According to the spirit of the 17th National Congress of the Communist Party of China, in order to establish a medical and health system with China characteristics, gradually realize the goal of everyone enjoying basic medical and health services, and improve the health level of the whole people, we hereby put forward the following opinions on the reform.

First, fully understand the importance, urgency and arduousness of deepening the reform of the medical and health system. Health is the foundation of people's all-round development. Medical and health care is related to the happiness of thousands of families and is a major livelihood issue. Deepening the reform of medical and health system, speeding up the development of medical and health undertakings, adapting to the people's growing medical and health needs, and constantly improving the people's health quality are the inevitable requirements for implementing Scientific Outlook on Development, promoting comprehensive, coordinated and sustainable economic and social development, an important measure to safeguard social fairness and justice, an important symbol to improve people's quality of life, and an important task to build a well-off society in an all-round way and a harmonious socialist society. Since the founding of New China, especially since the reform and opening up, China's medical and health undertakings have made remarkable achievements. The medical and health service system covering urban and rural areas has basically taken shape, the ability of disease prevention and control has been continuously enhanced, the population covered by medical insurance has gradually expanded, the level of health science and technology has been rapidly improved, and the people's health level has been significantly improved. The main health indicators of residents rank among the top in developing countries. Especially since the great victory in the fight against SARS, governments at all levels have increased investment, public health, rural medical care and urban community health have accelerated development, and new rural cooperative medical care and basic medical insurance for urban residents have made breakthroughs, laying a good foundation for deepening the reform of the medical and health system. At the same time, we should also see that the contradiction between the development level of China's medical and health undertakings and the requirements of coordinated economic and social development and people's health needs is still outstanding. The development of medical and health services in urban and rural areas and regions is unbalanced, the allocation of resources is unreasonable, public health services and rural and community medical and health services are relatively weak, the medical security system is not perfect, the order of drug production and circulation is not standardized, the hospital management system and operation mechanism are not perfect, the government's health investment is insufficient, the medical expenses are rising too fast, and the people's reaction is relatively strong. From now until 2020, it is a crucial period for China to build a well-off society in an all-round way, and medical and health work has a long way to go. With the development of economy and the improvement of people's living standards, the masses will have higher requirements for improving medical and health services. Industrialization, urbanization, aging population, changes in disease spectrum and ecological environment all bring a series of new and severe challenges to medical and health work. Deepening the reform of medical and health system is a strategic choice to accelerate the development of medical and health undertakings, an important way to realize people's enjoyment of the fruits of reform and development, and an urgent desire of the broad masses of the people. Medicine is a social system engineering, which involves a wide range and is difficult. China has a large population, a low per capita income level, a large gap between urban and rural areas and regions, and is in the primary stage of socialism for a long time, which determines that deepening the reform of the medical and health system is a very complicated and arduous task and a gradual process. Through long-term efforts and unremitting exploration, a medical and health system in line with China's national conditions should be established on the basis of a clear direction and framework.

Second, the guiding ideology, basic principles and overall objectives of the medical system reform

(1) guiding ideology. The guiding ideology of medical system reform is: under the guidance of Deng Xiaoping Theory and Theory of Three Represents, thoroughly implement Scientific Outlook on Development, proceed from China's national conditions, draw lessons from international beneficial experience, strive to achieve the goal that everyone enjoys basic medical and health services, and strive to solve the most concerned, direct and realistic interests of the people. Adhere to the public welfare nature of public health, adhere to the policy of giving priority to prevention, focusing on rural areas, and paying equal attention to traditional Chinese and western medicine, implement separation of government affairs, management, medicine, profit-making and non-profit, strengthen government responsibility and investment, improve national health policy, improve institutional system, strengthen supervision and management, innovate institutional mechanisms, encourage social participation, build a basic medical and health system covering urban and rural residents, and continuously improve the health level of the whole people and promote social harmony.

(2) Basic principles. The reform of the medical system should follow the following basic principles: adhere to the people-oriented principle and give priority to safeguarding people's health rights and interests. Adhere to the purpose of medical and health services for people's health, take ensuring people's health as the center, take everyone's access to basic medical and health services as the fundamental starting point and end result, follow the principle of public welfare from the design of reform scheme, the establishment of health system to the construction of service system, focus on solving outstanding problems strongly reflected by the masses, and strive to achieve universal medical treatment. Adhere to the national conditions and establish a medical and health system with China characteristics. Adhere to the basic national conditions of our country, sum up the practical experience of medical and health reform and development realistically, and accurately grasp the laws and main contradictions of medical and health development; Adhere to the coordination of basic medical and health services with national economic and social development and people's affordability; Give full play to the role of traditional Chinese medicine; Adhere to local conditions, classified guidance, give full play to local enthusiasm, and explore the establishment of a basic medical and health system in line with national conditions. Adhere to the unity of fairness and efficiency, and combine the role of government-led and market mechanisms. Adhere to the government's leadership, strengthen the government's responsibility in the basic medical and health system, strengthen the government's responsibility in system, planning, financing, service and supervision, safeguard the public welfare of public medical and health, and promote fairness and justice; At the same time, pay attention to the role of the market mechanism, promote the formation of an orderly competition mechanism, improve the operational efficiency and service level and quality of medical and health care, and meet the multi-level and diversified medical and health needs of the people. Adhere to overall consideration and combine the improvement of the institutional system with the solution of current outstanding problems. Proceed from the overall situation, give consideration to the interests of all parties such as suppliers and demanders, pay attention to the combination of prevention, treatment and rehabilitation, and correctly handle the relationship between the government, health institutions, pharmaceutical enterprises, medical personnel and the people. Not only focus on the long-term, innovate the system and mechanism, but also focus on solving outstanding problems in the medical and health field; Pay attention to the overall design, define the overall reform direction, objectives and basic framework, highlight key points, implement them step by step, and actively and steadily promote the reform.

(3) the overall goal. The overall goal of medical system reform is to establish a basic medical and health system covering urban and rural residents and provide safe, effective, convenient and cheap medical and health services for the masses. By 2020, a basic medical and health system covering urban and rural residents will be basically established. We have generally established a relatively complete public health service system and medical service system, a relatively sound medical security system, a relatively standardized drug supply security system, and a more scientific management system and operation mechanism of medical and health institutions, thus forming a diversified medical service pattern. Everyone enjoys basic medical and health services, basically meeting the people's multi-level medical and health needs, and the people's health level has been further improved. Third, improve the four medical and health systems, establish a basic medical and health system covering urban and rural residents, and establish a four-in-one basic medical and health system covering urban and rural residents, including public health service system, medical service system, medical security system and drug supply security system. The four systems complement each other, support each other and develop in a coordinated way.

(4) comprehensively strengthen the construction of the public health service system. Establish and improve public health service networks such as disease prevention and control, health education, maternal and child health care, mental health, first aid, blood collection and supply, health supervision and family planning, improve the public health service function of the medical service system based on the primary health service network, establish a public health service system with clear division of labor, information exchange, resource sharing and coordination, and improve the level of public health. Determine the scope of public health services. Clarify the national public health service items, gradually increase the service content, and refine the service and assessment standards. Encourage local governments to increase public health services on the basis of the service items specified by the central government according to the local economic level and outstanding public health problems. Improve the public health service system. Further clarify the functions, objectives and tasks of the public health service system, optimize the allocation of personnel and equipment, and explore effective forms of integrating public health service resources. We will improve the prevention and control system for major diseases and the emergency mechanism for public health emergencies, and strengthen the prevention, control and monitoring of infectious diseases, endemic diseases, occupational diseases and chronic diseases that seriously threaten people's health. Strengthen the construction of urban and rural first aid system. Strengthen health promotion and education. Medical and health institutions and institutions, schools, communities, enterprises, etc. We should vigorously carry out health education, advocate a healthy and civilized lifestyle, use radio, television, internet, newspapers and other media to strengthen the dissemination of health and medical knowledge, promote the rational nutrition of the public, and improve the health awareness and self-care ability of the broad masses of the people. Carry out the patriotic health campaign in depth. Incorporate rural environmental sanitation and environmental pollution control into the construction plan of new socialist countryside, promote the construction of sanitary cities and civilized villages and towns, and continuously improve the sanitary environment for urban and rural residents to live and work. Strengthen health supervision services. Vigorously promote environmental hygiene, food hygiene, occupational hygiene, school hygiene and migrant workers' hygiene.

(5) Further improve the medical service system. Adhere to the principle of non-profit medical institutions as the main body, for-profit medical institutions as the supplement, public medical institutions as the leading factor, and non-public medical institutions as the same development, and build a medical service system with reasonable structure, clear division of labor, combination of prevention and treatment, appropriate technology and orderly operation, including the primary medical and health service network covering urban and rural areas and various hospitals. Vigorously develop the rural medical and health service system. Accelerate the establishment and improvement of the rural three-level medical and health service network with county-level hospitals as the leader, township hospitals as the backbone and village clinics as the foundation. As a medical and health center in the county, county hospitals mainly undertake basic medical services, such as hospitalization and emergency rescue, professional and technical guidance to rural health institutions and further training for rural health personnel; Township health centers are responsible for providing public health services and comprehensive services such as diagnosis and treatment of common diseases and frequently-occurring diseases, and undertaking business management and technical guidance of village clinics; Village clinics undertake public health services and diagnosis and treatment of general diseases in administrative villages. Conditional rural areas can implement integrated rural management. Accelerate the implementation of rural health service system construction and development planning, actively promote rural medical and health infrastructure and capacity building, the government will focus on running county-level hospitals, set up a health center in each township, support various forms of village clinic construction, vigorously improve rural medical and health conditions, and improve the quality of medical and health services. Improve the new urban medical and health service system based on community health service. Vigorously develop community health services, speed up the construction of urban community health service network with community health service centers as the main body, improve the functions of community health services, and provide public health services such as disease prevention and control, primary diagnosis and treatment services for common diseases, frequently-occurring diseases and chronic diseases with the maintenance of the health of community residents as the center. Change the mode of community health service, adhere to active service and door-to-door service, and gradually assume the responsibility of "gatekeeper" of residents' health. Improve the functions and responsibilities of various hospitals. Optimize the layout and structure of hospitals, and give full play to the backbone role of urban hospitals in the diagnosis and treatment of acute and critical diseases, medical education and scientific research, and guidance and training of grassroots health personnel. Conditional large hospitals can promote the rational flow of medical resources through trusteeship and reorganization in accordance with the requirements of regional health planning. Establish a division of labor and cooperation mechanism between urban hospitals and community health service institutions. City hospitals promote the healthy and sustainable development of community health through technical support and personnel training. At the same time, comprehensive measures such as improving service capacity, lowering charging standards and increasing reimbursement ratio will be taken to guide the general diagnosis and treatment to sink to the grassroots level and gradually realize the first consultation in the community, graded medical care and two-way referral. Integrate urban health resources, make full use of existing primary and secondary hospitals and affiliated medical institutions of state-owned enterprises and institutions, and develop and improve the community health service network. Give full play to the role of traditional Chinese medicine, including ethnic medicine, in disease prevention and control, responding to public health emergencies and medical services. Strengthen the construction of clinical research bases and hospitals of traditional Chinese medicine, organize joint research on prevention and treatment of difficult diseases of traditional Chinese medicine, and vigorously promote appropriate technologies of traditional Chinese medicine in medical and health institutions. Create a good policy environment, support the development of Chinese medicine, and promote the inheritance and innovation of Chinese medicine. Establish a system for urban hospitals to support rural medical and health work. Developed areas should strengthen their support for the development of medical and health undertakings in poor areas and ethnic minority areas. Hospitals in big cities should establish a long-term and stable counterpart support and cooperation system with county hospitals in poverty-stricken areas and ethnic minority areas, and help them improve their medical level and service ability by means of clinical service, personnel training, technical guidance and equipment support.

(6) Accelerate the construction of medical security system. Accelerate the establishment and improvement of a multi-level medical security system covering urban and rural residents, with basic medical security as the main body and other forms of supplementary medical insurance and commercial health insurance as supplements. Establish a basic medical security system covering urban and rural residents. Basic medical insurance for urban workers, basic medical insurance for urban residents, new rural cooperative medical care and urban and rural medical assistance constitute the basic medical security system, covering urban employed population, urban unemployed population, rural population and urban and rural poor population respectively. Adhere to the principle of wide coverage, basic protection and sustainability, start with the key protection of serious and serious diseases, and gradually extend to outpatient minor diseases to improve the level of protection. Establish a multi-channel financing mechanism with clear and reasonable responsibilities of the state, units, families and individuals to realize social mutual assistance and economic assistance. With the development of economy and society, we will gradually improve the level of financing and overall planning, narrow the gap in the level of security, and finally realize the basic unity of the institutional framework. Further improve the basic medical insurance system for urban workers, accelerate the coverage of the employed population, and focus on solving the medical insurance problems of employees and retirees such as state-owned closed and bankrupt enterprises and difficult enterprises, as well as employees and flexible employees of mixed ownership and non-public economic organizations; Accelerate the pilot project of basic medical insurance for urban residents, fully open it by 2009, and pay attention to solving the basic medical insurance problem for the elderly and children; We will fully implement the new rural cooperative medical system, gradually increase the level of government subsidies, appropriately increase farmers' contributions, and improve the security capacity. Improve the urban and rural medical assistance system. Subsidies will be given to people with difficulties in participating in insurance and their unaffordable medical expenses, and the bottom line of medical security will be built. Conditional areas should actively explore the establishment of a basic medical security management system integrating urban and rural areas in various ways. Encourage social organizations such as trade unions to carry out various forms of medical mutual assistance activities. Encourage and guide all kinds of public welfare organizations to develop social charitable medical assistance. Do a good job in connecting the basic medical insurance system for urban workers, urban residents, the new rural cooperative medical system and the urban and rural medical assistance system, and properly solve the basic medical insurance problem for migrant workers. Migrant workers who sign labor contracts with enterprises and establish stable labor relations shall clarify the payment responsibilities of employers in accordance with state regulations and incorporate them into the basic medical insurance system for urban workers; Other migrant workers, according to the actual situation, participate in the new rural cooperative medical system where the household registration is located or the basic medical insurance for urban residents where they work. Actively do a good job in the policy convergence of migrant workers' medical insurance relations, medical treatment in different places and fee settlement services. Actively develop commercial health insurance. Encourage commercial insurance institutions to develop health insurance products that meet different needs, simplify claims procedures, facilitate the masses and meet diversified health needs. Encourage enterprises and individuals to meet the needs beyond basic medical insurance by participating in commercial insurance and various forms of supplementary insurance. Continue to explore ways for commercial insurance institutions to participate in the management of the new rural cooperative medical system.

(seven) to establish and improve the drug supply security system. Based on the establishment of the national essential drug system, we will build a standardized and intensive drug supply security system, constantly improve the licensed pharmacist system, and ensure the people's drug safety by cultivating an internationally competitive pharmaceutical industry, improving the concentration of pharmaceutical production and circulation enterprises, standardizing the order of drug production and circulation, improving the drug price formation mechanism, and strengthening government supervision. Establish a national system of essential drugs. The central government uniformly formulates and publishes the national essential drugs list, and reasonably determines the variety and quantity of essential drugs in China according to the principles of prevention and control, safety and effectiveness, reasonable price, convenient use and equal emphasis on Chinese and western medicine, combined with the characteristics of drug use in China and referring to international experience. Establish a system of production and supply of essential drugs, give full play to the role of market mechanism under the macro-control of the government, produce essential drugs directly by the state through bidding or centralized procurement, reduce intermediate links, uniformly set retail prices on the basis of reasonably determining the profit level of production links, ensure the production and supply of essential drugs, and ensure the people's basic drugs. Standardize the use of essential drugs and formulate guidelines for the use and clinical application of essential drugs. Basic medical and health institutions such as urban community health service centers (stations), township hospitals and village clinics should all use basic drugs, and other medical institutions should also take basic drugs as the first choice and determine the proportion of use. All essential drugs are included in the drug reimbursement catalogue of the basic medical security system, and the reimbursement ratio is significantly higher than that of non-essential drugs, so as to standardize drug production and circulation. Improve the pharmaceutical industry development policy and industry development planning, strict market access, strict drug registration and approval, vigorously standardize and rectify the production and circulation order, promote the optimization and upgrading of the pharmaceutical industry and technological progress, develop modern pharmaceutical logistics and chain operations, and promote the integration of pharmaceutical production and circulation enterprises. Establish a rural drug supply network and supervision network with wide coverage, sound system and convenience for farmers. Support the production of special drugs and small-dose emergency drugs. Improve the drug reserve system. Standardize drug procurement and resolutely control commercial bribery in drug purchase and sale. Strengthen the monitoring of adverse drug reactions and establish an early warning mechanism and an emergency mechanism for drug safety. Fourth, improve the system and mechanism to ensure the effective and standardized operation of the medical and health system, improve the system and mechanism of management, operation, investment, price and supervision of the medical and health system, strengthen the construction of science and technology, talents, information and legal system, and ensure the effective and standardized operation of the medical and health system.

(eight) to establish a coordinated and unified medical and health management system. In accordance with the principles of separation of government affairs, separation of management and office, localization and industry-wide management, the scope of responsibilities between governments at all levels and between governments and medical and health institutions should be reasonably determined, and a management system with clear functions, clear positioning, comprehensive coordination and unified powers and responsibilities should be formed. Implement localization and industry-wide management. All medical and health institutions, regardless of ownership, investors, affiliation and business nature, are uniformly planned, accessed and supervised by the local health administrative department. A small number of medical centers or regional medical centers that undertake medical research and teaching functions, as well as specialized hospitals and other medical institutions that undertake the diagnosis and treatment of difficult diseases in the country or region can be established at the central and provincial levels; Counties (cities, districts) are mainly responsible for organizing county-level hospitals, rural health and community health institutions; The rest of the public hospitals are organized by cities with districts. Strengthen regional health planning. The people's governments at the provincial level shall formulate standards for the allocation of health resources, organize the preparation of regional health plans and plans for the establishment of medical institutions, and clarify the number, scale, layout and functions of medical institutions. Scientifically formulate standards for the construction and equipment allocation of township hospitals (village clinics), community health service centers (stations) and other grassroots health institutions and hospitals at all levels. Make full use of and optimize the allocation of existing medical and health resources, adjust and optimize the structure and layout, gradually integrate medical institutions that do not meet the planning requirements, strictly control the allocation of large medical equipment, encourage the construction of * * * *, and improve the utilization efficiency of medical and health resources. New health resources must conform to the regional health planning, focusing on weak links such as rural and community health. Strengthen the connection between regional health planning, urban development planning and land use planning. Establish a supervision and evaluation mechanism for regional health planning and resource allocation. Promote the reform of the management system of public hospitals. In order to strengthen the public welfare of public hospitals and the effective supervision of the government, we should actively explore various forms of separation of government affairs and management. To further transform government functions, the health administrative department mainly undertakes industry management functions such as health development planning, qualification access, standardization and service supervision, and other relevant departments manage and provide services according to their respective functions. Implement the independent legal person status of public hospitals. Further improve the basic medical insurance management system. The central government uniformly formulates the framework and policies of the basic medical insurance system, while local governments are responsible for organizing the implementation and management, and creating conditions to gradually improve the overall level. Effectively integrate basic medical insurance resources and gradually realize the unification of urban and rural basic medical insurance agencies.

(nine) to establish an efficient and standardized operating mechanism of medical and health institutions. Focus on maintaining the public welfare nature of public medical and health institutions, and gradually establish a standardized, scientific, efficient and orderly operating mechanism of medical and health institutions. The revenue and expenditure of public health institutions are all included in the budget management. According to the responsibilities and tasks undertaken, the government should reasonably determine the staffing, salary level and funding standard, clarify the post responsibilities of all kinds of personnel, strictly enforce personnel access, strengthen performance appraisal, establish an employment system that can enter and exit, and improve work efficiency and service quality. Change the operating mechanism of primary medical and health institutions. Grass-roots medical and health institutions such as urban community health service centers (stations) and township hospitals organized by the government should strictly define the service functions, clearly stipulate the use of appropriate technologies, appropriate talents, appropriate equipment and basic drugs, provide low-cost services for the masses, and safeguard the public welfare nature. It is necessary to strictly verify the staffing, implement the personnel employment system, and establish an effective human resource management system that can enter and exit. It is necessary to clarify the scope and standards of revenue and expenditure, implement financial management methods such as approved tasks, approved revenue and expenditure, performance appraisal subsidies, explore various effective management methods such as two lines of revenue and expenditure, prepayment of total public health and medical security funds, strictly manage revenue and expenditure budgets, and improve the efficiency of fund use. It is necessary to reform the drug addition policy and implement zero-difference sales of drugs. Strengthen and improve internal management, establish an assessment and incentive system based on service quality and post responsibility performance, form a long-term mechanism to ensure fairness and efficiency, and establish a standardized operation mechanism for public hospitals. Public hospitals should follow the principles of public welfare and social benefits, adhere to patient-centered, optimize service processes, standardize drug use inspection and medical behavior, and deepen the reform of operating mechanism. Establish and improve the corporate governance structure of hospitals, clarify the responsibilities and rights of owners and managers, and form a mechanism of checks and balances between decision-making, implementation and supervision, which is responsible, motivated, restrained, competitive and energetic. Implement the management of two lines of medical income and expenditure, and explore an effective way to gradually reform the mechanism of supplementing medicine with medicine. Gradually reform or cancel the drug addition policy by implementing the differential price increase between drug purchase and sale and setting up pharmaceutical service fees, and at the same time take appropriate measures such as adjusting the price of medical services, increasing government investment and reforming payment methods to improve the compensation mechanism of public hospitals. Further improve the financial accounting management system, strict budget management, and strengthen financial supervision and operational supervision. All localities can, in light of local conditions, carry out pilot projects of various management measures such as "fixing expenditure by income, offsetting expenditure by income, over-payment, differential subsidies and clear rewards and punishments" for qualified hospitals. Reform the personnel system, improve the distribution incentive mechanism, implement the employment system and post management system, strictly manage the total salary, implement the comprehensive performance appraisal and post performance salary system based on service quality and post workload, and effectively mobilize the enthusiasm of medical staff. Improve the operating mechanism of medical insurance agencies. Improve the internal governance structure, establish a reasonable employment mechanism and distribution system, improve the incentive and restraint mechanism, and improve the management ability and efficiency of medical insurance.