The General Office of the State Council recently issued "20 1 1 Main Work Arrangement for Five Key Reforms of Medical and Health System", which defined 17 specific tasks from five aspects, such as accelerating the construction of basic medical security system, initially establishing the national basic drug system, improving the medical and health service system, promoting the gradual equalization of basic public health services, and actively and steadily promoting the reform of public hospitals, and delineated the responsible departments for each task.
The specific tasks of 17 proposed in this work arrangement are as follows:
Accelerate the construction of the basic medical security system.
1. Consolidate and expand the coverage of basic medical insurance, and basically realize universal medical insurance.
-The number of employees' basic medical insurance (hereinafter referred to as employee medical insurance) and urban residents' basic medical insurance (hereinafter referred to as urban medical insurance) reached 440 million, and the participation rate increased to over 90%. Properly solve the problem of retirees from closed bankrupt enterprises and employees from difficult enterprises participating in insurance. College students will all be included in the scope of medical insurance for urban residents. Actively promote employees of non-public economic organizations, flexible employees and migrant workers to participate in employee medical insurance. Promote unemployed people to participate in insurance. We will implement a selective insurance policy for flexible employees and migrant workers who have not established labor relations.
-further consolidate the coverage of the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system), and keep the participation rate above 90%.
2. Comprehensively improve the basic medical security level and enhance the security capacity.
-To further raise the funding standard, the government will raise the medical insurance subsidy standard for the new rural cooperative medical system and urban residents to 200 yuan per person per year, and the individual payment standard will be appropriately raised.
-Expand the scope of outpatient co-ordination, generally carry out urban residents' medical insurance and the new rural cooperative medical system outpatient co-ordination, and include the drugs in the medical insurance catalogue used by grassroots medical and health institutions and the general medical expenses collected in the scope of payment according to regulations; Actively explore the outpatient co-ordination of employee medical insurance.
Significantly improve the level of protection. The proportion of hospitalization expenses within the scope of urban residents' medical insurance and the new rural cooperative medical system policy will strive to reach about 70%. The maximum payment limit of the co-ordination fund within the scope of employee medical insurance, urban residents' medical insurance and the new rural cooperative medical system in all co-ordination areas is more than 6 times of the annual average salary of local employees, the annual disposable income of local residents and the annual per capita net income of farmers nationwide, and it is not less than 50,000 yuan.
-Actively carry out pilot projects to improve the medical security level of major diseases, promote the pilot projects to improve the security level of childhood leukemia and congenital heart disease in all provinces (autonomous regions and municipalities), increase the number of pilot diseases on the basis of summary and evaluation, and expand the scope of pilot areas. Pay close attention to the study of policies and measures to provide necessary support for the treatment of opportunistic infections in AIDS patients from the aspects of medical insurance and assistance.
-comprehensively improve the level of medical assistance. Funding for people with difficulties to participate in insurance has expanded from low-income objects and five-guarantee households to low-income seriously ill patients, severely disabled people, elderly people from low-income families and other special hardship groups. Carry out outpatient assistance. Gradually reduce and cancel the deductible line of medical assistance, and the proportion of out-of-pocket hospitalization assistance within the policy scope shall not be less than 50% in principle. Explore and carry out pilot projects for major disease relief. Encourage social forces to donate to medical aid charities and broaden financing channels.
3. Improve the management level of basic medical security to facilitate the settlement of medical treatment for the masses.
-Continue to promote the "one-card" method for medical treatment, and basically realize the immediate settlement of medical expenses in the overall planning area (or report, the same below). Strengthen the construction of settlement capacity for medical treatment in different places, carry out instant settlement for medical treatment in different places in provinces (autonomous regions and municipalities), and explore instant settlement for medical treatment in different places with the focus on resettling retirees in different places. Do a good job in the transfer and continuation of the basic medical insurance relationship between migrant workers and other migrant workers, and study the related issues of cumulative calculation of payment years.
-Strengthen the budget management of the medical insurance fund, establish a fund operation analysis and risk early warning system, control the fund balance, and improve the efficiency of use. In areas with excessive balances of employee medical insurance and urban residents' medical insurance funds, the balance should be gradually reduced to a reasonable level; The balance rate of the new rural cooperative medical fund in the current year is controlled within 65438 05%, and the accumulated balance does not exceed 25% of the fund in the current year. In areas where the current income of the fund is insufficient, effective measures should be taken to ensure the smooth operation of the fund.
-Give full play to the role of medical insurance in guiding the supply and demand sides of medical services and restricting medical expenses. For those who go to primary medical and health institutions, the proportion of medical insurance payment will be tilted. Reform the payment method of medical insurance, and vigorously promote prepaid payment according to head, disease type and total amount. Actively explore the establishment of a negotiation mechanism between medical insurance agencies and medical institutions and drug suppliers.
-Strengthening the supervision of medical insurance on medical services. Strengthen the dynamic management of designated medical institutions and retail pharmacies, establish and improve the credit rating system of medical insurance, implement hierarchical management of designated medical institutions, and further standardize the service behavior of designated medical institutions and retail pharmacies. The research gradually extends the supervision of medical insurance on medical services in medical institutions to the supervision of medical service behavior of medical staff. Increase the punishment for insurance fraud in accordance with the law.
-Medical insurance for employees and medical insurance for urban residents have basically achieved overall planning at the city (prefecture) level, and local governments are encouraged to explore provincial-level overall planning. Conditional areas should further improve the overall level of the new rural cooperative medical system. Accelerate the overall planning of urban and rural basic medical security and steadily promote the integration of management resources. Do a good job in the convergence of policies and management of various basic medical security systems, realize information sharing, and avoid repeated participation in insurance. Actively explore entrusting qualified commercial insurance institutions to handle all kinds of medical security management services.
-Support the development of commercial health insurance, and encourage enterprises and individuals to meet the needs beyond basic medical insurance by participating in commercial insurance and various forms of supplementary insurance.
Initially establish a national system of essential drugs.
4. Expand the scope of implementation of the national essential drug system and achieve full coverage at the grassroots level.
-expand the scope of implementation of the basic drug system, implement the national basic drug system in all government-run primary medical and health institutions, and implement zero-difference sales of drugs.
-Study and improve the national list of essential drugs (for use at the grass-roots level), standardize drug supplements in all provinces (autonomous regions and municipalities), give consideration to the needs of adults and children, and better meet the needs of basic drugs at the grass-roots level. Simultaneously implement the basic drug medical insurance payment policy.
5. Establish a standardized mechanism for purchasing essential drugs, and reshape the guarantee system for the supply of essential drugs.
—— The essential drugs (including supplementary varieties of all provinces, autonomous regions and municipalities) used by government-run primary medical and health institutions that implement the basic drug system are centrally purchased and uniformly distributed by all provinces (autonomous regions and municipalities) to ensure the safety, effectiveness, excellent quality, reasonable price and timely supply of essential drugs.
-Formulating a centralized purchasing plan for essential drugs, determining the specific dosage forms, specifications and quality requirements for purchasing essential drugs, and specifying the purchasing quantity, which is linked to the price. Provinces (autonomous regions and municipalities) that are temporarily unable to determine the purchase quantity adopt single-source commitment to purchase.
-Adhere to quality first and reasonable price, and encourage all localities to adopt the "double envelope" bidding system. Only enterprises that have passed the economic and technical bid evaluation can enter the commercial bid evaluation, and the commercial bid evaluation will win the bid at the lowest price.
-sign a purchase and sale contract by combining bidding and procurement. Authorized or entrusted by primary medical and health institutions, procurement institutions sign purchase and sale contracts with drug supply enterprises and are responsible for the implementation of the contracts, and make unified payment for the payment of basic drugs in primary medical and health institutions. In principle, the time from delivery acceptance to payment shall not exceed 30 days.
-Establish and improve the dynamic adjustment mechanism of the guided prices of essential drugs, classify and manage the guided retail prices of essential drugs, and implement unified national pricing for exclusive varieties of essential drugs and varieties whose prices have been basically stable and sufficient after repeated centralized purchases.
-formulate and improve the policy of using essential drugs at the grassroots level, and ensure that all government-run primary medical and health institutions are equipped with essential drugs.
-Ensuring the production and supply of essential drugs. Supplier enterprises independently choose to operate enterprises for distribution or self-distribution. Encourage the development of modern logistics and other means to improve distribution efficiency. Promote pharmaceutical production and circulation enterprises to optimize their structure and realize scale operation.
-Full implementation of the new national quality standards for essential drugs. Strengthen the supervision of essential drugs, speed up the construction of information systems, carry out sampling inspection and electronic supervision of all varieties of essential drugs, and improve the traceability of essential drugs from production to circulation.
6. Comprehensively promote the comprehensive reform of primary medical and health institutions and establish a new operating mechanism.
-adjust the charging items and medical insurance payment policies of primary medical and health institutions, and merge the original registration fees, inspection fees, injection fees and pharmacy service fees of primary medical and health institutions into general medical treatment fees. Reasonably formulate and adjust the charging standard of general medical expenses, and reasonably determine the proportion of medical insurance payment without increasing the existing personal burden of the masses.
-Establish a stable and long-term multi-channel compensation mechanism for primary medical and health institutions. The implementation of the government's special subsidies for primary medical and health institutions and regular balance of payments subsidies, conditional areas can implement "two lines of revenue and expenditure."
-Improve staffing management. Accelerate the formulation of staffing standards for primary medical and health institutions. Innovative organization staffing management methods, with counties (cities, districts) as the unit to implement total staffing control, overall arrangement and dynamic adjustment.
-Deepening the reform of the personnel system. We will promote the implementation of quota and posts in all localities, comprehensively establish a personnel employment system and post management system, implement post setting on demand, competition for posts, post employment and contract management, and establish an employment mechanism that combines performance appraisal, survival of the fittest, lifting and entry and exit. Complete the competition for posts for primary medical staff, and properly resettle the unemployed in light of the actual situation in all localities to ensure social stability.
-Improve the performance appraisal mechanism, and conduct a comprehensive and quantitative assessment of primary medical and health institutions and medical personnel according to the indicators such as the quantity and quality of work, the satisfaction of clients, and the improvement of residents' health status. The assessment results are linked to the subsidies of primary medical and health institutions and the income level of medical staff.
-improve the distribution incentive mechanism. Fully implement performance pay to ensure that the reasonable income level of primary medical staff does not decrease. Adhere to more pay for more work, excellent performance and excellent remuneration, appropriately widen the income gap of medical staff, tilt to key positions, business backbones and personnel with outstanding contributions, and mobilize the enthusiasm of medical staff.
-Encourage qualified areas to bring village clinics and primary medical and health institutions run by non-governmental organizations into the scope of implementation of the basic drug system, and make reasonable compensation by purchasing services. Implement the subsidy support policy for village doctors.
-The central government will continue to reward and subsidize the implementation of the national basic drug system and the comprehensive reform of primary medical and health institutions in various places through the way of substituting awards for subsidies.
BEIJING, Feb. 17 (Xinhua)-The General Office of the State Council recently issued "Five Key Reforms of the Medical and Health System: Main Work Arrangements for 20 1 1 year", which clarified/KLOC from five aspects: accelerating the construction of the basic medical security system, initially establishing the national essential drug system, improving the medical and health service system, promoting the gradual equalization of basic public health services, and actively and steadily promoting the reform of public hospitals.
The specific tasks of 17 proposed in this work arrangement are as follows:
Accelerate the construction of the basic medical security system.
1. Consolidate and expand the coverage of basic medical insurance, and basically realize universal medical insurance.
-The number of employees' basic medical insurance (hereinafter referred to as employee medical insurance) and urban residents' basic medical insurance (hereinafter referred to as urban medical insurance) reached 440 million, and the participation rate increased to over 90%. Properly solve the problem of retirees from closed bankrupt enterprises and employees from difficult enterprises participating in insurance. College students will all be included in the scope of medical insurance for urban residents. Actively promote employees of non-public economic organizations, flexible employees and migrant workers to participate in employee medical insurance. Promote unemployed people to participate in insurance. We will implement a selective insurance policy for flexible employees and migrant workers who have not established labor relations.
-further consolidate the coverage of the new rural cooperative medical system (hereinafter referred to as the new rural cooperative medical system), and keep the participation rate above 90%.
2. Comprehensively improve the basic medical security level and enhance the security capacity.
-To further raise the funding standard, the government will raise the medical insurance subsidy standard for the new rural cooperative medical system and urban residents to 200 yuan per person per year, and the individual payment standard will be appropriately raised.
-Expand the scope of outpatient co-ordination, generally carry out urban residents' medical insurance and the new rural cooperative medical system outpatient co-ordination, and include the drugs in the medical insurance catalogue used by grassroots medical and health institutions and the general medical expenses collected in the scope of payment according to regulations; Actively explore the outpatient co-ordination of employee medical insurance.
Significantly improve the level of protection. The proportion of hospitalization expenses within the scope of urban residents' medical insurance and the new rural cooperative medical system policy will strive to reach about 70%. The maximum payment limit of the co-ordination fund within the scope of employee medical insurance, urban residents' medical insurance and the new rural cooperative medical system in all co-ordination areas is more than 6 times of the annual average salary of local employees, the annual disposable income of local residents and the annual per capita net income of farmers nationwide, and it is not less than 50,000 yuan.
-Actively carry out pilot projects to improve the medical security level of major diseases, promote the pilot projects to improve the security level of childhood leukemia and congenital heart disease in all provinces (autonomous regions and municipalities), increase the number of pilot diseases on the basis of summary and evaluation, and expand the scope of pilot areas. Pay close attention to the study of policies and measures to provide necessary support for the treatment of opportunistic infections in AIDS patients from the aspects of medical insurance and assistance.
-comprehensively improve the level of medical assistance. Funding for people with difficulties to participate in insurance has expanded from low-income objects and five-guarantee households to low-income seriously ill patients, severely disabled people, elderly people from low-income families and other special hardship groups. Carry out outpatient assistance. Gradually reduce and cancel the deductible line of medical assistance, and the proportion of out-of-pocket hospitalization assistance within the policy scope shall not be less than 50% in principle. Explore and carry out pilot projects for major disease relief. Encourage social forces to donate to medical aid charities and broaden financing channels.
3. Improve the management level of basic medical security to facilitate the settlement of medical treatment for the masses.
-Continue to promote the "one-card" method for medical treatment, and basically realize the immediate settlement of medical expenses in the overall planning area (or report, the same below). Strengthen the construction of settlement capacity for medical treatment in different places, carry out instant settlement for medical treatment in different places in provinces (autonomous regions and municipalities), and explore instant settlement for medical treatment in different places with the focus on resettling retirees in different places. Do a good job in the transfer and continuation of the basic medical insurance relationship between migrant workers and other migrant workers, and study the related issues of cumulative calculation of payment years.
-Strengthen the budget management of the medical insurance fund, establish a fund operation analysis and risk early warning system, control the fund balance, and improve the efficiency of use. In areas with excessive balances of employee medical insurance and urban residents' medical insurance funds, the balance should be gradually reduced to a reasonable level; The balance rate of the new rural cooperative medical fund in the current year is controlled within 65438 05%, and the accumulated balance does not exceed 25% of the fund in the current year. In areas where the current income of the fund is insufficient, effective measures should be taken to ensure the smooth operation of the fund.
-Give full play to the role of medical insurance in guiding the supply and demand sides of medical services and restricting medical expenses. For those who go to primary medical and health institutions, the proportion of medical insurance payment will be tilted. Reform the payment method of medical insurance, and vigorously promote prepaid payment according to head, disease type and total amount. Actively explore the establishment of a negotiation mechanism between medical insurance agencies and medical institutions and drug suppliers.
-Strengthening the supervision of medical insurance on medical services. Strengthen the dynamic management of designated medical institutions and retail pharmacies, establish and improve the credit rating system of medical insurance, implement hierarchical management of designated medical institutions, and further standardize the service behavior of designated medical institutions and retail pharmacies. The research gradually extends the supervision of medical insurance on medical services in medical institutions to the supervision of medical service behavior of medical staff. Increase the punishment for insurance fraud in accordance with the law.
-Medical insurance for employees and medical insurance for urban residents have basically achieved overall planning at the city (prefecture) level, and local governments are encouraged to explore provincial-level overall planning. Conditional areas should further improve the overall level of the new rural cooperative medical system. Accelerate the overall planning of urban and rural basic medical security and steadily promote the integration of management resources. Do a good job in the convergence of policies and management of various basic medical security systems, realize information sharing, and avoid repeated participation in insurance. Actively explore entrusting qualified commercial insurance institutions to handle all kinds of medical security management services.
-Support the development of commercial health insurance, and encourage enterprises and individuals to meet the needs beyond basic medical insurance by participating in commercial insurance and various forms of supplementary insurance.
Initially establish a national system of essential drugs.
4. Expand the scope of implementation of the national essential drug system and achieve full coverage at the grassroots level.
-expand the scope of implementation of the basic drug system, implement the national basic drug system in all government-run primary medical and health institutions, and implement zero-difference sales of drugs.
-Study and improve the national list of essential drugs (for use at the grass-roots level), standardize drug supplements in all provinces (autonomous regions and municipalities), give consideration to the needs of adults and children, and better meet the needs of basic drugs at the grass-roots level. Simultaneously implement the basic drug medical insurance payment policy.
5. Establish a standardized mechanism for purchasing essential drugs, and reshape the guarantee system for the supply of essential drugs.
—— The essential drugs (including supplementary varieties of all provinces, autonomous regions and municipalities) used by government-run primary medical and health institutions that implement the basic drug system are centrally purchased and uniformly distributed by all provinces (autonomous regions and municipalities) to ensure the safety, effectiveness, excellent quality, reasonable price and timely supply of essential drugs.
-Formulating a centralized purchasing plan for essential drugs, determining the specific dosage forms, specifications and quality requirements for purchasing essential drugs, and specifying the purchasing quantity, which is linked to the price. Provinces (autonomous regions and municipalities) that are temporarily unable to determine the purchase quantity adopt single-source commitment to purchase.
-Adhere to quality first and reasonable price, and encourage all localities to adopt the "double envelope" bidding system. Only enterprises that have passed the economic and technical bid evaluation can enter the commercial bid evaluation, and the commercial bid evaluation will win the bid at the lowest price.
-sign a purchase and sale contract by combining bidding and procurement. Authorized or entrusted by primary medical and health institutions, procurement institutions sign purchase and sale contracts with drug supply enterprises and are responsible for the implementation of the contracts, and make unified payment for the payment of basic drugs in primary medical and health institutions. In principle, the time from delivery acceptance to payment shall not exceed 30 days.
-Establish and improve the dynamic adjustment mechanism of the guided prices of essential drugs, classify and manage the guided retail prices of essential drugs, and implement unified national pricing for exclusive varieties of essential drugs and varieties whose prices have been basically stable and sufficient after repeated centralized purchases.
-formulate and improve the policy of using essential drugs at the grassroots level, and ensure that all government-run primary medical and health institutions are equipped with essential drugs.
-Ensuring the production and supply of essential drugs. Supplier enterprises independently choose to operate enterprises for distribution or self-distribution. Encourage the development of modern logistics and other means to improve distribution efficiency. Promote pharmaceutical production and circulation enterprises to optimize their structure and realize scale operation.
-Full implementation of the new national quality standards for essential drugs. Strengthen the supervision of essential drugs, speed up the construction of information systems, carry out sampling inspection and electronic supervision of all varieties of essential drugs, and improve the traceability of essential drugs from production to circulation.
6. Comprehensively promote the comprehensive reform of primary medical and health institutions and establish a new operating mechanism.
-adjust the charging items and medical insurance payment policies of primary medical and health institutions, and merge the original registration fees, inspection fees, injection fees and pharmacy service fees of primary medical and health institutions into general medical treatment fees. Reasonably formulate and adjust the charging standard of general medical expenses, and reasonably determine the proportion of medical insurance payment without increasing the existing personal burden of the masses.
-Establish a stable and long-term multi-channel compensation mechanism for primary medical and health institutions. The implementation of the government's special subsidies for primary medical and health institutions and regular balance of payments subsidies, conditional areas can implement "two lines of revenue and expenditure."
-Improve staffing management. Accelerate the formulation of staffing standards for primary medical and health institutions. Innovative organization staffing management methods, with counties (cities, districts) as the unit to implement total staffing control, overall arrangement and dynamic adjustment.
-Deepening the reform of the personnel system. We will promote the implementation of quota and posts in all localities, comprehensively establish a personnel employment system and post management system, implement post setting on demand, competition for posts, post employment and contract management, and establish an employment mechanism that combines performance appraisal, survival of the fittest, lifting and entry and exit. Complete the competition for posts for primary medical staff, and properly resettle the unemployed in light of the actual situation in all localities to ensure social stability.
-Improve the performance appraisal mechanism, and conduct a comprehensive and quantitative assessment of primary medical and health institutions and medical personnel according to the indicators such as the quantity and quality of work, the satisfaction of clients, and the improvement of residents' health status. The assessment results are linked to the subsidies of primary medical and health institutions and the income level of medical staff.
-improve the distribution incentive mechanism. Fully implement performance pay to ensure that the reasonable income level of primary medical staff does not decrease. Adhere to more pay for more work, excellent performance and excellent remuneration, appropriately widen the income gap of medical staff, tilt to key positions, business backbones and personnel with outstanding contributions, and mobilize the enthusiasm of medical staff.
-Encourage qualified areas to bring village clinics and primary medical and health institutions run by non-governmental organizations into the scope of implementation of the basic drug system, and make reasonable compensation by purchasing services. Implement the subsidy support policy for village doctors.
-The central government will continue to reward and subsidize the implementation of the national basic drug system and the comprehensive reform of primary medical and health institutions in various places through the way of substituting awards for subsidies.