The National Health Commission issued a blockbuster medical reform document to deepen the reform of the medical and health system

On October 15, the National Health Commission issued the "Implementation Opinions of the State Council Leading Group on Deepening the Reform of the Medical and Health System on Deepening the Promotion of the Experience of Sanming City, Fujian Province and Deepening the Reform of the Medical and Health System"
.
It is worth mentioning that the opinions pointed out that the normalization and institutionalization of the centralized procurement of pharmaceutical consumables organized by the state will gradually expand the scope of procurement, and strive to purchase more than 300 generic names for drugs by the end of 2022
.
At the end of the "14th Five-Year Plan" period, the number of generic names for centralized procurement of drugs by national and provincial organizations in each province will exceed 500
.
Strengthen the procurement and inventory management of medical institutions to meet the requirements of centralized procurement
.
The full text is as follows: Implementation opinions of the State Council Leading Group on Deepening the Reform of the Medical and Health System on Deepening the Implementation of the Experience of Sanming City, Fujian Province and Deepening the Reform of the Medical and Health System Guoyi Gaifa [2021] No.
2 All provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps deepen the reform of the medical and health system The leading group, the member units of the leading group of the State Council to deepen the reform of the medical and health system: In order to thoroughly implement the spirit of the important instructions on the reform of the medical and health system during the inspection of General Secretary Xi Jinping in Sanming City, Fujian Province, earnestly implement the decisions and deployments of the Party Central Committee and the State Council and the national medical reform work The teleconference calls for further intensifying efforts to promote Sanming’s medical reform experience, deepen the linkage reform of medical care, medical insurance, and medicine, promote the balanced distribution of high-quality medical resources, and accelerate the realization of the solution of serious and serious diseases in the province, common and frequently-occurring diseases in cities and counties, headaches and brain fever, etc.
Minor illnesses are resolved in the villages, and we will accelerate the improvement of a new mechanism for maintaining public welfare, mobilizing enthusiasm, and ensuring sustainable operation of public medical institutions.
Here are the following opinions: 1.
Deeply promote the experience of Sanming's medical reform and adhere to the clear reform path of learning and promoting the experience of Sanming's medical reform in recent years We will persevere and implement the basic requirements, consolidate the results of reforms, and ensure the sound operation of the new mechanism
.
1.
The most important thing in Sanming's medical reform experience is the determination and courage to reform, not to avoid contradictions, and to dare to touch interests
.
All localities and relevant departments should learn from Sanming’s reform spirit of adhering to the people’s supremacy and daring to be the first, and should work hard and act hard.

.
Implement the "Notice of the General Office of the Central Committee of the Communist Party of China and the General Office of the State Council to forward the "Several Opinions of the Leading Group for Deepening the Reform of the Medical and Health System of the State Council on Further Promoting and Deepening the Experience in the Reform of the Medical and Health System" (Ting Zi [2016] No.
36) and other requirements, and promote local The main responsible comrade of the party committee and the government or a main responsible comrade shall serve as the leader of the medical reform leading group, and give full play to the overall coordination and coordination role of the medical reform leading group
.
The standing committees of the Party committees of all provinces (autonomous regions and municipalities) conduct special research on medical reform at least once a year
.
(The Secretariat of the Medical Reform Leading Group of the State Council and all relevant localities and departments are responsible according to the division of responsibilities) 2．Promote the construction of medical complexes, enhance the clinical expertise of county-level hospitals, improve family doctors' contracted services, strengthen the construction of rural doctors, innovate hierarchical diagnosis and treatment and medical prevention coordination mechanisms, promote the sinking of high-quality medical resources and orderly medical treatment, and gradually increase county-level medical treatment Rate and attendance rate of primary medical and health institutions
.
Strengthen the performance appraisal of medical consortia centered on people's health
.
(National Health Commission, National Development and Reform Commission, National Disease Control Bureau, National Medical Insurance Bureau and other departments and relevant localities are responsible according to the division of responsibilities) 3.
Normalize and institutionalize the centralized procurement of pharmaceutical consumables organized by the state, gradually expand the scope of procurement, and strive to purchase more than 300 generic names for drugs by the end of 2022
.
At the end of the "14th Five-Year Plan" period, the number of generic names for centralized procurement of drugs by national and provincial organizations in each province will exceed 500
.
Strengthen the procurement and inventory management of medical institutions to meet the requirements of centralized procurement
.
(Departments such as the National Medical Insurance Bureau and relevant localities are responsible according to the division of responsibilities) 4．In accordance with the path of freeing up space, adjusting structure, and ensuring connection, standardize diagnosis and treatment behaviors, reduce costs of medicines and consumables, rationally adjust prices of medical services, advance the reform of the salary system, and generally do not increase the burden on the masses, and promote the innovation and healthy development of the pharmaceutical industry
.
Implement the national organization policy of centralizing the procurement of medical insurance funds for pharmaceuticals and consumables, and encourage medical institutions to use them rationally and give priority to the use of selected products
.
(The Secretariat of the Medical Reform Leading Group of the State Council, the National Medical Insurance Bureau, the National Health Commission, the Ministry of Human Resources and Social Security and other relevant localities shall be responsible according to the division of responsibilities) 5.
Before the end of June 2022, all provinces shall print and publish the establishment of medical service price dynamics Adjust the relevant documents of the mechanism, scientifically set the start conditions, trigger standards and constraints of the price adjustment of medical services, and stabilize the price adjustment expectations
.
During the "14th Five-Year Plan" period, all provinces and prefecture-level cities with price management authority will carry out an annual medical service price adjustment work evaluation.
Those who meet the conditions should use the medical service fees of public medical institutions in the region as the base, and reasonably determine the total price adjustment , Adjust the price of medical services within the scope of the total amount, and adjust the price of medical services
.
The price items of medical services that meet the regulations shall be included in the scope of medical insurance payment in a timely manner
.
(Departments such as the National Medical Insurance Bureau and relevant localities are responsible according to the division of responsibilities) 6．All localities should reform and optimize the government’s rules for setting medical service prices in accordance with laws and regulations, adjust the cost supervision and review and price hearing catalogs in a timely manner, and allow price authorities to investigate costs and listen to opinions in a concise and easy way
.
Strengthen the price monitoring and evaluation of public hospitals, and accelerate the establishment of a monitoring system for the price, cost, expense, income distribution and reform operation of public medical institutions to provide a basis for the implementation of the dynamic adjustment of medical service prices
.
(National Medical Insurance Bureau, National Development and Reform Commission, National Health Commission, State Administration of Traditional Chinese Medicine and other departments and relevant localities are responsible according to the division of responsibilities) 7.
Implement the "Guiding Opinions on Deepening the Reform of the Remuneration System in Public Hospitals" (Human Social Ministry Fa [2021] No.
52) to comprehensively deepen the reform of the remuneration system in public hospitals
.
After deducting costs based on the medical service income of the year and withdrawing various funds according to regulations, all localities will reasonably increase the total remuneration of public hospitals according to the requirements of "two permits" according to different levels and different types of hospitals, not included in the total approved base, and reasonably determine the personnel Expenses accounted for the proportion of public hospital business expenditures
.
Promote public hospitals to reasonably determine the internal salary structure, pay attention to the stable income of medical staff, and give full play to the guarantee function of salary
.
(The Ministry of Human Resources and Social Security, the National Health Commission, the State Administration of Traditional Chinese Medicine, the National Medical Insurance Bureau and other departments and all relevant localities are responsible according to the division of responsibilities) 8.
Deepen the reform of medical insurance payment methods, implement a diversified and compound medical insurance payment method based on disease-based payment, gradually reduce the proportion of medical insurance fund payment by project, and increase payment by disease diagnosis-related grouping, payment by disease score, and bed-day The proportion of medical insurance payment methods such as payment and outpatient services based on head payment
.
By 2025, the proportion of medical insurance funds that are grouped by disease diagnosis-related or paid by disease will account for 70% of all eligible inpatient medical insurance fund expenditures
.
(The National Medical Insurance Bureau and all relevant localities are responsible according to the division of responsibilities) 9.
Improve the standardization of medical services, organize and improve the code of conduct for medical services, guide medical institutions to improve clinical pathways, increase the training and promotion of diagnosis and treatment standards, strengthen supervision, and improve the standardization of medical services
.
Local health departments at all levels should make rational use of drugs and standardized diagnosis and treatment an important part of the information disclosure of medical institutions, and publish them to the public on a regular basis
.
(National Health Commission, State Administration of Traditional Chinese Medicine and other departments and relevant localities are responsible according to the division of responsibilities) 10.
Establish and complete a reasonable increase mechanism for medical expenses in public hospitals that is coordinated with economic and social development and compatible with the affordability of all parties.
Focusing on large public hospitals, strengthen monitoring of the increase in medical services, medicines, inspections and inspections, and control medical expenses Incorporate the evaluation indicators for the directors of public hospitals, promote the balanced and orderly development of public hospitals at all levels, and promote the increase in service supply of primary medical institutions
.
(National Health Commission, State Administration of Traditional Chinese Medicine, National Medical Insurance Bureau, Ministry of Finance and other departments and relevant localities are responsible according to the division of responsibilities) 11.
Strengthen the investment responsibility for health care, implement the local government's investment policy in medical and health institutions, increase the focus on public health, grassroots, etc.
, and improve public health and grassroots medical and health service capabilities
.
Improve the Chinese medicine service network system
.
Encourage and support non-public medical institutions and public medical institutions to complement each other and develop together
.
(Ministry of Finance, National Development and Reform Commission, National Health Commission, National Disease Control and Prevention Bureau and other relevant localities are responsible according to the division of responsibilities) 2.
Pilot key reforms continue to deepen reforms that are tailored to local conditions and still need to be explored, and actively and steadily carry out pilots , Explore and innovate based on actual conditions, and accumulate experience for deepening reforms
.
12.
Promote the pilot project of the construction of a compact county medical community, and gradually realize the overall management of administration, personnel, finance, business, drug catalog, and information system within the county medical community
.
Explore the implementation of the payment of total medical insurance funds for the close-type county medical community, strengthen supervision and assessment, retain the balance, and share the reasonable over-expenditure
.
Localities with conditions are allowed to explore the packaging of basic public health service funds, basic drug system subsidies and other related funds to the compact county medical community for overall planning and use
.
(The National Health Commission, the State Administration of Traditional Chinese Medicine, the National Medical Insurance Bureau, the Ministry of Finance, the National Development and Reform Commission and other relevant departments are responsible according to the division of responsibilities) 13.
Carry out pilot projects of compact urban medical groups.
Each province selects 2-3 cities with districts to carry out the pilot projects, implements grid layout management, and is responsible for the integrated and continuous medical care of residents in the grid such as prevention, treatment, rehabilitation, and health promotion.
Service
.
Encourage pilot areas to explore and innovate methods of medical insurance payment and financial subsidies for compact medical groups, and guide them to better improve the efficiency and level of medical and health services
.
Support traditional Chinese medicine hospitals to take the lead in forming a compact urban medical group
.
(The National Health Commission, the State Administration of Traditional Chinese Medicine, the National Medical Insurance Bureau, the Ministry of Finance, the National Development and Reform Commission and other relevant departments are responsible according to the division of responsibilities) 14.
Encourage localities to actively explore and improve the management system and supervision mechanism of the close medical consortium based on actual conditions, straighten out the relationship between the medical consortium and its sponsors, regulators, and the member units of the medical consortium, and form clear rights and responsibilities and management Scientific and sustainable institutional arrangements
.
Strengthen the responsibility of organizers and regulators, strengthen the performance appraisal and supervision and management of the close medical consortium, ensure that it performs its due duties, and protect the reasonable interests and enthusiasm of the member units of the medical consortium
.
(National Health Commission, National Administration of Traditional Chinese Medicine, National Medical Insurance Bureau, Ministry of Finance, National Development and Reform Commission and other departments and relevant localities are responsible according to the division of responsibilities) 15.
Encourage the province as a unit or the establishment of inter-provincial alliances to implement centralized procurement of pharmaceuticals and consumables that are in large quantities and high purchases in addition to the centralized procurement of national organizations.
At least one time each year is carried out or participated in the centralized procurement of pharmaceuticals and consumables
.
Encourage localities to join the "Sanming Procurement Alliance"
.
All provinces and inter-provincial procurement alliances, "Sanming Procurement Alliance" and other selected results, transaction information, price reductions of selected products, and agreed purchase quantities are uploaded to the National Medical Insurance Information System in a timely manner
.
(Departments such as the National Medical Insurance Bureau and all relevant localities are responsible according to the division of responsibilities) 16.
Optimize the management of new medical service price projects, select some provinces to formulate new medical service price project management measures, simplify the application process for new price projects, speed up the acceptance and review process, clarify the processing time limit, and promote the development of medical technology innovation and clinical application
.
Explore and improve the price items of pharmacy medical services
.
(Departments such as the National Medical Insurance Bureau and relevant localities are responsible according to the division of responsibilities) 17.
Accelerate the implementation of pilot reforms such as group payment by disease diagnosis, total budget based on regional points method, and payment by disease type.
By the end of 2021, all pilot cities will enter the actual payment stage, and experience will be summarized in a timely manner and promoted nationwide
.
Encourage the exploration of payment methods that meet the characteristics of traditional Chinese medicine services
.
(The National Medical Insurance Bureau and all relevant localities are responsible according to the division of responsibilities) 18.
Encourage localities to explore effective ways of tapping the potential of the internal business organization and innovating management based on actual conditions
.
Make full use of the establishment resources, follow the principle of “guarantee basic medical care, ensure public health, and ensure discipline guidance”, and gradually digest the existing non-staff hired professional and technical personnel.
For those who meet the requirements, they can fully consider their medical experience, performance, contribution, etc.
, Through open recruitment and other strict and standardized procedures
.
(The National Health Commission, the Central Planning Office, the Ministry of Human Resources and Social Security, the National Bureau of Disease Control and other departments and all relevant localities are responsible according to the division of responsibilities) 19.
In each city divided into districts, at least one tertiary hospital with high medical level, strong technical ability, perfect personnel management, and willingness to conduct independent review shall be selected as a pilot for independent review of senior professional titles
.
(The Ministry of Human Resources and Social Security, the National Health Commission, the State Administration of Traditional Chinese Medicine and other relevant departments are responsible according to the division of responsibilities) 20.
Encourage localities to explore and deepen the reform of the salary system in public hospitals based on actual conditions, explore the implementation of annual salary system, post salary system, agreed salary system, project salary and other salary forms, gradually establish a salary system that reflects job responsibilities and knowledge value, and give full play to the effective incentive role of the salary system
.
Encourage and support local governments to explore salary distribution policies that are conducive to mobilizing the enthusiasm of primary medical and health institutions for services
.
Fully consider the characteristics of traditional Chinese medicine services, and promote the reform of the salary system in the field of traditional Chinese medicine based on actual conditions
.
(Ministry of Human Resources and Social Security, National Health Commission, National Disease Control and Prevention Bureau and other relevant localities are responsible according to the division of responsibilities) 21.
Encourage qualified places to learn from Sanming's practices, reform and improve the total salary assessment method of public hospitals, calculate the total hospital salary based on medical service income (excluding medicines, consumables, inspection, and laboratory income), and implement a target annual salary system for all employees.
Improve the work-point system, informatization, and open performance appraisal system, and maintain the public welfare of public hospitals
.
(The National Health Commission, the Ministry of Human Resources and Social Security, the National Disease Control and Prevention Bureau and other relevant localities are responsible according to the division of responsibilities) 3.
Strengthen the organization and implementation 22.
All provinces shall follow the requirements of this opinion and combine actual conditions to refine and improve the measures and requirements for the promotion of Sanming medical reform experience
.
The leading coordinating agencies for medical reform in all provinces should establish task accounts to promote Sanming's medical reform experience, track and monitor the work progress of relevant departments and the city and county levels, and strengthen regular scheduling and supervision
.
All relevant departments should strengthen the guidance to the local area, provide necessary support for local reforms and explorations, help solve existing problems, and promptly upgrade mature experience to national policies
.
(The Secretariat of the Medical Reform Leading Group of the State Council and all relevant localities and departments are responsible according to the division of responsibilities) 23.
Comprehensive medical reform pilot provinces, compact county medical community pilot areas, public hospital comprehensive reform demonstration places, and places with obvious practical results should be compared with the requirements of this opinion, combined with actual practice, and boldly break through and innovate
.
The Secretariat of the Medical Reform Leading Group of the State Council and related departments closely follow up and evaluate the work progress of each province, summarize and exchange good experience and practices in a timely manner, increase the publicity of typical experiences, and promptly notify and urge rectification of work that lags behind
.
During the "14th Five-Year Plan" period, the central and local finances continued to arrange funds to support the comprehensive reform of public hospitals, and give preference to areas where the promotion of Sanming's medical reform experience has been significant
.
(The Secretariat of the Medical Reform Leading Group of the State Council, the Ministry of Finance, the National Health Commission and other relevant localities are responsible according to the division of responsibilities) The Leading Group of the State Council to Deepen the Reform of the Medical and Health System October 8, 2021