医改方案英文版[5篇范文]

第一篇：医改方案英文版

中共中央国务院

关于深化医药卫生体制改革的意见

参考译文

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：山东省医改方案

山东省“十二五”医改实施方案

2012年5月22日公布

省政府昨天召开全省深化医药卫生体制改革工作会议，同时印发《山东省“十二五”期间深化医药卫生体制改革规划暨实施方案》。根据方案，到2015年，群众看病负担将明显减轻，个人卫生支出比例降到30%以下。将建区域集中检查检验中心，实现大型设备资源共享。同时，我省敲定今年医改重点任务，其中一条是将合理调整公立医院医疗服务价格，提高诊疗费、护理费、手术费。据悉，调增收费将纳入医保报销，避免增加患者负担。今年，全省将选择30个左右的县（市）开展县级医院综合改革试点，根据改革需要，在奖励性绩效工资分配、定价、药品采购等方面给予试点地区一定自主权。经批准，可在县级医院设立特设岗位，引进急需高层次人才。

我省将合理调整医疗服务价格，提高诊疗费、手术费、护理费等体现技术劳务价值的医疗技术服务价格，降低大型设备检查价格。发挥医保补偿作用，将调增的收费纳入医保报销范围，避免增加群众负担。

鼓励和支持具备条件的县级综合医院参照三级医院建设发展。同时禁止公立医院举债建设，每千常住人口医疗卫生机构床位数达到4张的，原则上不再扩大公立医院规模。实行试点公立医院药品集中采购，按照招采合一、量价挂钩、单一货源承诺、双信封制的要求带量采购基本药物。稳步开展高值医用耗材集中采购。通过压缩药品和高值医用耗材采购中间环节和费用，着力降低虚高价格。

2015年实现县级公立医院阶段性改革目标。鼓励社会资本对部分公立医院进行多种形式的公益性投入，以合资合作方式参与改制的不得改变非盈利性质。

今年医改重点内容

鼓励社会办医 有资质就可开诊所

目前，我省有关部门正在研究制定相关政策文件，放宽准入，鼓励有实力的企业、慈善机构、基金会、商业保险机构等社会力量及境外投资者开办医疗机构，鼓励具有资质的人员（包括港、澳、台地区）依法开办私人诊所。

对社会办医，我省将落实价格、医保定点、土地、重点学科建设、职称评定等方面政策，对各类社会资本举办非盈利性医疗机构给予优先支持，鼓励非公立医疗机构向高水平、规模化的大型医疗集团发展。发展一批有规模、有质量、有品牌的非公立医疗机构，力争到2015年，全省非公立医疗机构床位数和服务量达到全省医疗卫生机构的20%左右。同时，我省鼓励康复医疗机构发展，扩大和丰富全社会医疗资源。

二级以上医院基药配备占9成以上

在纳入省统一规划设置的村卫生室全面推行基本药物制度的基础上，今年，我省逐步将其他符合省规划要求的村卫生室纳入基本药物制度实施范围，同步落实对乡村医生的各项补助和支持政策。对非政府办基层医疗卫生机构，各地可结合实际，采取购买服务等方式将其纳入基本药物制度实施范围。二级以上医疗机构需优先配备使用基本药物，配备品种数占到基本药物总数的90%以上。

我省将适时开展新一轮基本药物采购工作。研究调整优化省级增补药物目录，更好的适应群众基本用药需求。

统筹资金最高支付不低于10万元

今年，我省职工医保、城镇居民医保和新农合三项基本医疗保险参保率将稳定在97%以上。重点做好农民工、非公有制经济组织从业人员、灵活就业人员以及学生、学龄前儿童和新生儿参保管理工作。继续推进关闭破产企业退休人员和困难企业职工等困难群体参保工作。

新农合和城镇居民医保补助标准提高到每人每年240元，个人缴费60元，人均筹资达到300元左右。统筹资金最高支付限额不低于10万元。

20种疾病纳入重大疾病保障

积极探索利用基本医保基金购买商业大病保险或建立补充保险等方式，有效提高重特大疾病保障水平，切实解决重特大疾病患者因病致贫的问题。做好基本医保、医疗救助、商业保险等的衔接。制定出台新农合重大疾病医疗保障政策，全面推开尿毒症、儿童白血病、儿童先天性心脏病、乳腺癌、宫颈癌、重性精神疾病、耐多药肺结核、艾滋病机会性感染等8类大病保障，将肺癌、食道癌、胃癌、结肠癌、直肠癌、慢性粒细胞白血病、急性心肌梗塞、脑梗死、血友病、I型糖尿病、甲亢、唇腭裂等12类大病纳入保障和救助试点范围。

【关键词】 卫生资源布局

建区域集中检查检验中心

鼓励各地整合辖区内医疗资源，建立区域集中检查检验中心，实现大型设备资源共建共享。医疗机构检验服务对社会开放，实现检查结果互认。

至2015年，政府投资购置的公立医院大型设备按扣除折旧后的成本制定检查价格，贷款或集资购买的大型设备原则上由政府回购，回购有困难的限期降低检查价格。此项亏损通过调整医疗技术服务价格、增加政府投入等途径补偿。

【关键词】 全民医保

2015年，跨省也能即时结算

我省将加快推进基本医保和医疗救助即时结算，使患者看病只需支付自付部分费用，其余费用由医保经办机构与医疗机构直接结算。2014年实现省内新农合即时结算。建立异地就医结算机制，2015年全面实现统筹区域内和省内医疗费用异地即时结算；开展省际医保结算合作，初步实现跨省医疗费用异地即时结算。2015年基本实现职工医保制度内跨区域转移接续，推进各项基本医疗保险制度之间衔接。

我省城乡医疗救助，主要资助低保家庭成员、五保户、重度残疾人及城乡低收入家庭参加城镇居民医保或新农合。取消医疗救助起付线，提高封顶线。对救助对象政策范围内住院自负医疗费用救助比例提高到70%以上。

【关键词】药品价格

适时调整最高零售指导价

我省将改革药品价格形成机制，建立和完善药品价格动态调整管理机制，选取临床使用量较大的药品，依据主导企业成本，参考药品集中采购价格和零售药店销售价等市场交易价格，制定最高零售指导价格，并根据市场交易价格变化等因素适时调整。

到“十二五”期末，所有零售药店法定代表人或主要管理者必须具备执业药师资格，所有零售药店和医院药房营业时有职业药师指导合理用药。

此外将调整省增补药物目录，优化基本药物品种、类别，适当增加慢性病和儿童用药品种，减少使用率低、重合率低的药品。对独家品种和经多次集中采购价格已基本稳定且市场供应充足的省增补基本药物，试行省统一定价。

【关键词】公立医院改革

设立专门的政府办医机构

我省将研究探索采取设立专门管理机构等多种形式确定政府办医机构，由其履行政府举办公立医院的职能，负责公立医院的资产管理、财务监管、绩效考核和医院主要负责人的任用。

各级卫生行政部门负责人不得兼任公立医院领导职务，逐步取消公立医院行政级别，新设立的公立医院不再明确行政级别。探索建立理事会、董事会、管委会等多种形式的公立医院法人治理结构。

【关键词】基层卫生

至2015年培养1.28万全科医生

为提高基层医疗机构的服务水平，到2015年，我省将为基层医疗卫生机构培养1.28万余名全科医生，每万名城市居民拥有2名以上全科医生，每个乡镇卫生院有2—3名合格的全科医生。

为促进人才向基层流动，我省鼓励开展全科医生县乡联动试点项目；70%的城市建立起公立医院和社区卫生服务机构上下联动的协同机制。

第三篇：2009公开最新医改方案全文

2009公开最新医改方案全文

按照党的十七大精神，为建立中国特色的医药卫生体制，逐步实现人人享有基本医疗卫生服务的目标，提高全民健康水平，现就改革提出如下意见。

一、充分认识深化医药卫生体制改革的重要性、紧迫性和艰巨性健康是人全面发展的基础。医药卫生事业关系千家万户幸福，是重大民生问题。深化医药卫生体制改革，加快医药卫生事业发展，适应人民群众日益增长的医药卫生需求，不断提高人民群众健康素质，是贯彻落实科学发展观、促进经济和社会全面协调可持续发展的必然要求，是维护社会公平正义的重要举措，是人民生活质量改善的重要标志，是全面建设小康社会和构建社会主义和谐社会的一项重大任务。新中国成立以来，特别是改革开放以来，我国医药卫生事业取得了显着成就，覆盖城乡的医药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，卫生科技水平迅速提高，人民群众健康水平明显改善，居民主要健康指标处于发展中国家前列。尤其是抗击“非典”取得重大胜利以来，各级政府加大投入，公共卫生、农村医疗卫生和城市社区卫生加快发展，新型农村合作医疗和城镇居民基本医疗保险取得突破性进展，为深化医药卫生体制改革打下了良好基础。同时，也应该看到，当前我国医药卫生事业发展水平与经济社会协调发展要求和人民群众健康需求不适应的矛盾还比较突出。城乡和区域医疗卫生事业发展不平衡，资源配置不合理，公共卫生和农村、社区医疗卫生工作比较薄弱，医疗保障制度不健全，药品生产流通秩序不规范，医院管理体制和运行机制不完善，政府卫生投入不足，医药费用上涨过快，人民群众反映比较强烈。从现在到2020年，是我国全面建设小康社会的关键时期，医药卫生工作肩负着繁重的任务。随着经济的发展和人民生活水平的提高，群众对改善医药卫生服务将会有更高的要求。工业化、城镇化、人口老龄化、疾病谱变化和生态环境变化等，都给医药卫生工作带来一系列新的严峻挑战。深化医药卫生体制改革，是加快医药卫生事业发展的战略选择，是实现人民共享改革发展成果的重要途径，是广大人民群众的迫切愿望。医药是一项涉及面广、难度大的社会系统工程。我国人口多，人均收入水平低，城乡、区域差距大，长期处于社会主义初级阶段的基本国情，决定了深化医药卫生体制改革是一项十分复杂艰巨的任务，是一个渐进的过程，需要在明确方向和框架的基础上，经过长期艰苦努力和坚持不懈的探索，才能逐步建立符合我国国情的医药卫生体制。

二、医药体制改革的指导思想、基本原则和总体目标

（一）指导思想。医药体制改革的指导思想是：以邓小平理论和“三个代表”重要思想为指导，深入贯彻落实科学发展观，从我国国情出发，借鉴国际有益经验，着眼于实现人人享有基本医疗卫生服务的目标，着力解决人民群众最关心、最直接、最现实的利益问题。坚持公共医疗卫生的公益性质，坚持预防为主、以农村为重点、中西医并重的方针，实行政事分开、管办分开、医药分开、营利性和非营利性分开，强化政府责任和投入，完善国民健康政策，健全制度体系，加强监督管理，创新体制机制，鼓励社会参与，建设覆盖城乡居民的基本医疗卫生制度，不断提高全民健康水平，促进社会和谐。

（二）基本原则。医药体制改革应遵循以下基本原则：坚持以人为本，把维护人民健康权益放在第一位。坚持医药卫生事业为人民健康服务的宗旨，以保障人民健康为中心，以人人享有基本医疗卫生服务为根本出发点和落脚点，从改革方案设计、卫生制度建立到服务体系建设都要遵循公益性的原则，着力解决群众反映强烈的突出问题，努力实现全体人民病有所医。坚持立足国情，建立中国特色的医药卫生体制。坚持从我国的基本国情出发，实事求是地总结医药卫生事业改革发展的实践经验，准确把握医药卫生发展规律和主要矛盾；坚持基本医疗卫生服务水平与国民经济和社会发展相协调、与人民群众的承受能力相适应；充分发挥中医药作用；坚持因地制宜、分类指导，发挥地方积极性，探索建立符合国情的基本医疗卫生制度。坚持公平效率统一，政府主导与发挥市场机制作用相结合。坚持政府主导，强化政府在基本医疗卫生制度中的责任，加强政府在制度、规划、筹资、服务、监管等方面的职责，维护公共医疗卫生的公益性，促进公平公正；同时，注重发挥市场机制作用，促进有序竞争机制的形成，提高医疗卫生运行效率和服务水平、质量，满足人民群众多层次、多样化的医疗卫生需求。坚持统筹兼顾，把完善制度体系与解决当前突出问题结合起来。从全局出发，兼顾供给方和需求方等各方利益，注重预防、治疗、康复三者的结合，正确处理政府、卫生机构、医药企业、医务人员和人民群众之间的关系。既着眼长远，创新体制机制，又立足当前，着力解决医药卫生中存在的突出问题；既注重整体设计，明确总体改革方向目标和基本框架，又突出重点，分步实施，积极稳妥地推进改革。

（三）总体目标。医药体制改革的总体目标是:建立覆盖城乡居民的基本医疗卫生制度，为群众提供安全、有效、方便、价廉的医疗卫生服务。到2020年，覆盖城乡居民的基本医疗卫生制度基本建立。普遍建立比较完善的公共卫生服务体系和医疗服务体系，比较健全的医疗保障体系，比较规范的药品供应保障体系，比较科学的医疗卫生机构管理体制和运行机制，形成多元办医格局，人人享有基本医疗卫生服务，基本适应人民群众多层次的医疗卫生需求，人民群众健康水平进一步提高。

三、完善医药卫生四大体系，建立覆盖城乡居民的基本医疗卫生制度建立覆盖城乡居民的公共卫生服务体系、医疗服务体系、医疗保障体系、药品供应保障体系四位一体的基本医疗卫生制度，四大体系相辅相成，配套建设，协调发展。

（四）全面加强公共卫生服务体系建设。建立健全疾病预防控制、健康教育、妇幼保健、精神卫生、应急救治、采供血、卫生监督和计划生育等专业公共卫生服务网络，并完善以基层医疗卫生服务网络为基础的医疗服务体系的公共卫生服务功能，建立分工明确、信息互通、资源共享、协调互动的公共卫生服务体系，提高公共卫生服务能力和突发公共卫生事件应急处置能力，促进城乡居民逐步享有均等化的基本公共卫生服务。确定公共卫生服务范围。明确国家公共卫生服务项目，逐步增加服务内容，细化服务和考核标准。鼓励地方政府根据当地经济水平和突出的公共卫生问题，在中央规定服务项目的基础上增加公共卫生服务内容。完善公共卫生服务体系。进一步明确公共卫生服务体系的职能、目标和任务，优化人员和设备配置，探索整合公共卫生服务资源的有效形式。完善重大疾病防控体系和突发公共卫生事件应急机制，加强对严重威胁人民健康的传染病、地方病、职业病和慢性病等疾病的预防控制和监测。加强城乡急救体系建设。加强健康促进与教育。医疗卫生机构及机关、学校、社区、企业等要大力开展健康教育，倡导健康文明的生活方式，利用广播、电视、网络、报刊杂志等媒体，加强健康、医药卫生知识的传播，促进公众合理营养，提高广大人民群众的健康意识和自我保健能力。深入开展爱国卫生运动。将农村环境卫生与环境污染治理纳入社会主义新农村建设规划，推动卫生城市和文明村镇建设，不断改善城乡居民的生活、工作等方面的卫生环境。加强卫生监督服务。大力促进环境卫生、食品卫生、职业卫生、学校卫生和农民工卫生工作。

（五）进一步完善医疗服务体系。坚持非营利性医疗机构为主体、营利性医疗机构为补充，公立医疗机构为主导、非公立医疗机构共同发展的办医原则，建设结构合理、分工明确、防治结合、技术适宜、运转有序，包括覆盖城乡的基层医疗卫生服务网络和各类医院在内的医疗服务体系。大力发展农村医疗卫生服务体系。加快建立健全以县级医院为龙头、乡镇卫生院为骨干、村卫生室为基础的农村三级医疗卫生服务网络。县级医院作为县域内的医疗卫生中心，主要负责以住院为主的基本医疗服务及危重急症病人的抢救，并承担对乡村卫生机构的业务技术指导和乡村卫生人员的进修培训；乡镇卫生院负责提供公共卫生服务和常见病、多发病的诊疗等综合服务，并承担对村卫生室的业务管理和技术指导等工作；村卫生室承担行政村的公共卫生服务及一般疾病的诊治等工作。有条件的农村可以实行乡村一体化管理。加快实施农村卫生服务体系建设与发展规划，积极推进农村医疗卫生基础设施和能力建设，政府重点办好县级医院并在每个乡镇办好一所卫生院，采取多种形式支持村卫生室建设，大力改善农村医疗卫生条件，提高医疗卫生服务质量。完善以社区卫生服务为基础的新型城市医疗卫生服务体系。大力发展社区卫生服务，加快建设以社区卫生服务中心为主体的城市社区卫生服务网络，完善社区卫生服务功能，以维护社区居民健康为中心，提供疾病预防控制等公共卫生服务和一般常见病、多发病、慢性病的初级诊疗服务。转变社区卫生服务模式，坚持主动服务、上门服务，逐步承担起居民健康“守门人”的职责。健全各类医院的功能和职责。优化医院布局和结构，充分发挥城市医院在急危重症和疑难病症的诊疗、医学教育和科研、指导和培训基层卫生人员等方面的骨干作用。有条件的大医院按照区域卫生规划要求，可以通过托管、重组等方式促进医疗资源合理流动。建立城市医院与社区卫生服务机构的分工协作机制。城市医院通过技术支持、人员培训等方式，带动社区卫生健康持续发展。同时，采取改善服务能力、降低收费标准、提高报销比例等综合措施，引导一般诊疗下沉到基层，逐步实现社区首诊、分级医疗和双向转诊。整合城市卫生资源，充分利用城市现有一、二级医院及国有企事业所属医疗机构等基层医疗资源，发展和完善社区卫生服务网络。充分发挥包括民族医药在内的中医药在疾病预防控制、应对突发公共卫生事件、医疗服务中的作用。加强中医临床研究基地和中医院建设，组织开展中医药防治疑难疾病的联合攻关，在医疗卫生机构中大力推广中医药适宜技术。创造良好的政策环境，扶持中医药发展，促进中医药继承和创新。建立城市医院对口支援农村医疗卫生工作的制度。发达地区要加强对口支援贫困地区和少数民族地区发展医疗卫生事业。城市大医院要与贫困地区和少数民族地区的县级医院建立长期稳定的对口支援和合作制度，采取临床服务、人员培训、技术指导、设备支援等方式，帮助其提高医疗水平和服务能力。

（六）加快建设医疗保障体系。加快建立和完善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，覆盖城乡居民的多层次医疗保障体系。建立覆盖城乡居民的基本医疗保障体系。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共同组成基本医疗保障体系，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。坚持广覆盖、保基本、可持续的原则，从重点保障大病起步，逐步向门诊小病延伸，提高保障水平。建立国家、单位、家庭和个人责任明确、分担合理的多渠道筹资机制，实现社会互助共济。随着经济社会发展，逐步提高筹资水平和统筹层次，缩小保障水平差距，最终实现制度框架的基本统一。进一步完善城镇职工基本医疗保险制度，加快覆盖就业人口，重点解决国有关闭破产企业、困难企业等职工和退休人员以及混合所有制、非公有制经济组织从业人员和灵活就业人员的医疗保险问题；加快推进城镇居民基本医疗保险试点，到2009年全面推开，重视解决老人和儿童的基本医疗保险问题；全面实施新型农村合作医疗制度，逐步提高政府补助水平，适当增加农民缴费，提高保障能力。完善城乡医疗救助制度。对困难人群参保及其难以负担的医疗费用提供补助，筑牢医疗保障底线。有条件的地区要采取多种方式积极探索建立城乡一体化的基本医疗保障管理体系。鼓励工会等社会团体开展多种形式的医疗互助活动。鼓励和引导各类公益性组织发展社会慈善医疗救助。做好城镇职工基本医疗保险制度、城镇居民基本医疗保险制度、新型农村合作医疗制度和城乡医疗救助制度之间的衔接，妥善解决农民工基本医疗保险问题。签订劳动合同并与企业建立稳定劳动关系的农民工，要按照国家规定明确用人单位缴费责任，将其纳入城镇职工基本医疗保险制度；其他农民工根据实际情况，参加户籍所在地新型农村合作医疗或务工所在地城镇居民基本医疗保险。积极做好农民工医保关系接续、异地就医和费用结算服务等政策衔接。积极发展商业健康保险。鼓励商业保险机构开发适应不同需要的健康保险产品，简化理赔手续，方便群众，满足多样化的健康需求。鼓励企业和个人通过参加商业保险及多种形式的补充保险解决基本医疗保障之外的需求。继续探索商业保险机构参与新型农村合作医疗等经办管理的方式。

（七）建立健全药品供应保障体系。以建立国家基本药物制度为基础，以培育具有国际竞争力的医药产业、提高药品生产流通企业集中度、规范药品生产流通秩序、完善药品价格形成机制、加强政府监管为主要内容，建设规范化、集约化的药品供应保障体系，不断完善执业药师制度，保障人民群众安全用药。建立国家基本药物制度。中央政府统一制定和发布国家基本药物目录，按照防治必需、安全有效、价格合理、使用方便、中西药并重的原则，结合我国用药特点，参照国际经验，合理确定我国基本药物品种和数量。建立基本药物的生产供应体系，在政府宏观调控下充分发挥市场机制的作用，基本药物由国家实行招标定点生产或集中采购，直接配送，减少中间环节，在合理确定生产环节利润水平的基础上统一制定零售价，确保基本药物的生产供应，保障群众基本用药。规范基本药物使用，制订基本药物使用规范和临床应用指南。城市社区卫生服务中心（站）、乡镇卫生院、村卫生室等基层医疗卫生机构应全部使用基本药物，其他各类医疗机构也要将基本药物作为首选药物并确定使用比例。基本药物全部纳入基本医疗保障体系药物报销目录，报销比例明显高于非基本药物规范药品生产流通。完善医药产业发展政策和行业发展规划，严格市场准入，严格药品注册审批，大力规范和整顿生产流通秩序，推动医药产业优化升级和技术进步，发展药品现代物流和连锁经营，促进药品生产、流通企业的整合。建立覆盖面广、体系健全、便民惠农的农村药品供应网和监督网。支持用量小的特殊用药、急救用药生产。完善药品储备制度。规范药品采购，坚决治理医药购销中的商业贿赂。加强药品不良反应监测，建立药品安全预警机制和应急处置机制。

四、完善体制机制，保障医药卫生体系有效规范运转完善医药卫生的管理、运行、投入、价格、监管体制机制，加强科技与人才、信息、法制建设，保障医药卫生体系有效规范运转。

（八）建立协调统一的医药卫生管理体制。按照政事分开、管办分开、属地化和全行业管理的原则，合理确定不同层级政府之间、政府与医药卫生机构之间的职责范围，形成职能明确、定位清晰、综合协调、权责统一的管理体制。实施属地化和全行业管理。所有医疗卫生机构，不论所有制、投资主体、隶属关系和经营性质，均由所在地卫生行政部门实行统一规划、统一准入、统一监管。中央、省级可以设置少量承担医学科研、教学功能的医学中心或区域医疗中心、承担全国或区域性疑难病症诊治的专科医院等医疗机构；县（市、区）主要负责举办县级医院、乡村卫生和社区卫生机构；其余公立医院由设区的市负责举办。强化区域卫生规划。省级人民政府制定卫生资源配置标准，组织编制区域卫生规划和医疗机构设置规划，明确医疗机构的数量、规模、布局和功能。科学制定乡镇卫生院（村卫生室）、社区卫生服务中心（站）等基层卫生机构和各级医院建设和设备配置标准。充分利用和优化配置现有医疗卫生资源，调整优化结构和布局，对不符合规划要求的医疗机构要逐步进行整合，严格控制大型医疗设备配置，鼓励共建共享，提高医疗卫生资源利用效率。新增卫生资源必须符合区域卫生规划，重点投向农村和社区卫生等薄弱环节。加强区域卫生规划与城市发展规划、土地利用规划等的衔接。建立区域卫生规划和资源配置监督评价机制。推进公立医院管理体制改革。从有利于强化公立医院公益性和政府有效监管出发，积极探索政事分开、管办分开的多种实现形式。进一步转变政府职能，卫生行政部门主要承担卫生发展规划、资格准入、规范标准、服务监管等行业管理职能，其他有关部门按照各自职能进行管理和提供服务。落实公立医院独立法人地位。进一步完善基本医疗保险管理体制。中央统一制定基本医疗保险制度框架和政策，地方政府负责组织实施管理，创造条件逐步提高统筹层次。有效整合基本医疗保险经办资源，逐步实现城乡基本医疗保险行政管理的统一。

（九）建立高效规范的医药卫生机构运行机制。以维护公立医疗卫生机构公益性质为核心，逐步建立规范、科学、高效、有序的医药卫生机构运行机制。公共卫生机构收支全部纳入预算管理。按照承担的职责任务，由政府合理确定人员编制、工资水平和经费标准，明确各类人员岗位职责，严格人员准入，加强绩效考核，建立能进能出的用人制度，提高工作效率和服务质量。转变基层医疗卫生机构运行机制。政府举办的城市社区卫生服务中心（站）和乡镇卫生院等基层医疗卫生机构，要严格界定服务功能，明确规定使用适宜技术、适宜人才、适宜设备和基本药物，为广大群众提供低成本服务，维护公益性质。要严格核定人员编制，实行人员聘用制，建立能进能出和激励有效的人力资源管理制度。要明确收支范围和标准，实行核定任务、核定收支、绩效考核补助的财务管理办法，并探索实行收支两条线、公共卫生和医疗保障经费的总额预付等多种行之有效的管理办法，严格收支预算管理，提高资金使用效益。要改革药品加成政策，实行药品零差率销售。加强和完善内部管理，建立以服务质量为核心、以岗位责任与绩效为基础的考核和激励制度，形成保障公平效率的长效机制建立规范的公立医院运行机制。公立医院要遵循公益性质和社会效益原则，坚持以病人为中心，优化服务流程，规范用药检查和医疗行为，深化运行机制改革。建立和完善医院法人治理结构，明确所有者和管理者的责权，形成决策、执行、监督相互制衡，有责任、有激励、有约束、有竞争、有活力的机制。实行医药收支分开管理，探索有效方式逐步改革以药补医机制。通过实行药品购销差别加价、设立药事服务费等多种方式逐步改革或取消药品加成政策，同时采取适当调整医疗服务价格、增加政府投入、改革支付方式等措施完善公立医院补偿机制。进一步完善财务、会计管理制度，严格预算管理，加强财务监管和运行监督。地方可结合本地实际，对有条件的医院开展“核定收支、以收抵支、超收上缴、差额补助、奖惩分明”等多种管理办法的试点。改革人事制度，完善分配激励机制，推行聘用制度和岗位管理制度，严格工资总额管理，实行以服务质量及岗位工作量为主的综合绩效考核和岗位绩效工资制度，有效调动医务人员的积极性。健全医疗保险经办机构运行机制。完善内部治理结构，建立合理的用人机制和分配制度，完善激励约束机制，提高医疗保险经办管理能力和管理效率。

医改的意义

第四篇：新医改方案

宗地乡医药卫生体制改革实施方案

根据《中共中央 国务院关于深化医药卫生体制改革的意见》，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。

一、加快推进基本医疗保障制度建设

(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。

(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。(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。

(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。

(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。

二、初步建立国家基本药物制度

(六)建立国家基本药物目录遴选调整管理机制。制订国家基本药物遴选和管理办法。基本药物目录定期调整和更新。2009年初，公布国家基本药物目录。

(七)初步建立基本药物供应保障体系。充分发挥市场机制作用，推动药品生产流通企业兼并重组，发展统一配送，实现规模经营；鼓励零售药店发展连锁经营。完善执业药师制度，零售药店必须按规定配备执业药师为患者提供购药咨询和指导。政府举办的医疗卫生机构使用的基本药物，由省级人民政府指定的机构公开招标采购，并由招标选择的配送企业统一配送。参与投标的生产企业和配送企业应具备相应的资格条件。招标采购药品和选择配送企业，要坚持全国统一市场，不同地区、不同所有制企业平等参与、公平竞争。药品购销双方要根据招标采购结果签订合同并严格履约。用量较少的基本药物，可以采用招标方式定点生产。完善基本药物国家储备制度。加强药品质量监管，对药品定期进行质量抽检，并向社会公布抽检结果。

国家制定基本药物零售指导价格。省级人民政府根据招标情况在国家指导价格规定的幅度内确定本地区基本药物统一采购价格，其中包含配送费用。政府举办的基层医疗卫生机构按购进价格实行零差率销售。鼓励各地探索进一步降低基本药物价格的采购方式。

(八)建立基本药物优先选择和合理使用制度。所有零售药店和医疗机构均应配备和销售国家基本药物，满足患者需要。不同层级医疗卫生机构基本药物使用率由卫生行政部门规定。从2009年起，政府举办的基层医疗卫生机构全部配备和使用基本药物，其他各类医疗机构也都必须按规定使用基本药物。卫生行政部门制订临床基本药物应用指南和基本药物处方集，加强用药指导和监管。允许患者凭处方到零售药店购买药物。基本药物全部纳入基本医疗保障药品报销目录，报销比例明显高于非基本药物。

三、健全基层医疗卫生服务体系

(九)加强基层医疗卫生机构建设。完善农村三级医疗卫生服务网络。发挥县级医院的龙头作用，三年内中央重点支持2000所左右县级医院(含中医院)建设，使每个县至少有1所县级医院基本达到标准化水平。完善乡镇卫生院、社区卫生服务中心建设标准。2009年，全面完成中央规划支持的2.9万所乡镇卫生院建设任务，再支持改扩建5000所中心乡镇卫生院，每个县1－3所。支持边远地区村卫生室建设，三年内实现全国每个行政村都有卫生室。三年内新建、改造3700所城市社区卫生服务中心和1.1万个社区卫生服务站。中央支持困难地区2400所城市社区卫生服务中心建设。公立医院资源过剩地区，要进行医疗资源重组，充实和加强基层医疗卫生机构。对社会力量举办基层医疗卫生机构提供的公共卫生服务，采取政府购买服务等方式给予补偿；对其提供的基本医疗服务，通过签订医疗保险定点合同等方式，由基本医疗保障基金等渠道补偿。鼓励有资质的人员开办诊所或个体行医。

(十)加强基层医疗卫生队伍建设。制定并实施免费为农村定向培养全科医生和招聘执业医师计划。用三年时间，分别为乡镇卫生院、城市社区卫生服务机构和村卫生室培训医疗卫生人员36万人次、16万人次和137万人次。完善城市医院对口支援农村制度。每所城市三级医院要与3所左右县级医院(包括有条件的乡镇卫生院)建立长期对口协作关系。继续实施“万名医师支援农村卫生工程”。采取到城市大医院进修、参加住院医师规范化培训等方式，提高县级医院医生水平。

落实好城市医院和疾病预防控制机构医生晋升中高级职称前到农村服务一年以上的政策。鼓励高校医学毕业生到基层医疗机构工作。从2009年起，对志愿去中西部地区乡镇卫生院工作三年以上的高校医学毕业生，由国家代偿学费和助学贷款。

(十一)改革基层医疗卫生机构补偿机制。基层医疗卫生机构运行成本通过服务收费和政府补助补偿。政府负责其举办的乡镇卫生院、城市社区卫生服务中心和服务站按国家规定核定的基本建设、设备购置、人员经费及所承担公共卫生服务的业务经费，按定额定项和购买服务等方式补助、医务人员的工资水平，要与当地事业单位工作人员平均工资水平相衔接。基层医疗卫生机构提供的医疗服务价格，按扣除政府补助后的成本制定。实行药品零差率销售后，药品收入不再作为基层医疗卫生机构经费的补偿渠道，不得接受药品折扣。探索对基层医疗卫生机构实行收支两条线等管理方式。

政府对乡村医生承担的公共卫生服务等任务给予合理补助，补助标准由地方人民政府规定。

(十二)转变基层医疗卫生机构运行机制。基层医疗卫生机构要使用适宜技术、适宜设备和基本药物，大力推广包括民族医药在内的中医药，为城乡居民提供安全有效和低成本服务。乡镇卫生院要转变服务方式，组织医务人员在乡村开展巡回医疗；城市社区卫生服务中心和服务站对行动不便的患者要实行上门服务、主动服务。鼓励地方制定分级诊疗标准，开展社区首诊制试点，建立基层医疗机构与上级医院双向转诊制度。全面实行人员聘用制，建立能进能出的人力资源管理制度。完善收入分配制度，建立以服务质量和服务数量为核心、以岗位责任与绩效为基础的考核和激励制度。

四、促进基本公共卫生服务逐步均等化

(十三)基本公共卫生服务覆盖城乡居民。制定基本公共卫生服务项目，明确服务内容。从2009年开始，逐步在全国统一建立居民健康档案，并实施规范管理。定期为65岁以上老年人做健康检查、为3岁以下婴幼儿做生长发育检查、为孕产妇做产前检查和产后访视，为高血压、糖尿病、精神疾病、艾滋病、结核病等人群提供防治指导服务。普及健康知识，2009年开设中央电视台健康频道，中央和地方媒体均应加强健康知识宣传教育。

(十四)增加国家重大公共卫生服务项目。继续实施结核病、艾滋病等重大疾病防控和国家免疫规划、农村妇女住院分娩等重大公共卫生项目。从2009年开始开展以下项目：为15岁以下人群补种乙肝疫苗；消除燃煤型氟中毒危害；农村妇女孕前和孕早期补服叶酸等，预防出生缺陷；贫困白内障患者复明；农村改水改厕等。

(十五)加强公共卫生服务能力建设。重点改善精神卫生、妇幼卫生、卫生监督、计划生育等专业公共卫生机构的设施条件。加强重大疾病以及突发公共卫生事件预测预警和处置能力。积极推广和应用中医药预防保健方法和技术。落实传染病医院、鼠防机构、血防机构和其他疾病预防控制机构从事高风险岗位工作人员的待遇政策。

(十六)保障公共卫生服务所需经费。专业公共卫生机构人员经费、发展建设经费、公用经费和业务经费由政府预算全额安排，服务性收入上缴财政专户或纳入预算管理。按项目为城乡居民免费提供基本公共卫生服务。提高公共卫生服务经费标准。2009年人均基本公共卫生服务经费标准不低于15元，2011年不低于20元。中央财政通过转移支付对困难地区给予补助。

五、推进公立医院改革试点

(十七)改革公立医院管理体制、运行机制和监管机制。公立医院要坚持维护公益性和社会效益原则，以病人为中心。鼓励各地积极探索政事分开、管办分开的有效形式。界定公立医院所有者和管理者的责权。完善医院法人治理结构。推进人事制度改革，明确院长选拔任用和岗位规范，完善医务人员职称评定制度，实行岗位绩效工资制度。建立住院医师规范化培训制度。鼓励地方探索注册医师多点执业的办法和形式。强化医疗服务质量管理。规范公立医院临床检查、诊断、治疗、使用药物和植(介)入类医疗器械行为，优先使用基本药物和适宜技术，实行同级医疗机构检查结果互认。

探索建立由卫生行政部门、医疗保险机构、社会评估机构、群众代表和专家参与的公立医院质量监管和评价制度。严格医院预算和收支管理，加强成本核算与控制。全面推行医院信息公开制度，接受社会监督。

(十八)推进公立医院补偿机制改革。逐步将公立医院补偿由服务收费、药品加成收入和财政补助三个渠道改为服务收费和财政补助两个渠道。政府负责公立医院基本建设和大型设备购置、重点学科发展、符合国家规定的离退休人员费用和政策性亏损补偿等，对公立医院承担的公共卫生任务给予专项补助，保障政府指定的紧急救治、援外、支农、支边等公共服务经费，对中医院(民族医院)、传染病医院、职业病防治院、精神病医院、妇产医院和儿童医院等在投入政策上予以倾斜。严格控制公立医院建设规模、标准和贷款行为。推进医药分开，逐步取消药品加成，不得接受药品折扣。医院由此减少的收入或形成的亏损通过增设药事服务费、调整部分技术服务收费标准和增加政府投入等途径解决。药事服务费纳入基本医疗保险报销范围。积极探索医药分开的多种有效途径。适当提高医疗技术服务价格，降低药品、医用耗材和大型设备检查价格。定期开展医疗服务成本测算，科学考评医疗服务效率。

公立医院提供特需服务的比例不超过全部医疗服务的10%。鼓励各地探索建立医疗服务定价由利益相关方参与协商的机制。

(十九)加快形成多元办医格局。省级卫生行政部门会同有关部门，按照区域卫生规划，明确辖区内公立医院的设置数量、布局、床位规模、大型医疗设备配置和主要功能。要积极稳妥地把部分公立医院转制为民营医疗机构。制定公立医院转制政策措施，确保国有资产保值和职工合法权益。

鼓励民营资本举办非营利性医院。民营医院在医保定点、科研立项、职称评定和继续教育等方面，与公立医院享受同等待遇；对其在服务准入、监督管理等方面一视同仁。落实非营利性医院税收优惠政策，完善营利性医院税收政策。公立医院改革2009年开始试点，2011年逐步推开。

六、保障措施

(二十)加强组织领导。国务院深化医药卫生体制改革领导小组统筹组织和协调改革工作。国务院有关部门要抓紧研究制定相关配套文件。各级政府要切实加强领导，抓好组织落实，加快推进各项重点改革。

(二十一)加强财力保障。各级政府要认真落实《意见》提出的各项卫生投入政策，调整支出结构，转变投入机制，改革补偿办法，切实保障改革所需资金，提高财政资金使用效益。为了实现改革的目标，经初步测算，2009－2011年各级政府需要投入8500亿元，其中中央政府投入3318亿元。

(二十二)鼓励各地试点。医药卫生体制改革涉及面广，情况复杂，政策性强，一些重大改革要先行试点，逐步推开。各地情况差别很大，要鼓励地方因地制宜制定具体实施方案，开展多种形式的试点，进行探索创新。国务院深化医药卫生体制改革领导小组负责统筹协调、指导各地试点工作。要注意总结和积累经验，不断深入推进改革。

(二十三)加强宣传引导。坚持正确的舆论导向，制定分步骤、分阶段的宣传方案；采取通俗易懂、生动形象的方式，广泛宣传实施方案的目标、任务和主要措施，解答群众关心的问题；及时总结、宣传改革经验，为深化改革营造良好的社会和舆论环境。

宗地乡卫生院 2011年5月15日

第五篇：2009公开最新医改方案全文

2009公开最新医改方案全文

按照党的十七大精神，为建立中国特色的医药卫生体制，逐步实现人人享有基本医疗卫生服务的目标，提高全民健康水平，现就改革提出如下意见。

一、充分认识深化医药卫生体制改革的重要性、紧迫性和艰巨性。健康是人全面发展的基础。医药卫生事业关系千家万户幸福，是重大民生问题。深化医药卫生体制改革，加快医药卫生事业发展，适应人民群众日益增长的医药卫生需求，不断提高人民群众健康素质，是贯彻落实科学发展观、促进经济和社会全面协调可持续发展的必然要求，是维护社会公平正义的重要举措，是人民生活质量改善的重要标志，是全面建设小康社会和构建社会主义和谐社会的一项重大任务。新中国成立以来，特别是改革开放以来，我国医药卫生事业取得了显着成就，覆盖城乡的医药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，卫生科技水平迅速提高，人民群众健康水平明显改善，居民主要健康指标处于发展中国家前列。尤其是抗击“非典”取得重大胜利以来，各级政府加大投入，公共卫生、农村医疗卫生和城市社区卫生加快发展，新型农村合作医疗和城镇居民基本医疗保险取得突破性进展，为深化医药卫生体制改革打下了良好基础。同时，也应该看到，当前我国医药卫生事业发展水平与经济社会协调发展要求和人民群众健康需求不适应的矛盾还比较突出。城乡和区域医疗卫生事业发展不平衡，资源配置不合理，公共卫生和农村、社区医疗卫生工作比较薄弱，医疗保障制度不健全，药品生产流通秩序不规范，医院管理体制和运行机制不完善，政府卫生投入不足，医药费用上涨过快，人民群众反映比较强烈。从现在到2020年，是我国全面建设小康社会的关键时期，医药卫生工作肩负着繁重的任务。随着经济的发展和人民生活水平的提高，群众对改善医药卫生服务将会有更高的要求。工业化、城镇化、人口老龄化、疾病谱变化和生态环境变化等，都给医药卫生工作带来一系列新的严峻挑战。深化医药卫生体制改革，是加快医药卫生事业发展的战略选择，是实现人民共享改革发展成果的重要途径，是广大人民群众的迫切愿望。医药是一项涉及面广、难度大的社会系统工程。我国人口多，人均收入水平低，城乡、区域差距大，长期处于社会主义初级阶段的基本国情，决定了深化医药卫生体制改革是一项十分复杂艰巨的任务，是一个渐进的过程，需要在明确方向和框架的基础上，经过长期艰苦努力和坚持不懈的探索，才能逐步建立符合我国国情的医药卫生体制。

二、医药体制改革的指导思想、基本原则和总体目标

（一）指导思想。医药体制改革的指导思想是：以邓小平理论和“三个代表”重要思想为指导，深入贯彻落实科学发展观，从我国国情出发，借鉴国际有益经验，着眼于实现人人享有基本医疗卫生服务的目标，着力解决人民群众最关心、最直接、最现实的利益问题。坚持公共医疗卫生的公益性质，坚持预防为主、以农村为重点、中西医并重的方针，实行政事分开、管办分开、医药分开、营利性和非营利性分开，强化政府责任和投入，完善国民健康政策，健全制度体系，加强监督管理，创新体制机制，鼓励社会参与，建设覆盖城乡居民的基本医疗卫生制度，不断提高全民健康水平，促进社会和谐。

（二）基本原则。医药体制改革应遵循以下基本原则：坚持以人为本，把维护人民健康权益放在第一位。坚持医药卫生事业为人民健康服务的宗旨，以保障人民健康为中心，以人人享有基本医疗卫生服务为根本出发点和落脚点，从改革方案设计、卫生制度建立到服务体系建设都要遵循公益性的原则，着力解决群众反映强烈的突出问题，努力实现全体人民病有所医。坚持立足国情，建立中国特

色的医药卫生体制。坚持从我国的基本国情出发，实事求是地总结医药卫生事业改革发展的实践经验，准确把握医药卫生发展规律和主要矛盾；坚持基本医疗卫生服务水平与国民经济和社会发展相协调、与人民群众的承受能力相适应；充分发挥中医药作用；坚持因地制宜、分类指导，发挥地方积极性，探索建立符合国情的基本医疗卫生制度。坚持公平效率统一，政府主导与发挥市场机制作用相结合。坚持政府主导，强化政府在基本医疗卫生制度中的责任，加强政府在制度、规划、筹资、服务、监管等方面的职责，维护公共医疗卫生的公益性，促进公平公正；同时，注重发挥市场机制作用，促进有序竞争机制的形成，提高医疗卫生运行效率和服务水平、质量，满足人民群众多层次、多样化的医疗卫生需求。坚持统筹兼顾，把完善制度体系与解决当前突出问题结合起来。从全局出发，兼顾供给方和需求方等各方利益，注重预防、治疗、康复三者的结合，正确处理政府、卫生机构、医药企业、医务人员和人民群众之间的关系。既着眼长远，创新体制机制，又立足当前，着力解决医药卫生中存在的突出问题；既注重整体设计，明确总体改革方向目标和基本框架，又突出重点，分步实施，积极稳妥地推进改革。

（三）总体目标。医药体制改革的总体目标是:建立覆盖城乡居民的基本医疗卫生制度，为群众提供安全、有效、方便、价廉的医疗卫生服务。到2020年，覆盖城乡居民的基本医疗卫生制度基本建立。普遍建立比较完善的公共卫生服务体系和医疗服务体系，比较健全的医疗保障体系，比较规范的药品供应保障体系，比较科学的医疗卫生机构管理体制和运行机制，形成多元办医格局，人人享有基本医疗卫生服务，基本适应人民群众多层次的医疗卫生需求，人民群众健康水平进一步提高。

三、完善医药卫生四大体系，建立覆盖城乡居民的基本医疗卫生制度建立覆盖城乡居民的公共卫生服务体系、医疗服务体系、医疗保障体系、药品供应保障体系四位一体的基本医疗卫生制度，四大体系相辅相成，配套建设，协调发展。

（四）全面加强公共卫生服务体系建设。建立健全疾病预防控制、健康教育、妇幼保健、精神卫生、应急救治、采供血、卫生监督和计划生育等专业公共卫生服务网络，并完善以基层医疗卫生服务网络为基础的医疗服务体系的公共卫生服务功能，建立分工明确、信息互通、资源共享、协调互动的公共卫生服务体系，提高公共卫生服务能力和突发公共卫生事件应急处置能力，促进城乡居民逐步享有均等化的基本公共卫生服务。确定公共卫生服务范围。明确国家公共卫生服务项目，逐步增加服务内容，细化服务和考核标准。鼓励地方政府根据当地经济水平和突出的公共卫生问题，在中央规定服务项目的基础上增加公共卫生服务内容。完善公共卫生服务体系。进一步明确公共卫生服务体系的职能、目标和任务，优化人员和设备配置，探索整合公共卫生服务资源的有效形式。完善重大疾病防控体系和突发公共卫生事件应急机制，加强对严重威胁人民健康的传染病、地方病、职业病和慢性病等疾病的预防控制和监测。加强城乡急救体系建设。加强健康促进与教育。医疗卫生机构及机关、学校、社区、企业等要大力开展健康教育，倡导健康文明的生活方式，利用广播、电视、网络、报刊杂志等媒体，加强健康、医药卫生知识的传播，促进公众合理营养，提高广大人民群众的健康意识和自我保健能力。深入开展爱国卫生运动。将农村环境卫生与环境污染治理纳入社会主义新农村建设规划，推动卫生城市和文明村镇建设，不断改善城乡居民的生活、工作等方面的卫生环境。加强卫生监督服务。大力促进环境卫生、食品卫生、职业卫生、学校卫生和农民工卫生工作。

（五）进一步完善医疗服务体系。坚持非营利性医疗机构为主体、营利性医疗机构为补充，公立医疗机构为主导、非公立医疗机构共同发展的办医原则，建设结构合理、分工明确、防治结合、技术适宜、运转有序，包括覆盖城乡的基层医疗卫生服务网络和各类医院在内的医疗服务体系。大力发展农村医疗卫生服务体系。加快建立健全以县级医院为龙头、乡镇卫生院为骨干、村卫生室为基础的农村三级医疗卫生服务网络。县级医院作为县域内的医疗卫生中心，主要负责以住院为主的基本医疗服务及危重急症病人的抢救，并承担对乡村卫生机构的业务技术指导和乡村卫生人员的进修培训；乡镇卫生院负责提供公共卫生服务和常见病、多发病的诊疗等综合服务，并承担对村卫生室的业务管理和技术指导等工作；村卫生室承担行政村的公共卫生服务及一般疾病的诊治等工作。有条件的农村可以实行乡村一体化管理。加快实施农村卫生服务体系建设与发展规划，积极推进农村医疗卫生基础设施和能力建设，政府重点办好县级医院并在每个乡镇办好一所卫生院，采取多种形式支持村卫生室建设，大力改善农村医疗卫生条件，提高医疗卫生服务质量。完善以社区卫生服务为基础的新型城市医疗卫生服务体系。大力发展社区卫生服务，加快建设以社区卫生服务中心为主体的城市社区卫生服务网络，完善社区卫生服务功能，以维护社区居民健康为中心，提供疾病预防控制等公共卫生服务和一般常见病、多发病、慢性病的初级诊疗服务。转变社区卫生服务模式，坚持主动服务、上门服务，逐步承担起居民健康“守门人”的职责。健全各类医院的功能和职责。优化医院布局和结构，充分发挥城市医院在急危重症和疑难病症的诊疗、医学教育和科研、指导和培训基层卫生人员等方面的骨干作用。有条件的大医院按照区域卫生规划要求，可以通过托管、重组等方式促进医疗资源合理流动。建立城市医院与社区卫生服务机构的分工协作机制。城市医院通过技术支持、人员培训等方式，带动社区卫生健康持续发展。同时，采取改善服务能力、降低收费标准、提高报销比例等综合措施，引导一般诊疗下沉到基层，逐步实现社区首诊、分级医疗和双向转诊。整合城市卫生资源，充分利用城市现有一、二级医院及国有企事业所属医疗机构等基层医疗资源，发展和完善社区卫生服务网络。充分发挥包括民族医药在内的中医药在疾病预防控制、应对突发公共卫生事件、医疗服务中的作用。加强中医临床研究基地和中医院建设，组织开展中医药防治疑难疾病的联合攻关，在医疗卫生机构中大力推广中医药适宜技术。创造良好的政策环境，扶持中医药发展，促进中医药继承和创新。建立城市医院对口支援农村医疗卫生工作的制度。发达地区要加强对口支援贫困地区和少数民族地区发展医疗卫生事业。城市大医院要与贫困地区和少数民族地区的县级医院建立长期稳定的对口支援和合作制度，采取临床服务、人员培训、技术指导、设备支援等方式，帮助其提高医疗水平和服务能力。

（六）加快建设医疗保障体系。加快建立和完善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，覆盖城乡居民的多层次医疗保障体系。建立覆盖城乡居民的基本医疗保障体系。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共同组成基本医疗保障体系，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。坚持广覆盖、保基本、可持续的原则，从重点保障大病起步，逐步向门诊小病延伸，提高保障水平。建立国家、单位、家庭和个人责任明确、分担合理的多渠道筹资机制，实现社会互助共济。随着经济社会发展，逐步提高筹资水平和统筹层次，缩小保障水平差距，最终实现制度框架的基本统一。进一步完善城镇职工基本医疗保险制度，加快覆盖就业人口，重点解决国有关闭破产企业、困难企业等职工

和退休人员以及混合所有制、非公有制经济组织从业人员和灵活就业人员的医疗保险问题；加快推进城镇居民基本医疗保险试点，到2009年全面推开，重视解决老人和儿童的基本医疗保险问题；全面实施新型农村合作医疗制度，逐步提高政府补助水平，适当增加农民缴费，提高保障能力。完善城乡医疗救助制度。对困难人群参保及其难以负担的医疗费用提供补助，筑牢医疗保障底线。有条件的地区要采取多种方式积极探索建立城乡一体化的基本医疗保障管理体系。鼓励工会等社会团体开展多种形式的医疗互助活动。鼓励和引导各类公益性组织发展社会慈善医疗救助。做好城镇职工基本医疗保险制度、城镇居民基本医疗保险制度、新型农村合作医疗制度和城乡医疗救助制度之间的衔接，妥善解决农民工基本医疗保险问题。签订劳动合同并与企业建立稳定劳动关系的农民工，要按照国家规定明确用人单位缴费责任，将其纳入城镇职工基本医疗保险制度；其他农民工根据实际情况，参加户籍所在地新型农村合作医疗或务工所在地城镇居民基本医疗保险。积极做好农民工医保关系接续、异地就医和费用结算服务等政策衔接。积极发展商业健康保险。鼓励商业保险机构开发适应不同需要的健康保险产品，简化理赔手续，方便群众，满足多样化的健康需求。鼓励企业和个人通过参加商业保险及多种形式的补充保险解决基本医疗保障之外的需求。继续探索商业保险机构参与新型农村合作医疗等经办管理的方式。

（七）建立健全药品供应保障体系。以建立国家基本药物制度为基础，以培育具有国际竞争力的医药产业、提高药品生产流通企业集中度、规范药品生产流通秩序、完善药品价格形成机制、加强政府监管为主要内容，建设规范化、集约化的药品供应保障体系，不断完善执业药师制度，保障人民群众安全用药。建立国家基本药物制度。中央政府统一制定和发布国家基本药物目录，按照防治必需、安全有效、价格合理、使用方便、中西药并重的原则，结合我国用药特点，参照国际经验，合理确定我国基本药物品种和数量。建立基本药物的生产供应体系，在政府宏观调控下充分发挥市场机制的作用，基本药物由国家实行招标定点生产或集中采购，直接配送，减少中间环节，在合理确定生产环节利润水平的基础上统一制定零售价，确保基本药物的生产供应，保障群众基本用药。规范基本药物使用，制订基本药物使用规范和临床应用指南。城市社区卫生服务中心（站）、乡镇卫生院、村卫生室等基层医疗卫生机构应全部使用基本药物，其他各类医疗机构也要将基本药物作为首选药物并确定使用比例。基本药物全部纳入基本医疗保障体系药物报销目录，报销比例明显高于非基本药物规范药品生产流通。完善医药产业发展政策和行业发展规划，严格市场准入，严格药品注册审批，大力规范和整顿生产流通秩序，推动医药产业优化升级和技术进步，发展药品现代物流和连锁经营，促进药品生产、流通企业的整合。建立覆盖面广、体系健全、便民惠农的农村药品供应网和监督网。支持用量小的特殊用药、急救用药生产。完善药品储备制度。规范药品采购，坚决治理医药购销中的商业贿赂。加强药品不良反应监测，建立药品安全预警机制和应急处置机制。

四、完善体制机制，保障医药卫生体系有效规范运转完善医药卫生的管理、运行、投入、价格、监管体制机制，加强科技与人才、信息、法制建设，保障医药卫生体系有效规范运转。

（八）建立协调统一的医药卫生管理体制。按照政事分开、管办分开、属地化和全行业管理的原则，合理确定不同层级政府之间、政府与医药卫生机构之间的职责范围，形成职能明确、定位清晰、综合协调、权责统一的管理体制。实施属地化和全行业管理。所有医疗卫生机构，不论所有制、投资主体、隶属关系和经营性质，均由所在地卫生行政部门实行统一规划、统一准入、统一监管。中央、省级可以设置少量承担医学科研、教学功能的医学中心或区域医疗中心、承担全国或区域性疑难病症诊治的专科医院等医疗机构；县（市、区）主要负责举办县级医院、乡村卫生和社区卫生机构；其余公立医院由设区的市负责举办。强化区域卫生规划。省级人民政府制定卫生资源配置标准，组织编制区域卫生规划和医疗机构设置规划，明确医疗机构的数量、规模、布局和功能。科学制定乡镇卫生院（村卫生室）、社区卫生服务中心（站）等基层卫生机构和各级医院建设和设备配置标准。充分利用和优化配置现有医疗卫生资源，调整优化结构和布局，对不符合规划要求的医疗机构要逐步进行整合，严格控制大型医疗设备配置，鼓励共建共享，提高医疗卫生资源利用效率。新增卫生资源必须符合区域卫生规划，重点投向农村和社区卫生等薄弱环节。加强区域卫生规划与城市发展规划、土地利用规划等的衔接。建立区域卫生规划和资源配置监督评价机制。推进公立医院管理体制改革。从有利于强化公立医院公益性和政府有效监管出发，积极探索政事分开、管办分开的多种实现形式。进一步转变政府职能，卫生行政部门主要承担卫生发展规划、资格准入、规范标准、服务监管等行业管理职能，其他有关部门按照各自职能进行管理和提供服务。落实公立医院独立法人地位。进一步完善基本医疗保险管理体制。中央统一制定基本医疗保险制度框架和政策，地方政府负责组织实施管理，创造条件逐步提高统筹层次。有效整合基本医疗保险经办资源，逐步实现城乡基本医疗保险行政管理的统一。

（九）建立高效规范的医药卫生机构运行机制。以维护公立医疗卫生机构公益性质为核心，逐步建立规范、科学、高效、有序的医药卫生机构运行机制。公共卫生机构收支全部纳入预算管理。按照承担的职责任务，由政府合理确定人员编制、工资水平和经费标准，明确各类人员岗位职责，严格人员准入，加强绩效考核，建立能进能出的用人制度，提高工作效率和服务质量。转变基层医疗卫生机构运行机制。政府举办的城市社区卫生服务中心（站）和乡镇卫生院等基层医疗卫生机构，要严格界定服务功能，明确规定使用适宜技术、适宜人才、适宜设备和基本药物，为广大群众提供低成本服务，维护公益性质。要严格核定人员编制，实行人员聘用制，建立能进能出和激励有效的人力资源管理制度。要明确收支范围和标准，实行核定任务、核定收支、绩效考核补助的财务管理办法，并探索实行收支两条线、公共卫生和医疗保障经费的总额预付等多种行之有效的管理办法，严格收支预算管理，提高资金使用效益。要改革药品加成政策，实行药品零差率销售。加强和完善内部管理，建立以服务质量为核心、以岗位责任与绩效为基础的考核和激励制度，形成保障公平效率的长效机制建立规范的公立医院运行机制。公立医院要遵循公益性质和社会效益原则，坚持以病人为中心，优化服务流程，规范用药检查和医疗行为，深化运行机制改革。建立和完善医院法人治理结构，明确所有者和管理者的责权，形成决策、执行、监督相互制衡，有责任、有激励、有约束、有竞争、有活力的机制。实行医药收支分开管理，探索有效方式逐步改革以药补医机制。通过实行药品购销差别加价、设立药事服务费等多种方式逐步改革或取消药品加成政策，同时采取适当调整医疗服务价格、增加政府投入、改革支付方式等措施完善公立医院补偿机制。进一步完善财务、会计管理制度，严格预算管理，加强财务监管和运行监督。地方可结合本地实际，对有条件的医院开展“核定收支、以收抵支、超收上缴、差额补助、奖惩分明”等多种管理办法的试点。改革人事制度，完善分配激励机制，推行聘用制度和岗位管理制度，严格工资总额管理，实行以服务质量及岗位工作量为主的综合绩效考核和岗位绩效工资制度，有效调动医务人员的积极性。健全医疗保险经办机构运行机制。

完善内部治理结构，建立合理的用人机制和分配制度，完善激励约束机制，提高医疗保险经办管理能力和管理效率。