Recent work on deepening healthcare reform

( en.nhfpc.gov.cn)

Updated: 2015-05-25

This year marks the conclusion of China's 12th Five-Year Plan (2011-2015) on healthcare reform. It is also an important year for comprehensively deepening reform. The State Council's healthcare reform leadership team has asked relevant personnel to summarize the development of healthcare reform, results and major problems discovered during 2014; fully implement the Central Government's requirement; meet the requirements of the five-year plan on healthcare reform and this year's government work report and propose major tasks to deepen the reform. Therefore, the State Council's health reform office has worked with related member units to settle on major tasks, responsible departments and work development. A total of 27 major reform tasks in seven areas were put forward.

Deepening public hospital reform is front and center and key to its success. We should accelerate public hospital reform to make a substantive breakthrough. The State Council's General Office issued the Opinions on Comprehensively Carrying out County-Level Public Hospital Reform and the Instructions on Urban Public Hospital Comprehensive Reform's Pilot Work. We will follow the State Council's guidance and launch urban public hospital reform in 100 cities at prefecture level or above.

President Xi Jinping hosted the 11th plenary session of the Central Government's comprehensive in-depth reform leadership team on April 1. The session pointed out that public hospital reform is the main part of China's medical service system, and deepening the reform is an important measure to safeguard and improve people's livelihood and public problems in seeking medical service should be tackled. The meeting asked all parties to ensure public welfare at public hospitals, as well as equal access to them during the reform. It called for government responsibilities in hospital development, innovation and the elimination of system where hospital revenues and staff income were closely tied to drug prescriptions. The meeting placed the reform focus on management and operations mechanism, service price adjustment, medical insurance payment, personnel management and income distribution. It urged all to build a new public hospital mechanism that maintains public welfare, gives incentives to medical personnel and is sustainable. The meeting stressed that public hospital reforms cover a wide range of parties and government leaders should live up to their responsibilities and speed up reform based on China's national conditions.

The Opinions on Comprehensively Carrying out County-Level Public Hospital Reform made it clear that the goal of the reform includes maintaining public welfare, ensuring government officials living up to their responsibilities, making full use of the market mechanism and establishing a new public hospital operation mechanism that maintains public welfare, gives incentives to medical personnel, and is sustainable. This year, the method where hospital revenues and staff income were closely tied to drug prescriptions is to be eliminated at all county-level public hospitals. County-level public hospital reform will be fully implemented, with a focus on management and operations mechanism, service price adjustment, medical insurance payment, personnel management and income distribution. A modern hospital management system will be established in 2017, county-level medical and healthcare service systems will be improved and county-level public hospitals will see improved strength in treating major and critical diseases so the public at county level can solve their problems at a local hospital.

The Instructions on Urban Public Hospital Comprehensive Reform's Pilot Work proposed 31 reform tasks in nine areas. First, county-level medical resource allocation should be optimized and things should be clear in county-level public hospital positioning, the number of beds, construction and equipment allocation standards. Policy should be carried out to support and guide social capital in medical development. Second, a unified and effective government-run medical system that integrates authority and responsibilities should be created, and independent legal status and management autonomy at county-level public hospital should be implemented. A scientific performance appraisal system should be set up and internal management system be improved. Third, a new operation mechanism should be built, the method where hospital revenues and staff income were closely tied to drug prescriptions be eliminated, medical service price should be coordinated and government should live up to its responsibilities. Fourth, the drug supply security system should be improved and drugs and high-value medical consumables costs brought down. Drug distribution management and procurement process supervision should be enhanced. Fifth, reform on medical insurance payment method should be deepened, and various medical insurances should be used to regulate, guide and supervise medical service behavior and costs. Sixth, a salary system that fits the medical industry should be established and personnel management and medical worker evaluation system should be improved. Seventh, capacity and information development should be strengthened at county-level public hospitals. Eighth, intensive allocation of medical resources should be encouraged, work coordination mechanism that connects personnel from top to bottom should be built and tiered system of medical care services should be advanced. Ninth, service supervision should be strengthened and unreasonable hike in medical costs should be curbed.

The basic goal of urban public hospital reform boils down to establishing a new mechanism and pattern and letting the public receive more benefits. The establishment of a new mechanism calls for elimination of profit-oriented mechanism at public hospital and founding a new operation mechanism and modern hospital management system that maintain public welfare, give incentives to medical personnel and are sustainable. The work needs government officials' responsibilities in management and supervision. It will give the public more benefits, motivate medical workers and ensure sustainable funds to drive hospital development. Establishment of a new pattern requires relevant personnel to change the unbalanced public hospital resource distribution, as well as the isolated work relations among various medical facilities. Big hospitals are overcrowded, while patients are thin on the ground at community-level facilities. Quality medical resources should trickle down to primary medical facilities and medical service system featuring reasonable layout and coordinated work should be established. Guidance should be given to help foster a reasonable tiered system of medical care service and medical service structure, so the public can get access to safe, effective, convenient and cheap basic medical and healthcare services

Three principles should be abided by in deepening urban public hospital comprehensive reform. First, reforms should be linked. Medical treatment and insurance as well as drug reforms should be advanced simultaneously, and regional public hospitals reform should be in sync. Coordination and linkage between public hospital and community-level medical facilities should be strengthened. Social capital-funded medical development should be coordinated. A good environment should be created for public hospital reform. All reforms should be systematic, integral and coordinated and reach superimposed effect. Second, differentiated guidance should be given. There are approximately 6,800 urban public hospitals nationwide with different functions and roles, and their locations feature different economic and social development. Therefore, differentiated guidance on medical insurance payment, price adjustment and worker evaluation should be given to those hospitals. Measures should be adjusted to local conditions and specific implementation plans should be formulated. Third, innovation should be insisted on. At the moment, public hospital reform is dealing with problems and marching forward. Regions should be encouraged to make bold explorations and innovations, break policy and profit barriers and establish practical mechanism.

Urban public hospital reform should focus on the following tasks. First, the method where hospital revenues and staff income were closely tied to drug prescriptions should be eliminated. A new public hospital operation mechanism should be established. All public hospitals at pilot cities should separate the clinic from the pharmacy, eliminate a system where drugs are sold at higher prices than wholesale (not including traditional Chinese medicine decoction pieces), and build scientific compensation mechanism. Second, public hospital management system should be reformed to build a modern hospital management system. Rights and obligations among government, public hospital, patients and other social parties should be reasonably defined. A coordinated and checks-and-balances mechanism among decision-making, execution and supervision authorities should be constructed. Third, medical insurance's role in payment and supervision should be strengthened. The payment method reform should cover all public hospitals in the same region and take steps to include all medical services. Links between various medical insurance systems should be enhanced and public medical costs should be brought down. Fourth, a salary system that fits the medical industry should be developed. Personnel employment system should undergo reform, and a public hospital should have autonomy in choosing medical workers. The salary reform should reflect medical worker's value, improve performance evaluation, give incentives to workers to improve services and raise public satisfaction. Fifth, service system where various medical facilities enjoy coordinated development should be set up. Work coordination mechanism that connects personnel from top to bottom should be strengthened. Talent cultivation should be strengthened and service capacity should be upgraded. Social forces should be categorized and encouraged to participate in public hospital reform and expand service resources to satisfy different needs. Sixth, things should be speeded up to develop the tiered system of medical care services, where patients with minor ailments will be encouraged to go to local community-level medical institutions for treatment to allow the higher-level hospitals to concentrate on the diagnosis and treatment of serious illnesses with multi-tier diagnosis and treatment trials in urban public hospitals. Primary service capacity should be upgraded and signed general practitioner service should be advanced to enhance public confidence in community-level medical and health services. Medical insurance payment policy should be improved to adapt to the tiered system of medical care services. Transfer treatment channels should be smoothed to help guide the public in reasonably seeking medical assistance. Seventh, medical and healthcare information development should be accelerated. Regional population health information platform should be developed. Information coordination and sharing concerning public health should be realized by degrees. A new model featuring comprehensive regulation, scientific decision-making and fine service should be developed. A healthcare information action plan that benefits the public should be fully implemented to make it convenient for the public to seek medical treatment.