第一篇：醫改方案英文版

中共中央國務院

關于深化醫藥衛生體制改革的意見

參考譯文

Opinions of the CPC Central Committee and the State Council on Deepening the

Health Care System Reform

In the spirit of the 17th CPC National Congress, for the purpose of establishing a health care system with Chinese characteristics, of gradually realizing the goal that everyone is entitled to basic health care services, and of raising the health level of the Chinese people, we hereby put forward the following opinions on deepening the health care system reform.I.Fully recognizing the importance, urgency and arduousness of deepening the health care system reform

The health care sector is a major livelihood issue, as it is closely related to the health of billions of people and the happiness of every household.To deepen the health care system reform, quicken the development of health care sector, meet the people’s ever increasing health care demands, and continuously improve the people’s health is an inevitable requirement of implementing the Scientific Outlook on Development and accelerating economic and social development in a coordinated and sustainable manner, an important measure to maintain social fairness and justice and improve the quality of people’s life, and also a major task of building moderately prosperous society in an all-round way and constructing harmonious socialist society.Since the founding of the People’s Republic of China in 1949, and since the beginning of the reform and opening-up in particular, China’s health care sector has made remarkable achievements.A health service system covering both urban and rural residents has basically come into being;the disease prevention and treatment capacity has been continuously strengthened;the population covered by health care has gradually expanded;health science and technology level has rapidly risen;the people’s health level has been markedly improved;and the major resident health indexes now rank among the highest in the developing countries.Since the major victory won in combating SARS in particular, governments at various levels have increased their investment, the development of public health, rural health care and urban community health care has been accelerated, and the New Rural Cooperative Medical Scheme and the basic medical insurance system for urban residents have made breakthroughs, all of which have laid a solid foundation for deepening the health care system reform.At the same time, however, we must be aware that there is still a rather prominent contradiction between the current development level of China’s health care sector and the people’s health demands and the requirements of balanced socio-economic development.Health care undertakings are developing unevenly between urban and rural areas and among different regions;resource allocation is unreasonable;the work of public health as well as rural and community health care is comparatively weak;the medical insurance system is incomplete;pharmaceutical production and circulation order is not well regulated;the hospital managerial system and operational mechanism are imperfect;government investment in health is insufficient;medical costs are soaring, individual burden is too heavy, and therefore, the people’s reaction is very strong.Featuring arduous health care tasks, the period from now to 2020 is crucial for China to build moderately prosperous society in an all-round way.Along with economic development and improvement of people’s living standards, the people will make higher demands on bettering health care services.Industrialization, urbanization, population aging, disease spectrum change, eco-environmental change and other factors pose a series of new and serious challenges to the health care work.To deepen the health care system reform is a strategic choice to accelerate the development of health care undertakings, an important channel to realize the goal of enabling people to share the achievements of reform and development, and an urgent aspiration of the broad masses of the people.Deepening the health care system reform is a difficult social systemic project involving broad aspects.China has a large population, low per capita income, significant urban-rural and regional disparities, and will be at the primary stage of socialism for a long period of time.These basic national conditions determine that the task of deepening the health care system reform is extremely complicated and arduous, and that it will be a gradual process.Therefore, only through long and arduous endeavors and perseverant explorations on the basis of specified directions and framework can we progressively establish a health care system in line with the country’s actual national conditions.To ensure the reform proceed smoothly and reach the expected goals, not only the reform should be pushed forward with firm determination, but also the work be well organized and steadily implemented.II.The guidelines, basic principles and overall goal of deepening the health care system reform

(i)The guidelines for deepening the health care system reform It should be guided by the important thoughts of Deng Xiaoping theory and Three Represents;it should implement in depth the Scientific Outlook on Development;it should proceed from China’s national conditions, and draw on the useful international experience;it should aim at achieving the goal of ensuring basic health care services for everyone, and emphatically address the problems concerning the most direct and real interests of the people or the ones that the people are most concerned about.It should adhere to the commonweal nature of public health care;it should adhere to the policy of regarding prevention as the main task and the rural areas as the focal point, and of laying equal stress on traditional Chinese medicine(TCM)and western medicine;it should implement separation between government agencies and public institutions, between government administration and business operations, between medical and pharmaceutical services, and between profit and non-profit;it should strengthen government responsibility and investment, improve national health policies, perfect institutional systems, enhance supervision and regulation, promote institutional innovations, and encourage social participation, so as to construct a basic health care system covering urban and rural residents, continuously raise the health level of the entire population, and promote social harmony.(ii)The principles for deepening the health care system reform The health care system reform must be firmly based on the country’s basic conditions and proceed from reality, adhere to the right reform principles.-We should adhere to the people-first principle and attach primary importance to safeguarding the rights and interests of the people’s health.We should adhere to the tenet of serving the people’s health with health care undertakings;regard safeguarding the people’s health as the center, and take the entitlement of basic health care services to everyone as the fundamental aim and outcome;make sure that the principle of commonweal nature be complied with throughout the entire process, from designing the reform program, establishing the health system, to constructing the health care service system;ensure that the basic health care system be public goods provided to the entire population;emphatically resolve the prominent problems to which people strongly react, and strive to achieve the goal of ensuring that health care services be available to the entire population.-We should adhere to finding a foothold in China’s national conditions and build the health care system with Chinese characteristics.We should adhere to proceeding from the country’s basic conditions, sum up the practical experience of the reform and development of China’s health care undertakings by seeking truth from facts, and accurately identify the law of development and principal challenges of health care undertakings;adhere to ensuring that the basic health care service level is in coordination with the socio-economic development, and in conjunction with the affordability of the people;bring the role of TCM(including ethnic minority traditional medicine)into full play;adhere to positioning on local conditions, specifying guidance for different localities, giving full play to local initiatives, and exploring with the aim to establishing the basic health care system conforming to the country’s national conditions.-We should adhere to the unity of fairness and efficiency and combine government’s leading role with the role of market forces.We should intensify government’s responsibility in the basic health care system, strengthen governmental functions in institutionalization, planning, fund-raising, service provision, supervision and regulation, etc., safeguard the commonweal nature of public health care system, and advance fairness and justice.In addition, we should emphatically give full play to the role of market forces, call on social participation, promote the formation of orderly competition mechanism, upgrade operational efficiency, service level and quality of the health care system, and satisfy the people’s multi-layer and diversified demands for health care services.-We should adhere to overall planning and all-round consideration and combine resolving currently prominent problems with improving the institutional system.We should proceed from taking the overall situation into consideration, balance urban and rural development and development among different regions, reconcile the interests of the supplier, the customer and other stakeholders, emphasize the combination of prevention, treatment and rehabilitation, and appropriately handle the relationship among government, health care institutions, pharmaceutical enterprises, health care workers and the people.We should be far-sighted and engage in institutional innovations on the one hand, and focus on current situation and emphatically tackle the prominent problems of the health care system on the other hand;We should pay adequate attention to the overall design, clarify the overall reform direction, objective and basic framework on the one hand, and highlight the key points, conduct step-by-step implementation, and actively and prudently press ahead with the reform on the other hand.(iii)The overall goal of deepening the health care system Establish and improve the basic health care system covering urban and rural residents, and provide the people with secure, efficient, convenient and affordable health care services.By 2011, the basic medical security system shall have completely covered urban and rural residents, the essential medicines system shall have been preliminarily established, urban and rural grass-roots health care service system shall have been further strengthened, the basic public health services shall have been available far and wide, pilot projects for reforming state-owned hospitals shall have made breakthroughs, the accessibility to the basic health care services shall have been improved markedly, residents’ burden of medical costs shall be effectively reduced, and the problem of “difficult and costly access to health care services” shall have been remarkably relieved.By 2020, the basic health care system covering urban and rural residents shall have been fundamentally established.We shall have set up, across the country, a fairly complete public health service system and health care service system, a comparatively sound medical security system, a secured and relatively well regulated pharmaceutical supply system, a comparatively sound health care institution management and operational system, a multi-sponsored medical configuration shall be formed, everyone shall have access to the basic health care services, the multi-layer demands of the people for health care services shall be met preliminarily, and the health level of the people shall be further enhanced.III.Improving four major health care systems and establishing the basic health care system covering urban and rural residents

Four systems covering urban and rural residents shall be established, including the public health service system, health care service system, medical security system, and a secured pharmaceutical supply system, with an aim to forming a “four in one” basic health care system.The four systems shall be constructed in conjunction with each other, supplement each other and develop in a coordinated way.(iv)Strengthening the construction of the public health service system in an all-round way Efforts should be made to establish and improve professional public health service networks, which include diseases prevention and control, health education, maternity and child care, mental health, emergency treatment, blood collection and supply, hygiene supervision, family planning, and etc.;improve the public health service functions of the basic health care service system, which is based on grass-roots health care service network;establish a public health service system featuring a clear-cut division of work, information-exchanging, resource-sharing, coordination and interaction;improve the capacity to deal with public health service and public health emergencies, and make equalized basic public health services gradually available to urban and rural residents.Efforts should be made to identify the scope of public health services.Clarify the national basic public health service items, and increase step by step the service contents.Encourage the local governments to increase, in accordance with the local economic development level and prominent public health problems, their public health service contents on the basis of the service items defined by the central government.Efforts should be made to improve the public health service system.Further clarify the functions, goal and tasks of the public health service system, optimize personnel and equipment configurations, and explore the effective means of integrating public health service resources.Perfect the major diseases prevention and control system as well as public health emergency mechanism, strengthen the surveillance, prevention and control of the diseases that severely threatening the people’s health, such as infectious diseases, chronic diseases, endemic diseases, occupational diseases, birth defects, and so on.And strengthen the construction of urban and rural first-aid system.Efforts should be made to strengthen health promotion and education.Health care institutions, government agencies, schools, communities, enterprises, etc.shall massively carry out health education, take full advantage of various media, strengthen the dissemination of medical and health knowledge, advocate healthy and civilized lifestyle, promote rational nutrition among the public, and enhance the health awareness and self-care ability of the people.Efforts should be made to implement in depth the patriotic public health campaign.Integrate the rural environmental sanitation and environmental pollution treatment into the new socialist rural construction plan, promote the construction of “Hygienic Cities and Civilized Villages and Towns”, and continuously improve the environmental sanitation of life and work of urban and rural residents.Efforts should be made to strengthen hygiene supervision services.Intensively promote environmental sanitation, food hygiene, occupational health, school health as well as the health services for floating population, such as migrant workers, etc.(v)Further improving the health care service system A rationally structured health care service system covering urban and rural residents should be established by adhering to the operational principle of taking the non-profit health care institutions as the main body, for-profit health care institutions as the supplement, with the state-owned institutions playing a leading role, while non-state-owned health care institutions making synergies in the development.Efforts should be made to energetically develop the rural health care service system.Efforts should be made to further complete the rural health care service network with county-level hospitals as the bellwether, township health centers and village clinics as the basis.As the intra-county health care center, the county-level hospitals shall be mainly in charge of the basic health care services, treating and saving patients with severe or acute diseases, as well as take the responsibility of providing professional and technical guidance to township health centers and village clinics and offering further education and training to the health care workers of two latter institutions.The township health centers shall take the responsibility of providing public health services and comprehensive services of diagnosing and treating the commonly or frequently encountered diseases, and of offering professional management over and technical guidance to village clinics, which shall, in turn, take the responsibility of the administrative villages’ public health services, the diagnoses and treatment of general diseases and other services.An integrated approach shall be adopted to manage both the township health centers and village clinics in the rural areas where conditions permit.Efforts should be made to actively promote the construction of rural health care infrastructure and capacity building.The government shall focus on the well-running of the county-level hospitals and a health center in each town, support the construction of village clinics through various ways, and ensure that each administrative village have a clinic, so as to vigorously improve rural health care conditions and upgrade service quality.Efforts should be made to improve the new urban health care service system on the basis of community health care services.Quicken the building of the urban community health care service network with community health centers as the main body, and improve service functions.With safeguarding the community residents’ health as the focal point, provide them with public health services such as diseases prevention and control, preliminary diagnoses and treatment of the general, commonly and frequently encountered diseases, chronic diseases management and rehabilitation services.Transform the community health care service mode, continuously raise the service level, take the initiative to offer services, provide household visits, and gradually assume the responsibility and duties of the “gate-keeper” for residents’ health.Efforts should be made to complete the functions and responsibilities of various hospitals.Efforts should be made to optimize the configuration and structure, give full play to the backbone role of urban hospitals in terms of diagnoses and treatment of dangerous, severe and acute diseases as well as difficult and complicated diseases, medical education, research, guiding and training grass-roots health care workers, and etc.Conditions permitting, major hospitals may, in light of demands of the regional health planning, promote the rational flowing of health care resources through means of trusteeship, reorganization, and etc.Efforts should be made to establish the mechanism of labor division and work coordination between urban hospitals and community health service institutions.Urban hospitals shall, through technical support, personnel training and other ways, lead the sustainable development of community health services.Meanwhile, urban hospitals shall take such comprehensive measures as strengthening service capacity, reducing fees and charges, raising reimbursement ratio and etc.to guide general diagnosis and treatment down to grass-roots medical institutions, and gradually achieve the goal of the initial diagnosis to be conducted in community health centers, classification of medical treatments, and dual referral.Efforts should be made to integrate urban health resources, make full use of existing sources, such as primary and secondary urban hospitals, health care institutions affiliated to state-owned enterprises and public institutions and other privately-run medical institutions, and develop and improve the community health service network.Efforts should be made to bring into full play the role of TCM(including ethnic minority traditional medicine)in the prevention and control of diseases, public health emergency response, as well as in health care services.Reinforce the construction of TCM clinical research bases and TCM hospitals, organize and carry out the joint research of preventing and treating difficult and complicated diseases with TCM.Vigorously promote appropriate TCM techniques in grass-roots health care services.Take up favorable policies to foster TCM development, and promote the inheritance and innovations of TCM.Efforts should be made to establish the system of urban hospitals offering counterpart support to rural health care.The developed regions shall reinforce their counterpart support to the development of health care undertakings in the poverty-stricken regions and ethnic minority regions.Major urban hospitals shall establish long-term stable counterpart support to and cooperation with county-level hospitals, assisting the latter to improve health care level and service capacity through clinical practice, staff training, technical guidance, equipment support and other ways.(vi)Quickening the construction of the medical security system Efforts should be made to quicken the construction and improvement of the multi-layer medical security system covering urban and rural residents, with the basic medical security as the main body, and other diversified supplemental medical insurance and commercial health insurance as the supplement.Efforts should be made to establish the basic medical security system covering urban and rural residents.The basic medical security system shall be jointly composed of urban employees’ basic medical insurance, urban residents’ basic medical insurance, New Rural Cooperative Medical Scheme and urban-rural medical assistance system, covering urban employees, urban non-employees, rural population, and urban and rural economically strained residents, respectively.Efforts should be made to adhere to the principle of covering a wide coverage, ensuring basic medical services and pursuing sustainable development, proceed from emphatically ensuring the treatment of major diseases, gradually extend to the ailments for clinics, and continuously raise the medical security level.Efforts should be made to establish a multi-channel fund-raising mechanism featuring a clear-cut division of responsibility of the government, employer, family and individual, and rational expense-sharing proportions, so as to achieve social mutual-aid.Along with economic and social development, efforts should be made to uplift the fund raising and pooling levels step by step, narrow the gap between different insurance schemes, and eventually achieve the fundamental unity of those schemes.Efforts should be made to further complete urban employees’ basic medical insurance system, quicken the coverage of the employed population, emphatically address basic medical insurance problems of employees and retirees of the closed-down or bankrupted state-owned enterprises and enterprises with financial difficulties, employees of non-public economic sectors as well as temporary contract workers;fully implement the urban resident basic medical insurance in 2009, and lay stress on tackling basic medical insurance problems concerning the aged, the disabled and the children;fully implement the New Rural Cooperative Medical Scheme, progressively raise the government subsidy level, and appropriately increase the farmers’ contributions, so as to enhance the medical security capacity;upgrade the urban and rural medical assistance system, subsidize those who are economically strained for the premium payment，and subsidize them for their unbearable medical expenses, by this way to build a firm medical security baseline.And efforts should be made to explore the establishment of management mechanism for an integrated urban and rural basic medical security system.Efforts should be made to encourage trade unions and other social groups to carry out diversified mutual aid activities for health care, and encourage and guide various organizations and individuals to develop charity medical assistance.Efforts should be made to properly link the urban employees’ basic medical insurance system, urban residents’ basic medical insurance system, New Rural Cooperative Medical Scheme and urban and rural medical assistance system.Efforts should be made to actively and properly conduct the transferal and continuation of basic medical insurance credentials from one region to another, laying stress on the migrant workers floating between urban and rural areas;improve the settlement services for treatment received allopatry, focusing attention on the retirees settled in places other than the locality where they used to work;properly address basic medical insurance issues concerning migrant workers;in light of government regulations, clarify the contribution obligations of enterprises with whom migrant workers sign employment contracts and establish steady labor relationship, and such migrant workers shall be integrated into urban employees’ basic medical insurance system;other migrant workers may participate, in accordance with their actual situation, in the New Rural Cooperative Medical Scheme of the places of their origin, or the urban residents’ basic medical insurance of their work locations.Efforts should be made to actively develop commercial health insurance.Encourage commercial insurance agencies to develop health insurance products to meet different demands, simplify claim formalities, provide convenience to the people, and satisfy diversified health demands.Encourage enterprises and individuals to resolve their demands beyond the basic medical insurance through participating in commercial insurance and diversified supplemental insurance.On the premise ensuring fund security and effective supervision, actively advocate, in the form of government purchase of medical security services, to explore the possibility of entrusting qualified commercial insurance agencies with handling various medical security management services.(vii)Establishing and completing a secured pharmaceutical supply system Efforts should be made to accelerate the establishment of a secured pharmaceutical supply system on the basis of the national essential medicines system, and ensure medicine safety for the people.Efforts should be made to establish the national essential medicines system.The central government shall unitarily formulate and issue national essential medicines list, and rationally determine the categories and quantities of medicines in line with China’s medication characteristics and with reference to international experience;in this process, the following principle shall be adhered to, i.e., medicines selected must be necessary for disease prevention and treatment, must be safe and effective, must be of reasonable price, must be convenient to use, and equal stress must be laid upon TCM and western medicines.Efforts should be made to establish a secured production and supply system of essential medicines, and bring market forces into full play under government macro-control;open tender and unified distribution shall be adopted for the essential medicines procurement, and the intermediary links shall be reduced, so as to ensure the people’s access to the essential medicines.The central government shall set government-guided retail prices for the essential medicines, within which, the provincial people’s government shall determine unified purchasing prices of its own region according to its actual situation of tender invitation.Efforts should be made to regulate the use of the essential medicines, and formulate the essential medicines clinical application guide and formulary.All urban and rural grass-roots health care institutions shall be equipped with and use the essential medicines for medication, and other various health care institutions shall also take the essential medicines as their primary choice remedy, and ascertain the due application proportions.All essential medicines shall be integrated into the reimbursement list of basic medical insurance, with markedly higher reimbursement proportions than those of non-essential medicines.Efforts should be made to regulate pharmaceutical production and circulation.Efforts should be made to improve development policies and programs for the pharmaceutical industry, enforce rigorous market access and drug registration and approval, vigorously regulate and consolidate the production and circulation order, promote independent innovation capacity of pharmaceutical enterprises and optimize and upgrade the structure of the pharmaceutical industry, develop modern drug logistics and chain-store operations, and promote the integration of drug production and circulation enterprises.Efforts should be made to establish the rural drug supply network offering more convenience to the people and more benefit to farmers;improve the drug reserve system;support the production of small-quantity special medication and first-aid medicines;regulate medicine procurement and resolutely crack down on commercial bribery in pharmaceutical procurement and sales;strengthen the surveillance of drug adverse reaction and establish early warning and emergency response mechanism for drug safety.IV.Improving institutional mechanism, ensuring effective and well regulated operations of the health care system

Efforts should be made to improve the health institutional mechanisms, involving management, operation, investment, price and supervision, reinforce the development of science, technology, professional talents, information and legal system, and ensure that the health care system shall operate in an effective and well regulated way.(viii)Establishing a coordinated and unified health care administration system Efforts should be made to implement localization and sector-wide administration.Each health care institution, regardless of their ownership, investor, administrative affiliation, business operation category, shall be subject to the unified planning, access and regulation implemented by the health administrative department in the location concerned.The central and provincial governments may establish limited number of medical centers or regional centers undertaking medical research and teaching functions, as well as specialized hospitals undertaking the diagnoses and treatment of the difficult and complicated diseases across the country or a region.County(city)governments shall mainly take the responsibility of establishing county-level hospitals, village and community health service institutions;and other public hospitals shall be established by the cities.Efforts should be made to strengthen regional health planning.Provincial governments shall formulate allocation criteria for health resources, organize the formulation of regional health planning and plans for setting up health care institutions, and define the quantity, scale, layout and functions of health care institutions.Efforts should be made to rationally formulate the construction and equipment configuration standards for township health centers(village clinics), community health centers(stations)and other grass-roots health care institutions and hospitals at various levels.Efforts should be made to make full use of and optimize the distribution of existing health care resources, gradually integrate and consolidate health care institutions that are inconsistent with requirements of relevant plans, strictly control the deployment of large-sized medical equipment, encourage joint construction and sharing, and enhance the utilization efficiency of medical and health resources.The newly added health resources must be in conformity with regional health planning, and priority should be given to weak areas such as rural and community health services.Efforts should be made to strengthen the connection between regional health planning and urban-rural development plans, land use overall plans and etc;establish the monitoring and assessment mechanism for regional health planning and resource allocation.Efforts should be made to promote the reform on the administration system for public hospitals.The reform shall be conducive to reinforcing of the commonweal nature of public hospitals and the effectiveness of government regulation, and actively explore diversified forms for effectively realizing the separation of functions of government agencies and public institutions, and separation of administration and business operations.Efforts should be made to further transform government functions, with health administrative departments mainly taking the responsibility of sector administration functions, such as health development planning, review of qualification and access, formulation of rules and standards, supervision and regulation on services, and etc., and other departments concerned, each according to their own functions, conducting administration and providing services.Efforts should be made to put into effect the independent corporate status of public hospitals.Efforts should be made to further improve the basic medical insurance management system.The central government shall unitarily formulate the framework and policies of the basic medical insurance system, while local governments shall take the responsibility of organizing the implementation and management, create conditions for gradually uplifting the level of fund-pooling.Efforts should be made to effectively integrate the resources handling the basic medical insurance, and progressively achieve unified administration of urban and rural basic medical insurance.(ix)Establishing an efficient and well regulated operation system for health care institutions All expenditures and revenues of public health institutions shall be integrated into budget management.In light of the duties and tasks of the said institutions, the government shall rationally determine their staff size, salary level, and budget scale, clarify the duties of various positions, exercise rigorous staff enrolment criteria, strengthen performance assessment, establish the staff placement system on the basis of competitive selection, and improve work efficiency and service quality.Efforts should be made to transform the operation mechanism of grass-roots health care institutions.As for the government-sponsored grass-roots health care institutions, such as urban health service centers(stations)and township health centers, their service functions shall be strictly defined, and the use of appropriate techniques, equipment and essential medicines be clearly required;and the said institutions shall provide the people with low-cost services, and maintain their commonweal nature.Efforts should be made to strictly verify the staff size, implement personnel employment system, and establish the human resources management system featuring competitiveness, motivation and efficiency;clarify the scope and standard of expenditure and income, implement financial management measures, including task verification, expenditure and revenue verification, performance assessment and subsidy;explore the possibility of implementing diversified effective management methods, such as separate management of expenditure and revenue, prepayment of the total amount of public health and basic medical insurance funds, exercise strict management of expenditure and revenue budgeting, and increase the funds utilization efficiency;reform the drug margin policy and implement drug sale with no markup;strengthen and improve internal management, establish an evaluation and incentive system with service quality as the core, and post responsibility and performance as the basis, and form a long-term mechanism ensuring fairness and efficiency.Efforts should be made to establish a well regulated operational mechanism of public hospitals, which shall comply with the principle of commonweal nature and social benefits, adopt a patient-oriented approach, optimize service process, and regulate medication, examination and treatment.Efforts should be made to deepen the operation mechanism reform, establish and better the hospital corporate governance structure, specify rights and responsibilities of owners and managers, and form a mechanism featuring check and balance of policy-making, implementation and supervision, and integrating responsibility, incentives, restraints, competitiveness and vitality.Efforts should be made to promote the separation between health care services and drug sale, and actively explore diversified effective ways to gradually reform the mechanism of compensating the medical cost through drug sale;gradually reform or rescind the drug margin policy through implementing differentiated price markup between drug purchase and sale and through setting up prescription service fees;meanwhile, improve the compensation mechanism of public hospitals through appropriately adjusting health care service prices, increasing government investment, reforming methods of payment, and etc.Efforts should be made to further improve the financial and accounting management system, implement rigorous budget management, and strengthen financial regulation and operation supervision.Local governments may, in line with local circumstances, conduct pilot projects of diversified management methods in hospitals where conditions permit, for instance, methods such as “expenditure and revenue verification, compensating expenditure with revenue, turning in the surplus, subsidy for the gap, clear-cut reward and penalty”.Efforts should be made to reform the human resources system, improve income distribution and incentives, promote the employment system and post management system, enforce rigorous management on total salary, implement the system of comprehensive performance evaluation and post-performance based salary in line with service quality and workload, and effectively mobilize the initiatives of health care workers.Efforts should be made to construct a sound operation system for institutions handling medical insurance, including completing the internal governance structure, establishing a reasonable staff placement mechanism and a fair distribution system, improving the incentive and restraint mechanism, and enhancing the handling capacity and management efficiency of medical insurance.(x)Working out a multi-source health investment mechanism with the government playing the dominant role Efforts should be made to specify the health investment responsibility of the government, society and individuals;establish the dominant position of the government in providing public health and basic health care services.The public health services shall be mainly provided, through government funding, to urban and rural residents in an equalized way.The expenses of the basic health care services shall be rationally proportioned and borne among the government, society and individuals.And special health care shall be directly paid for by individuals or borne by commercial health insurance.Efforts should be made to construct and improve the government health investment mechanism.Both the central and local governments shall increase their health investment, and reconcile the needs of both the supplier and the recipient.Gradually raise the proportion of government investment in the total health expenditure, and effectively alleviate individual residents’ burden in terms of basic health care expenses;the growth rate of government health investment shall be higher than that of the current financial expenditure, so as to gradually increase the proportion of government health investment in the current financial expenditures.The newly added government investment shall be emphatically used in supporting public health, rural health, urban community health and basic medical security.In light of the principle of burden-sharing at all government levels, efforts should be made to rationally divide the health investment responsibility among the central government and local governments at various levels.The local governments shall take the principal responsibility, while the central government shall mainly subsidize national immunization program, interregional prevention and control of major communicable diseases and other issues of public health, basic medical security of urban and rural residents as well as the development of relevant public-owned health care institutions.And efforts should be made to increase special transfer payments by the central and provincial governments to financially constrained regions.Efforts should be made to improve the mechanism of government investment in public health.Regarding specialized public health service institutions, the funding for their staff, development, construction and operations shall be appropriated in full amount by the government, and the legitimate service income of the said institutions shall be turned over to be kept in a special fiscal account or integrated into budget management.Gradually increase the average per capita public health funding, and complete a secured mechanism for public health service funding.Efforts should be made to improve the mechanism for government investment in urban and rural grass-roots health care institutions.The government takes the responsibility of providing funding for the basic construction, equipment purchasing and staffing for the government-sponsored township health centers, urban community health centers(stations), as well as the operational funds for offering public health services so that the said institutions can fully function.As to all the township health centers and urban community health service institutions sponsored by various non-public sponsors, local authorities may set due government subsidies through ways such as purchasing services and etc.Efforts should be made to support the construction of village clinics, and grant reasonable subsidies to rural doctors who take the responsibility of fulfilling such tasks as public health services and etc.Efforts should be made to implement the policy of granting government subsidies to public hospitals.Gradually increase the government investment, which shall be mainly used for basic construction and equipment procurement, development of key subjects, funds for retirees in conformity with the state regulations concerned, and subsidies for policy-related losses, and be also used for granting special subsidies to government-sponsored tasks, such as public health services, etc.All these shall aim to a well-regulated and sound mechanism of government investment in public hospitals.In terms of investment policies, preference shall be given to TCM hospitals(including ethnic minority hospitals), gynecology and obstetrics hospitals, children’s hospitals, and hospitals specialized in prevention and treatment of communicable diseases, mental disorders, occupational diseases, and etc.Efforts should be made to strictly control the construction scope, standards and loan-taking of public hospitals.Efforts should be made to improve the mechanism of government investment in the basic medical security.The government shall appropriate necessary funds to support the development and improvement of the New Rural Cooperative Medical Scheme, urban residents’ basic medical insurance, urban employees’ basic medical insurance as well as urban and rural medical assistance system;guarantee normal funding of the relevant institutions handling the above tasks.Efforts should be made to encourage and guide social capital to sponsor health care undertakings.Actively promote the development of non-public health care institutions, and form a health care system with multiple categories of investors and diversified investment modes.Waste no time in working out and complete relevant policies and regulations, regulate the access conditions of social capital, including overseas capital, for sponsoring health care institutions, and complete sector-wide administration policies featuring fairness and justice.Encourage social capital to sponsor non-profit health care institutions in accordance with the law.The government shall work out guiding opinions on the system reform of public hospitals, and actively guide social capital to participate in the system reform and reorganization of some public hospitals, including the hospitals sponsored by state-owned enterprises.Steadily launch pilot projects in the system reform of public hospitals, appropriately reduce the proportion of public health care institutions, and form the configuration of public hospitals and non-public hospitals featuring mutual promotion and common development.Support the qualified personnel to start business in accordance with the law and provide people with convenient access to health care services.Improve the classified administration policy and preferential taxation policy for health care institutions.Strengthen, in accordance with the law, the regulation on the health care services sponsored by non-public investors.Efforts should be made to energetically develop medical charity undertakings.Work out relevant preferential policies to encourage non-public entities to sponsor charity health care institutions, or make charity donations to medical assistance and health care institutions, and etc.(xi)Establishing a sound health care pricing system Efforts should be made to regulate the management on health care service pricing.As to the basic health care services provided by non-profit health care institutions, the government-guided pricing shall be used, and the other services shall be priced independently by health care institutions.The central government shall take the responsibility of formulating pricing policies, items, pricing principles and methods for health care services;the provincial or municipal competent pricing departments shall verify, in conjunction with the health, human resources and social security departments, government-guided prices for basic health care services.The basic health care services shall be priced by deducting the service cost subsidized by government funding, so as to embody the reasonable cost and technical value of health care services.The services provided by health care institutions and doctors at different levels shall be priced at different grades.Efforts should be made to regulate the pricing items and standards of public health care institutions, and explore the reform on charging methods such as Diagnoses-Related Groups Payment;establish the system for price surveillance on medical device, supervision on and auditing of the service cost of medical examination and treatment and their regular pricing adjustment.Efforts should be made to reform the drug pricing mechanism.Rationally adjust the government pricing scope, improve the pricing methods, increase transparency, encourage enterprises to be engaged in independent innovations with the price leverage, and promote the production and utilization of national essential medicines.Gradually implement the pre-pricing economic evaluation system for new and patent drugs.Implement the low price system for generic drugs when it enters the market, so as to curb the low-level repeated construction.Strictly control the price difference ratio in pharmaceutical circulation.Carry out pilot projects, such as differentiated price markup on drugs sold in hospitals, prescription service fees and etc.to guide hospitals on rational medication.Strengthen the price control and management on medical consumables and the medical appliances used for implantation(intervention)during the circulation and utilization.Optimize the medical pricing surveillance system, and regulate independent pricing behavior of hospitals.Efforts should be made to actively explore and build the negotiation mechanism for medical insurance handling institutions, health care institutions and pharmaceutical suppliers, and bring into full play the restraining role of medical security over health care services and pharmaceutical expenditures.(xii)Establishing a rigorous and effective health care regulatory system Efforts should be made to reinforce the regulation on the health care system.Complete the health supervision and enforcement system, and enhance the capacity building of urban and rural health supervision institutions.Strengthen the regulation on health care service behavior and quality, improve the health care service standards and quality evaluation system, regulate the management system and work flows, quicken the formulation of the treatment protocols, and complete the health care service quality surveillance networks.Strengthen the regulation on the admittance and operation of health care institutions.Strengthen public health regulations, including drinking water safety, occupational hazards prevention, food security, medical waste disposal, etc.and rigorously crack down, in accordance with the law, the law-breaking behavior that jeopardizes the health and life safety of the people.Efforts should be made to improve medical security regulation.Strengthen the regulation on medical insurance handling, fund management and use, etc., establish the mechanism for effective utilization of medical insurance funds and risk prevention.Strengthen the monitoring role of medical security on health care services, improve payment system, actively explore the payment methods such as capitation, Diagnoses-Related Groups as well as prepayment of total amount, etc., and establish an effective restraining mechanism that lays equal stress on incentives and penalty.Strengthen the regulation on commercial health insurance and promote sound development.Efforts should be made to strengthen pharmaceutical regulation.Strengthen government regulation responsibility, improve the regulation system, and implement strict regulation on pharmaceutical research, production, circulation, utilization, pricing and advertisement.Implement regulated quality management of pharmaceutical production, and strengthen the regulation on the production of high-risk items.Strictly implement the regulations on pharmaceutical business operation and management, explore and put in place categorized and graded licensing for the administration of pharmaceutical operation, and reinforce the supervision and sampling inspection on key categories of drugs.Establish the rural drug supervision networks.Strengthen government regulation on drug pricing, and effectively inhibit bubble prices.Regulate the clinical utilization of drugs, and bring into full play certified pharmacists’ guidance on the rational medication and pharmaceutical quality management.Efforts should be made to establish the regulation system featuring open information and multiple-stakeholder participation.Encourage social organizations, such as trade unions and individuals to exercise independent appraisal and supervision on the performance of the competent government departments, health care institutions and the relevant systems.And strengthen self-discipline in the sector.(xiii)Establishing a sustainable development mechanism for scientific and technological innovation and a secured mechanism for professional talents in the health sector Efforts should be made to promote the scientific and technological progress of health care services.Treat health care technological innovation as a priority of national scientific and technological progress, strive to tackle difficult health care issues, and provide technological safeguard for the health of the people.Increase investment in medical research, deepen the health care system reform, integrate advantageous medical research resources, quicken the implementation of key projects of medical science and technology, encourage independent innovation, reinforce the research on prevention and treatment technology of major diseases and key technology of new medicine, and strive to make new breakthroughs in basic and applied medical research, hi-tech research, research on TCM, integration of TCM and western medicine, etc.Develop and produce medical appliances conforming to China’s national conditions.And extensively carry out international cooperation and exchanges on health science and technology.Efforts should be made to reinforce the development of professional health care talents.Work out and implement the development program for professionals, emphatically strengthen the training and cultivation of health care professionals and paramedic personnel in fields such as public health, rural health, urban community health, etc.Formulate preferential policies, encourage outstanding health talents to provide their services in rural areas, urban communities and the mid-western regions.Those health professionals, who have worked for a long period of time in urban and rural grass-roots health care institutions, shall be rendered appropriate preferential policies in terms of professional title promotion, professional training, compensation policy, etc.Complete the qualification system for general practitioners, complete the on-the-job training system for the health professionals working in both rural areas and urban communities, encourage the said personnel to receive academic education, promote the professional standardization for rural doctors, and realize as soon as possible the goal that all the grass-roots health care institutions are staffed with qualified general practitioners.Reinforce the development of high-level professionals in research, medical treatment, health management, etc.Establish the standardized training system for resident physicians, and intensify continued medical education.Reinforce the development of paramedic professionals, and gradually resolve the existing problem of the low proportion of paramedic personnel.Cultivate TCM professionals and expand the team.Steadily promote the rational flow of health care professionals, facilitate diversified ways of talent exchange among different health care institutions, and explore the feasibility of multiple-site practice of certified practitioners.Regulate the qualifications for hospital managerial personnel, and gradually form a professional and specialized managerial team for health care institutions.Efforts should be made to readjust the structure and scale of higher medical education.Strengthen education on general medicine, improve standardized and regulated clinical medical education, and enhance the quality of medical education.Increase investment in medical education, intensively develop undergraduate and non-degree medical college education, which should be geared to the needs of rural areas and urban communities, adopt diversified methods such as targeted free training to cultivate health care professionals for poverty-stricken rural areas, and foster a large number of qualified medical practitioners who are devoted to rural areas and ready to serve farmers.Efforts should be made to build sound and harmonious relations between health care workers and patients.Strengthen medical ethics, pay adequate attention to the humanitarian quality cultivation and professional caliber education of the health care workers, vigorously carry forward the spirit of “healing the wounded and rescuing the dying”.Optimize the work surroundings and conditions, safeguard the legitimate rights and interests of health care workers, and arouse their enthusiasm to better services and improve efficiency.Improve the medical practice insurance, carry out medical social work, complete the mechanism for handling medical disputes, and enhance the communications between practitioners and patients.Foster in the entire society a good atmosphere of respecting medical science, health care workers as well as patients.(xiv)Establishing practical and shared health care information system Efforts should be made to energetically promote health care informatization.Focusing on promoting the informatization of public health, health care services, medical insurance, drugs, financial regulation, etc., efforts should be made to integrate resources, strengthen the construction of information standardization and public service information platform, and gradually realize unified standards, high efficiency and interrelated communications.Efforts should be made to accelerate the construction of health care information system.Improve the public health information system with the disease control network as the mainstay, and enhance the capacity for forecast, early warning, analysis and reporting;take creating resident health archives as the priority, construct the rural and community information network platform;take hospital management and electronic medical record as the priority, promote hospital informatization;take advantage of the network information technology to promote the cooperation between urban hospitals and community health service institutions.Vigorously develop the remote health care services geared to the needs of rural areas and remote and border regions.Efforts should be made to establish and improve medical security information system.Speed up the construction of the multi-functional medical security information system, including fund management, expenses settlement and control, medical behavior management and supervision, management services of employers and individuals participating in insurance programs, etc.Strengthen the information system construction of urban employee’s basic medical insurance, urban residents’ basic medical insurance, New Rural Cooperative Medical Scheme and medical assistance system, and realize its connection with the information system of medical institutions, actively promote the “All-in-One Card”(a multi-purpose card), etc.to facilitate insurance(cooperative scheme)participants to receive medical services, and increase the transparency of medical services.Efforts should be made to establish and improve the three-tier(state, province and municipality)information network of drug regulation, drug testing and drug adverse reaction surveillance.And establish the information system of supply and demand of essential medicines.(xv)Establishing and improving health care legal system Efforts should be made to improve the health legislation.Quicken the promotion of the basic health care legislation, specify the rights and obligations of government, society and residents in terms of enhancing health to ensure that everyone is entitled to the basic health care services.Establish and improve health standard system, properly deal with the connection and coordination of relevant laws and regulations, and gradually establish and improve a comparatively complete health legal system in line with the basic medical and health care system.Efforts should be made to promote government administration in accordance with the law.Exercise rigorous and regulated law enforcement, earnestly improve the capacity of the governments at various levels to develop and manage health care undertakings through legal means.Make greater efforts in the popularization of the health care law, and strive to create a legal environment that is conducive to the health of the people.V.Concentrating on five key reform projects and striving to achieve remarkable results in the near future

In order to achieve results of the reform at an earlier date, efforts should be made to implement the commonweal nature of health care services, concentrate on ensuring the people’s basic needs of seeking health care services, and in light of the requirements that the people enjoy real benefits, health care workers be encouraged and regulators can easily understand the contents of the reform, strength shall be exerted on the following five key reform projects from 2009-2011.(xvi)Accelerating the construction of the basic medical security system The basic medical security system shall completely cover urban and rural residents, and within three years, the insurance(cooperative scheme)participation rate of urban employees’ basic medical insurance, urban residents’ basic medical insurance and New Rural Cooperative Medical Scheme shall all reach over 90%;and the urban and rural medical assistance system shall cover all the economically constrained households across the country.Giving priority to improving the benefit level of insurance for in-patient treatment and major diseases treated at clinics, efforts should be made to gradually enhance the fund-raising and medical security level, and by 2010, the threshold of subsidy granted by the government at various levels shall be increased to 120 Yuan per person per annum for both urban residents’ basic medical insurance and New Rural Cooperative Medical Scheme.Regarding the basic medical insurance, efforts should be made to properly conduct the credential transfer and connection and the settlement services for receiving health care services from allopatry;improve medical security management system and mechanism and effectively alleviate the burden of medical expenses on urban and rural individuals.(xvii)Preliminarily establishing a national essential medicines system Efforts should be made to establish a relatively complete system for the selection, production and supply, use and reimbursement of essential medicines through medical insurance.In 2009, the national essential medicines list shall be released, the procurement and distribution of essential medicines regulated and the prices of the essential medicines rationally determined.From 2009, the essential medicines shall be supplied to all the government-sponsored grass-roots health care institutions for medication, other health care institutions shall also use the essential medicines as required, and all the retail pharmacies shall be supplied with the essential medicines for sale.Efforts should be made to improve the medical insurance and reimbursement policies concerning the essential medicines;ensure the availability, safety and effectiveness of the essential medicines for the people, and alleviate the burden of the essential medicines expenses on the people.(xviii)Improving the grass-roots health care services system Efforts should be made to accelerate the construction of the three-tier rural health care services network and urban community health service institutions, bring into full play of the leading role of county-level hospitals, and build a relatively complete grass-roots health care services system in three years.Efforts should be made to cultivate and train grass-roots health care professionals, particularly general practitioners, and concentrate on improving the level and quality of grass-roots health care institutions;transform the operational mechanism and service modes of grass-roots health care institutions, and improve the compensation mechanism;gradually establish the system of graded diagnoses and treatment and for dual referral, so as to provide the people with convenient, fast and low-cost basic health care services.(xix)Promoting the progressive equalization of the basic public health services The state shall work out the basic public health service items, and from 2009, gradually provide urban and rural residents with the basic public health services, including disease prevention and control, maternal and child care, health education, etc.Efforts should be made to implement national major public health service programs, effectively prevent and control major diseases as well as their hazardous elements, and further improve the capacity of tackling major public health emergencies.Improve urban and rural public health service system and optimize funds provision mechanism for public health services, so that by 2009, the standard average per capita funding for the basic public health services shall be no less than 15 Yuan, and no less than 20 Yuan by 2011.Strengthen performance appraisal, and improve the service efficiency and quality, gradually narrow the gap in the basic public health services between urban and rural residents, and strive to ensure that the people shall contract as few diseases as possible.(xx)Promoting the pilot reform on public hospitals Efforts should be made to reform the management system as well as operational and regulatory mechanisms of public hospitals, and actively explore the effective forms of separating the functions of government agencies and public institutions, separating government administration and business operation.Improve the structure of hospital corporate governance.Promote the reform on the compensation mechanism of public hospitals, increase government investment, and improve the financial compensation policy for public hospitals so that the problem of “compensating the medical cost with drug sale” can be gradually resolved.Accelerate the formation of a multi-sponsored configuration for running health care institutions, and encourage non-public investors to invest in not-for-profit hospitals.Intensively reform the internal management of public hospitals, optimize service flows, regulate diagnoses and treatment behaviors, arouse the enthusiasm of health care workers, enhance service quality and efficiency, markedly shorten patients’ waiting time, and achieve the mutual recognition of the testing and inspecting results by different hospitals of the same level.Strive to facilitate the people to receive proper health care services.VI.Actively and steadily promoting the health care system reform

(xxi)Raising awareness and strengthening leadership Party committees and governments at various levels shall fully understand the importance, urgency and arduousness of deepening the health care system reform, raise awareness, proceed with confidence, earnestly reinforce organization and leadership, put people’s access to health care services high on the agenda as one priority of improving people’s livelihood and expanding domestic demand, make clear division of work, and fulfill the public health care responsibilities of the government.The State Council shall form a leading group in charge of deepening the health care system reform, and organize the implementation of deepening the health care system reform in a coordinated way.The departments concerned under the State Council shall conscientiously fulfill their duties and responsibilities, closely cooperate with each other, form a concerted force and strengthen supervision and evaluation.In light of the requirements of this document and its Implementation Plan, the various local governments shall, based on their actual conditions, work out the concrete implementation plans and effective measures, carry out intensive organization work, promote the reform driving in an orderly way, and ensure that the reform results shall benefit the entire population.(xxii)Prioritizing key issues and conducting step-by-step implementation It is a long-term task to establish the basic health care system covering urban and rural residents, so we should adhere to the combination of long-term and short-term prospective.Proceed from the basis and grass-roots level, with the recent reform projects focusing on the five key areas, including the basic medical security system, national essential medicines system, grass-roots health care service system, equalization of the basic public health service and pilot reform projects of public hospitals.We should lose no time in formulating the operation documents and specific plans to further deepen and elaborate the policy measures, specify the implementation steps, properly conduct coordination and conjunction, and promote the various reforms in a balanced way.(xxiii)Launching pilot projects with gradual dissemination As the health care reform involves broad aspects, complex situations and strong policy-orientation, for some major reforms, we must experiment with pilot projects.The State Council Leading Group of Deepening the Health Care System Reform is in charge of formulating the principles and policy framework for pilot programs, conducting coordination on the basis of overall planning, and guiding the work of the various pilot sites.Each province(autonomous region and municipality)shall formulate the specific pilot programs and organize the implementation.Different local governments are encouraged to carry out diversified pilot projects on the basis of their actual conditions, and actively explore the effective channels of implementation.The experience shall be summarized on a timely basis, and gradually disseminated to other areas.(xxiv)Strengthening publicity and correctly guiding public opinion It requires the understanding, support and participation from all social sectors and the people to deepen the health care system reform.We shall stick to a correct orientation of public opinion, disseminate far and wide the great significance and major policy measures of the reform, actively guide the social expectancy, reinforce the people’s confidence, so that the reform, which shall benefit the people, can find its way deep into the people’s heart and create a sound public opinion environment for deepening the reform.

第二篇：山東省醫改方案

山東省“十二五”醫改實施方案

2012年5月22日公布

省政府昨天召開全省深化醫藥衛生體制改革工作會議，同時印發《山東省“十二五”期間深化醫藥衛生體制改革規劃暨實施方案》。根據方案，到2015年，群眾看病負擔將明顯減輕，個人衛生支出比例降到30%以下。將建區域集中檢查檢驗中心，實現大型設備資源共享。同時，我省敲定今年醫改重點任務，其中一條是將合理調整公立醫院醫療服務價格，提高診療費、護理費、手術費。據悉，調增收費將納入醫保報銷，避免增加患者負擔。今年，全省將選擇30個左右的縣（市）開展縣級醫院綜合改革試點，根據改革需要，在獎勵性績效工資分配、定價、藥品采購等方面給予試點地區一定自主權。經批準，可在縣級醫院設立特設崗位，引進急需高層次人才。

我省將合理調整醫療服務價格，提高診療費、手術費、護理費等體現技術勞務價值的醫療技術服務價格，降低大型設備檢查價格。發揮醫保補償作用，將調增的收費納入醫保報銷范圍，避免增加群眾負擔。

鼓勵和支持具備條件的縣級綜合醫院參照三級醫院建設發展。同時禁止公立醫院舉債建設，每千常住人口醫療衛生機構床位數達到4張的，原則上不再擴大公立醫院規模。實行試點公立醫院藥品集中采購，按照招采合一、量價掛鉤、單一貨源承諾、雙信封制的要求帶量采購基本藥物。穩步開展高值醫用耗材集中采購。通過壓縮藥品和高值醫用耗材采購中間環節和費用，著力降低虛高價格。

2015年實現縣級公立醫院階段性改革目標。鼓勵社會資本對部分公立醫院進行多種形式的公益性投入，以合資合作方式參與改制的不得改變非盈利性質。

今年醫改重點內容

鼓勵社會辦醫 有資質就可開診所

目前，我省有關部門正在研究制定相關政策文件，放寬準入，鼓勵有實力的企業、慈善機構、基金會、商業保險機構等社會力量及境外投資者開辦醫療機構，鼓勵具有資質的人員（包括港、澳、臺地區）依法開辦私人診所。

對社會辦醫，我省將落實價格、醫保定點、土地、重點學科建設、職稱評定等方面政策，對各類社會資本舉辦非盈利性醫療機構給予優先支持，鼓勵非公立醫療機構向高水平、規模化的大型醫療集團發展。發展一批有規模、有質量、有品牌的非公立醫療機構，力爭到2015年，全省非公立醫療機構床位數和服務量達到全省醫療衛生機構的20%左右。同時，我省鼓勵康復醫療機構發展，擴大和豐富全社會醫療資源。

二級以上醫院基藥配備占9成以上

在納入省統一規劃設置的村衛生室全面推行基本藥物制度的基礎上，今年，我省逐步將其他符合省規劃要求的村衛生室納入基本藥物制度實施范圍，同步落實對鄉村醫生的各項補助和支持政策。對非政府辦基層醫療衛生機構，各地可結合實際，采取購買服務等方式將其納入基本藥物制度實施范圍。二級以上醫療機構需優先配備使用基本藥物，配備品種數占到基本藥物總數的90%以上。

我省將適時開展新一輪基本藥物采購工作。研究調整優化省級增補藥物目錄，更好的適應群眾基本用藥需求。

統籌資金最高支付不低于10萬元

今年，我省職工醫保、城鎮居民醫保和新農合三項基本醫療保險參保率將穩定在97%以上。重點做好農民工、非公有制經濟組織從業人員、靈活就業人員以及學生、學齡前兒童和新生兒參保管理工作。繼續推進關閉破產企業退休人員和困難企業職工等困難群體參保工作。

新農合和城鎮居民醫保補助標準提高到每人每年240元，個人繳費60元，人均籌資達到300元左右。統籌資金最高支付限額不低于10萬元。

20種疾病納入重大疾病保障

積極探索利用基本醫保基金購買商業大病保險或建立補充保險等方式，有效提高重特大疾病保障水平，切實解決重特大疾病患者因病致貧的問題。做好基本醫保、醫療救助、商業保險等的銜接。制定出臺新農合重大疾病醫療保障政策，全面推開尿毒癥、兒童白血病、兒童先天性心臟病、乳腺癌、宮頸癌、重性精神疾病、耐多藥肺結核、艾滋病機會性感染等8類大病保障，將肺癌、食道癌、胃癌、結腸癌、直腸癌、慢性粒細胞白血病、急性心肌梗塞、腦梗死、血友病、I型糖尿病、甲亢、唇腭裂等12類大病納入保障和救助試點范圍。

【關鍵詞】 衛生資源布局

建區域集中檢查檢驗中心

鼓勵各地整合轄區內醫療資源，建立區域集中檢查檢驗中心，實現大型設備資源共建共享。醫療機構檢驗服務對社會開放，實現檢查結果互認。

至2015年，政府投資購置的公立醫院大型設備按扣除折舊后的成本制定檢查價格，貸款或集資購買的大型設備原則上由政府回購，回購有困難的限期降低檢查價格。此項虧損通過調整醫療技術服務價格、增加政府投入等途徑補償。

【關鍵詞】 全民醫保

2015年，跨省也能即時結算

我省將加快推進基本醫保和醫療救助即時結算，使患者看病只需支付自付部分費用，其余費用由醫保經辦機構與醫療機構直接結算。2014年實現省內新農合即時結算。建立異地就醫結算機制，2015年全面實現統籌區域內和省內醫療費用異地即時結算；開展省際醫保結算合作，初步實現跨省醫療費用異地即時結算。2015年基本實現職工醫保制度內跨區域轉移接續，推進各項基本醫療保險制度之間銜接。

我省城鄉醫療救助，主要資助低保家庭成員、五保戶、重度殘疾人及城鄉低收入家庭參加城鎮居民醫保或新農合。取消醫療救助起付線，提高封頂線。對救助對象政策范圍內住院自負醫療費用救助比例提高到70%以上。

【關鍵詞】藥品價格

適時調整最高零售指導價

我省將改革藥品價格形成機制，建立和完善藥品價格動態調整管理機制，選取臨床使用量較大的藥品，依據主導企業成本，參考藥品集中采購價格和零售藥店銷售價等市場交易價格，制定最高零售指導價格，并根據市場交易價格變化等因素適時調整。

到“十二五”期末，所有零售藥店法定代表人或主要管理者必須具備執業藥師資格，所有零售藥店和醫院藥房營業時有職業藥師指導合理用藥。

此外將調整省增補藥物目錄，優化基本藥物品種、類別，適當增加慢性病和兒童用藥品種，減少使用率低、重合率低的藥品。對獨家品種和經多次集中采購價格已基本穩定且市場供應充足的省增補基本藥物，試行省統一定價。

【關鍵詞】公立醫院改革

設立專門的政府辦醫機構

我省將研究探索采取設立專門管理機構等多種形式確定政府辦醫機構，由其履行政府舉辦公立醫院的職能，負責公立醫院的資產管理、財務監管、績效考核和醫院主要負責人的任用。

各級衛生行政部門負責人不得兼任公立醫院領導職務，逐步取消公立醫院行政級別，新設立的公立醫院不再明確行政級別。探索建立理事會、董事會、管委會等多種形式的公立醫院法人治理結構。

【關鍵詞】基層衛生

至2015年培養1.28萬全科醫生

為提高基層醫療機構的服務水平，到2015年，我省將為基層醫療衛生機構培養1.28萬余名全科醫生，每萬名城市居民擁有2名以上全科醫生，每個鄉鎮衛生院有2—3名合格的全科醫生。

為促進人才向基層流動，我省鼓勵開展全科醫生縣鄉聯動試點項目；70%的城市建立起公立醫院和社區衛生服務機構上下聯動的協同機制。

第三篇：2009公開最新醫改方案全文

2009公開最新醫改方案全文

按照黨的十七大精神，為建立中國特色的醫藥衛生體制，逐步實現人人享有基本醫療衛生服務的目標，提高全民健康水平，現就改革提出如下意見。

一、充分認識深化醫藥衛生體制改革的重要性、緊迫性和艱巨性健康是人全面發展的基礎。醫藥衛生事業關系千家萬戶幸福，是重大民生問題。深化醫藥衛生體制改革，加快醫藥衛生事業發展，適應人民群眾日益增長的醫藥衛生需求，不斷提高人民群眾健康素質，是貫徹落實科學發展觀、促進經濟和社會全面協調可持續發展的必然要求，是維護社會公平正義的重要舉措，是人民生活質量改善的重要標志，是全面建設小康社會和構建社會主義和諧社會的一項重大任務。新中國成立以來，特別是改革開放以來，我國醫藥衛生事業取得了顯著成就，覆蓋城鄉的醫藥衛生服務體系基本形成，疾病防治能力不斷增強，醫療保障覆蓋人口逐步擴大，衛生科技水平迅速提高，人民群眾健康水平明顯改善，居民主要健康指標處于發展中國家前列。尤其是抗擊“非典”取得重大勝利以來，各級政府加大投入，公共衛生、農村醫療衛生和城市社區衛生加快發展，新型農村合作醫療和城鎮居民基本醫療保險取得突破性進展，為深化醫藥衛生體制改革打下了良好基礎。同時，也應該看到，當前我國醫藥衛生事業發展水平與經濟社會協調發展要求和人民群眾健康需求不適應的矛盾還比較突出。城鄉和區域醫療衛生事業發展不平衡，資源配置不合理，公共衛生和農村、社區醫療衛生工作比較薄弱，醫療保障制度不健全，藥品生產流通秩序不規范，醫院管理體制和運行機制不完善，政府衛生投入不足，醫藥費用上漲過快，人民群眾反映比較強烈。從現在到2020年，是我國全面建設小康社會的關鍵時期，醫藥衛生工作肩負著繁重的任務。隨著經濟的發展和人民生活水平的提高，群眾對改善醫藥衛生服務將會有更高的要求。工業化、城鎮化、人口老齡化、疾病譜變化和生態環境變化等，都給醫藥衛生工作帶來一系列新的嚴峻挑戰。深化醫藥衛生體制改革，是加快醫藥衛生事業發展的戰略選擇，是實現人民共享改革發展成果的重要途徑，是廣大人民群眾的迫切愿望。醫藥是一項涉及面廣、難度大的社會系統工程。我國人口多，人均收入水平低，城鄉、區域差距大，長期處于社會主義初級階段的基本國情，決定了深化醫藥衛生體制改革是一項十分復雜艱巨的任務，是一個漸進的過程，需要在明確方向和框架的基礎上，經過長期艱苦努力和堅持不懈的探索，才能逐步建立符合我國國情的醫藥衛生體制。

二、醫藥體制改革的指導思想、基本原則和總體目標

（一）指導思想。醫藥體制改革的指導思想是：以鄧小平理論和“三個代表”重要思想為指導，深入貫徹落實科學發展觀，從我國國情出發，借鑒國際有益經驗，著眼于實現人人享有基本醫療衛生服務的目標，著力解決人民群眾最關心、最直接、最現實的利益問題。堅持公共醫療衛生的公益性質，堅持預防為主、以農村為重點、中西醫并重的方針，實行政事分開、管辦分開、醫藥分開、營利性和非營利性分開，強化政府責任和投入，完善國民健康政策，健全制度體系，加強監督管理，創新體制機制，鼓勵社會參與，建設覆蓋城鄉居民的基本醫療衛生制度，不斷提高全民健康水平，促進社會和諧。

（二）基本原則。醫藥體制改革應遵循以下基本原則：堅持以人為本，把維護人民健康權益放在第一位。堅持醫藥衛生事業為人民健康服務的宗旨，以保障人民健康為中心，以人人享有基本醫療衛生服務為根本出發點和落腳點，從改革方案設計、衛生制度建立到服務體系建設都要遵循公益性的原則，著力解決群眾反映強烈的突出問題，努力實現全體人民病有所醫。堅持立足國情，建立中國特色的醫藥衛生體制。堅持從我國的基本國情出發，實事求是地總結醫藥衛生事業改革發展的實踐經驗，準確把握醫藥衛生發展規律和主要矛盾；堅持基本醫療衛生服務水平與國民經濟和社會發展相協調、與人民群眾的承受能力相適應；充分發揮中醫藥作用；堅持因地制宜、分類指導，發揮地方積極性，探索建立符合國情的基本醫療衛生制度。堅持公平效率統一，政府主導與發揮市場機制作用相結合。堅持政府主導，強化政府在基本醫療衛生制度中的責任，加強政府在制度、規劃、籌資、服務、監管等方面的職責，維護公共醫療衛生的公益性，促進公平公正；同時，注重發揮市場機制作用，促進有序競爭機制的形成，提高醫療衛生運行效率和服務水平、質量，滿足人民群眾多層次、多樣化的醫療衛生需求。堅持統籌兼顧，把完善制度體系與解決當前突出問題結合起來。從全局出發，兼顧供給方和需求方等各方利益，注重預防、治療、康復三者的結合，正確處理政府、衛生機構、醫藥企業、醫務人員和人民群眾之間的關系。既著眼長遠，創新體制機制，又立足當前，著力解決醫藥衛生中存在的突出問題；既注重整體設計，明確總體改革方向目標和基本框架，又突出重點，分步實施，積極穩妥地推進改革。

（三）總體目標。醫藥體制改革的總體目標是:建立覆蓋城鄉居民的基本醫療衛生制度，為群眾提供安全、有效、方便、價廉的醫療衛生服務。到2020年，覆蓋城鄉居民的基本醫療衛生制度基本建立。普遍建立比較完善的公共衛生服務體系和醫療服務體系，比較健全的醫療保障體系，比較規范的藥品供應保障體系，比較科學的醫療衛生機構管理體制和運行機制，形成多元辦醫格局，人人享有基本醫療衛生服務，基本適應人民群眾多層次的醫療衛生需求，人民群眾健康水平進一步提高。

三、完善醫藥衛生四大體系，建立覆蓋城鄉居民的基本醫療衛生制度建立覆蓋城鄉居民的公共衛生服務體系、醫療服務體系、醫療保障體系、藥品供應保障體系四位一體的基本醫療衛生制度，四大體系相輔相成，配套建設，協調發展。

（四）全面加強公共衛生服務體系建設。建立健全疾病預防控制、健康教育、婦幼保健、精神衛生、應急救治、采供血、衛生監督和計劃生育等專業公共衛生服務網絡，并完善以基層醫療衛生服務網絡為基礎的醫療服務體系的公共衛生服務功能，建立分工明確、信息互通、資源共享、協調互動的公共衛生服務體系，提高公共衛生服務能力和突發公共衛生事件應急處置能力，促進城鄉居民逐步享有均等化的基本公共衛生服務。確定公共衛生服務范圍。明確國家公共衛生服務項目，逐步增加服務內容，細化服務和考核標準。鼓勵地方政府根據當地經濟水平和突出的公共衛生問題，在中央規定服務項目的基礎上增加公共衛生服務內容。完善公共衛生服務體系。進一步明確公共衛生服務體系的職能、目標和任務，優化人員和設備配置，探索整合公共衛生服務資源的有效形式。完善重大疾病防控體系和突發公共衛生事件應急機制，加強對嚴重威脅人民健康的傳染病、地方病、職業病和慢性病等疾病的預防控制和監測。加強城鄉急救體系建設。加強健康促進與教育。醫療衛生機構及機關、學校、社區、企業等要大力開展健康教育，倡導健康文明的生活方式，利用廣播、電視、網絡、報刊雜志等媒體，加強健康、醫藥衛生知識的傳播，促進公眾合理營養，提高廣大人民群眾的健康意識和自我保健能力。深入開展愛國衛生運動。將農村環境衛生與環境污染治理納入社會主義新農村建設規劃，推動衛生城市和文明村鎮建設，不斷改善城鄉居民的生活、工作等方面的衛生環境。加強衛生監督服務。大力促進環境衛生、食品衛生、職業衛生、學校衛生和農民工衛生工作。

（五）進一步完善醫療服務體系。堅持非營利性醫療機構為主體、營利性醫療機構為補充，公立醫療機構為主導、非公立醫療機構共同發展的辦醫原則，建設結構合理、分工明確、防治結合、技術適宜、運轉有序，包括覆蓋城鄉的基層醫療衛生服務網絡和各類醫院在內的醫療服務體系。大力發展農村醫療衛生服務體系。加快建立健全以縣級醫院為龍頭、鄉鎮衛生院為骨干、村衛生室為基礎的農村三級醫療衛生服務網絡。縣級醫院作為縣域內的醫療衛生中心，主要負責以住院為主的基本醫療服務及危重急癥病人的搶救，并承擔對鄉村衛生機構的業務技術指導和鄉村衛生人員的進修培訓；鄉鎮衛生院負責提供公共衛生服務和常見病、多發病的診療等綜合服務，并承擔對村衛生室的業務管理和技術指導等工作；村衛生室承擔行政村的公共衛生服務及一般疾病的診治等工作。有條件的農村可以實行鄉村一體化管理。加快實施農村衛生服務體系建設與發展規劃，積極推進農村醫療衛生基礎設施和能力建設，政府重點辦好縣級醫院并在每個鄉鎮辦好一所衛生院，采取多種形式支持村衛生室建設，大力改善農村醫療衛生條件，提高醫療衛生服務質量。完善以社區衛生服務為基礎的新型城市醫療衛生服務體系。大力發展社區衛生服務，加快建設以社區衛生服務中心為主體的城市社區衛生服務網絡，完善社區衛生服務功能，以維護社區居民健康為中心，提供疾病預防控制等公共衛生服務和一般常見病、多發病、慢性病的初級診療服務。轉變社區衛生服務模式，堅持主動服務、上門服務，逐步承擔起居民健康“守門人”的職責。健全各類醫院的功能和職責。優化醫院布局和結構，充分發揮城市醫院在急危重癥和疑難病癥的診療、醫學教育和科研、指導和培訓基層衛生人員等方面的骨干作用。有條件的大醫院按照區域衛生規劃要求，可以通過托管、重組等方式促進醫療資源合理流動。建立城市醫院與社區衛生服務機構的分工協作機制。城市醫院通過技術支持、人員培訓等方式，帶動社區衛生健康持續發展。同時，采取改善服務能力、降低收費標準、提高報銷比例等綜合措施，引導一般診療下沉到基層，逐步實現社區首診、分級醫療和雙向轉診。整合城市衛生資源，充分利用城市現有一、二級醫院及國有企事業所屬醫療機構等基層醫療資源，發展和完善社區衛生服務網絡。充分發揮包括民族醫藥在內的中醫藥在疾病預防控制、應對突發公共衛生事件、醫療服務中的作用。加強中醫臨床研究基地和中醫院建設，組織開展中醫藥防治疑難疾病的聯合攻關，在醫療衛生機構中大力推廣中醫藥適宜技術。創造良好的政策環境，扶持中醫藥發展，促進中醫藥繼承和創新。建立城市醫院對口支援農村醫療衛生工作的制度。發達地區要加強對口支援貧困地區和少數民族地區發展醫療衛生事業。城市大醫院要與貧困地區和少數民族地區的縣級醫院建立長期穩定的對口支援和合作制度，采取臨床服務、人員培訓、技術指導、設備支援等方式，幫助其提高醫療水平和服務能力。

（六）加快建設醫療保障體系。加快建立和完善以基本醫療保障為主體，其他多種形式補充醫療保險和商業健康保險為補充，覆蓋城鄉居民的多層次醫療保障體系。建立覆蓋城鄉居民的基本醫療保障體系。城鎮職工基本醫療保險、城鎮居民基本醫療保險、新型農村合作醫療和城鄉醫療救助共同組成基本醫療保障體系，分別覆蓋城鎮就業人口、城鎮非就業人口、農村人口和城鄉困難人群。堅持廣覆蓋、保基本、可持續的原則，從重點保障大病起步，逐步向門診小病延伸，提高保障水平。建立國家、單位、家庭和個人責任明確、分擔合理的多渠道籌資機制，實現社會互助共濟。隨著經濟社會發展，逐步提高籌資水平和統籌層次，縮小保障水平差距，最終實現制度框架的基本統一。進一步完善城鎮職工基本醫療保險制度，加快覆蓋就業人口，重點解決國有關閉破產企業、困難企業等職工和退休人員以及混合所有制、非公有制經濟組織從業人員和靈活就業人員的醫療保險問題；加快推進城鎮居民基本醫療保險試點，到2009年全面推開，重視解決老人和兒童的基本醫療保險問題；全面實施新型農村合作醫療制度，逐步提高政府補助水平，適當增加農民繳費，提高保障能力。完善城鄉醫療救助制度。對困難人群參保及其難以負擔的醫療費用提供補助，筑牢醫療保障底線。有條件的地區要采取多種方式積極探索建立城鄉一體化的基本醫療保障管理體系。鼓勵工會等社會團體開展多種形式的醫療互助活動。鼓勵和引導各類公益性組織發展社會慈善醫療救助。做好城鎮職工基本醫療保險制度、城鎮居民基本醫療保險制度、新型農村合作醫療制度和城鄉醫療救助制度之間的銜接，妥善解決農民工基本醫療保險問題。簽訂勞動合同并與企業建立穩定勞動關系的農民工，要按照國家規定明確用人單位繳費責任，將其納入城鎮職工基本醫療保險制度；其他農民工根據實際情況，參加戶籍所在地新型農村合作醫療或務工所在地城鎮居民基本醫療保險。積極做好農民工醫保關系接續、異地就醫和費用結算服務等政策銜接。積極發展商業健康保險。鼓勵商業保險機構開發適應不同需要的健康保險產品，簡化理賠手續，方便群眾，滿足多樣化的健康需求。鼓勵企業和個人通過參加商業保險及多種形式的補充保險解決基本醫療保障之外的需求。繼續探索商業保險機構參與新型農村合作醫療等經辦管理的方式。

（七）建立健全藥品供應保障體系。以建立國家基本藥物制度為基礎，以培育具有國際競爭力的醫藥產業、提高藥品生產流通企業集中度、規范藥品生產流通秩序、完善藥品價格形成機制、加強政府監管為主要內容，建設規范化、集約化的藥品供應保障體系，不斷完善執業藥師制度，保障人民群眾安全用藥。建立國家基本藥物制度。中央政府統一制定和發布國家基本藥物目錄，按照防治必需、安全有效、價格合理、使用方便、中西藥并重的原則，結合我國用藥特點，參照國際經驗，合理確定我國基本藥物品種和數量。建立基本藥物的生產供應體系，在政府宏觀調控下充分發揮市場機制的作用，基本藥物由國家實行招標定點生產或集中采購，直接配送，減少中間環節，在合理確定生產環節利潤水平的基礎上統一制定零售價，確保基本藥物的生產供應，保障群眾基本用藥。規范基本藥物使用，制訂基本藥物使用規范和臨床應用指南。城市社區衛生服務中心（站）、鄉鎮衛生院、村衛生室等基層醫療衛生機構應全部使用基本藥物，其他各類醫療機構也要將基本藥物作為首選藥物并確定使用比例。基本藥物全部納入基本醫療保障體系藥物報銷目錄，報銷比例明顯高于非基本藥物規范藥品生產流通。完善醫藥產業發展政策和行業發展規劃，嚴格市場準入，嚴格藥品注冊審批，大力規范和整頓生產流通秩序，推動醫藥產業優化升級和技術進步，發展藥品現代物流和連鎖經營，促進藥品生產、流通企業的整合。建立覆蓋面廣、體系健全、便民惠農的農村藥品供應網和監督網。支持用量小的特殊用藥、急救用藥生產。完善藥品儲備制度。規范藥品采購，堅決治理醫藥購銷中的商業賄賂。加強藥品不良反應監測，建立藥品安全預警機制和應急處置機制。

四、完善體制機制，保障醫藥衛生體系有效規范運轉完善醫藥衛生的管理、運行、投入、價格、監管體制機制，加強科技與人才、信息、法制建設，保障醫藥衛生體系有效規范運轉。

（八）建立協調統一的醫藥衛生管理體制。按照政事分開、管辦分開、屬地化和全行業管理的原則，合理確定不同層級政府之間、政府與醫藥衛生機構之間的職責范圍，形成職能明確、定位清晰、綜合協調、權責統一的管理體制。實施屬地化和全行業管理。所有醫療衛生機構，不論所有制、投資主體、隸屬關系和經營性質，均由所在地衛生行政部門實行統一規劃、統一準入、統一監管。中央、省級可以設置少量承擔醫學科研、教學功能的醫學中心或區域醫療中心、承擔全國或區域性疑難病癥診治的專科醫院等醫療機構；縣（市、區）主要負責舉辦縣級醫院、鄉村衛生和社區衛生機構；其余公立醫院由設區的市負責舉辦。強化區域衛生規劃。省級人民政府制定衛生資源配置標準，組織編制區域衛生規劃和醫療機構設置規劃，明確醫療機構的數量、規模、布局和功能。科學制定鄉鎮衛生院（村衛生室）、社區衛生服務中心（站）等基層衛生機構和各級醫院建設和設備配置標準。充分利用和優化配置現有醫療衛生資源，調整優化結構和布局，對不符合規劃要求的醫療機構要逐步進行整合，嚴格控制大型醫療設備配置，鼓勵共建共享，提高醫療衛生資源利用效率。新增衛生資源必須符合區域衛生規劃，重點投向農村和社區衛生等薄弱環節。加強區域衛生規劃與城市發展規劃、土地利用規劃等的銜接。建立區域衛生規劃和資源配置監督評價機制。推進公立醫院管理體制改革。從有利于強化公立醫院公益性和政府有效監管出發，積極探索政事分開、管辦分開的多種實現形式。進一步轉變政府職能，衛生行政部門主要承擔衛生發展規劃、資格準入、規范標準、服務監管等行業管理職能，其他有關部門按照各自職能進行管理和提供服務。落實公立醫院獨立法人地位。進一步完善基本醫療保險管理體制。中央統一制定基本醫療保險制度框架和政策，地方政府負責組織實施管理，創造條件逐步提高統籌層次。有效整合基本醫療保險經辦資源，逐步實現城鄉基本醫療保險行政管理的統一。

（九）建立高效規范的醫藥衛生機構運行機制。以維護公立醫療衛生機構公益性質為核心，逐步建立規范、科學、高效、有序的醫藥衛生機構運行機制。公共衛生機構收支全部納入預算管理。按照承擔的職責任務，由政府合理確定人員編制、工資水平和經費標準，明確各類人員崗位職責，嚴格人員準入，加強績效考核，建立能進能出的用人制度，提高工作效率和服務質量。轉變基層醫療衛生機構運行機制。政府舉辦的城市社區衛生服務中心（站）和鄉鎮衛生院等基層醫療衛生機構，要嚴格界定服務功能，明確規定使用適宜技術、適宜人才、適宜設備和基本藥物，為廣大群眾提供低成本服務，維護公益性質。要嚴格核定人員編制，實行人員聘用制，建立能進能出和激勵有效的人力資源管理制度。要明確收支范圍和標準，實行核定任務、核定收支、績效考核補助的財務管理辦法，并探索實行收支兩條線、公共衛生和醫療保障經費的總額預付等多種行之有效的管理辦法，嚴格收支預算管理，提高資金使用效益。要改革藥品加成政策，實行藥品零差率銷售。加強和完善內部管理，建立以服務質量為核心、以崗位責任與績效為基礎的考核和激勵制度，形成保障公平效率的長效機制建立規范的公立醫院運行機制。公立醫院要遵循公益性質和社會效益原則，堅持以病人為中心，優化服務流程，規范用藥檢查和醫療行為，深化運行機制改革。建立和完善醫院法人治理結構，明確所有者和管理者的責權，形成決策、執行、監督相互制衡，有責任、有激勵、有約束、有競爭、有活力的機制。實行醫藥收支分開管理，探索有效方式逐步改革以藥補醫機制。通過實行藥品購銷差別加價、設立藥事服務費等多種方式逐步改革或取消藥品加成政策，同時采取適當調整醫療服務價格、增加政府投入、改革支付方式等措施完善公立醫院補償機制。進一步完善財務、會計管理制度，嚴格預算管理，加強財務監管和運行監督。地方可結合本地實際，對有條件的醫院開展“核定收支、以收抵支、超收上繳、差額補助、獎懲分明”等多種管理辦法的試點。改革人事制度，完善分配激勵機制，推行聘用制度和崗位管理制度，嚴格工資總額管理，實行以服務質量及崗位工作量為主的綜合績效考核和崗位績效工資制度，有效調動醫務人員的積極性。健全醫療保險經辦機構運行機制。完善內部治理結構，建立合理的用人機制和分配制度，完善激勵約束機制，提高醫療保險經辦管理能力和管理效率。

醫改的意義

第四篇：新醫改方案

宗地鄉醫藥衛生體制改革實施方案

根據《中共中央 國務院關于深化醫藥衛生體制改革的意見》，2009－2011年重點抓好五項改革：一是加快推進基本醫療保障制度建設，二是初步建立國家基本藥物制度，三是健全基層醫療衛生服務體系，四是促進基本公共衛生服務逐步均等化，五是推進公立醫院改革試點。

推進五項重點改革，旨在著力解決群眾反映較多的“看病難、看病貴”問題。推進基本醫療保障制度建設，將全體城鄉居民納入基本醫療保障制度，切實減輕群眾個人支付的醫藥費用負擔。建立國家基本藥物制度，完善基層醫療衛生服務體系，方便群眾就醫，充分發揮中醫藥作用，降低醫療服務和藥品價格。促進基本公共衛生服務逐步均等化，使全體城鄉居民都能享受基本公共衛生服務，最大限度地預防疾病。推進公立醫院改革試點，提高公立醫療機構服務水平，努力解決群眾“看好病”問題。

推進五項重點改革，旨在落實醫療衛生事業的公益性質，具有改革階段性的鮮明特征。把基本醫療衛生制度作為公共產品向全民提供，實現人人享有基本醫療衛生服務，這是我國醫療衛生事業發展從理念到體制的重大變革，是貫徹落實科學發展觀的本質要求。醫藥衛生體制改革是艱巨而長期的任務，需要分階段有重點地推進。要處理好公平與效率的關系，在改革初期首先著力解決公平問題，保障廣大群眾看病就醫的基本需求，并隨著經濟社會發展逐步提高保障水平。逐步解決城鎮職工基本醫療保險、城鎮居民基本醫療保險、新型農村合作醫療制度之間的銜接問題。鼓勵社會資本投入，發展多層次、多樣化的醫療衛生服務，統籌利用全社會的醫療衛生資源，提高服務效率和質量，滿足人民群眾多樣化的醫療衛生需求。

推進五項重點改革，旨在增強改革的可操作性，突出重點，帶動醫藥衛生體制全面改革。建立基本醫療衛生制度是一項重大制度創新，是醫藥衛生體制全面改革的關鍵環節。五項重點改革涉及醫療保障制度建設、藥品供應保障、醫藥價格形成機制、基層醫療衛生機構建設、公立醫療機構改革、醫療衛生投入機制、醫務人員隊伍建設、醫藥衛生管理體制等關鍵環節和重要領域。抓好這五項改革，目的是從根本上改變部分城鄉居民沒有醫療保障和公共醫療衛生服務長期薄弱的狀況，扭轉公立醫療機構趨利行為，使其真正回歸公益性，有效解決當前醫藥衛生領域的突出問題，為全面實現醫藥衛生體制改革的長遠目標奠定堅實基礎。

一、加快推進基本醫療保障制度建設

(一)擴大基本醫療保障覆蓋面。三年內，城鎮職工基本醫療保險(以下簡稱城鎮職工醫保)、城鎮居民基本醫療保險(以下簡稱城鎮居民醫保)和新型農村合作醫療(以下簡稱新農合)覆蓋城鄉全體居民，參保率均提高到90%以上。用兩年左右時間，將關閉破產企業退休人員和困難企業職工納入城鎮職工醫保，確有困難的，經省級人民政府批準后，參加城鎮居民醫保。關閉破產企業退休人員實現醫療保險待遇與企業繳費脫鉤。中央財政對困難地區的國有關閉破產企業退休人員參保給予適當補助。2009年全面推開城鎮居民醫保制度，將在校大學生全部納入城鎮居民醫保范圍。積極推進城鎮非公有制經濟組織從業人員、靈活就業人員和農民工參加城鎮職工醫保。政府對符合就業促進法規定的就業困難人員參加城鎮職工醫保的參保費用給予補貼。靈活就業人員自愿選擇參加城鎮職工醫保或城鎮居民醫保。參加城鎮職工醫保有困難的農民工，可以自愿選擇參加城鎮居民醫保或戶籍所在地的新農合。

(二)提高基本醫療保障水平。逐步提高城鎮居民醫保和新農合籌資標準和保障水平。2010年，各級財政對城鎮居民醫保和新農合的補助標準提高到每人每年120元，并適當提高個人繳費標準，具體繳費標準由省級人民政府制定。城鎮職工醫保、城鎮居民醫保和新農合對政策范圍內的住院費用報銷比例逐步提高。逐步擴大和提高門診費用報銷范圍和比例。將城鎮職工醫保、城鎮居民醫保最高支付限額分別提高到當地職工年平均工資和居民可支配收入的6倍左右，新農合最高支付限額提高到當地農民人均純收入的6倍以上。(三)規范基本醫療保障基金管理。各類醫保基金要堅持以收定支、收支平衡、略有結余的原則。合理控制城鎮職工醫保基金、城鎮居民醫保基金的結余和累計結余，結余過多的地方要采取提高保障水平等辦法，把結余逐步降到合理水平。新農合統籌基金當年結余率原則上控制在15%以內，累計結余不超過當年統籌基金的25%。建立基本醫療保險基金風險調劑金制度。基金收支情況要定期向社會公布。提高基金統籌層次，2011年城鎮職工醫保、城鎮居民醫保基本實現市(地)級統籌。

(四)完善城鄉醫療救助制度。有效使用救助資金，簡化救助資金審批發放程序，資助城鄉低保家庭成員、五保戶參加城鎮居民醫保或新農合，逐步提高對經濟困難家庭成員自負醫療費用的補助標準。

(五)提高基本醫療保障管理服務水平。鼓勵地方積極探索建立醫保經辦機構與醫藥服務提供方的談判機制和付費方式改革，合理確定藥品、醫療服務和醫用材料支付標準，控制成本費用。改進醫療保障服務，推廣參保人員就醫“一卡通”，實現醫保經辦機構與定點醫療機構直接結算。允許參加新農合的農民在統籌區域內自主選擇定點醫療機構就醫，簡化到縣域外就醫的轉診手續。建立異地就醫結算機制，探索異地安置的退休人員就地就醫、就地結算辦法。制定基本醫療保險關系轉移接續辦法，解決農民工等流動就業人員基本醫療保障關系跨制度、跨地區轉移接續問題。做好城鎮職工醫保、城鎮居民醫保、新農合、城鄉醫療救助之間的銜接。探索建立城鄉一體化的基本醫療保障管理制度，并逐步整合基本醫療保障經辦管理資源。在確保基金安全和有效監管的前提下，積極提倡以政府購買醫療保障服務的方式，探索委托具有資質的商業保險機構經辦各類醫療保障管理服務。

二、初步建立國家基本藥物制度

(六)建立國家基本藥物目錄遴選調整管理機制。制訂國家基本藥物遴選和管理辦法。基本藥物目錄定期調整和更新。2009年初，公布國家基本藥物目錄。

(七)初步建立基本藥物供應保障體系。充分發揮市場機制作用，推動藥品生產流通企業兼并重組，發展統一配送，實現規模經營；鼓勵零售藥店發展連鎖經營。完善執業藥師制度，零售藥店必須按規定配備執業藥師為患者提供購藥咨詢和指導。政府舉辦的醫療衛生機構使用的基本藥物，由省級人民政府指定的機構公開招標采購，并由招標選擇的配送企業統一配送。參與投標的生產企業和配送企業應具備相應的資格條件。招標采購藥品和選擇配送企業，要堅持全國統一市場，不同地區、不同所有制企業平等參與、公平競爭。藥品購銷雙方要根據招標采購結果簽訂合同并嚴格履約。用量較少的基本藥物，可以采用招標方式定點生產。完善基本藥物國家儲備制度。加強藥品質量監管，對藥品定期進行質量抽檢，并向社會公布抽檢結果。

國家制定基本藥物零售指導價格。省級人民政府根據招標情況在國家指導價格規定的幅度內確定本地區基本藥物統一采購價格，其中包含配送費用。政府舉辦的基層醫療衛生機構按購進價格實行零差率銷售。鼓勵各地探索進一步降低基本藥物價格的采購方式。

(八)建立基本藥物優先選擇和合理使用制度。所有零售藥店和醫療機構均應配備和銷售國家基本藥物，滿足患者需要。不同層級醫療衛生機構基本藥物使用率由衛生行政部門規定。從2009年起，政府舉辦的基層醫療衛生機構全部配備和使用基本藥物，其他各類醫療機構也都必須按規定使用基本藥物。衛生行政部門制訂臨床基本藥物應用指南和基本藥物處方集，加強用藥指導和監管。允許患者憑處方到零售藥店購買藥物。基本藥物全部納入基本醫療保障藥品報銷目錄，報銷比例明顯高于非基本藥物。

三、健全基層醫療衛生服務體系

(九)加強基層醫療衛生機構建設。完善農村三級醫療衛生服務網絡。發揮縣級醫院的龍頭作用，三年內中央重點支持2000所左右縣級醫院(含中醫院)建設，使每個縣至少有1所縣級醫院基本達到標準化水平。完善鄉鎮衛生院、社區衛生服務中心建設標準。2009年，全面完成中央規劃支持的2.9萬所鄉鎮衛生院建設任務，再支持改擴建5000所中心鄉鎮衛生院，每個縣1－3所。支持邊遠地區村衛生室建設，三年內實現全國每個行政村都有衛生室。三年內新建、改造3700所城市社區衛生服務中心和1.1萬個社區衛生服務站。中央支持困難地區2400所城市社區衛生服務中心建設。公立醫院資源過剩地區，要進行醫療資源重組，充實和加強基層醫療衛生機構。對社會力量舉辦基層醫療衛生機構提供的公共衛生服務，采取政府購買服務等方式給予補償；對其提供的基本醫療服務，通過簽訂醫療保險定點合同等方式，由基本醫療保障基金等渠道補償。鼓勵有資質的人員開辦診所或個體行醫。

(十)加強基層醫療衛生隊伍建設。制定并實施免費為農村定向培養全科醫生和招聘執業醫師計劃。用三年時間，分別為鄉鎮衛生院、城市社區衛生服務機構和村衛生室培訓醫療衛生人員36萬人次、16萬人次和137萬人次。完善城市醫院對口支援農村制度。每所城市三級醫院要與3所左右縣級醫院(包括有條件的鄉鎮衛生院)建立長期對口協作關系。繼續實施“萬名醫師支援農村衛生工程”。采取到城市大醫院進修、參加住院醫師規范化培訓等方式，提高縣級醫院醫生水平。

落實好城市醫院和疾病預防控制機構醫生晉升中高級職稱前到農村服務一年以上的政策。鼓勵高校醫學畢業生到基層醫療機構工作。從2009年起，對志愿去中西部地區鄉鎮衛生院工作三年以上的高校醫學畢業生，由國家代償學費和助學貸款。

(十一)改革基層醫療衛生機構補償機制。基層醫療衛生機構運行成本通過服務收費和政府補助補償。政府負責其舉辦的鄉鎮衛生院、城市社區衛生服務中心和服務站按國家規定核定的基本建設、設備購置、人員經費及所承擔公共衛生服務的業務經費，按定額定項和購買服務等方式補助、醫務人員的工資水平，要與當地事業單位工作人員平均工資水平相銜接。基層醫療衛生機構提供的醫療服務價格，按扣除政府補助后的成本制定。實行藥品零差率銷售后，藥品收入不再作為基層醫療衛生機構經費的補償渠道，不得接受藥品折扣。探索對基層醫療衛生機構實行收支兩條線等管理方式。

政府對鄉村醫生承擔的公共衛生服務等任務給予合理補助，補助標準由地方人民政府規定。

(十二)轉變基層醫療衛生機構運行機制。基層醫療衛生機構要使用適宜技術、適宜設備和基本藥物，大力推廣包括民族醫藥在內的中醫藥，為城鄉居民提供安全有效和低成本服務。鄉鎮衛生院要轉變服務方式，組織醫務人員在鄉村開展巡回醫療；城市社區衛生服務中心和服務站對行動不便的患者要實行上門服務、主動服務。鼓勵地方制定分級診療標準，開展社區首診制試點，建立基層醫療機構與上級醫院雙向轉診制度。全面實行人員聘用制，建立能進能出的人力資源管理制度。完善收入分配制度，建立以服務質量和服務數量為核心、以崗位責任與績效為基礎的考核和激勵制度。

四、促進基本公共衛生服務逐步均等化

(十三)基本公共衛生服務覆蓋城鄉居民。制定基本公共衛生服務項目，明確服務內容。從2009年開始，逐步在全國統一建立居民健康檔案，并實施規范管理。定期為65歲以上老年人做健康檢查、為3歲以下嬰幼兒做生長發育檢查、為孕產婦做產前檢查和產后訪視，為高血壓、糖尿病、精神疾病、艾滋病、結核病等人群提供防治指導服務。普及健康知識，2009年開設中央電視臺健康頻道，中央和地方媒體均應加強健康知識宣傳教育。

(十四)增加國家重大公共衛生服務項目。繼續實施結核病、艾滋病等重大疾病防控和國家免疫規劃、農村婦女住院分娩等重大公共衛生項目。從2009年開始開展以下項目：為15歲以下人群補種乙肝疫苗；消除燃煤型氟中毒危害；農村婦女孕前和孕早期補服葉酸等，預防出生缺陷；貧困白內障患者復明；農村改水改廁等。

(十五)加強公共衛生服務能力建設。重點改善精神衛生、婦幼衛生、衛生監督、計劃生育等專業公共衛生機構的設施條件。加強重大疾病以及突發公共衛生事件預測預警和處置能力。積極推廣和應用中醫藥預防保健方法和技術。落實傳染病醫院、鼠防機構、血防機構和其他疾病預防控制機構從事高風險崗位工作人員的待遇政策。

(十六)保障公共衛生服務所需經費。專業公共衛生機構人員經費、發展建設經費、公用經費和業務經費由政府預算全額安排，服務性收入上繳財政專戶或納入預算管理。按項目為城鄉居民免費提供基本公共衛生服務。提高公共衛生服務經費標準。2009年人均基本公共衛生服務經費標準不低于15元，2011年不低于20元。中央財政通過轉移支付對困難地區給予補助。

五、推進公立醫院改革試點

(十七)改革公立醫院管理體制、運行機制和監管機制。公立醫院要堅持維護公益性和社會效益原則，以病人為中心。鼓勵各地積極探索政事分開、管辦分開的有效形式。界定公立醫院所有者和管理者的責權。完善醫院法人治理結構。推進人事制度改革，明確院長選拔任用和崗位規范，完善醫務人員職稱評定制度，實行崗位績效工資制度。建立住院醫師規范化培訓制度。鼓勵地方探索注冊醫師多點執業的辦法和形式。強化醫療服務質量管理。規范公立醫院臨床檢查、診斷、治療、使用藥物和植(介)入類醫療器械行為，優先使用基本藥物和適宜技術，實行同級醫療機構檢查結果互認。

探索建立由衛生行政部門、醫療保險機構、社會評估機構、群眾代表和專家參與的公立醫院質量監管和評價制度。嚴格醫院預算和收支管理，加強成本核算與控制。全面推行醫院信息公開制度，接受社會監督。

(十八)推進公立醫院補償機制改革。逐步將公立醫院補償由服務收費、藥品加成收入和財政補助三個渠道改為服務收費和財政補助兩個渠道。政府負責公立醫院基本建設和大型設備購置、重點學科發展、符合國家規定的離退休人員費用和政策性虧損補償等，對公立醫院承擔的公共衛生任務給予專項補助，保障政府指定的緊急救治、援外、支農、支邊等公共服務經費，對中醫院(民族醫院)、傳染病醫院、職業病防治院、精神病醫院、婦產醫院和兒童醫院等在投入政策上予以傾斜。嚴格控制公立醫院建設規模、標準和貸款行為。推進醫藥分開，逐步取消藥品加成，不得接受藥品折扣。醫院由此減少的收入或形成的虧損通過增設藥事服務費、調整部分技術服務收費標準和增加政府投入等途徑解決。藥事服務費納入基本醫療保險報銷范圍。積極探索醫藥分開的多種有效途徑。適當提高醫療技術服務價格，降低藥品、醫用耗材和大型設備檢查價格。定期開展醫療服務成本測算，科學考評醫療服務效率。

公立醫院提供特需服務的比例不超過全部醫療服務的10%。鼓勵各地探索建立醫療服務定價由利益相關方參與協商的機制。

(十九)加快形成多元辦醫格局。省級衛生行政部門會同有關部門，按照區域衛生規劃，明確轄區內公立醫院的設置數量、布局、床位規模、大型醫療設備配置和主要功能。要積極穩妥地把部分公立醫院轉制為民營醫療機構。制定公立醫院轉制政策措施，確保國有資產保值和職工合法權益。

鼓勵民營資本舉辦非營利性醫院。民營醫院在醫保定點、科研立項、職稱評定和繼續教育等方面，與公立醫院享受同等待遇；對其在服務準入、監督管理等方面一視同仁。落實非營利性醫院稅收優惠政策，完善營利性醫院稅收政策。公立醫院改革2009年開始試點，2011年逐步推開。

六、保障措施

(二十)加強組織領導。國務院深化醫藥衛生體制改革領導小組統籌組織和協調改革工作。國務院有關部門要抓緊研究制定相關配套文件。各級政府要切實加強領導，抓好組織落實，加快推進各項重點改革。

(二十一)加強財力保障。各級政府要認真落實《意見》提出的各項衛生投入政策，調整支出結構，轉變投入機制，改革補償辦法，切實保障改革所需資金，提高財政資金使用效益。為了實現改革的目標，經初步測算，2009－2011年各級政府需要投入8500億元，其中中央政府投入3318億元。

(二十二)鼓勵各地試點。醫藥衛生體制改革涉及面廣，情況復雜，政策性強，一些重大改革要先行試點，逐步推開。各地情況差別很大，要鼓勵地方因地制宜制定具體實施方案，開展多種形式的試點，進行探索創新。國務院深化醫藥衛生體制改革領導小組負責統籌協調、指導各地試點工作。要注意總結和積累經驗，不斷深入推進改革。

(二十三)加強宣傳引導。堅持正確的輿論導向，制定分步驟、分階段的宣傳方案；采取通俗易懂、生動形象的方式，廣泛宣傳實施方案的目標、任務和主要措施，解答群眾關心的問題；及時總結、宣傳改革經驗，為深化改革營造良好的社會和輿論環境。

宗地鄉衛生院 2011年5月15日

第五篇：2009公開最新醫改方案全文

2009公開最新醫改方案全文

按照黨的十七大精神，為建立中國特色的醫藥衛生體制，逐步實現人人享有基本醫療衛生服務的目標，提高全民健康水平，現就改革提出如下意見。

一、充分認識深化醫藥衛生體制改革的重要性、緊迫性和艱巨性。健康是人全面發展的基礎。醫藥衛生事業關系千家萬戶幸福，是重大民生問題。深化醫藥衛生體制改革，加快醫藥衛生事業發展，適應人民群眾日益增長的醫藥衛生需求，不斷提高人民群眾健康素質，是貫徹落實科學發展觀、促進經濟和社會全面協調可持續發展的必然要求，是維護社會公平正義的重要舉措，是人民生活質量改善的重要標志，是全面建設小康社會和構建社會主義和諧社會的一項重大任務。新中國成立以來，特別是改革開放以來，我國醫藥衛生事業取得了顯著成就，覆蓋城鄉的醫藥衛生服務體系基本形成，疾病防治能力不斷增強，醫療保障覆蓋人口逐步擴大，衛生科技水平迅速提高，人民群眾健康水平明顯改善，居民主要健康指標處于發展中國家前列。尤其是抗擊“非典”取得重大勝利以來，各級政府加大投入，公共衛生、農村醫療衛生和城市社區衛生加快發展，新型農村合作醫療和城鎮居民基本醫療保險取得突破性進展，為深化醫藥衛生體制改革打下了良好基礎。同時，也應該看到，當前我國醫藥衛生事業發展水平與經濟社會協調發展要求和人民群眾健康需求不適應的矛盾還比較突出。城鄉和區域醫療衛生事業發展不平衡，資源配置不合理，公共衛生和農村、社區醫療衛生工作比較薄弱，醫療保障制度不健全，藥品生產流通秩序不規范，醫院管理體制和運行機制不完善，政府衛生投入不足，醫藥費用上漲過快，人民群眾反映比較強烈。從現在到2020年，是我國全面建設小康社會的關鍵時期，醫藥衛生工作肩負著繁重的任務。隨著經濟的發展和人民生活水平的提高，群眾對改善醫藥衛生服務將會有更高的要求。工業化、城鎮化、人口老齡化、疾病譜變化和生態環境變化等，都給醫藥衛生工作帶來一系列新的嚴峻挑戰。深化醫藥衛生體制改革，是加快醫藥衛生事業發展的戰略選擇，是實現人民共享改革發展成果的重要途徑，是廣大人民群眾的迫切愿望。醫藥是一項涉及面廣、難度大的社會系統工程。我國人口多，人均收入水平低，城鄉、區域差距大，長期處于社會主義初級階段的基本國情，決定了深化醫藥衛生體制改革是一項十分復雜艱巨的任務，是一個漸進的過程，需要在明確方向和框架的基礎上，經過長期艱苦努力和堅持不懈的探索，才能逐步建立符合我國國情的醫藥衛生體制。

二、醫藥體制改革的指導思想、基本原則和總體目標

（一）指導思想。醫藥體制改革的指導思想是：以鄧小平理論和“三個代表”重要思想為指導，深入貫徹落實科學發展觀，從我國國情出發，借鑒國際有益經驗，著眼于實現人人享有基本醫療衛生服務的目標，著力解決人民群眾最關心、最直接、最現實的利益問題。堅持公共醫療衛生的公益性質，堅持預防為主、以農村為重點、中西醫并重的方針，實行政事分開、管辦分開、醫藥分開、營利性和非營利性分開，強化政府責任和投入，完善國民健康政策，健全制度體系，加強監督管理，創新體制機制，鼓勵社會參與，建設覆蓋城鄉居民的基本醫療衛生制度，不斷提高全民健康水平，促進社會和諧。

（二）基本原則。醫藥體制改革應遵循以下基本原則：堅持以人為本，把維護人民健康權益放在第一位。堅持醫藥衛生事業為人民健康服務的宗旨，以保障人民健康為中心，以人人享有基本醫療衛生服務為根本出發點和落腳點，從改革方案設計、衛生制度建立到服務體系建設都要遵循公益性的原則，著力解決群眾反映強烈的突出問題，努力實現全體人民病有所醫。堅持立足國情，建立中國特

色的醫藥衛生體制。堅持從我國的基本國情出發，實事求是地總結醫藥衛生事業改革發展的實踐經驗，準確把握醫藥衛生發展規律和主要矛盾；堅持基本醫療衛生服務水平與國民經濟和社會發展相協調、與人民群眾的承受能力相適應；充分發揮中醫藥作用；堅持因地制宜、分類指導，發揮地方積極性，探索建立符合國情的基本醫療衛生制度。堅持公平效率統一，政府主導與發揮市場機制作用相結合。堅持政府主導，強化政府在基本醫療衛生制度中的責任，加強政府在制度、規劃、籌資、服務、監管等方面的職責，維護公共醫療衛生的公益性，促進公平公正；同時，注重發揮市場機制作用，促進有序競爭機制的形成，提高醫療衛生運行效率和服務水平、質量，滿足人民群眾多層次、多樣化的醫療衛生需求。堅持統籌兼顧，把完善制度體系與解決當前突出問題結合起來。從全局出發，兼顧供給方和需求方等各方利益，注重預防、治療、康復三者的結合，正確處理政府、衛生機構、醫藥企業、醫務人員和人民群眾之間的關系。既著眼長遠，創新體制機制，又立足當前，著力解決醫藥衛生中存在的突出問題；既注重整體設計，明確總體改革方向目標和基本框架，又突出重點，分步實施，積極穩妥地推進改革。

（三）總體目標。醫藥體制改革的總體目標是:建立覆蓋城鄉居民的基本醫療衛生制度，為群眾提供安全、有效、方便、價廉的醫療衛生服務。到2020年，覆蓋城鄉居民的基本醫療衛生制度基本建立。普遍建立比較完善的公共衛生服務體系和醫療服務體系，比較健全的醫療保障體系，比較規范的藥品供應保障體系，比較科學的醫療衛生機構管理體制和運行機制，形成多元辦醫格局，人人享有基本醫療衛生服務，基本適應人民群眾多層次的醫療衛生需求，人民群眾健康水平進一步提高。

三、完善醫藥衛生四大體系，建立覆蓋城鄉居民的基本醫療衛生制度建立覆蓋城鄉居民的公共衛生服務體系、醫療服務體系、醫療保障體系、藥品供應保障體系四位一體的基本醫療衛生制度，四大體系相輔相成，配套建設，協調發展。

（四）全面加強公共衛生服務體系建設。建立健全疾病預防控制、健康教育、婦幼保健、精神衛生、應急救治、采供血、衛生監督和計劃生育等專業公共衛生服務網絡，并完善以基層醫療衛生服務網絡為基礎的醫療服務體系的公共衛生服務功能，建立分工明確、信息互通、資源共享、協調互動的公共衛生服務體系，提高公共衛生服務能力和突發公共衛生事件應急處置能力，促進城鄉居民逐步享有均等化的基本公共衛生服務。確定公共衛生服務范圍。明確國家公共衛生服務項目，逐步增加服務內容，細化服務和考核標準。鼓勵地方政府根據當地經濟水平和突出的公共衛生問題，在中央規定服務項目的基礎上增加公共衛生服務內容。完善公共衛生服務體系。進一步明確公共衛生服務體系的職能、目標和任務，優化人員和設備配置，探索整合公共衛生服務資源的有效形式。完善重大疾病防控體系和突發公共衛生事件應急機制，加強對嚴重威脅人民健康的傳染病、地方病、職業病和慢性病等疾病的預防控制和監測。加強城鄉急救體系建設。加強健康促進與教育。醫療衛生機構及機關、學校、社區、企業等要大力開展健康教育，倡導健康文明的生活方式，利用廣播、電視、網絡、報刊雜志等媒體，加強健康、醫藥衛生知識的傳播，促進公眾合理營養，提高廣大人民群眾的健康意識和自我保健能力。深入開展愛國衛生運動。將農村環境衛生與環境污染治理納入社會主義新農村建設規劃，推動衛生城市和文明村鎮建設，不斷改善城鄉居民的生活、工作等方面的衛生環境。加強衛生監督服務。大力促進環境衛生、食品衛生、職業衛生、學校衛生和農民工衛生工作。

（五）進一步完善醫療服務體系。堅持非營利性醫療機構為主體、營利性醫療機構為補充，公立醫療機構為主導、非公立醫療機構共同發展的辦醫原則，建設結構合理、分工明確、防治結合、技術適宜、運轉有序，包括覆蓋城鄉的基層醫療衛生服務網絡和各類醫院在內的醫療服務體系。大力發展農村醫療衛生服務體系。加快建立健全以縣級醫院為龍頭、鄉鎮衛生院為骨干、村衛生室為基礎的農村三級醫療衛生服務網絡。縣級醫院作為縣域內的醫療衛生中心，主要負責以住院為主的基本醫療服務及危重急癥病人的搶救，并承擔對鄉村衛生機構的業務技術指導和鄉村衛生人員的進修培訓；鄉鎮衛生院負責提供公共衛生服務和常見病、多發病的診療等綜合服務，并承擔對村衛生室的業務管理和技術指導等工作；村衛生室承擔行政村的公共衛生服務及一般疾病的診治等工作。有條件的農村可以實行鄉村一體化管理。加快實施農村衛生服務體系建設與發展規劃，積極推進農村醫療衛生基礎設施和能力建設，政府重點辦好縣級醫院并在每個鄉鎮辦好一所衛生院，采取多種形式支持村衛生室建設，大力改善農村醫療衛生條件，提高醫療衛生服務質量。完善以社區衛生服務為基礎的新型城市醫療衛生服務體系。大力發展社區衛生服務，加快建設以社區衛生服務中心為主體的城市社區衛生服務網絡，完善社區衛生服務功能，以維護社區居民健康為中心，提供疾病預防控制等公共衛生服務和一般常見病、多發病、慢性病的初級診療服務。轉變社區衛生服務模式，堅持主動服務、上門服務，逐步承擔起居民健康“守門人”的職責。健全各類醫院的功能和職責。優化醫院布局和結構，充分發揮城市醫院在急危重癥和疑難病癥的診療、醫學教育和科研、指導和培訓基層衛生人員等方面的骨干作用。有條件的大醫院按照區域衛生規劃要求，可以通過托管、重組等方式促進醫療資源合理流動。建立城市醫院與社區衛生服務機構的分工協作機制。城市醫院通過技術支持、人員培訓等方式，帶動社區衛生健康持續發展。同時，采取改善服務能力、降低收費標準、提高報銷比例等綜合措施，引導一般診療下沉到基層，逐步實現社區首診、分級醫療和雙向轉診。整合城市衛生資源，充分利用城市現有一、二級醫院及國有企事業所屬醫療機構等基層醫療資源，發展和完善社區衛生服務網絡。充分發揮包括民族醫藥在內的中醫藥在疾病預防控制、應對突發公共衛生事件、醫療服務中的作用。加強中醫臨床研究基地和中醫院建設，組織開展中醫藥防治疑難疾病的聯合攻關，在醫療衛生機構中大力推廣中醫藥適宜技術。創造良好的政策環境，扶持中醫藥發展，促進中醫藥繼承和創新。建立城市醫院對口支援農村醫療衛生工作的制度。發達地區要加強對口支援貧困地區和少數民族地區發展醫療衛生事業。城市大醫院要與貧困地區和少數民族地區的縣級醫院建立長期穩定的對口支援和合作制度，采取臨床服務、人員培訓、技術指導、設備支援等方式，幫助其提高醫療水平和服務能力。

（六）加快建設醫療保障體系。加快建立和完善以基本醫療保障為主體，其他多種形式補充醫療保險和商業健康保險為補充，覆蓋城鄉居民的多層次醫療保障體系。建立覆蓋城鄉居民的基本醫療保障體系。城鎮職工基本醫療保險、城鎮居民基本醫療保險、新型農村合作醫療和城鄉醫療救助共同組成基本醫療保障體系，分別覆蓋城鎮就業人口、城鎮非就業人口、農村人口和城鄉困難人群。堅持廣覆蓋、保基本、可持續的原則，從重點保障大病起步，逐步向門診小病延伸，提高保障水平。建立國家、單位、家庭和個人責任明確、分擔合理的多渠道籌資機制，實現社會互助共濟。隨著經濟社會發展，逐步提高籌資水平和統籌層次，縮小保障水平差距，最終實現制度框架的基本統一。進一步完善城鎮職工基本醫療保險制度，加快覆蓋就業人口，重點解決國有關閉破產企業、困難企業等職工

和退休人員以及混合所有制、非公有制經濟組織從業人員和靈活就業人員的醫療保險問題；加快推進城鎮居民基本醫療保險試點，到2009年全面推開，重視解決老人和兒童的基本醫療保險問題；全面實施新型農村合作醫療制度，逐步提高政府補助水平，適當增加農民繳費，提高保障能力。完善城鄉醫療救助制度。對困難人群參保及其難以負擔的醫療費用提供補助，筑牢醫療保障底線。有條件的地區要采取多種方式積極探索建立城鄉一體化的基本醫療保障管理體系。鼓勵工會等社會團體開展多種形式的醫療互助活動。鼓勵和引導各類公益性組織發展社會慈善醫療救助。做好城鎮職工基本醫療保險制度、城鎮居民基本醫療保險制度、新型農村合作醫療制度和城鄉醫療救助制度之間的銜接，妥善解決農民工基本醫療保險問題。簽訂勞動合同并與企業建立穩定勞動關系的農民工，要按照國家規定明確用人單位繳費責任，將其納入城鎮職工基本醫療保險制度；其他農民工根據實際情況，參加戶籍所在地新型農村合作醫療或務工所在地城鎮居民基本醫療保險。積極做好農民工醫保關系接續、異地就醫和費用結算服務等政策銜接。積極發展商業健康保險。鼓勵商業保險機構開發適應不同需要的健康保險產品，簡化理賠手續，方便群眾，滿足多樣化的健康需求。鼓勵企業和個人通過參加商業保險及多種形式的補充保險解決基本醫療保障之外的需求。繼續探索商業保險機構參與新型農村合作醫療等經辦管理的方式。

（七）建立健全藥品供應保障體系。以建立國家基本藥物制度為基礎，以培育具有國際競爭力的醫藥產業、提高藥品生產流通企業集中度、規范藥品生產流通秩序、完善藥品價格形成機制、加強政府監管為主要內容，建設規范化、集約化的藥品供應保障體系，不斷完善執業藥師制度，保障人民群眾安全用藥。建立國家基本藥物制度。中央政府統一制定和發布國家基本藥物目錄，按照防治必需、安全有效、價格合理、使用方便、中西藥并重的原則，結合我國用藥特點，參照國際經驗，合理確定我國基本藥物品種和數量。建立基本藥物的生產供應體系，在政府宏觀調控下充分發揮市場機制的作用，基本藥物由國家實行招標定點生產或集中采購，直接配送，減少中間環節，在合理確定生產環節利潤水平的基礎上統一制定零售價，確保基本藥物的生產供應，保障群眾基本用藥。規范基本藥物使用，制訂基本藥物使用規范和臨床應用指南。城市社區衛生服務中心（站）、鄉鎮衛生院、村衛生室等基層醫療衛生機構應全部使用基本藥物，其他各類醫療機構也要將基本藥物作為首選藥物并確定使用比例。基本藥物全部納入基本醫療保障體系藥物報銷目錄，報銷比例明顯高于非基本藥物規范藥品生產流通。完善醫藥產業發展政策和行業發展規劃，嚴格市場準入，嚴格藥品注冊審批，大力規范和整頓生產流通秩序，推動醫藥產業優化升級和技術進步，發展藥品現代物流和連鎖經營，促進藥品生產、流通企業的整合。建立覆蓋面廣、體系健全、便民惠農的農村藥品供應網和監督網。支持用量小的特殊用藥、急救用藥生產。完善藥品儲備制度。規范藥品采購，堅決治理醫藥購銷中的商業賄賂。加強藥品不良反應監測，建立藥品安全預警機制和應急處置機制。

四、完善體制機制，保障醫藥衛生體系有效規范運轉完善醫藥衛生的管理、運行、投入、價格、監管體制機制，加強科技與人才、信息、法制建設，保障醫藥衛生體系有效規范運轉。

（八）建立協調統一的醫藥衛生管理體制。按照政事分開、管辦分開、屬地化和全行業管理的原則，合理確定不同層級政府之間、政府與醫藥衛生機構之間的職責范圍，形成職能明確、定位清晰、綜合協調、權責統一的管理體制。實施屬地化和全行業管理。所有醫療衛生機構，不論所有制、投資主體、隸屬關系和經營性質，均由所在地衛生行政部門實行統一規劃、統一準入、統一監管。中央、省級可以設置少量承擔醫學科研、教學功能的醫學中心或區域醫療中心、承擔全國或區域性疑難病癥診治的專科醫院等醫療機構；縣（市、區）主要負責舉辦縣級醫院、鄉村衛生和社區衛生機構；其余公立醫院由設區的市負責舉辦。強化區域衛生規劃。省級人民政府制定衛生資源配置標準，組織編制區域衛生規劃和醫療機構設置規劃，明確醫療機構的數量、規模、布局和功能。科學制定鄉鎮衛生院（村衛生室）、社區衛生服務中心（站）等基層衛生機構和各級醫院建設和設備配置標準。充分利用和優化配置現有醫療衛生資源，調整優化結構和布局，對不符合規劃要求的醫療機構要逐步進行整合，嚴格控制大型醫療設備配置，鼓勵共建共享，提高醫療衛生資源利用效率。新增衛生資源必須符合區域衛生規劃，重點投向農村和社區衛生等薄弱環節。加強區域衛生規劃與城市發展規劃、土地利用規劃等的銜接。建立區域衛生規劃和資源配置監督評價機制。推進公立醫院管理體制改革。從有利于強化公立醫院公益性和政府有效監管出發，積極探索政事分開、管辦分開的多種實現形式。進一步轉變政府職能，衛生行政部門主要承擔衛生發展規劃、資格準入、規范標準、服務監管等行業管理職能，其他有關部門按照各自職能進行管理和提供服務。落實公立醫院獨立法人地位。進一步完善基本醫療保險管理體制。中央統一制定基本醫療保險制度框架和政策，地方政府負責組織實施管理，創造條件逐步提高統籌層次。有效整合基本醫療保險經辦資源，逐步實現城鄉基本醫療保險行政管理的統一。

（九）建立高效規范的醫藥衛生機構運行機制。以維護公立醫療衛生機構公益性質為核心，逐步建立規范、科學、高效、有序的醫藥衛生機構運行機制。公共衛生機構收支全部納入預算管理。按照承擔的職責任務，由政府合理確定人員編制、工資水平和經費標準，明確各類人員崗位職責，嚴格人員準入，加強績效考核，建立能進能出的用人制度，提高工作效率和服務質量。轉變基層醫療衛生機構運行機制。政府舉辦的城市社區衛生服務中心（站）和鄉鎮衛生院等基層醫療衛生機構，要嚴格界定服務功能，明確規定使用適宜技術、適宜人才、適宜設備和基本藥物，為廣大群眾提供低成本服務，維護公益性質。要嚴格核定人員編制，實行人員聘用制，建立能進能出和激勵有效的人力資源管理制度。要明確收支范圍和標準，實行核定任務、核定收支、績效考核補助的財務管理辦法，并探索實行收支兩條線、公共衛生和醫療保障經費的總額預付等多種行之有效的管理辦法，嚴格收支預算管理，提高資金使用效益。要改革藥品加成政策，實行藥品零差率銷售。加強和完善內部管理，建立以服務質量為核心、以崗位責任與績效為基礎的考核和激勵制度，形成保障公平效率的長效機制建立規范的公立醫院運行機制。公立醫院要遵循公益性質和社會效益原則，堅持以病人為中心，優化服務流程，規范用藥檢查和醫療行為，深化運行機制改革。建立和完善醫院法人治理結構，明確所有者和管理者的責權，形成決策、執行、監督相互制衡，有責任、有激勵、有約束、有競爭、有活力的機制。實行醫藥收支分開管理，探索有效方式逐步改革以藥補醫機制。通過實行藥品購銷差別加價、設立藥事服務費等多種方式逐步改革或取消藥品加成政策，同時采取適當調整醫療服務價格、增加政府投入、改革支付方式等措施完善公立醫院補償機制。進一步完善財務、會計管理制度，嚴格預算管理，加強財務監管和運行監督。地方可結合本地實際，對有條件的醫院開展“核定收支、以收抵支、超收上繳、差額補助、獎懲分明”等多種管理辦法的試點。改革人事制度，完善分配激勵機制，推行聘用制度和崗位管理制度，嚴格工資總額管理，實行以服務質量及崗位工作量為主的綜合績效考核和崗位績效工資制度，有效調動醫務人員的積極性。健全醫療保險經辦機構運行機制。

完善內部治理結構，建立合理的用人機制和分配制度，完善激勵約束機制，提高醫療保險經辦管理能力和管理效率。