Beijing, 3 Mar (Xinhua) -- Recently, the General Office of the CPC Central Committee and the General Office of the State Council issued the "Opinions on Further Improving the Medical and Health Service System" and issued a circular urging all localities and departments to conscientiously implement it in light of actual conditions.
The full text of the Opinions on Further Improving the Medical and Health Service System is as follows.
In order to thoroughly implement the decision-making and deployment of the Party Central Committee on the implementation of the Healthy China Strategy, promote the comprehensive establishment of a high-quality and efficient medical and health service system with Chinese characteristics, and provide the people with all-round and full-cycle health services, the following opinions are hereby put forward.
1. General requirements
(1) Guiding ideology. Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, deeply implement the spirit of the 20th National Congress of the Communist Party of China, put the protection of people's health in a strategic position of priority development, implement the Party's health and health work policy in the new era, summarize the experience of new crown epidemic prevention and control, adhere to people's health as the center, adhere to prevention first, adhere to the public welfare of medical and health undertakings, promote the shift of medical and health development mode to pay more attention to connotative development, service mode to pay more attention to system continuity, and management methods to pay more attention to scientific governance. Promote the expansion of high-quality medical resources and balanced regional layout, build a high-quality and efficient medical and health service system with Chinese characteristics, and continuously enhance the people's sense of gain, happiness and security.
(2025) Work objectives. By 2035, the medical and health service system will be further improved, the resource allocation and service balance will be gradually improved, the capacity of major disease prevention and control, treatment and emergency response will be significantly enhanced, the development of traditional Chinese and Western medicine will be more coordinated, and the construction of orderly medical treatment and diagnosis and treatment system will achieve positive results. By <>, form an integrated medical and health service system that is compatible with the basic realization of socialist modernization, with a complete system, clear division of labor, complementary functions, continuous coordination, efficient operation and resilience, significantly enhance the fairness, accessibility and high-quality service supply capacity of medical and health services, and significantly improve the health level of the people.
Second, optimize the allocation of resources, strengthen the construction of talent teams, and promote the modernization of capabilities
(1) Improve the capacity of health personnel. Develop and strengthen the health workforce, focusing on rural areas and communities. Increase support for the training of professional talents at the grassroots level, in remote areas and in short supply, and narrow the gap in talent allocation between urban and rural areas, regions, and specialties. Promote the targeted training of rural health personnel, implement the system of serving medical practitioners at the grassroots level, and encourage physicians to practice at multiple sites at grassroots levels, remote areas, areas with scarce medical resources, and other medical institutions in need. Encourage rural doctors to participate in academic education, obtain the qualifications of practicing (assistant) physicians, and promote the training of assistant general practitioners. Strengthen the training of urgently needed professionals in public health, general medicine, pediatrics, intensive care medicine, respiratory, psychiatry, infectious diseases, geriatrics, and other fields, and improve the training mechanism for public health and clinical medicine compound talents. Continue to strengthen the standardized training of residents in general practice, implement general practitioner transfer training, and expand the team of general practitioners. Strengthen coordination between medicine and education, implement post-graduation education and continuing education, and improve the standardized training system for resident physicians. Implement the high-level medical talent plan and cultivate a group of leading talents. Implement the training project of talents with Chinese medicine characteristics.
(2) Improve the capacity of public health services. Improve the public health system, strengthen the standardization of public health departments in professional public health institutions and hospitals and primary medical and health institutions. Improve staffing standards for all types of professional public health institutions, and strengthen disease prevention and control capabilities and team building. Build a public health laboratory testing network with resource linkage, unified quality control, and information sharing, and improve inspection and testing capabilities. Improve the monitoring and early warning system and improve the ability to detect major epidemics early. Strengthen the major epidemic prevention and control treatment system and emergency response capacity-building, and establish and complete hierarchical, stratified, and triage mechanisms for the treatment of major epidemics. Improve the public health emergency management system, and establish public health emergency response teams by level and classification. Formulate a list of public health responsibilities of medical and health institutions, clarify the job responsibilities and allocation requirements of public health personnel in various medical institutions, and include them in performance appraisals. Improve the system of public health physicians, and explore granting public health physicians the right to prescribe. Explore the establishment of a training mechanism for grassroots military doctors to practice in local first-aid institutions.
(3) Strengthen the basic medical and health service network in urban and rural areas. Strengthen the standardized construction of township health centers and community health service centers, develop community hospitals, and improve the setup and equipment of clinical departments. Strengthen the capacity of diagnosis and treatment of common diseases, public health, health management, and traditional Chinese medicine services, improve the level of screening and prevention of infectious diseases, strengthen the health management of major chronic diseases, carry out guidance on residents' mental health, and enhance the capacity of township hospitals for routine surgery and other medical services at level 2 and below. According to the population distribution, optimize the setting up of community health service stations and village clinics, build central village clinics, and facilitate the masses to see a doctor in villages with a small population through methods such as itinerant medical treatment, extended services in neighboring (joint) villages, and village-based services by higher-level medical and health institutions. Innovate the mechanism for the use of rural medical and health personnel, strengthen the integrated allocation and management of county medical and health personnel, and improve the attractiveness of rural medical and health posts in places where conditions permit.
(4) Highlight the leading position of county-level hospitals. Strengthen the capacity building of clinical specialties and management in county-level hospitals (including traditional Chinese medicine hospitals, the same below), and strengthen the public health service functions of county-level hospitals. Develop emergency departments, obstetrics and gynecology, pediatrics, intensive care medicine, traditional Chinese medicine, psychiatry, geriatrics, rehabilitation medicine, infectious diseases and other disciplines, improve the diagnosis and treatment capacity of tumors, cardiovascular and cerebrovascular diseases and other major diseases, and encourage the establishment of relevant specialized centers based on existing resources. Coordinate and promote the work of medical talents to help the national rural revitalization key county hospitals. Strengthen the counterpart support for the construction of county-level hospitals in tertiary public hospitals through various methods.
(5) Promote the construction of medical centers. Relying on the layout of high-level hospitals to lay out national medical centers, carry out the construction of national and provincial regional medical centers according to the plan, improve the capacity of medical services and treatment of major infectious diseases, and drive the overall level of medical services at the national and regional levels. Support high-level hospitals to build clinical diagnosis and treatment centers, talent training bases and medical science and technology innovation and transformation platforms for difficult and complex special diseases and rare diseases, strengthen the construction of clinical specialties guided by meeting the clinical needs of major diseases, and form specialty alliances and telemedicine collaboration networks. Encourage all localities to support the construction of outstanding innovation teams in the fields of major health issues, key clinical disciplines, shortage specialties, and health industry development.
(6) Expand the supply of continuous services such as rehabilitation and nursing. By supporting areas rich in medical resources to transform some public medical institutions into nursing homes and rehabilitation hospitals, and supporting social forces to organize them, increase the number of specialized medical institutions such as rehabilitation and nursing, improve the continuous service system, and expand the supply of services such as rehabilitation medicine, elderly care, disability care, maternal and infant care, community nursing, palliative care and nutritional support. Standardize the development of social medical services.
3. Strengthen the division of labor and cooperation, promote hierarchical diagnosis and treatment, and promote system integration
(1) Complete the family doctor system. With primary medical and health institutions as the main platform, establish a family doctor contract service model with general practitioners as the main body, effective linkage of general practice specialties, and organic integration of medical and prevention to provide comprehensive and continuous public health, basic medical and health management services. Guide general practitioners in secondary hospitals and above to serve as family doctors or join the primary family doctor team to provide contracting, diagnosis and treatment services in primary medical and health institutions. Improve the financing mechanism for contracted services, and areas with the capacity can explore capitation payments to primary medical and health institutions or family doctor teams for contracted residents' medical insurance outpatient pooling funds. Improve the mechanism for collecting and paying for contracted services. Implement differentiated policies for contracted residents in areas such as medical treatment, referral, medication, and medical insurance, and gradually form a service model for family doctors' first consultation, referral, and lower referral.
(2) Promote the construction of urban medical complexes. Combined with the development trend of new urbanization and population aging, rationally layout all types of medical and health institutions at all levels, and clarify their functional positioning. In urban areas, a medical consortium composed of municipal hospitals, district-level hospitals, community health service institutions, nursing homes, professional rehabilitation institutions, palliative care institutions, etc. is gridded. With business cooperation, talent training, technical support, etc. as the link, municipal hospitals strengthen the division of labor and cooperation with district-level hospitals, explore various forms such as integrated management of district-level hospitals and community health service organizations, form a development model that integrates and diversifies with municipal districts and districts, and improves a continuous and smooth two-way referral service path. Socially-run medical institutions may take the lead in forming or participating in medical consortia. Establish a unified and coordinated management system for medical consortia, and scientifically formulate a list of rights and responsibilities of all parties such as organization, operation, and supervision.
(3) Promote the establishment of county medical communities. In rural areas, medical communities are developed at the county level, with county-level hospitals taking the lead, with several other county-level medical and health institutions, township health centers, and community health service centers as members. Promote the construction of a close-knit county medical community, implement integrated management of counties and townships, gradually realize the overall management of administration, personnel, finance, business, medication catalog, information system, etc., and establish a community of responsibility, management, service and interests. Establish open and shared centers for imaging, electrocardiogram, pathological diagnosis, and medical testing, and promote mutual recognition of grassroots examinations, higher-level diagnosis, and examination and test results. Strengthen the overall use of beds, sources and equipment within and between medical communities. Continue to promote the integrated management of medical and health villages. Improve the performance appraisal of the medical community as a unit, and evaluate the overall performance of the medical community from the aspects of medical treatment and diagnosis and treatment order, medical and health service capacity, utilization of medical and health resources, and efficiency of the use of medical insurance funds.
(4) Strengthen the combination of prevention and treatment. Innovate medical and prevention coordination and medical and prevention integration mechanisms. Public medical institutions have set up departments directly engaged in disease prevention and control, such as public health departments. Comprehensively promote in-depth collaboration between medical institutions and professional public health institutions, and establish mechanisms such as talent flow, cross-training, service integration, and information sharing. Explore the participation of disease prevention and control professionals in the work of medical consortiums, establish a community disease prevention and control area responsibility system, and improve the gridded grassroots disease prevention and control network. With the management of key populations and key diseases as the main content, optimize public health services, and carry out targeted health promotion and preventive health care services for pregnant women, infants and young children, students, occupational groups and the elderly.
(5) Promote the integration of medical and elderly care. Rationally arrange the geriatric department, nursing home, rehabilitation and nursing institution, palliative care institution, etc. of the elderly institution and general hospital, and promote the formation of a health service network for the elderly with resource sharing, mechanism connection, and function optimization. Establish and improve the business coordination mechanism between medical and health institutions and elderly care institutions, actively open green channels for appointment visits and emergency first aid between elderly care institutions and medical institutions, improve the ability of medical institutions run by elderly care institutions to carry out medical services and pharmaceutical affairs management, and coordinate to do a good job in the management, rehabilitation and nursing services of chronic diseases of the elderly. Promote grassroots medical and health institutions to support services such as medical care for the elderly, family beds, and home care.
(6) Give play to the important role of traditional Chinese medicine. Support the inheritance, innovation and development of Chinese medicine, strengthen the construction of Chinese medicine service system, and give play to the important role of Chinese medicine in the treatment of pre-existing diseases, treatment and rehabilitation of major diseases, prevention and control of infectious diseases and health emergencies. Establish a clinical treatment and scientific research system for TCM infectious diseases, rely on high-level TCM hospitals to build a national TCM epidemic prevention and control base, and build a TCM epidemic prevention and emergency medical rescue team. Improve the consultation system of traditional Chinese and Western medicine, and carry out in-depth clinical cooperation between traditional Chinese and western medicine for major and difficult diseases. Implement the project of improving the capacity of Chinese medicine rehabilitation services. Support qualified Chinese medicine hospitals to take the lead in building medical consortia, and strengthen the construction of traditional Chinese medicine halls in grassroots medical and health institutions. Adhere to the past for the present, keep the right innovation, strengthen cultural self-confidence, and promote the creative transformation and innovative development of Chinese medicine health and wellness culture.
4. Improve service quality, improve service experience, and promote service quality
(1) Ensure the quality and safety of medical services. Establish a high-level medical quality management and control system, and improve the national, provincial and municipal medical quality control organizations covering major specialties. Improve medical quality and safety management systems and norms, and strictly implement the core medical quality and safety system. Improve the code of conduct for medical services, and increase the level of standardization and standardization of medical services. Medical institutions establish and improve the quality management and control work system with full participation and covering the whole process of clinical services, and fully implement clinical path management. Improve results-oriented service quality data system evaluation, feedback and incentive mechanisms. Explore the establishment of a medical service review system. Improve the security of drug supply and the level of pharmacy services.
(2) Improve the level of medical and health technology. Strengthen the R&D system and capacity building of clinical medicine, public health and medical devices, and develop cutting-edge medical technologies such as omics technology, stem cell and regenerative medicine, new vaccines, biological therapy, and precision medicine. Accelerate the construction of a health science and technology innovation system, highlight the role of medical and health institutions as an innovation resource gathering platform, and rely on high-level medical institutions to build a national clinical medical research center. Adhere to the coordination of clinical research and clinical treatment, strengthen the important supporting role of scientific research in the response to major public health events, and promote scientific research in the fields of vaccines, detection technologies, and new drug creation related to major infectious diseases and major diseases. Strive to break through the bottleneck of technical equipment and accelerate the completion of the shortcomings of high-end medical equipment.
(3) Promote service continuity. Improve technical standards and working mechanisms for graded diagnosis and treatment. Encourage medical institutions to carry out service coordination and guide and assist patients in referral. Improve the multidisciplinary joint diagnosis and treatment and ward rounds system. Establish treatment centers for major acute diseases such as chest pain, stroke, critically ill pregnant women, critically ill newborns and children, and trauma, and provide green channels and integrated services for treatment. Explore the establishment of joint outpatient clinics for chronic diseases between primary medical and health institutions and higher-level medical institutions to carry out the treatment, prevention and rehabilitation of common chronic diseases.
(4) Improve the convenience of services. Actively use the Internet, artificial intelligence and other technologies to continuously optimize the service process. Build smart hospitals, implement time-based appointment services for diagnosis and treatment, examination and testing, and promote services such as inter-clinic settlement, mobile payment, online inquiry, and drug delivery. Integrate and open up relevant online service terminals. Promote the application of residents' electronic health records, and improve authorized access and open service channels and interaction methods. Gradually expand day medical services and expand the coverage of telemedicine. Actively promote the joint application of multiple certificates related to newborns. Vigorously promote the facilitation of public health services such as immunization programs. Optimize direct billing services for medical treatment across provinces.
(5) Enhance service comfort. Improve the medical environment, optimize the layout of facilities, and accelerate the construction of age-friendly medical institutions. Support the provision of door-to-door services for the elderly, disabled and semi-disabled persons, severely disabled, etc. Strengthen the service awareness of medical staff, strengthen doctor-patient communication, promote humanistic care, and protect patient privacy. Implement the requirements of high-quality nursing, and continue to strengthen services such as clinical psychology, anesthesia and analgesia, medication guidance, and nutrition guidance. Improve the system of medical social workers and volunteer services. Give full play to the role of the people's mediation as the main channel, improve the long-term mechanism for resolving medical disputes, and build a harmonious doctor-patient relationship.
5. Strengthen scientific management, compact responsibility, and promote refined management
(1) Improve the modern hospital management system. Adhere to and strengthen the party's overall leadership over hospital work, conscientiously implement the president's responsibility system under the leadership of the party committee, improve the deliberative decision-making system of public hospitals, and build a working mechanism for unified leadership of the party committee, division of labor and cooperation between the party and government, and coordinated operation. Improve the new mechanism for maintaining public welfare, mobilizing enthusiasm, and ensuring sustainable operation of public hospitals. Implement comprehensive budget performance management. Comprehensively carry out performance appraisal of public hospitals, improve the performance appraisal system oriented by public welfare and focusing on health output and service quality, increase the weight of indicators related to graded diagnosis and treatment, and implement assessment and evaluation according to the management level and type of institution. In accordance with the principle of consistency of authority and responsibility, further rationalize the management system and mechanism of hospitals affiliated to colleges and universities.
(2) Improve the management of professional public health institutions. Promote the reform of the public health service system, optimize and improve the functional setup of disease prevention and control institutions, and standardize the provision of public health technical services to the society. Select and allocate strong leadership groups, implement hierarchical and categorical management of posts, and increase the proportion of professional and technical personnel. Strictly implement technical specifications, strengthen quality control, risk prevention and performance evaluation.
(3) Strengthen the management of grassroots medical and health institutions. Improve the capacity standards of primary medical and health institutions, and further clarify the requirements for resource allocation, service capacity, and management system construction. Establish and improve an evaluation and evaluation system that conforms to the positioning of grassroots functions and service characteristics. Strengthen primary medical quality management and incorporate it into the national medical quality management and control system. Strengthen performance appraisal, take service quality and quantity, operational efficiency, patient satisfaction, etc. as the main assessment content, and strengthen the sharing and application of assessment results.
6. Deepen the reform of systems and mechanisms, enhance motivation, and promote scientific governance
(1) Improve government input mechanisms. Establish a stable investment mechanism for public health undertakings, implement the government's responsibility for ensuring investment in professional public health institutions and basic public health services, and implement funding guarantee policies for medical institutions to undertake public health service tasks. Strengthen the normative role of regional health planning and medical institution setup planning in the allocation of medical and health resources. Implement the government's investment policy for public hospitals in line with regional health plans in accordance with regulations, and increase the investment in traditional Chinese medicine hospitals and primary medical and health institutions. Establish a sustainable and stable diversified investment mechanism for the development of Chinese medicine.
(2) Complete mechanisms for purchasing services. Deepen the reform of medical service prices, and establish a medical service price mechanism with categorical management, hospital participation, scientific determination, and dynamic adjustment. Improve charging policies such as "Internet +" medical services and door-to-door medical services. Promote the reform of medical insurance payment methods and improve diversified and complex medical insurance payment methods. Improve medical insurance payment methods that meet the characteristics of traditional Chinese medicine. Explore the implementation of total payment for close-knit medical complexes, strengthen supervision and assessment, and implement balance retention and reasonable overexpenditure sharing. Gradually increase the proportion of services provided by primary medical and health institutions in the total amount of medical services and medical insurance fund payments. Establish a long-term care insurance system. Actively develop commercial health insurance.
(3) Improve the establishment and personnel system. Rationally formulate and implement staffing standards for public medical and health institutions, and establish a dynamic verification mechanism. Promote the separate approval and overall use of the establishment of public medical and health institutions in medical consortia, and the unified recruitment and management of personnel. Reform the post management system of public hospitals, and optimize the recruitment standards and procedures for grassroots medical personnel. Deepen the reform of the professional title system for health professional and technical personnel, take moral ability and performance as the guide, scientifically set evaluation standards, and put medical ethics and medical style in the first place in talent evaluation.
(4) Deepen the reform of the remuneration system. Implement the requirements of "allowing medical and health institutions to break through the current level of wage regulation and control of public institutions, allowing medical service income to be used mainly for personnel incentives after deducting costs and withdrawing various funds according to regulations", and establish and improve a salary system that adapts to the characteristics of the medical and health industry. Comprehensively deepen the reform of the salary system of public hospitals. Reasonably approve the total amount and level of performance-based wages of professional public health establishments, and truly ensure the treatment of public health physicians. The income of the personnel of the public health department of a medical institution shall not be lower than the average salary level of the personnel of the medical institution where they are located, and explore the establishment of a corresponding allowance and subsidy system. Implement the policy on performance-based wages for primary medical and healthcare establishments, and reasonably approve the total amount and level of performance-based wages for primary medical and healthcare establishments. Implement incentive policies for wage distribution of qualified high-level talents at the grassroots level. Implement the treatment of rural doctors, and do a good job in social security work for rural doctors.
(5) Give play to the supporting role of information technology. Develop "Internet + medical health", build an industrial Internet platform for the medical field, accelerate the application of the Internet, blockchain, Internet of Things, artificial intelligence, cloud computing, big data, etc. in the medical and health field, and strengthen the construction of health and medical big data sharing exchange and guarantee system. Establish a cross-departmental and cross-institutional public health data sharing and scheduling mechanism and an intelligent early warning multi-point trigger mechanism. Promote the unified operation and interconnection of information systems in medical consortia, and strengthen digital management. Accelerate the establishment of a health and medical data security system, strengthen data security monitoring and early warning, improve the data security protection capacity of medical and health institutions, and strengthen the protection of important information.
(6) Strengthen comprehensive supervision. Improve a diversified and comprehensive regulatory system, innovate supervision methods, and focus on strengthening the supervision of service element access, quality and safety, public health, institutional operation, practitioners, service behavior, medical expenses, industry order, and health industry. Establish and improve the work system for the construction of the work style of the medical and health industry, carry out special actions for honest practice, increase the intensity of supervision and inspection, and enforce discipline, maintain the public interest of public medical and health institutions, and regulate the practice behavior of socially-run medical institutions in accordance with the law. Strengthen the establishment of the rule of law, advancing the formulation and revision of laws and regulations in relevant fields. Complete joint punishment systems in accordance with law, strengthening accountability and linkage accountability.
7. Organization and implementation
(1) Strengthen organizational leadership. Adhere to and strengthen the party's overall leadership, and strengthen the leadership responsibility of local party committees at all levels for the reform and development of the medical and health service system. All provincial (autonomous region and directly governed municipality) governments should attach great importance to the construction of a high-quality and efficient medical and health service system, include it in the government's work goals and assessment goals, formulate specific implementation plans, implement various tasks, and strengthen institutional and mechanism innovation in accordance with local conditions.
(2) Refine supporting measures. All relevant departments should conscientiously perform their duties, coordinate to promote the construction of the medical and health service system, formulate and introduce supporting policies in a timely manner, strengthen coordination and cooperation, and form a joint force. Establish a monitoring and evaluation mechanism for the medical and health service system with a regional unit and a focus on overall performance.
(3) Strengthen publicity and guidance. Focusing on the goals and key tasks of the reform, actively publicize the progress and results of the work, do a good job in policy interpretation and related training, timely summarize and promote local good practices and experiences, actively respond to social concerns, and create a good social environment for the reform and development of the medical and health service system.