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China will carry for- ward public hospital reforms to optimize medical care resources for public health， according to a decision at a State Council executive meeting chaired by Premier Li Keqiang on Oct 9. The reform on medical care pricing at public hospitals will continue toward dynamic price adjustments in medical services so that the expertise and efforts of medical workers are better reflected in values.
One or two cities in provincial areas where comprehensive medical reform are being piloted will be chosen for medical insurance payment reform， covering all medical care institutions and services. The government will also designate over 100 disease categories for an insurance payment by-category reform. “Medical care reform is not only a major project to better public well-being， but also a major economic measure，” Premier Li said. He said public hospital reform should be pushed forward across the board， and that reforms on medical care partnerships should be piloted in multiple forms to serve a “healthy China” with better and more convenient healthcare services.
China’s medical care reform should adhere to the principle of guaranteeing basic healthcare， building working mechanisms and strengthening community health services， he added. China started the latest round of healthcare reform in 2009， with the core objective of offering healthcare services to all people as a public good. As of September， all public hospitals in China have joined the comprehensive reform program to end the 60-year-old practice of drug price markups， which enables rationalization of medical care costs. As the reform proceeds， the share of drug sales in hospitals’ total revenue dropped from 46.3 percent in 2010 to 38.1 percent in 2016.
Public hospitals， which totaled 12，708 by the end of 2016， provided 2.85 billion diagnoses and treatments last year， accounting for 87.2 percent of cases provided by all hospitals in China， according to the National Health and Family Planning Commission. The reform on medication dispensing plans will also be expanded as public hospitals will be encouraged to practice categorybased pharmaceutical procurement. Hospitals across different regions and different specialized hospitals will be encouraged to conduct procurement together.
The public hospital oversight mechanism will be reformed to better supervise the quality and safety of medical care， medical services and medical expenses. The number of hospital beds， construction standards and procurement of large medical equipment will undergo greater scrutiny. ”Medical care reform is an ongoing reform， and these are progresses yet to be consolidated. The government should provide due financial support. The reform on the remuneration mechanism of medical workers should get stronger support to provide them with more incentives，”Premier Li said. The meeting on Oct 9 decided to speed up efforts to establish medical treatment partnerships， which would promote effective cooperation and coordination between different types of medical institutions， including major hospitals and grassroots clinics. All major public hospitals must take part in the development of the partnerships before the end of October. The operating mechanism of medical partnerships will be further improved to ensure better coordination in technical support， staffing， staff salary arrangements， and resource-sharing among different medical institutes.
Private medical care facilities， aged care and rehabilitation centers will also be encouraged to join the partnerships to provide integrated services for the public.
More efforts will be made to expand the availability of family doctors， and to enable the doctors to offer more services based on demand and improve the fee collecting and paying mechanisms. Medical services at the grassroots level will be further improved， with more emphasis on improving the talent， technology and key departments at county-level hospitals.
“Medical treatment partnerships should be developed in parallel with systematic reform. Instead of exclusivity， openness to private capital is the way to go. A lot can be done to advance China’s medical equipment and pharmaceutical industry， not least the traditional Chinese medicine， including with internet plus medical care that can help better consolidate our resources，” Premier Li said.
China will step up efforts to improve public hospital management in order to deepen the country’s healthcare reform， according to guidelines released on July 25. The guidelines， released by the State Council， the country’s cabinet， aim for modern hospital management with clear responsibilities， scientific governance， efficient operation and strong supervision by 2020. “They focus on public health at its core， keep public hospitals non-profit， and create a modern hospital management system，” said Wang Hesheng， director of the medical reform office under the State Council at a press conference regarding the guidelines.
All public hospitals in Chinese cities should carry out comprehensive reforms before the end of September and remove all the medicine markups， according to this year’s government work report. Wang said that the prices of surgery， rehabilitation therapy， nursing care and traditional Chinese medicine treatment will be increased and that the fees for using medical equipment will be lowered. In addition， the guidelines call for medical institutions at different levels to establish regulations on management and procedures. “Most public hospitals do not have regulations which has led to problems such as blindly wasting hospital beds，” Yang Dungan from Peking Union College Hospital said at the press conference. “Regulations can help hospitals to improve operating efficiency.” The guidelines also ask hospitals to form committees to offer professional advice on medical quality and pharmaceutical management. Wang said that the guidelines highlight the responsibility of local government to establish and supervise public hospitals， and stress the importance of Party work on public hospitals. More than 2，300 public hospitals nationwide participated in healthcare reform in 2016， according to a report issued by the healthcare reform leading group under the State Council.
The guidelines request governments at all levels to draft relevant reform plans， for example， to issue policies regarding the hierarchical medical system. “They will help to direct resources to grassroots health institutions， and ease the burden of registration and surgery operations in public hospitals，”Wang said. The hierarchical medical system pilot program will be expanded to reach at least 85 percent of prefecturelevel regions this year， according to the National Health and Family Planning Commission. China has earmarked over 1.4 trillion yuan （$207 billion） in its budget for health and medical expenditure in 2017.
President Xi Jinping and Premier Li Keqiang called for speeding up the building of primary medical and healthcare systems in China. They made the remarks in two separate letters to a national conference to honor outstanding staff in the medical， health and family planning sectors on Aug 17， according to Xinhua News Agency. According to a road map on China’s medical reform during the 13th Five-Year Plan period（2016-2020） issued by the State Council in January， basic medical and healthcare systems will be established by 2020， covering all urban and rural residents across the country.
The systems will comprise of five major pillars， namely a multitiered diagnosis and treatment system， a modern hospital administration system， a medical security system that covers the entire population， a “streamlined and orderly”medical supply system as well as a regulatory system. China has already built the world’s largest basic healthcare network， covering 98.8 percent of its population， or 1.34 billion people， according to a report released last month. The country’s budget for health and medical expenditure this year has reached 1.4 trillion yuan （about $207 billion）.
President Xi， also General Secretary of the Central Committee of the Communist Party of China （CPC）， said the party and the central government had attached great importance to the development of the medical and healthcare sector and improvement of public health. He called on those working in the sector to offer better medical and health services to the people， adding that a healthy social environment that respects doctors and values health should also be fostered. Premier Li congratulated the 775 individuals and 251 groups honored at the meeting and encouraged them to make more contributions to building China into a health power.The State Council recently issued a circular to boost medical partnership and further reform the current medical system.
The move will help optimize structure of medical resources， improve services of local medical institutions， and boost the whole medical service system， according to the circular. During a visit to Sunjiatuan Hospital in Weihai city of Shandong province on April 20， Premier Li Keqiang stressed the significance of medical partnership， saying free flow of high-quality resources will benefit patients. The community hospital featuring traditional Chinese medicine has formed a medical alliance with Weihai City Chinese Medicine Hospital. “We should make efforts to break through the barriers and make high-quality medi- cal resources flow， to seek better treatment for patients by means of medical alliances，” he said.
The major target of the partnership is to send superior medical resources to lower level medical institutions. All top-level public hospitals of provinces carrying out such medical reform will take part in the initiative and at least one effective medical partnership will be formed in each city， according to the circular. In addition to medical partnership among urban and community hospitals， such alliance will also be formed among medical institutions within county-level administrative regions. The partnership will bring conveniences to patients as previously diagnosis reports and drugs cannot be shared and medical insurances stipulations were different among hospitals in some regions.
The unshared medical resources make a Matthew Effect， in which big hospitals become monopoly， absorbing more and more resources from grassroots clinics. However， they are， at the same time， cannot provide quality services to every patient. So medical partnerships are about to push them delegate some resources to grassroots， thus cutting their burdens to allow them focus on critical cases and academic research. Performance assessment is emphasized for the partnerships. Whether the medical resources and technologies are shared will be directly connected with medical staff’s wage and promotion. Time table is clear. The reform will be implemented nationwide in 2020. Many things will be tried in pilot projects in the coming years， including public hospital reform and payment mode reform of medical insurance. Medical partnership also has connection with elder care industry. The reform will make more old people be treated just in their home and communities. In Weihai， Premier Li said China has already has 200 million elders， so we must connect elder care and healthcare industry.
Several departments are involved in the reform， including the national health and family planning commission， traditional Chinese medicine administration， technology， finance and social insurance bureau. A collaboration mechanism among those departments is necessary. The central government has detailed major tasks for healthcare reform in 2017 in a circular issued by the State Council on May 5.
The document lists 56 tasks focusing on making quality medical care more accessible and setting up diversified medical services.
According to the circular， China will expand its tiered medical system and contract-based family doctor services to 85 percent of prefecture-level cities. The contract rate for family doctors among key groups should reach above 60 percent in 2017， covering all impoverished populations， said the circular. Meanwhile， more diversified forms of medical partnership pilot projects should be started nationwide， with top-level public hospitals playing leading roles. Each province should deliver an action plan for carrying out such efforts before the end of June.
The government also plans to fully strengthen its ability to serve people with traditional Chinese medicine especially among the grassroots-level hos- pitals. All public hospitals should carry out comprehensive reforms before the end of September and remove all the medicine markups， the document stated. The circular also emphasized building modern hospital management systems with efficient coordination， supervision and interaction.
Local governments are required to control annual medical fee increases， with average growth rates kept below 10 percent for all public hospitals， and related indicators should be released to the public periodically. The document stressed the need to finish medical insurance integration among urban and rural residents， forming a unified standard on related items， such as medical benefits and fund management.
The government also pledged to roll out an enhanced health information platform across the country which will be better connected with provincial and lower-level platforms， to further meet the growing demand for health and medical services. In addition， eight ministerial departments are expected to introduce 14 related guidelines this year on medical reforms such as promoting medical partnerships， modern hospital management， diversified healthcare services with enhanced social support and a credit system for buying and selling medicine.
One or two cities in provincial areas where comprehensive medical reform are being piloted will be chosen for medical insurance payment reform， covering all medical care institutions and services. The government will also designate over 100 disease categories for an insurance payment by-category reform. “Medical care reform is not only a major project to better public well-being， but also a major economic measure，” Premier Li said. He said public hospital reform should be pushed forward across the board， and that reforms on medical care partnerships should be piloted in multiple forms to serve a “healthy China” with better and more convenient healthcare services.
China’s medical care reform should adhere to the principle of guaranteeing basic healthcare， building working mechanisms and strengthening community health services， he added. China started the latest round of healthcare reform in 2009， with the core objective of offering healthcare services to all people as a public good. As of September， all public hospitals in China have joined the comprehensive reform program to end the 60-year-old practice of drug price markups， which enables rationalization of medical care costs. As the reform proceeds， the share of drug sales in hospitals’ total revenue dropped from 46.3 percent in 2010 to 38.1 percent in 2016.
Public hospitals， which totaled 12，708 by the end of 2016， provided 2.85 billion diagnoses and treatments last year， accounting for 87.2 percent of cases provided by all hospitals in China， according to the National Health and Family Planning Commission. The reform on medication dispensing plans will also be expanded as public hospitals will be encouraged to practice categorybased pharmaceutical procurement. Hospitals across different regions and different specialized hospitals will be encouraged to conduct procurement together.
The public hospital oversight mechanism will be reformed to better supervise the quality and safety of medical care， medical services and medical expenses. The number of hospital beds， construction standards and procurement of large medical equipment will undergo greater scrutiny. ”Medical care reform is an ongoing reform， and these are progresses yet to be consolidated. The government should provide due financial support. The reform on the remuneration mechanism of medical workers should get stronger support to provide them with more incentives，”Premier Li said. The meeting on Oct 9 decided to speed up efforts to establish medical treatment partnerships， which would promote effective cooperation and coordination between different types of medical institutions， including major hospitals and grassroots clinics. All major public hospitals must take part in the development of the partnerships before the end of October. The operating mechanism of medical partnerships will be further improved to ensure better coordination in technical support， staffing， staff salary arrangements， and resource-sharing among different medical institutes.
Private medical care facilities， aged care and rehabilitation centers will also be encouraged to join the partnerships to provide integrated services for the public.
More efforts will be made to expand the availability of family doctors， and to enable the doctors to offer more services based on demand and improve the fee collecting and paying mechanisms. Medical services at the grassroots level will be further improved， with more emphasis on improving the talent， technology and key departments at county-level hospitals.
“Medical treatment partnerships should be developed in parallel with systematic reform. Instead of exclusivity， openness to private capital is the way to go. A lot can be done to advance China’s medical equipment and pharmaceutical industry， not least the traditional Chinese medicine， including with internet plus medical care that can help better consolidate our resources，” Premier Li said.
China will step up efforts to improve public hospital management in order to deepen the country’s healthcare reform， according to guidelines released on July 25. The guidelines， released by the State Council， the country’s cabinet， aim for modern hospital management with clear responsibilities， scientific governance， efficient operation and strong supervision by 2020. “They focus on public health at its core， keep public hospitals non-profit， and create a modern hospital management system，” said Wang Hesheng， director of the medical reform office under the State Council at a press conference regarding the guidelines.
All public hospitals in Chinese cities should carry out comprehensive reforms before the end of September and remove all the medicine markups， according to this year’s government work report. Wang said that the prices of surgery， rehabilitation therapy， nursing care and traditional Chinese medicine treatment will be increased and that the fees for using medical equipment will be lowered. In addition， the guidelines call for medical institutions at different levels to establish regulations on management and procedures. “Most public hospitals do not have regulations which has led to problems such as blindly wasting hospital beds，” Yang Dungan from Peking Union College Hospital said at the press conference. “Regulations can help hospitals to improve operating efficiency.” The guidelines also ask hospitals to form committees to offer professional advice on medical quality and pharmaceutical management. Wang said that the guidelines highlight the responsibility of local government to establish and supervise public hospitals， and stress the importance of Party work on public hospitals. More than 2，300 public hospitals nationwide participated in healthcare reform in 2016， according to a report issued by the healthcare reform leading group under the State Council.
The guidelines request governments at all levels to draft relevant reform plans， for example， to issue policies regarding the hierarchical medical system. “They will help to direct resources to grassroots health institutions， and ease the burden of registration and surgery operations in public hospitals，”Wang said. The hierarchical medical system pilot program will be expanded to reach at least 85 percent of prefecturelevel regions this year， according to the National Health and Family Planning Commission. China has earmarked over 1.4 trillion yuan （$207 billion） in its budget for health and medical expenditure in 2017.
President Xi Jinping and Premier Li Keqiang called for speeding up the building of primary medical and healthcare systems in China. They made the remarks in two separate letters to a national conference to honor outstanding staff in the medical， health and family planning sectors on Aug 17， according to Xinhua News Agency. According to a road map on China’s medical reform during the 13th Five-Year Plan period（2016-2020） issued by the State Council in January， basic medical and healthcare systems will be established by 2020， covering all urban and rural residents across the country.
The systems will comprise of five major pillars， namely a multitiered diagnosis and treatment system， a modern hospital administration system， a medical security system that covers the entire population， a “streamlined and orderly”medical supply system as well as a regulatory system. China has already built the world’s largest basic healthcare network， covering 98.8 percent of its population， or 1.34 billion people， according to a report released last month. The country’s budget for health and medical expenditure this year has reached 1.4 trillion yuan （about $207 billion）.
President Xi， also General Secretary of the Central Committee of the Communist Party of China （CPC）， said the party and the central government had attached great importance to the development of the medical and healthcare sector and improvement of public health. He called on those working in the sector to offer better medical and health services to the people， adding that a healthy social environment that respects doctors and values health should also be fostered. Premier Li congratulated the 775 individuals and 251 groups honored at the meeting and encouraged them to make more contributions to building China into a health power.The State Council recently issued a circular to boost medical partnership and further reform the current medical system.
The move will help optimize structure of medical resources， improve services of local medical institutions， and boost the whole medical service system， according to the circular. During a visit to Sunjiatuan Hospital in Weihai city of Shandong province on April 20， Premier Li Keqiang stressed the significance of medical partnership， saying free flow of high-quality resources will benefit patients. The community hospital featuring traditional Chinese medicine has formed a medical alliance with Weihai City Chinese Medicine Hospital. “We should make efforts to break through the barriers and make high-quality medi- cal resources flow， to seek better treatment for patients by means of medical alliances，” he said.
The major target of the partnership is to send superior medical resources to lower level medical institutions. All top-level public hospitals of provinces carrying out such medical reform will take part in the initiative and at least one effective medical partnership will be formed in each city， according to the circular. In addition to medical partnership among urban and community hospitals， such alliance will also be formed among medical institutions within county-level administrative regions. The partnership will bring conveniences to patients as previously diagnosis reports and drugs cannot be shared and medical insurances stipulations were different among hospitals in some regions.
The unshared medical resources make a Matthew Effect， in which big hospitals become monopoly， absorbing more and more resources from grassroots clinics. However， they are， at the same time， cannot provide quality services to every patient. So medical partnerships are about to push them delegate some resources to grassroots， thus cutting their burdens to allow them focus on critical cases and academic research. Performance assessment is emphasized for the partnerships. Whether the medical resources and technologies are shared will be directly connected with medical staff’s wage and promotion. Time table is clear. The reform will be implemented nationwide in 2020. Many things will be tried in pilot projects in the coming years， including public hospital reform and payment mode reform of medical insurance. Medical partnership also has connection with elder care industry. The reform will make more old people be treated just in their home and communities. In Weihai， Premier Li said China has already has 200 million elders， so we must connect elder care and healthcare industry.
Several departments are involved in the reform， including the national health and family planning commission， traditional Chinese medicine administration， technology， finance and social insurance bureau. A collaboration mechanism among those departments is necessary. The central government has detailed major tasks for healthcare reform in 2017 in a circular issued by the State Council on May 5.
The document lists 56 tasks focusing on making quality medical care more accessible and setting up diversified medical services.
According to the circular， China will expand its tiered medical system and contract-based family doctor services to 85 percent of prefecture-level cities. The contract rate for family doctors among key groups should reach above 60 percent in 2017， covering all impoverished populations， said the circular. Meanwhile， more diversified forms of medical partnership pilot projects should be started nationwide， with top-level public hospitals playing leading roles. Each province should deliver an action plan for carrying out such efforts before the end of June.
The government also plans to fully strengthen its ability to serve people with traditional Chinese medicine especially among the grassroots-level hos- pitals. All public hospitals should carry out comprehensive reforms before the end of September and remove all the medicine markups， the document stated. The circular also emphasized building modern hospital management systems with efficient coordination， supervision and interaction.
Local governments are required to control annual medical fee increases， with average growth rates kept below 10 percent for all public hospitals， and related indicators should be released to the public periodically. The document stressed the need to finish medical insurance integration among urban and rural residents， forming a unified standard on related items， such as medical benefits and fund management.
The government also pledged to roll out an enhanced health information platform across the country which will be better connected with provincial and lower-level platforms， to further meet the growing demand for health and medical services. In addition， eight ministerial departments are expected to introduce 14 related guidelines this year on medical reforms such as promoting medical partnerships， modern hospital management， diversified healthcare services with enhanced social support and a credit system for buying and selling medicine.