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Medical and Health Services in China
中国的医疗卫生事业
【法宝引证码】
 
  
Medical and Health Services in China
(December 2012Information Office of the State Council of The People's Republic of China
 中国的医疗卫生事业
(2012年12月 中华人民共和国国务院新闻办公室)
Contents
 目录
Foreword
 前言
I. Basic Conditions
 一、卫生基本状况
II. Reform of Medical and Healthcare Systems
 二、医药卫生体制改革
III. Infectious Disease Prevention and Treatment, and Health Emergency Management
 三、传染病防治与卫生应急
IV. Prevention and Treatment of Chronic Non-communicable Disorders
 四、慢性非传染性疾病防治
V. Protecting Women and Children's Right to Health
 五、妇女儿童健康权益保护
VI. Development of Traditional Chinese Medicine
 六、中医药发展
VII. International Medical and Healthcare Cooperation
 七、卫生国际合作
Conclusion
 结束语
Foreword
Good health is a prerequisite for promoting all-round development of the person. And it is a common pursuit of human societies to improve people's health and ensure their right to medical care. For China, a large developing country, medical and healthcare is of vital importance to its population of over 1.3 billion, and is a major issue concerning its people's well being.
China pays great attention to protecting and improving its people's health. As the Constitution stipulates, “The state develops medical and health services, promotes modern medicine and traditional Chinese medicine…, all for the protection of the people's health.” Based on this constitutional stipulation, China has put in place a complete system of laws and regulations concerning medical and health services.
Over the years, China has worked hard to develop its medical and health services with Chinese characteristics in accordance with the policy of “making rural areas the focus of our work, putting disease prevention first, supporting both traditional Chinese medicine and Western medicine, relying on science, technology and education, and mobilizing the whole of society to join the efforts, improving the people's health and serving socialist modernization.” Thanks to unremitting efforts that have been made, medical and healthcare systems covering both urban and rural residents have taken shape, the capabilities of disease prevention and control have been enhanced, the coverage of medical insurance has expanded, continuous progress has been made in medical science and technology, and the people's health has been remarkably improved.
To put into place basic medical and healthcare systems covering both urban and rural residents, and ensure that every resident has access to safe, effective, convenient and affordable basic medical and health services, China has kept advancing the reform of its medical and healthcare system, and made important achievements in the current stage.
 前言
健康是促进人的全面发展的必然要求。提高人民健康水平,实现病有所医的理想,是人类社会的共同追求。在中国这个有着13亿多人口的发展中大国,医疗卫生关系亿万人民健康,是一个重大民生问题。
中国高度重视保护和增进人民健康。宪法规定,国家发展医疗卫生事业,发展现代医药和传统医药,保护人民健康。围绕宪法,中国逐步形成了相对完善的卫生法律法规体系。
多年来,中国坚持“以农村为重点,预防为主,中西医并重,依靠科技与教育,动员全社会参与,为人民健康服务,为社会主义现代化建设服务”的卫生工作方针,努力发展具有中国特色的医疗卫生事业。经过不懈努力,覆盖城乡的医疗卫生服务体系基本形成,疾病防治能力不断增强,医疗保障覆盖人口逐步扩大,卫生科技水平日益提高,居民健康水平明显改善。
为建立起覆盖城乡居民的基本医疗卫生制度,保障每个居民都能享有安全、有效、方便、价廉的基本医疗卫生服务,中国深入推进医药卫生体制改革,取得了重要阶段性成效。
I. Basic Conditions
The people's health has been improved. Judging from important indicators that give expression to national health, the health of the Chinese people is now among the top in developing countries. In 2010, the life expectancy was 74.8 years - 72.4 years for males and 77.4 years for females; the maternal mortality rate went down from 51.3 per 100,000 in 2002 to 26.1 per 100,000 in 2011; the infant mortality rate and the mortality rate of children under the age of five have kept dropping, with the former going down from 29.2 per thousand in 2002 to 12.1 per thousand in 2011, and the latter, from 34.9 per thousand to 15.6 per thousand, attaining ahead of schedule the UN Millennium Development Goal in this regard.
Medical and Health Services in China-Figure 1: China's per-capita life expectancy (years), according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)
Medical and Health Services in China-Figure 2: China's maternal mortality rate (one in 100,000) from 1990 to 2011, according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)
Medical and Health Services in China-Figure 3: China's infant mortality rate from 1991 to 2011, according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)
Medical and Health Services in China-Figure 4: China's mortality rate of children under five years of age from 1991 to 2011, according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)
Medical and healthcare systems covering both urban and rural residents have been put in place. Of these systems, the first is the public health service system, which covers disease prevention and control, health education, maternity and child care, mental health, health emergency response, blood collection and supply, health supervision, family planning and some other specialized public health services, and a medical and healthcare system based on community-level healthcare networks that provides public health services. The second is the medical care system. In the rural areas, it refers to a three-level medical service network that comprises the county hospital, the township hospitals and village clinics, with the county hospital performing the leading role, and township hospitals and village clinics service at the base. And in the cities and towns, it refers to a new type of urban medical health service system that features division of responsibilities as well as cooperation among various types of hospitals at all levels and community healthcare centers. The third is the medical security system. This system comprises mainly the basic medical security, supported by many forms of supplementary medical insurance and commercial health insurance. The basic medical security system covers basic medical insurance for working urban residents, basic medical insurance for non-working urban residents, a new type of rural cooperative medical care and urban-rural medical aid, which cover, respectively, the employed urban population, unemployed urban population, rural population and people suffering from economic difficulties. And the fourth is the pharmaceutical supply system, which covers the production, circulation, price control, procurement, dispatching and use of pharmaceuticals. The recent work is focused on establishing a national system for basic drugs.
The health financing structure has been constantly improved. China's health expenditure comes from the government's general tax revenue, social medical insurance, commercial health insurance, residents' out-of-pocket spending, etc. In 2011, the total health expenditure in China reached 2,434.591 billion yuan, 1,806.95 yuan per capita. The total expenditure accounted for 5.1% of the country's GDP. In comparable prices, the health expenditure grew by an average annual rate of 11.32% from 1978 to 2011. Individual “out-of-pocket” spending declined from 57.7% in 2002 to 34.8% in 2011, showing that health financing is working better in the areas of risk protection and re-distribution. In 2011, the spending on hospitals and outpatient establishments was 1,808.94 billion yuan, and that on public health agencies, 204.067 billion yuan, comprising 71.74% and 8.09%, respectively, of the total health expenditure. Of the total spending on hospitals, those on urban hospitals, county hospitals, community health service centers and township health service centers stood at 64.13%, 21.28%, 5.17% and 9.3%, respectively.
Medical and Health Services in China-Figure 5: China's total health expenditure and its proportion of the GDP from 1978 to 2011, according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)
Medical and Health Services in China-Figure 6: China's health financing structure (%) from 2000 to 2011, according to a white paper released by the Information Office of the State Council on Dec. 26, 2012. (Xinhua)
Health resources have been developing in a sustained way. By the end of 2011, medical and healthcare institutions around the country totaled 954,000, an increase of 148,000 over 2003. Licensed doctors (assistants) reached 2,466,000, or 1.8 per thousand people, as compared with 1.5 per thousand people in 2002. Registered nurses totaled 2,244,000, or 1.7 per thousand people, as compared with one per thousand people in 2002. The number of hospital beds reached 5160,000, or 3.8 per thousand people, as compared with 2.5 per thou-sand people in 2002.
Marked improvement has been seen in the utilization of medical and health services. In 2011, medical institutions throughout the country hosted 6.27 billion outpatients, as compared with 2.15 billion in 2002; and admitted 150 million inpatients, as compared with 59.91 million in 2002. That year, Chinese residents went to the medical institutions for medical treatment 4.6 times on average; 11.3 of every 100 people were hospitalized; the utilization rate of hospital beds reached 88.5%; and the hospital stay of the inpatients averaged 10.3 days. These figures show that it has become increasingly convenient to see a doctor and more easily accessible to get medical services. In 2011, 83.3% of all households (80.8% in rural areas) could reach medical institutions within 15 minutes, as compared with 80.7% in 2002. Medical service quality management and control systems have been constantly improved. A system of blood donation without compensation has been established, so as to ensure blood supply and safety.
  一、卫生基本状况
居民健康状况不断改善。从反映国民健康状况的重要指标看,中国居民的健康水平已处于发展中国家前列。2010年人均期望寿命达到74.8岁,其中男性72.4岁,女性77.4岁。孕产妇死亡率从2002年的51.3/10万下降到2011年的26.1/10万。婴儿死亡率及5岁以下儿童死亡率持续下降,婴儿死亡率从2002年的29.2‰下降到2011年的12.1‰,5岁以下儿童死亡率从2002年的34.9‰下降到2011年的15.6‰,提前实现联合国千年发展目标。
图1 中国人均期望寿命(略)
图2 中国孕产妇死亡率(略)
图3 中国婴儿死亡率(略)
图4 中国5岁以下儿童死亡率(略)
建立起覆盖城乡的医疗卫生体系。一是公共卫生服务体系。包括疾病预防控制、健康教育、妇幼保健、精神卫生、卫生应急、采供血、卫生监督和计划生育等专业公共卫生服务网络,以及以基层医疗卫生服务网络为基础、承担公共卫生服务功能的医疗卫生服务体系。二是医疗服务体系。在农村建立起以县级医院为龙头、乡镇卫生院和村卫生室为基础的农村三级医疗卫生服务网络,在城市建立起各级各类医院与社区卫生服务机构分工协作的新型城市医疗卫生服务体系。三是医疗保障体系。这个体系以基本医疗保障为主体、其他多种形式补充医疗保险和商业健康保险为补充。基本医疗保障体系包括城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗和城乡医疗救助,分别覆盖城镇就业人口、城镇非就业人口、农村人口和城乡困难人群。四是药品供应保障体系。包括药品的生产、流通、价格管理、采购、配送、使用。近期重点是建立国家基本药物制度。
卫生筹资结构不断优化。卫生筹资来源包括政府一般税收、社会医疗保险、商业健康保险和居民自费等多种渠道。2011年,中国卫生总费用达24345.91亿元人民币,同期人均卫生总费用为1806.95元人民币,卫生总费用占国内生产总值的比重为5.1%。按可比价格计算,1978-2011年,中国卫生总费用年平均增长速度为11.32%。个人现金卫生支出由2002年的57.7%下降到2011年的34.8%,卫生筹资系统的风险保护水平和再分配作用不断提高。2011年,医院、门诊机构费用为18089.4亿元人民币,公共卫生机构费用为2040.67亿元人民币,分别占卫生总费用的71.74%和8.09%。医院费用中,城市医院、县医院、社区卫生服务中心、乡镇卫生院费用分别占64.13%、21.28%、5.17%、9.3%。
图5 中国卫生总费用和卫生总费用占国内生产总值比重(略)
图6 卫生总费用筹资构成(略)
卫生资源持续发展。截至2011年底,全国医疗卫生机构达95.4万个(所),与2003年比较,医疗卫生机构增加14.8万个(所)。执业(助理)医师246.6万人,每千人口执业(助理)医师数由2002年的1.5人增加到1.8人。注册护士224.4万人,每千人口注册护士数由2002年的1人增加到1.7人。医疗卫生机构床位数516万张,每千人口医疗卫生机构床位数由2002年的2.5张提高到3.8张。
医疗卫生服务利用状况显著改善。2011年,全国医疗机构诊疗人次由2002年的21.5亿人次增加到62.7亿人次,住院人数由2002年的5991万人增加到1.5亿人。中国居民到医疗卫生机构年均就诊4.6次,每百居民住院11.3人,医院病床使用率为88.5%,医院出院者平均住院日为10.3天。居民看病就医更加方便,可及性显著提高。15分钟内可到达医疗机构住户比例,由2003年的80.7%提高到2011年的83.3%,其中农村地区为80.8%。医疗质量管理和控制体系不断完善。建立无偿献血制度,血液安全得到保障。
II. Reform of Medical and Healthcare Systems
With years of effort, China has made remarkable achievements in the development of its healthcare undertakings, which, however, still fall far short of the public's demands for healthcare as well as the requirements of economic and social development. Especially when China turned from a planned economy to a market economy, the old medical care system has undergone great changes. So it became an issue of major importance for the Chinese government to provide better and more accessible medical and health services to the public. In the 1980s, the Chinese government initiated reform of the medical and healthcare systems, and speeded up the reform in 2003 after a success was won in the fight against the SARS. In March 2009, the Chinese government promulgated the “Opinions on Deepening Reform of the Medical and Health Care Systems,” setting off a new round of reform in this regard. The basic goal of this reform was to provide the whole nation with basic medical and health services as a public product, and ensure that everyone, regardless of location, nationality, age, gender, occupation and income, enjoys equal access to basic medical and health services. And the basic principles to be followed in the reform were to ensure basic services, improving such services at the grass-roots level and establishing the effective mechanisms.
Medical reform is a social program that covers a wide range and involves difficult tasks. And it is a hard and complicated task to deepen this reform in China, a developing country with a large population, low per-capita income and a wide gap between urban and rural areas. For over three years, the Chinese government has worked hard to strike a balance between improving medical and health services on one hand and economic and social development on the other, trying to find a solution to this worldwide problem. Thanks to the persistent efforts made, China has made positive progress in this new round of medical reform.
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  二、医药卫生体制改革
经过多年努力,中国卫生事业取得显著发展成就,但与公众健康需求和经济社会协调发展不适应的矛盾还比较突出。特别是随着中国从计划经济体制向市场经济体制的转型,原有医疗保障体系发生很大变化,如何使广大公众享有更好、更健全的医疗卫生服务,成为中国政府面临的一个重大问题。从20世纪80年代开始,中国启动医药卫生体制改革,并在2003年抗击传染性非典型肺炎取得重大胜利后加快推进。2009年3月,中国公布《关于深化医药卫生体制改革的意见》,全面启动新一轮医改。改革的基本理念,是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,从制度上保证每个居民不分地域、民族、年龄、性别、职业、收入水平,都能公平获得基本医疗卫生服务。改革的基本原则是保基本、强基层、建机制。
医改是一项涉及面广、难度大的社会系统工程,在中国这样一个人口多、人均收入水平低、城乡区域差距大的发展中国家,深化医改是一项十分艰巨复杂的任务。三年多来,中国政府大力推进医药卫生服务与经济社会协调发展,积极破解医改这一世界性难题。通过艰苦努力,中国的新一轮医改取得积极进展。
--基本医疗保障制度覆盖城乡居民。截至2011年,城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗参保人数超过13亿,覆盖面从2008年的87%提高到2011年的95%以上,中国已构建起世界上规模最大的基本医疗保障网。筹资水平和报销比例不断提高,新型农村合作医疗政府补助标准从最初的人均20元人民币,提高到2011年的200元人民币,受益人次数从2008年的5.85亿人次提高到2011年的13.15亿人次,政策范围内住院费用报销比例提高到70%左右,保障范围由住院延伸到门诊。推行医药费用即时结算报销,居民就医结算更为便捷。开展按人头付费、按病种付费和总额预付等支付方式改革,医保对医疗机构的约束、控费和促进作用逐步显现。实行新型农村合作医疗大病保障,截至2011年,23万患有先天性心脏病、终末期肾病、乳腺癌、宫颈癌、耐多药肺结核、儿童白血病等疾病的患者享受到重大疾病补偿,实际补偿水平约65%。2012年,肺癌、食道癌、胃癌等12种大病也被纳入农村重大疾病保障试点范围,费用报销比例最高可达90%。实施城乡居民大病保险,从城镇居民医保基金、新型农村合作医疗基金中划出大病保险资金,采取向商业保险机构购买大病保险的方式,以力争避免城乡居民发生家庭灾难性医疗支出为目标,实施大病保险补偿政策,对基本医疗保障补偿后需个人负担的合规医疗费用给予保障,实际支付比例不低于50%,有效减轻个人医疗费用负担。建立健全城乡医疗救助制度,救助对象覆盖城乡低保对象、五保对象,并逐步扩大到低收入重病患者、重度残疾人、低收入家庭老年人等特殊困难群体,2011年全国城乡医疗救助8090万人次。
--基本药物制度从无到有。初步形成了基本药物遴选、生产供应、使用和医疗保险报销的体系。2011年,基本药物制度实现基层全覆盖,所有政府办基层医疗卫生机构全部配备使用基本药物,并实行零差率销售,取消了以药补医机制。制定国家基本药物临床应用指南和处方集,规范基层用药行为,促进合理用药。建立基本药物采购新机制,基本药物实行以省为单位集中采购,基层医疗卫生机构基本药物销售价格比改革前平均下降了30%。基本药物全部纳入基本医疗保障药品报销目录。有序推进基本药物制度向村卫生室和非政府办基层医疗卫生机构延伸。药品生产流通领域改革步伐加快,药品供应保障水平进一步提高。
--城乡基层医疗卫生服务体系进一步健全。加大政府投入,完善基层医疗卫生机构经费保障机制,2009-2011年,中央财政投资471.5亿元人民币支持基层医疗机构建设发展。采取多种形式加强基层卫生人才队伍建设,制定优惠政策,为农村和社区培养、培训、引进卫生人才。建立全科医生制度,开展全科医生规范化培养,安排基层医疗卫生机构人员参加全科医生转岗培训,组织实施中西部地区农村订单定向医学生免费培养等。实施万名医师支援农村卫生工程,2009-2011年,1100余家城市三级医院支援了955个县级医院,中西部地区城市二级以上医疗卫生机构每年支援3600多所乡镇卫生院,提高了县级医院和乡镇卫生院医疗技术水平和管理能力。转变基层医疗服务模式,在乡镇卫生院开展巡回医疗服务,在市辖区推行社区全科医生团队、家庭签约医生制度,实行防治结合,保障居民看病就医的基本需求,使常见病、多发病等绝大多数疾病的诊疗在基层可以得到解决。经过努力,基层医疗卫生服务体系不断强化,农村和偏远地区医疗服务设施落后、服务能力薄弱的状况明显改变,基层卫生人才队伍的数量、学历、知识结构出现向好趋势。2011年,全国基层医疗卫生机构达到91.8万个,包括社区卫生服务机构2.6万个、乡镇卫生院3.8万所、村卫生室66.3万个,床位123.4万张。
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