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Vigorously Promoting Urban Medical and Health Structural Reform
Early this year, the General Office of the State Council transmitted the Opinions On Guidance to the Urban Medical and Health Structural Reform formulated jointly by the Structural Reform Office of the State Council and seven other departments.
The State Council has decided to carry out medical and health structural reform in cities and towns while establishing a basic medical insurance system for urban workers and staff members. The objective of reform is to set up an urban medical and health system suited to the requirements of the socialist market economy, promote the sound development of health institutions and medical industry, allow the masses to enjoy reasonably priced and fine-quality medical service and raise the health level of the people.
Since the introduction of the reform and opening policy, the average life expectancy of the Chinese people has extended and their health condition has generally improved. However, along with social and economic development, the defects of the current medical and health system has increasingly come to light. For example, medical resources are concentrated mainly in big urban hospitals, grass-roots health services are inadequate, waste and shortage of health resources exist side by side and the overall efficiency is low; the order of pharmaceutical production and circulation is chaotic and there exist the unhealthy trends of virtually high price-setting and rebate on sales promotion; staff of public medical institutions lack the awareness of competition, some of them abuse their monopoly power to one-sidedly pursue economic benefits, write out widely-inclusive descriptions and charge high examination fees; the rapid growth of medical fees has brought great pressure on the State, work units and employees. The basic starting-point of the medical and health structural reform is to overcome the various defects existing in the medical and health undertakings and to bring benefits for the broad masses of the people.
The medical and health structural reform is a very important and quite complicated work. In order to press ahead with this reform, currently we should come to grip with the following main links.
First is to introduce a competitive mechanism and improve the quality of medical service. First of all, we should guarantee the people's optional right to medical service, including the choice of hospitals, doctors and drugstores. Workers and staff members may choose hospitals from among a number of medical institutions, so as to promote competition among medical institutions. Employees may buy medicines either in the hospital, or in some designated drugstores by presenting doctors' prescriptions, so as to boost competition between hospital pharmacies and drugstores in society. The next objective of reform is to change the pharmacies of outpatient departments into medicine retail enterprises which engage in independent business accounting and pay taxes according to regulations, so as to break hospitals' previous monopoly over the use of medicines as listed in the prescriptions. As a transitional measure, the method may first be adopted whereby revenue and expenditure are managed separately with respect to the hospital's income from medicines, the balance shall all be handed over to the health administrative department in charge and be placed under the special management of the financial department, which shall be returned rationally. At the same time, the method for financial department to subsidize medical institutions should be standardized, and unreasonable medical service price shall be readjusted. The competitive mechanism should also be introduced into medical institutions to give patients the right to choose doctors, competition among employees should be encouraged and the principle of more pay for more work should be introduced, so as to give expression to the value of medical workers' skills and labor service and improve medical ethics and working styles.
Second is to introduce management of the whole trade of health work and conduct optimization and reorganization of medical resources. Government function and institution management should be separated, health departments in charge should, taking the stand of the State and the people, exercise supervision and control over the related trade and do away with the narrow departmental concepts. It is necessary to break down the administrative subordination relationship and the barriers of ownership, to institute the regional health program and strengthen macro-control over the allocation of health resources. Legal, administrative and economic means should be used to readjust and control the stock and increment of health resources including hospital beds, personnel, equipment as well as medical institutions. Logistic services of hospitals should be socialized gradually, various types of medical institutions should be encouraged to enter into cooperation, merge themselves and jointly build up medical service groups. Continued efforts should be made to strengthen prevention and health-care work, adhere to the principle of putting prevention first in medical work and set up a comprehensive system for the prevention and control of diseases and health care, which undertakes the tasks of giving professional and technical guidance in the fields of public sanitation, disease control and prevention and health care, provide technical consultation, and investigate and handle public health emergencies.
Third is to run medical undertaking by various forms and satisfy the demands of different social strata. It is necessary to establish a new categorized management system for profit-making and non-profit medical institutions, and to formulate different financial, taxation and pricing policies to meet the different demands set by different groups of people on medical services. Non-profit medical institutions should hold a dominant position in the medical service system and enjoy appropriate preferential taxation policy. Profit-making medical institutions introduce liberalized medical service prices, engage in independent management according to law and pay taxes according to regulations. It is imperative to set up a perfect service system featuring the rational division of labor between community health service organizations, general hospitals and specialized hospitals, to form a two-way diagnosis transfer system for the above-mentioned three establishments, so as to better satisfy the different demands of different diseases for medical services. Community health services are engaged mainly in prevention of diseases, health care, health education, family planning and the treatment and recovery of common diseases, frequently occurring ailments, and chronic diseases of clear diagnosis; General hospitals and specialized hospitals are engaged mainly in the diagnosis and treatment of illnesses, large hospitals are engaged mainly in the diagnosis and treatment of acute and critical diseases, and difficult and complicated diseases and, in connection with clinical practices, carry out education and scientific research work.
Fourth is to rectify the order of medicine production and circulation, and adjust the medicine pricing policy. It is essential to intensify efforts for adjusting the medicine production structure and stop low-level duplicated construction. Medicine production and circulation enterprises should be encouraged, taking property rights, products and markets as the bond, to organize standard companies, and establish large enterprises groups that integrate commerce and trade, industry and trade or science, industry and trade. It is essential to standardize the acts of both medicine suppliers and demanders and conduct experiment with the concentrated bidding and purchase of medicines. It is imperative to tighten law-enforcement supervision and control in the whole process of the development, production and circulation of medicines. At the same time, it is necessary to adjust the medicine pricing policy, government setting prices or government guidance prices should be instituted for medicines included in the catalog of basic medical insurance medicines, medicines for disease prevention, necessary medicines for pediatrics department and special medicines placed under monopoly management, places where conditions permit may work out nationally unified retail prices, with respect to the prices of other medicines, production enterprises may set the prices on their own in line with the State-set prices. Through experiment, productive enterprises may gradually apply the method of printing the retail prices on the outer packaging of the medicine.
Urban medical and health structural reform concerns the vital interests of the broad masses of the people, affects the whole situation with regard to the establishment of a perfect social security system in China, it has a great bearing on the sustained and sound development of the health undertaking and on the adjustment of the interests of various quarters. For this reason, it is hoped that various localities and departments should unify thinking, change concepts and forge ahead despite difficulties, they should set store by the overall interests, take the interests of the people to heart, press forward with the reform in an active yet steady manner and strive to initially set up an urban medical and health management system and service structure suited to the requirements of the socialist market economy in two to three years.
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