income and the hospital medicine and examination income.

At the same time, take the patient as the center, service oriented, begin energetically civilian Huimin services to facilitate the masses to get medical treatment. During the "12th Five-Year Plan", put the reform of the county public hospitals in prominent place, promote the overall development of the comprehensive reform like the management system, compensation system, personnel distribution, procurement system and price system; strengthen capability construction of taking the talent, technology, key specialty as the core, strive to make the visit rate increasing to about 90%, basically realizing the masses getting treated within the county if the illness is not serious. By 2015, achieve the target of reform in stage for the county public hospitals.

During the "12th Five-Year Plan", in encouraging and promoting the social medical aspects, what is the target, and what measures will be taken?

"Health reform plan" puts forward, by 2015, it will be achieved that the number of beds and service in the non-public medical institutes will respectively reach about 20% of the total for the total number of medical institutes and service. To achieve this goal, it will further encourage and promote social medical strength.

Firstly, relax the restrictions of social capital to manage the medical access. To implement the principle of adjusting and newly increasing medical and health resources and social capital priority, and among the every 1,000 inhabitants, if the number of beds amounts to 4 in a medical and health institute, in principle no longer expand the scale of public hospitals. Encourage and guide the social forces such as those strong enterprises, charities, foundations and commercial insurance institutes as well as the foreign investors to create the medical and health institutes. Encourage those qualified personnel(including Hong Kong, Macao and Taiwan)to set up private clinics by law. Meanwhile, actively and steadily push forward the reform in public hospitals.

Secondly, further improve the practice environment. To fully implement the encouragement and preferential policies for the non-public medical institutes in tax, price, medical insurance fixed sites, land, the construction of key disciplines, large medical equipment configuration and professional title assessment, to create a fair environment for the development of public medical institutions. For the non-profit medical institutes held by the social capital, carry out the same tax and price policy as the public hospitals.

Thirdly, insist on supporting the excellent and strong. Priority should be given to support the non-profit medical institutes held by the social capital, which fits in with welfare quality of health service, and also on the internationals. From the view of international experience, even in those countries with highly medical market and with high ratio of non-profit medical institutes, the non-public medical institutes mainly are non-profit ones. Encourage the social capital to create and develop the large medical group with a fixed scale, the medical institutes with characteristics, high level, high technology content. Actively develop the medical service industry, expand the health service industry chain, encourage the social capital to carry out the service like nursing care, rehabilitation nursing, health consultation and management and expand and enrich the social medical resources.

How to guarantee the smooth implementation of the planning?

"Health reform plan" defined the 2012-2015 medical and health system reform target, reform key and main task, and it is the guidance document to deepen the medical reform in the coming four years. To ensure the smooth implementation of the planning, a strong implementation guarantee system will be established.  

Firstly, strengthen the organization and leadership of the planning and implementing, strengthen the responsibility system, establish the working system of the government chief leaders to take the key responsibility, and that the leaders in charge of the routine work and health work are responsible for the specifics, establishing the division and cooperation between departments, cooperating closely and promoting together. At the same time, According to the plan of the overall goal and key tasks, refine the annual task, make working plan, and fully implement and plan the key tasks.

  Secondly, give full play to political and organizational advantage, outstand the party organizations at all levels the leading role in deepening the medical reform and the medical personnel’s main force, arouse their enthusiasm for the medical institutes and medical staff to participate in the reform, promoting the reform together. At the same time, continuously strengthen the construction of the health care team, and continuously enhance the leadership and executive force in reform.

   Thirdly, urther increase investment, cogently fulfill the requirement “government investment growth should be higher than the regular financial expenditure growth, and gradually increase the ratio of government health investment accounting for the recurrent expenditure”to ensure the funds for planning and implementation.

   Fourthly, on the basis of encouraging the local to make the bold exploration and to go ahead to have a try, strengthen the classification guide to the local medical reform work, timely sum up and popularize the successful experience and focus on the reform measures being integrated and sustainable.

  Fifthly, strengthen the propaganda and training, adhere to the correct direction of public opinion, make good advocacy of reform policy, create a good atmosphere, and meantime, carry out the extensive training, continuously improve the level of medical reform policy for the cadres at all levels to ensure the smooth planning.