Ten Key Health Care Reform Tasks in 2009

Ten Key Health Care Reform Tasks in 2009

Task 1: To expand the coverage of basic medical insurance

Main objectives:

1. The number of participants in basic medical insurance for urban workers and basic medical insurance for non-employed urban residents should be increased to 390 million people — an increase of 72 million compared with 2008. Medical insurance coverage for those who work in private sector, college students, the self-employed and migrant workers should also be promoted.

2. To develop solutions to provide medical insurance for 6.07 million retirees who had worked in state-owned enterprises that have been shut-down or gone bankrupt due to local government policy or bankruptcy according to law, or central enterprises and local state-own enterprises that have been shut down due to government policies. Local governments will be directed and encouraged to ensure that other retirees from bankrupt enterprises and employees from financially difficult enterprises can participate in medical insurance.

3. To ensure that the coverage of the new rural cooperative medical scheme is stabilized above 90%.

Task 2: To raise the level of basic medical insurance.

Main objectives:

1. The 80Yuan per capita annual subsidy should be provided to cover services for participants in the new rural cooperative medical scheme and medical insurance for non-working urban residents.

2. In principle, the maximum reimbursement cap for urban workers, urban residents and rural population should amount to 6 times the average annual salary of local workers, disposable income of the urban residents, or per capita net income of farmers, respectively. Regions that have already established the subsidy system for large medical expenses may reach this standard by 2010.

3. The reimbursement ratio for inpatient expenses in 50% of regions that have the basic medical insurance for urban workers, urban residents and the farmers should be increased by 5% as compared to the level of 2008.

4. 30% of the areas with medical insurance for urban residents shall conduct pilot projects on improved coverage of outpatient costs; in one-third of the areas covered by the new rural cooperative medical scheme, outpatient costs through fund-pooling should be consolidated.

5. The medical assistance system for low-income families in urban and rural areas should be further improved to reinforce the aid to enable all households enjoying the five guarantees (i.e., childless and infirm old persons who are guaranteed food, clothing, medical care, housing and burial expenses) and low subsistence recipients to enroll in medical insurance and make good use of aid funds.

6. To encourage the steady integration of local resources for the management of medical insurance in selected regions, and to explore the mechanisms of entrusting qualified commercial insurance agencies to deliver and manage medical insurance services. 

Task 3: To develop the system of national essential drugs

Main objectives:

1. National Essential Drug List (2009) should be promulgated.

2. The guidance for the retail price of essential drugs should be issued after the promulgation of the National Essential Drug List.

3. 30% of government directed urban community health services institutions and the county level health care institutions in each province (autonomous regions and municipalities directly under the central government) should have implemented the essential drug system no later than December 2009, including unified online purchasing and distribution via bidding at provincial level, essential medicine reserves, and the provision of essential drugs with zero sales profit.

4. By the end of November 2009, the revision of the national basic drug list should be finished. All national essential medicines should be covered under the basic medical insurance with significantly higher reimbursement for essential medicines compared with non-essential drugs.

5. Clinical guidelines for the use of essential drugs and essential medicine formularies shall be developed and promulgated.

Task 4: To strengthen the construction of grassroots level health care institutions

Main objectives:

1. To establish the standard for the construction of grassroots level health care facilities.

2. To support the construction of 986 county-level hospitals (including hospitals of traditional Chinese medicine), 3,549 township hospitals, and 1,154 urban community health service centers nationwide.

Task 5: To enhance the grassroots level health workforce capacity centered on training general practitioners

Main objectives:

1. To develop and implement the plan for general practitioners training oriented towards building capacity for the grassroots health workforce. 

2. To help the township hospitals with the recruitment of 1,000 licensed physicians, and encourage local governments to increase recruitment numbers. To provide continuing on-the-job training for health workers (120,000 persons for township hospitals and village clinics and 53,000 persons for urban community health service centers).

3. To establish long-term collaborative relationships between 900 class 3 hospitals and 2,000 county-level hospitals as counterparts.

4. To start a pilot project for standard resident doctor training programme.

Task 6: To reform the compensation mechanisms for grassroots health care institutions

Main objectives:

1. To improve the compensation mechanisms for the urban and rural government directed grassroots level health care institutions, implement financial subsidy policy, and maintain consistency with the zero profit sales of national essential drugs. Performance-based salary payments for health workers in grassroots health care institutions as well as public health organizations should be implemented. The subsidy by means of government purchase of services will be explored.

2. The subsidy policy for village doctors should be implemented by local government for their role as public health service providers.

Task 7: To steadily promote equal access to basic public health services

Main objectives:

1. To launch a system of health records for the whole population. In addition, access to basic public health services will cover nine basic public health programs, namely health education, immunization, infectious disease control, maternal and child health care, health care for the elderly, chronic disease management, management of patients with severe mental illnesses. By the end of 2009, the health records will be in place for 30% of urban residents and 5% of the rural population in pilot project areas.

2. In 2009, to initiate immunization with the hepatitis B vaccine for about 23 million people below the age of 15, accounting for about 31% of the target population.

3. To start the program for checkup of common diseases among women age 35-59 years in rural areas, and complete screening of two million people for cervical cancer and 400,000 people for breast cancer. Subsidize the provision of folic acid supplements and hospital delivery for about 11.8 million rural women. 

4. To perform cataract operation for 200,000 poor patients free of charge. 

5. To change the structure of cooking stoves for 870,000 households and offer stove maintenance to 450,000 households in areas with coal-burning stoves induced fluorosis.

6. To support the construction of 4,110,000 safe sanitary latrines in rural areas.

7. To ensure that per capita spending on basic public health services is no less than 15 Yuan annually.

Task 8: To adjust the layout and structure of public hospitals and improve the management system

Main objectives:

1. To develop plans for the regional layout and restructuring of public hospitals for pilot areas, and encourage the social capital to flow to the provision of medical services. 

2. To establish effective forms of separating government functions from those functions within health institutions and separating management from operations. To improve hospital legal governance structure and push forward the reform of the personnel system.

3. To improve the management of public hospitals, and establish a regulatory system with public welfare as the core function of public hospitals.

Task 9: To reform the compensation mechanism for public hospitals

Main objectives:

To research and develop new policies that effectively separates the pharmaceutical retail sales from hospital medical services. In addition, gradually reduce the reliance on medicines sales for operational costs, applying the pharmaceutical service fee, and adjusting medical service charges to enable those public hospitals in the pilot project to be compensated by medical service charges and government subsidies.

Task 10: To implement electronic medical records and the clinical pathways for common diseases

Main objectives:

To draft a unified national standard and specifications for hospital electronic medical records and clinical pathways for 100 common diseases, and select 50 hospitals for pilot study.

The reform of public hospitals should press ahead gradually with pilot studies in advance. About 100 public hospitals in 12 prefecture-level cities that conform to certain standards from eastern, central and western regions of the country will be chosen as the project areas for the reform program in 2009. The pilot projects will explore practical ways to improve efficiency in public hospitals and to uphold their public welfare nature,