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Notice of the State Council on Issuing the Plan on Recent Priorities in Carrying out the Reform of Health Care System (2009-2011)
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国务院关于印发医药卫生体制改革近期重点实施方案(2009－2011年)的通知
[失效]
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【法宝引证码】
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Notice of the State Council on Issuing the Plan on Recent Priorities in Carrying out the Reform of Health Care System (2009-2011)
(No. 12 [2009] of the State Council)
The people's governments of all provinces, autonomous regions and municipalities directly under the Central Government, all ministries and commissions of the State Council and all institutions directly under the State Council,
The Plan on Recent Priorities in Carrying out the Reform of Health Care System (2009-2011) are hereby distributed to you in print, please earnestly execute it by taking into account the local actualities and your own actualities.
State Council
March 18, 2009
Plan on Recent Priorities in Carrying out the Reform of Health Care System (2009-2011)
In accordance with the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of Health Care System (No. 6 [2009] of the Central Committee of the Communist Party of China, hereinafter referred to as the Opinions), the emphasis for the 2009-2011 period shall be laid on the 5 reform programs, namely, (a) to accelerate the construction of basic medical care guarantee system, (b)to preliminarily establish a national basic drug system, (c) to improve the grassroots medical and health service system, (d) to steadily promote equal access for all people to basic public health services and (e) to push forward the pilot reforms in public hospitals.
To push forward the 5 major reform programs is to solve the problem of unaffordable and inadequate medical services, which is complained about by many people. We should boost the construction of basic medical care guarantee system which will cover all urban and rural residents and effectively mitigate the individuals' burden of paying medical expenses. We should establish a national basic drug system, improve the grassroots medical and health service system, facilitate the people's access to medical care and give full play to the roles of traditional Chinese medicines and decrease the prices of medical care services and drugs. We should steadily promote equal access for all people to basic public health services so as to make all urban and rural residents have the access to the basic public health services, and prevent diseases to the maximum extent. We should give an impetus to the pilot reforms in public hospitals, improve the services of public medical institutions and strive to solve the people's difficulty in “getting good medical services”.
To push forward the five major reform programs is to ensure the public good nature of the public medical and health cause and the reform has a distinct phasic feature. To provide the basic medical and health care system to all people as a public product and realize all people's equal access to the basic public health services is a significant change in both the ideology and system of the development of the medical and health cause and is essentially required for the implementation of the Scientific Outlook on Development. The reform of health care system will remain as an arduous task for a long term and should be pressed ahead with priority phase by phase. To properly deal with the fairness-efficiency relationship, we should first solve the fairness problem at the initial phase of the reform, strive to meet the basic demands for medical services by the people and gradually enhance the guarantee level along with the economic and social development. We should gradually solve the problem of linkage between the programs, namely, the basic medical insurance for urban employees, basic medical insurance for non-working urban residents and new-type rural cooperative medical care for rural residents. We should encourage private investments to be made to develop multi-level and diversified medical and health care services, make an overall plan on utilization of the medical and health care resources of the whole society, improve the efficiency and quality of services and satisfy the people's demands for diversified medical and health care services.
To push forward the five major reform programs is to enhance the practicability of the reform, highlight the focuses and stimulate the thorough reform of the health care system. To establish a basic medical and health care system is a significant system innovation and a key link in the thorough reform of the health care system. The 5 major reform programs involve the construction of the basic medical care guarantee system, guarantee of pharmaceutical supplies, mechanism of formation of pharmaceutical prices, construction of grassroots medical and health institutions, reform of the public medical institutions, mechanism of investments to the medical and health care sector, construction of the team of medical workers, pharmaceutical and health care management system and other key links and important fields. To well implement the 5 reforms is to completely change the circumstance in which some urban and rural residents are not covered by the medical care guarantee system and the public medical and health care services have been weak for a long time, to make the public medical institutions really serve the public good rather than seek profits, to effectively solve the present major problems in the health care field and to lay a solid foundation for thoroughly accomplishing all goals of the reform of health care system.
| | 国务院关于印发医药卫生体制改革近期重点实施方案（2009－2011年）的通知
（国发〔2009〕12号）
各省、自治区、直辖市人民政府，国务院各部委、各直属机构：
现将《医药卫生体制改革近期重点实施方案（2009-2011年）》印发给你们，请结合本地区、本部门实际，认真贯彻执行。
国务院
二○○九年三月十八日
医药卫生体制改革近期重点实施方案（2009-2011年）
根据《中共中央 国务院关于深化医药卫生体制改革的意见》（中发〔2009〕6号，以下简称《意见》），2009-2011年重点抓好五项改革：一是加快推进基本医疗保障制度建设，二是初步建立国家基本药物制度，三是健全基层医疗卫生服务体系，四是促进基本公共卫生服务逐步均等化，五是推进公立医院改革试点。
推进五项重点改革，旨在着力解决群众反映较多的“看病难、看病贵”问题。推进基本医疗保障制度建设，将全体城乡居民纳入基本医疗保障制度，切实减轻群众个人支付的医药费用负担。建立国家基本药物制度，完善基层医疗卫生服务体系，方便群众就医，充分发挥中医药作用，降低医疗服务和药品价格。促进基本公共卫生服务逐步均等化，使全体城乡居民都能享受基本公共卫生服务，最大限度地预防疾病。推进公立医院改革试点，提高公立医疗机构服务水平，努力解决群众“看好病”问题。
推进五项重点改革，旨在落实医疗卫生事业的公益性质，具有改革阶段性的鲜明特征。把基本医疗卫生制度作为公共产品向全民提供，实现人人享有基本医疗卫生服务，这是我国医疗卫生事业发展从理念到体制的重大变革，是贯彻落实科学发展观的本质要求。医药卫生体制改革是艰巨而长期的任务，需要分阶段有重点地推进。要处理好公平与效率的关系，在改革初期首先着力解决公平问题，保障广大群众看病就医的基本需求，并随着经济社会发展逐步提高保障水平。逐步解决城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗制度之间的衔接问题。鼓励社会资本投入，发展多层次、多样化的医疗卫生服务，统筹利用全社会的医疗卫生资源，提高服务效率和质量，满足人民群众多样化的医疗卫生需求。
推进五项重点改革，旨在增强改革的可操作性，突出重点，带动医药卫生体制全面改革。建立基本医疗卫生制度是一项重大制度创新，是医药卫生体制全面改革的关键环节。五项重点改革涉及医疗保障制度建设、药品供应保障、医药价格形成机制、基层医疗卫生机构建设、公立医疗机构改革、医疗卫生投入机制、医务人员队伍建设、医药卫生管理体制等关键环节和重要领域。抓好这五项改革，目的是从根本上改变部分城乡居民没有医疗保障和公共医疗卫生服务长期薄弱的状况，扭转公立医疗机构趋利行为，使其真正回归公益性，有效解决当前医药卫生领域的突出问题，为全面实现医药卫生体制改革的长远目标奠定坚实基础。
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I. To accelerate the construction of the basic medical care guarantee system
| | 一、加快推进基本医疗保障制度建设
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1. To expand the coverage of basic medical care guarantee system. We should ensure that, within 3 years, the basic medical insurance for urban employees, basic medical insurance for non-working urban residents and new-type rural cooperative medical care system for rural residents will cover all urban and rural residents, and the contributors of all these insurances shall be over 90%. We should, within 2 years or so, ensure that the basic medical insurance for urban employees shall cover the retirees from closed or bankrupt enterprises and the employees of financially strained enterprises and, ensure that the basic medical insurance for non-working urban residents shall cover those from the enterprises with real financial difficulties upon approval of the provincial people's government. We should separate the medical insurance treatments to the retirees from closed or bankrupt enterprises from the insurance premiums paid by the said enterprises. The Central Treasury shall provide appropriate insurance subsidies to the insurance contributions for retirees from closed or bankrupt state-owned enterprises in financially strained regions. We should carry out the program of basic medical insurance for non-working urban residents in all round way in 2009 and make all university students covered by the basic medical insurance for non-working urban residents. We should actively encourage employees of urban non-public economic organizations, people with flexible employment and rural migrant workers to be covered by the basic medical insurance for urban employees. The government should provide subsidies to the people who have difficulty in getting a job, as prescribed in the Employment Promotion Law, for their participation in the basic medical insurance for urban employees. The people with flexible employment may, on their own initiatives, choose to participate in the basic medical insurance for urban employees or the basic medical insurance for non-working urban residents. Rural migrant workers who have difficulties in participating the basic medical insurance for urban employees may, on their own initiatives, choose to participate in the basic medical insurance for non-working urban residents or in the new-type rural cooperative medical care program.
| | （一）扩大基本医疗保障覆盖面。三年内，城镇职工基本医疗保险（以下简称城镇职工医保）、城镇居民基本医疗保险（以下简称城镇居民医保）和新型农村合作医疗（以下简称新农合）覆盖城乡全体居民，参保率均提高到90%以上。用两年左右时间，将关闭破产企业退休人员和困难企业职工纳入城镇职工医保，确有困难的，经省级人民政府批准后，参加城镇居民医保。关闭破产企业退休人员实现医疗保险待遇与企业缴费脱钩。中央财政对困难地区的国有关闭破产企业退休人员参保给予适当补助。2009年全面推开城镇居民医保制度，将在校大学生全部纳入城镇居民医保范围。积极推进城镇非公有制经济组织从业人员、灵活就业人员和农民工参加城镇职工医保。政府对符合就业促进法规定的就业困难人员参加城镇职工医保的参保费用给予补贴。灵活就业人员自愿选择参加城镇职工医保或城镇居民医保。参加城镇职工医保有困难的农民工，可以自愿选择参加城镇居民医保或户籍所在地的新农合。
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2. To enhance the basic medical care guarantee level. We should gradually step up the financing standards for and the guarantee level of the basic medical insurance for non-working urban residents and the new-type rural cooperative medical care program. By 2010, the criterion on the subsidies to be offered by the treasury at each level for the basic medical insurance for non-working urban residents and for the new-type rural cooperative medical care program should be increased to 120 yuan per capita every year, the rate of payment to be made by individuals should be increased appropriately, and the concrete criterions thereon should be formulated by the provincial people's government. The rate of reimbursement for the hospitalization expenses within the scope of policies under the programs for basic medical insurance for urban employees, basic medical insurance for non-working urban residents and new-type rural cooperative medical care program should be gradually increased. The scope of reimbursements for outpatient service expenses should be expanded gradually and the rate thereof should be increased gradually. The maximum limit for the payment out of the basic medical insurance for urban employees or out of the basic medical insurance for non-working urban residents should be increased to about 6 times the average annual pay of local employees or about 6 times the average annual disposable income of local urban residents, and the maximum limit for the payment out of the new-type rural cooperative medical care program shall be increased to 6 times the per capita net income of local farmers or more.
| | （二）提高基本医疗保障水平。逐步提高城镇居民医保和新农合筹资标准和保障水平。2010年，各级财政对城镇居民医保和新农合的补助标准提高到每人每年120元，并适当提高个人缴费标准，具体缴费标准由省级人民政府制定。城镇职工医保、城镇居民医保和新农合对政策范围内的住院费用报销比例逐步提高。逐步扩大和提高门诊费用报销范围和比例。将城镇职工医保、城镇居民医保最高支付限额分别提高到当地职工年平均工资和居民可支配收入的6倍左右，新农合最高支付限额提高到当地农民人均纯收入的6倍以上。
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3. To regulate the management of basic medical care guarantee funds. Various medical insurance funds should be managed by the principle of determining payments on the basis of incomes, maintaining the balance of incomes and payments and having a little surplus. We should reasonably control the annual surplus and accumulative surplus of the fund of basic medical insurance for urban employees and of the fund of basic medical insurance for non-working residents. In places where there is too much surplus, the surplus should be reduced to a reasonable level by increasing the guarantee level or other methods. In principle, the surplus of the pooling fund of new-type rural cooperative medical care program for rural residents of the current year should be controlled at 15% thereof or less and the accumulative surplus should not exceed 25% of the said pooling fund of the current year. A system of risk relief fund should be established for the basic medical insurance funds. The information about the incomes and payments of the fund should be regularly disclosed to the general public. The scope of overall planning of the fund should be expanded and by 2011 the city-level (prefecture-level) overall planning of the basic medical insurance for urban residents and of the basic medical insurance for non-working urban residents should be realized basically.
| | （三）规范基本医疗保障基金管理。各类医保基金要坚持以收定支、收支平衡、略有结余的原则。合理控制城镇职工医保基金、城镇居民医保基金的年度结余和累计结余，结余过多的地方要采取提高保障水平等办法，把结余逐步降到合理水平。新农合统筹基金当年结余率原则上控制在15%以内，累计结余不超过当年统筹基金的25%。建立基本医疗保险基金风险调剂金制度。基金收支情况要定期向社会公布。提高基金统筹层次，2011年城镇职工医保、城镇居民医保基本实现市（地）级统筹。
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4. To improve the system of urban and rural medical aid system. We should effectively use the aid fund, streamline the procedure for the examination, approval and grant of the aid fund, aid members from urban and rural families enjoying the minimum living subsidies, and “five guarantee” households, to participate in the basic medical insurance for non-working urban residents and the new-type rural cooperative medical care program, and gradually increase the rate of subsidies for the medical expenses of members of families with financial difficulties.
| | （四）完善城乡医疗救助制度。有效使用救助资金，简化救助资金审批发放程序，资助城乡低保家庭成员、五保户参加城镇居民医保或新农合，逐步提高对经济困难家庭成员自负医疗费用的补助标准。
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5. To improve the level of basic medical care guarantee management services. We should encourage local places to actively explore the establishment of a mechanism of negotiation between the medical insurance handling institutions and the pharmaceutical service providers as well as the reform of payment manner and reasonably determine the criterions on the payments for drugs, medical services and medical materials so as to control the costs. We should improve the medical care guarantee services, popularize the use of “all-purpose card” for medical care services by contributors of the basic medical insurance programs and realize direct settlement between the medical insurance handling institutions and the designated medical institutions for medical insurance. We should allow farmers who participate in the new-type rural cooperative medical care program to, on their own initiatives, choose the designated medical institutions within the overall-planned area to have medical services, and streamline the formalities for transferring to another medical institution outside the county. We should establish a mechanism for the settlement of medical expenses incurred at different places and explore the measures for the relocated retirees' enjoyment of medical care services and settlement of medical expenses at the place of relocation. We should formulate measures for the transfer and continuance of the basic medical insurance relationship and solve the problem of trans-system and trans-regional transfer and continuance of the basic medical care guarantee relationship for rural migrant workers and other migrant employees. We should do a good job in linking the basic medical insurance for urban employees, basic medical insurance for non-working urban residents, new-type rural cooperative medical care program and urban and rural medical aid together. We should explore the establishment of an integrated urban-rural basic medical care guarantee management system and gradually integrate the basic medical care guarantee handling and management resources, actively advocate the mode that the government purchases the medical care guarantee services, and explore the mode that qualified commercial insurance institutions are authorized to handle various medical care guarantee management services.
．．．．．． | | （五）提高基本医疗保障管理服务水平。鼓励地方积极探索建立医保经办机构与医药服务提供方的谈判机制和付费方式改革，合理确定药品、医疗服务和医用材料支付标准，控制成本费用。改进医疗保障服务，推广参保人员就医“一卡通”，实现医保经办机构与定点医疗机构直接结算。允许参加新农合的农民在统筹区域内自主选择定点医疗机构就医，简化到县域外就医的转诊手续。建立异地就医结算机制，探索异地安置的退休人员就地就医、就地结算办法。制定基本医疗保险关系转移接续办法，解决农民工等流动就业人员基本医疗保障关系跨制度、跨地区转移接续问题。做好城镇职工医保、城镇居民医保、新农合、城乡医疗救助之间的衔接。探索建立城乡一体化的基本医疗保障管理制度，并逐步整合基本医疗保障经办管理资源。在确保基金安全和有效监管的前提下，积极提倡以政府购买医疗保障服务的方式，探索委托具有资质的商业保险机构经办各类医疗保障管理服务。
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