Main work arrangements for deepening the reform of the medical and health system in 2012

1. Overall requirements

In-depth implementation of the "Regulations of the Central Committee of the Communist Party of China and the State Council on Deepening the Medical and Health System" Reform Opinions" (Zhongfa [2009] No. 6) and the "Notice of the State Council on Issuing the Plan and Implementation Plan for Deepening the Reform of the Medical and Health System During the Twelfth Five-Year Plan Period" (Guofa [2012] No. 11), in order to build a The basic medical and health system in accordance with my country's national conditions is at the core. We adhere to the core concept of providing the basic medical and health system as a public product to all the people. We adhere to the basic principles of ensuring the basics, strengthening the grassroots and building mechanisms. We insist on giving priority to prevention and focusing on rural areas. We will adhere to the policy of giving equal emphasis to both traditional Chinese and Western medicine, maintain the continuity and stability of basic medical reform policies, and focus on accelerating and improving the universal medical insurance system, consolidating and improving the essential drug system and new operating mechanisms of primary medical and health institutions, and actively promoting the reform of public hospitals. Make breakthroughs in key areas, coordinate the advancement of reforms in related fields, maintain the good momentum of medical reform, and lay a solid foundation for achieving the phased reform goals of the "Twelfth Five-Year Plan".

2. Work tasks

(1) Accelerate and improve the universal medical insurance system.

1. Consolidate and expand basic medical insurance coverage.

Participation rate of three basic medical insurances: Employee Basic Medical Insurance (hereinafter referred to as Employee Medical Insurance), Urban Resident Basic Medical Insurance (hereinafter referred to as Urban Resident Medical Insurance) and New Rural Cooperative Medical Care (hereinafter referred to as New Rural Cooperative Medical Care) Stable at 95%. Focus on the insurance management of migrant workers, employees of non-public economic organizations, flexible employment personnel, students, preschool children and newborns. Continue to promote the insurance coverage of needy groups such as retirees of closed and bankrupt enterprises and employees of enterprises in difficulty. (The Ministry of Human Resources and Social Security and the Ministry of Health are respectively responsible)

2. Continue to improve the level of basic medical security.

(1) The government’s subsidy standard for the New Rural Cooperative Medical System and urban residents’ medical insurance will be increased to 240 yuan per person per year, and the individual payment level will be increased accordingly, with per capita financing reaching about 300 yuan. (The Ministry of Finance, the Ministry of Health, and the Ministry of Human Resources and Social Security are responsible)

(2) The maximum payment limit of the collective fund within the scope of employee medical insurance, urban residents’ medical insurance, and new rural cooperative medical care policies will be increased to the average annual salary of local employees. More than 6 times of the annual per capita disposable income of local residents, more than 8 times of the national per capita net income of farmers, and not less than 60,000 yuan. The payment ratio of hospitalization expenses within the scope of urban residents' medical insurance and the new rural cooperative medical insurance policy has reached more than 70% and about 75% respectively, gradually narrowing the gap with the actual hospitalization expense payment ratio, and the outpatient overall payment ratio has further increased. Explore ways to gradually establish employee medical insurance outpatient coordination through personal account adjustments. (The Ministry of Human Resources and Social Security and the Ministry of Health are respectively responsible)

3. Reform the medical insurance payment system.

(1) Actively promote the reform of payment methods such as capitation payment, payment by disease type, payment by bed day, and total prepayment, and gradually cover designated medical insurance institutions in the coordinating region. Strengthen the control of total payment, establish a mechanism for medical insurance to restrict the growth of medical expenses in the coordinating region, formulate overall control targets for medical insurance fund expenditures and decompose them into designated medical institutions, and link them to payment standards. Actively promote the establishment of a negotiation mechanism and a payment mechanism for purchased services between medical insurance agencies and medical institutions, and determine the service scope, payment methods, payment standards and service quality requirements through negotiations. Combined with the reform of payment methods, explore ways to control personal burdens. Gradually include the growth control of total expenses of medical institutions and average medical expenses (by disease type) and personal burden control, as well as the quality of medical services into the medical insurance evaluation system. (The Ministry of Human Resources and Social Security and the Ministry of Health are respectively responsible)

(2) Improve the differential payment mechanism, further tilt the payment ratio to grassroots medical and health institutions, encourage the use of traditional Chinese medicine services, and guide the people to go to grassroots hospitals for the first time. Include qualified private clinics and other non-public medical institutions and retail pharmacies into the designated coverage of medical insurance. (The Ministry of Human Resources and Social Security and the Ministry of Health are responsible respectively)

(3) Strengthen the supervision of medical insurance on medical service activities, improve the monitoring and management mechanism, gradually establish a real-time monitoring system for medical insurance on medical services, and gradually integrate medical insurance into The supervision of medical services in medical institutions extends to the supervision of the medical service behavior of medical personnel. Establish a joint anti-fraud mechanism, increase penalties for insurance fraud, and disclose relevant information in a timely manner. (The Ministry of Human Resources and Social Security and the Ministry of Health are responsible respectively)

4. Further increase medical assistance.

(1) Increase investment in relief funds and build a solid bottom line for medical security. The scope of assistance has been expanded from members of families with minimum living allowances and five-guarantee households to low-income seriously ill patients, severely disabled people, and elderly people from low-income families, and they will be subsidized to participate in urban residents' medical insurance or new rural cooperative medical care. Improve the level of assistance, cancel the minimum payment line for medical assistance, steadily increase the cap line, and further increase the proportion of assistance for hospitalization medical expenses within the policy scope of the assistance recipients. (The Ministry of Civil Affairs and the Ministry of Finance are responsible)

(2) Study and establish a disease emergency relief fund. Funds are raised through various channels such as government funding and social donations to establish funds to solve the emergency medical treatment expenses incurred by patients who cannot afford the cost and have no owners. We will promptly formulate fund management measures. (The National Development and Reform Commission and the Ministry of Finance are responsible)

5. Explore the establishment of a serious disease protection mechanism.

(1) Study and formulate measures to protect major and serious diseases, actively explore ways to use basic medical insurance funds to purchase commercial serious illness insurance or establish supplementary insurance, effectively improve the level of protection for major and serious diseases, and effectively solve the problems caused by patients with major and serious diseases. The problem of poverty caused by illness. Make a good connection with basic medical insurance, medical assistance, commercial insurance, etc.

Governments at all levels must actively adjust the structure of fiscal expenditures, increase investment, and effectively ensure that the funds required for annual medical reform tasks are included in the fiscal budget and are allocated in full and on time. When arranging the annual health investment budget, it is necessary to effectively implement the requirement that "the growth rate of government health investment is higher than the growth rate of regular fiscal expenditures, and the proportion of government health investment in regular fiscal expenditures will gradually increase." According to the 2012 Investment in medical reform is significantly higher than in 2011. It is necessary to increase the intensity of special transfer payments from the central and provincial finances to areas in need. Financial departments at all levels must provide special explanations on health investment when reporting draft budgets and final accounts to the government. Strengthen fund supervision and management, make project execution and fund use performance an important assessment content of the medical reform accountability system, and improve fund use efficiency.

(3) Strengthen performance appraisal.

The Office of the State Council Leading Group for Medical Reform should work with relevant departments and localities to further strengthen the monitoring and evaluation of the progress and effects of the implementation of medical reform, and implement a performance appraisal mechanism with monthly reporting, quarterly assessment, and full-year assessment. It is necessary to continue to strengthen regular supervision, promptly discover problems existing in the implementation of medical reform, study and solve them, and urge local governments to carry out rectification. It is necessary to strengthen classified guidance, and adopt various methods such as sub-basing, supervision, interviews and notifications to strengthen organizational implementation. The General Office of the State Council will conduct timely supervision and inspection on the implementation of medical reform tasks.

(4) Strengthen publicity and guidance.

We must adhere to the correct direction of public opinion, improve departmental and local health reform publicity communication and coordination mechanisms, strengthen active guidance and positive publicity, deeply explore typical experiences, adopt methods that are close to the masses and go deep into the grassroots to demonstrate the effectiveness of the reform and expand publicity Effect. It is necessary to timely publish the progress of medical reform, improve the public opinion verification mechanism, actively accept supervision from the news media, and answer and respond to questions of social concern. It is necessary to mobilize the enthusiasm, initiative and creativity of all parties involved in medical reform, give full play to the main role of medical personnel, and create a good public opinion atmosphere and social environment for deepening the reform.