State Council Deepens Healthcare Reform: Increases医保 Fiscal Subsidy by 30 Yuan and Encourages Social Sector Participation in医保 Administration

Just now, the General Office of the State Council issued the “Notice on Printing and Distributing the Key Tasks for Deepening the Reform of the Medical and Health System in the Second Half of 2020,” which clearly stipulates that reforms of the medical security system shall be deepened.

Key highlights of this notice include:

1. Improve the level of basic medical security. Increase the per capita fiscal subsidy standard for urban and rural resident basic medical insurance by 30 yuan, and steadily raise individual contribution standards. Improve the mechanism for guaranteeing medical treatment costs during major epidemics. Launch pilot programs for direct cross-provincial settlement of outpatient expenses. (Responsibility: National Healthcare Security Administration, Ministry of Finance)

2. Advance reforms in healthcare insurance payment methods. Promote the national pilot program for Diagnosis-Related Groups (DRG)-based payment and case-based payment. Improve the negotiation mechanism between healthcare insurance agencies and medical institutions, reasonably determine and dynamically adjust the total budget indicators for healthcare insurance funds. In regions with favorable conditions, increase the advance disbursement of working capital to alleviate the financial burden on medical institutions arising from upfront payments. Explore the implementation of global budgeting for close-knit medical consortia, strengthen supervision and assessment, and allow retained surpluses while sharing reasonable overspending. Formulate guidelines for establishing payment standards for medicines covered by healthcare insurance. (National Healthcare Security Administration, National Health Commission, and National Administration of Traditional Chinese Medicine are responsible.)

3. Strengthen the management of medical insurance funds and improve regulatory mechanisms. Implement big data-based intelligent monitoring of medical insurance, promote the application of technologies such as video surveillance and facial recognition, and explore the implementation of centralized provincial-level monitoring. Advance “Internet + Medical Security,” accelerate the construction of a nationally unified medical security information platform, and ensure its integration with the National Integrated Government Service Platform. (The National Healthcare Security Administration is responsible.)

4. Accelerate the development of commercial health insurance. Encourage commercial insurance institutions to provide comprehensive health insurance products and services that include multiple coverages such as medical care, disease, rehabilitation, long-term care, and maternity. Actively introduce social forces to participate in the administration of medical security services.

The full text of the document is as follows:

Deepening the Reform of the Medical and Health Care System in 2020

Key Work Tasks for the Second Half of the Year

In recent years, and particularly since the Third Plenary Session of the 18th Central Committee of the Communist Party of China (CPC), China’s healthcare system reforms have been continuously deepened, with sustained improvements in the population’s health status and in the equity and accessibility of basic medical and health services. Since the outbreak of the COVID-19 pandemic, the healthcare system has withstood significant tests and played a vital role in winning the battle against COVID-19. In the second half of 2020, the deepening of healthcare system reforms should be guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the CPC and its Second, Third, and Fourth Plenary Sessions, carry out the decisions and deployments of the CPC Central Committee and the State Council, adhere to the people-centered development philosophy, uphold the principles of ensuring basic coverage, strengthening primary care, and establishing robust mechanisms, coordinate the advancement of healthcare reform with COVID-19 prevention and control efforts, give greater prominence to prevention, address shortcomings, plug loopholes, and strengthen weak links, continue to shift the focus from disease treatment to people’s health, deepen coordinated reforms among medical services, health insurance, and pharmaceuticals, persist in addressing the difficulties and high costs associated with accessing medical care, and provide strong support for winning the people’s war, the comprehensive war, and the containment war against the epidemic, thereby safeguarding people’s lives, safety, and health.

I. Strengthening the Public Health System

(1) Reform and improve the disease prevention and control system. Optimize and refine the functional setup of disease prevention and control institutions, and improve the basic conditions for disease prevention and control. Improve the coordination mechanism between medical treatment and disease prevention, strengthen the disease prevention and control responsibilities of medical institutions at all levels, enhance the capacity of public hospitals to treat infectious diseases, and promote the integration of personnel, information, and resources between medical and disease prevention institutions. Strengthen the disease prevention and control responsibilities of township health centers and community health service centers, and establish a sound linkage mechanism between disease prevention and control institutions and urban and rural communities. Strengthen the capacity for infectious disease prevention and control at ports of entry. (The National Health Commission and the General Administration of Customs shall be respectively responsible; the National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, and the National Administration of Traditional Chinese Medicine shall participate. “Respectively responsible” means that each department takes the lead according to its respective duties, as hereinafter applied.)

(II) Improve the infectious disease surveillance and early warning system. Implement the primary diagnosis responsibility system for infectious disease reporting, enhance the surveillance mechanisms for diseases of unknown etiology and abnormal health events, promote the establishment of an intelligent multi-point trigger mechanism for early warning, strengthen information sharing on infectious disease surveillance and early warning between military and civilian authorities and among various departments, and advance the improvement of a multi-channel surveillance and early warning mechanism. (The National Health Commission, the General Administration of Customs, the National Administration of Traditional Chinese Medicine, the Health Bureau of the Logistics Support Department of the Central Military Commission, etc., shall be respectively responsible, with participation from other relevant departments.)

(3) Improve the public health emergency material supply system. Increase medical facilities for epidemic prevention and treatment, as well as mobile laboratories. Adhere to equal emphasis on traditional Chinese medicine and Western medicine, strengthen the capacity for prevention and control of sudden public health incidents and emergency medical rescue in emergencies. Strengthen reserves of medicines and medical protective supplies, enhance nucleic acid testing capabilities, promote the renovation of fever clinics in medical institutions, and implement the “three zones and two passages” requirement. Increase investment in research and development of vaccines, drugs, and rapid detection technologies. (The National Development and Reform Commission, the Ministry of Science and Technology, the Ministry of Industry and Information Technology, the Ministry of Finance, the National Health Commission, the State-owned Assets Supervision and Administration Commission of the State Council, the General Administration of Customs, the National Administration of Traditional Chinese Medicine, etc., shall be respectively responsible, with participation from other relevant departments.)

(4) Strengthen the prevention and control of COVID-19 during autumn and winter. Guide localities to formulate specific plans in advance, enhance personnel training and emergency drills, solidify the “four-party responsibilities,” and implement the “five provisions and three strict measures” (provision of protection guidelines, establishment of prevention and control management systems with designated responsible persons, availability of protective supplies and equipment, support from medical and nursing staff, and arrangements for isolation and transfer; strict management of fever clinic setup, rigorous epidemiological investigations, and stringent prevention of nosocomial infections). Establish and improve a tiered, layered, and triaged treatment mechanism for major epidemics such as infectious diseases. Promote local efforts to provide long-term prescription services for patients with chronic diseases. (Led by the National Health Commission, together with the National Development and Reform Commission, the Ministry of Finance, the National Administration of Traditional Chinese Medicine, etc. The department listed first is the lead agency, as applies below.)

(5) Strengthen the development of public health workforce. Enhance the construction of public health-related disciplines and cultivate reserve talent. Intensify training for clinicians, including general practitioners, in public health knowledge such as epidemiology. Pilot provinces for comprehensive healthcare reform and other qualified regions shall increase efforts to explore improvements in areas such as access and utilization of public health personnel, compensation and benefits, performance evaluation, and incentive mechanisms. (The Ministry of Education, the Ministry of Human Resources and Social Security, the National Health Commission, the National Administration of Traditional Chinese Medicine, and the Secretariat of the State Council Leading Group for Healthcare Reform are respectively responsible; the Ministry of Finance and others participate.)

II. Deeply Implement the Healthy China Action

(6) Continuously improve production and living environments, and promote healthy and civilized lifestyles. Improve the mechanism for popularizing scientific health knowledge. Carry out in-depth improvements to rural human settlement environments. Refine technical guidelines for COVID-19 prevention and control in farmers’ markets. Promote the standardized development of farmers’ markets, regulate functional zoning and layout, and strengthen standardized management as well as supervision and law enforcement. Advance the revision of the General Rules for Nutrition Labeling of Prepackaged Foods. Formulate guidance documents for the in-depth implementation of the Patriotic Health Campaign in the new era. (The Ministry of Ecology and Environment, the Ministry of Agriculture and Rural Affairs, the Ministry of Commerce, the National Health Commission, and the State Administration for Market Regulation shall be responsible respectively.)

(7) Strengthen health promotion for key populations. Conduct national evaluations and assessments on the comprehensive prevention and control of myopia among children and adolescents. Comprehensively strengthen and improve school-based physical education, hygiene, and health education. Promote the expansion of pilot programs for institutional innovation in maternal and child health care institutions. Formulate management guidelines for institutions integrating medical and elderly care services. Enhance the provision of door-to-door medical and health services for the elderly. Implement projects to enhance community-level capacity for integrated medical and elderly care. (The Ministry of Education and the National Health Commission shall be respectively responsible, with the participation of the National Development and Reform Commission, the Ministry of Civil Affairs, the General Administration of Sport, and the National Administration of Traditional Chinese Medicine.)

(8) Enhance the prevention and control of chronic diseases. Improve public health service programs. Strengthen the integration of prevention and treatment at the primary care level, using the management of chronic diseases such as hypertension and diabetes as a breakthrough point. Promote the operational integration between disease prevention and control institutions and medical institutions, focusing on early screening and intervention for cardiovascular and cerebrovascular diseases, cancer, and pneumoconiosis. Develop public-friendly guidelines for cancer prevention and screening. Advance pilot programs for the construction of a social psychological service system. (Led by the National Health Commission, the Ministry of Finance, the National Administration of Traditional Chinese Medicine, etc.)

(9) Intensify prevention and control efforts for infectious diseases, endemic diseases, and occupational diseases. Implement effective influenza prevention and control measures during the winter and spring seasons. Achieve the goal of malaria elimination; control and eliminate key endemic diseases such as Kashin-Beck disease and mitigate the harm caused by schistosomiasis; and basically curb the prevalence of echinococcosis. Promote the initiative to cultivate “Occupational Health Experts.” (Responsibility: National Health Commission and National Administration of Traditional Chinese Medicine)

III. Deepening the Comprehensive Reform of Public Hospitals

(10) Improve the performance appraisal mechanisms for medical and health institutions and medical personnel. Refine performance appraisals for tertiary public hospitals, initiate performance appraisals for secondary public hospitals, and advance performance appraisals for maternal and child health care institutions. Incorporate disease prevention and control, public health emergency response, health promotion, and health education into the scope of assessment. Promote the disclosure of financial operational information in public hospitals. Advance pilot programs to establish and improve modern hospital management systems, and conduct in-depth demonstration and performance evaluation work for comprehensive reforms in public hospitals. Formulate policy documents to promote the high-quality development of public hospitals. (The National Health Commission and the National Administration of Traditional Chinese Medicine shall be respectively responsible, with participation from the Ministry of Human Resources and Social Security and other relevant departments.)

(11) Establish and improve a dynamic adjustment mechanism for medical service prices. Guide all provinces to design the dynamic adjustment mechanism holistically, following the basic pathway of setting initiation conditions, evaluating triggers for implementation, adjusting prices with both increases and decreases, aligning with health insurance payment policies, and conducting follow-up monitoring and assessment. Seize the window period created by centralized procurement of drugs and consumables and the elimination of markups on medical consumables—measures that reduce costs for drugs and consumables—to conduct timely price adjustment assessments; where initiation conditions are met, adjust prices in a steady and orderly manner. Promote the improvement of the access system for medical service items and accelerate the review and approval of newly added medical service price items. Monitor public medical institutions’ medical service prices, costs, expenses, income distribution, and reform implementation status, using this information as the basis for implementing dynamic adjustments to medical service prices. Strengthen cost accounting for medical services in public medical institutions. (The National Health Commission, the National Healthcare Security Administration, and the National Administration of Traditional Chinese Medicine shall be responsible respectively.)

(12) Deepen reforms in compensation systems and staffing management. Implement the “two allowances” policy, comprehensively roll out compensation system reforms in public hospitals, guide local authorities to improve methods for determining total compensation budgets, internal performance appraisals, and income distribution in public hospitals, and establish sound operational mechanisms for medical and health institutions that combine safeguards with incentives. Coordinate the revitalization and efficient use of staffing resources in the healthcare sector, prioritizing their allocation to strengthen staffing in public hospitals, primary healthcare institutions, and public health institutions at all levels, including disease prevention and control agencies. (The State Commission Office for Public Sector Reform and the Ministry of Human Resources and Social Security shall each take responsibility; the Ministry of Finance, the National Health Commission, the National Healthcare Security Administration, and the National Administration of Traditional Chinese Medicine shall participate.)

(13) Implement government policies on funding for basic infrastructure construction and equipment procurement in public hospitals that comply with regional health planning, and increase support for traditional Chinese medicine hospitals and infectious disease hospitals. Actively and prudently advance the resolution of long-term debts incurred by public hospitals in accordance with regulations; strictly prohibit debt-financed construction and renovations exceeding prescribed standards, and hold accountable any public hospital engaging in unauthorized debt financing. (The National Development and Reform Commission, the Ministry of Finance, the National Health Commission, and the National Administration of Traditional Chinese Medicine shall each be responsible.)

IV. Deepening the Reform of the Medical Security System

(14) Enhance the level of basic medical security. Increase the per capita fiscal subsidy standard for urban and rural resident basic medical insurance by RMB 30, and steadily raise individual contribution standards. Improve the mechanism for guaranteeing coverage of medical treatment costs during major epidemics. Launch pilot programs for direct cross-provincial settlement of outpatient expenses. (To be undertaken by the National Healthcare Security Administration and the Ministry of Finance.)

(15) Advance reforms in healthcare insurance payment methods. Promote national pilot programs for Diagnosis-Related Group (DRG)-based payment and case-based payment. Improve the negotiation mechanism between healthcare insurance agencies and medical institutions, reasonably determine and dynamically adjust the total budget indicators for healthcare insurance funds. In areas with appropriate conditions, increase the advance disbursement of revolving funds to alleviate the financial burden of upfront payments by medical institutions. Explore the implementation of global budgeting for closely integrated medical consortia, strengthen supervision and assessment, and allow retained surpluses while sharing reasonable overspending. Formulate guidelines for establishing payment standards for medicines covered by healthcare insurance. (The National Healthcare Security Administration, the National Health Commission, and the National Administration of Traditional Chinese Medicine are responsible.)

(16) Strengthen the management of medical insurance funds and improve regulatory mechanisms. Implement intelligent monitoring of medical insurance based on big data, promote the application of technologies such as video surveillance and facial recognition, and explore the implementation of centralized monitoring at the provincial level. Advance “Internet + Medical Security,” accelerate the construction of a unified national medical security information platform, and ensure its integration with the National Integrated Government Service Platform. (National Healthcare Security Administration is responsible.)

(17) Accelerate the development of commercial health insurance. Encourage commercial insurance institutions to provide comprehensive health insurance products and services that include multiple coverages such as medical care, disease, rehabilitation, long-term care, and maternity. Actively introduce social forces to participate in the administration of medical security services. (The National Healthcare Security Administration and the China Banking and Insurance Regulatory Commission are respectively responsible.)

V. Strengthening the Drug Supply and Assurance System

(18) Improve policies for the procurement of pharmaceuticals and medical consumables. Orderly expand the scope of varieties of pharmaceuticals included in the national centralized volume-based procurement and use program, and carry out pilot programs for the centralized procurement of high-value medical consumables. Encourage medical insurance handling agencies to settle payments for pharmaceuticals directly with pharmaceutical manufacturers or distributors. Provide guidance to localities on the comprehensive implementation of policies regarding the procurement, distribution, and use of winning-bid pharmaceuticals and high-value medical consumables. Formulate policy documents to reform and improve the pharmaceutical procurement mechanism. Provide guidance to localities on improving policies related to centralized procurement and medical insurance reimbursement for COVID-19 testing. (The National Healthcare Security Administration and the National Health Commission shall be respectively responsible, with participation from the Ministry of Finance and the National Medical Products Administration.)

(19) Promote rational and scientific medication use. Implement monitoring of rational drug use, regularly publish monitoring results, drive medical institutions to optimize and standardize their medication structures, promote the priority procurement and use of National Essential Medicines, and enforce requirements such as “prefer oral administration over intramuscular injection, and intramuscular injection over intravenous infusion.” Strengthen the development of the national platform for monitoring drug utilization. Advance the comprehensive clinical evaluation of drugs, and organize pilot programs for the comprehensive clinical evaluation of essential medicines for major diseases. Formulate the second batch of the Catalogue of Drugs Encouraged for Generic Production. (The National Health Commission and the National Administration of Traditional Chinese Medicine are responsible.)

(20) Strengthen supervision over the use of pharmaceuticals and medical consumables. Gradually establish and improve an information-based traceability mechanism for pharmaceuticals, achieving “one item, one code” for vaccines and drugs included in the national centralized volume-based procurement and utilization programs. Select certain high-value medical consumables and other key products for the implementation of Unique Device Identification (UDI). Develop a unified, nationwide, open market for centralized pharmaceutical procurement, standardize technical specifications and functional norms, and promote the adoption of standardized coding for medicines covered by medical insurance. Gradually unify the classification and coding systems for high-value medical consumables covered by medical insurance across China, and explore the integrated application of standardized codes throughout the registration, procurement, and utilization stages of high-value medical consumables. (The National Healthcare Security Administration and the National Medical Products Administration shall be respectively responsible, with participation from the National Health Commission and other relevant departments.)

(21) Ensure the supply and price stability of medicines in short supply. Promote the development of a multi-source information collection platform for medicines in short supply and establish an inter-departmental collaborative monitoring mechanism. Implement a reporting system for production halts of medicines in short supply and a list-based management system. Establish and improve a regular monitoring and early warning mechanism for the prices of medicines and medical consumables, strengthen dynamic monitoring of domestic procurement prices, and track international prices. Intensify law enforcement against monopolistic and illegal practices involving active pharmaceutical ingredients (APIs) and imported drugs. (The Ministry of Industry and Information Technology, the National Health Commission, the State Administration for Market Regulation, the National Healthcare Security Administration, and the National Medical Products Administration shall each be responsible for their respective duties, with the participation of the National Administration of Traditional Chinese Medicine.)

VI. Coordinated Advancement of Key Related Reforms

(22) Continue to advance the development of regional medical centers, promote the expansion, decentralization, and balanced distribution of high-quality medical resources, and establish management systems and operational mechanisms commensurate with regional medical centers. (The National Development and Reform Commission, the National Health Commission, the National Administration of Traditional Chinese Medicine, and the Secretariat of the State Council’s Leading Group for Healthcare Reform shall each be responsible for their respective areas.)

(23) Promote the tiered diagnosis and treatment system and the informatization of the medical and health sector. Comprehensively advance the development of community hospitals, refine and substantiate family doctor contract services, enhance the capacity of medical services in urban and rural communities, improve the tiered diagnosis and treatment system, and strengthen grassroots epidemic prevention and control. Deepen comprehensive medical reforms at the county level, advance pilot programs for close-knit county-level medical consortia, and promote the integration of county and township services as well as village and township services. Facilitate the implementation of multi-channel subsidy policies for the service income of rural medical and health personnel. Accelerate the development of “Internet + Healthcare,” improve the national universal health information platform, promote the application of next-generation information technologies in the medical and health field, and facilitate the reshaping of medical and health management and service models. Support the sustained, healthy, and standardized development of privately run medical institutions. Provide support to medical institutions affected by the epidemic. Formulate opinions on comprehensively establishing a high-quality and efficient medical and health service system with Chinese characteristics. (The National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, the National Health Commission, the National Healthcare Security Administration, the National Administration of Traditional Chinese Medicine, the Secretariat of the State Council’s Leading Group for Medical Reform, and other relevant departments shall be responsible respectively.)

(24) Promote the revitalization and development of Traditional Chinese Medicine (TCM). Vigorously promote the integrated medical model of TCM and Western medicine in general hospitals, infectious disease hospitals, and specialized hospitals, and incorporate its implementation into hospital accreditation and performance evaluations. Accelerate the establishment of TCM evidence-based medicine centers, initiate the construction of National TCM Medical Centers and Regional TCM Medical Centers, launch pilot programs for TCM classic wards, enhance the emergency response and treatment capabilities of TCM hospitals, and leverage the unique role of TCM in the treatment of major epidemics. Select and publish a list of conditions where TCM demonstrates advantages and corresponding diagnostic and therapeutic items, and encourage and guide medical and health institutions to provide TCM services. Strengthen the capacity building and workforce development of county-level TCM medical services, and achieve full coverage of county-administered TCM medical institutions. When adjusting medical service prices, give priority to reflecting the value of technical labor in pricing, thereby supporting the inheritance, innovation, and development of TCM. Formulate policy measures to accelerate the characteristic development of TCM. (The National Administration of Traditional Chinese Medicine, the National Development and Reform Commission, the National Health Commission, and the National Healthcare Security Administration shall be responsible respectively.)

(25) Solidly advance health-focused poverty alleviation. Comprehensively address prominent issues in ensuring access to basic medical care, and strengthen policy support for the cultivation of health professionals and the enhancement of technical capabilities in impoverished areas. Provide medical security for the rural poor in accordance with regulations. Increase guidance and support for deeply impoverished regions such as the “Three Regions and Three Prefectures,” and intensify efforts to prevent and control major infectious and endemic diseases. Address problems such as malnutrition in impoverished areas. (The National Health Commission, the National Development and Reform Commission, the Ministry of Education, the Ministry of Finance, the National Healthcare Security Administration, the National Administration of Traditional Chinese Medicine, the State Council Leading Group Office of Poverty Alleviation and Development, etc., are responsible.)

(26) Improve the coordination and inspection mechanisms for comprehensive supervision in the healthcare sector. Launch pilot programs for “credit-based + comprehensive supervision.” Formulate policy documents on accountability and inspection mechanisms for comprehensive supervision in the healthcare sector. Develop several provisions to strengthen the construction of health supervision systems and promote the standardized development of supervisory institutions. Further regulate medical practices and promote appropriate medical examinations. (To be led by the National Health Commission, the National Administration of Traditional Chinese Medicine, and other relevant agencies.)

All regions and relevant departments must strengthen the concept of comprehensive health and well-being, earnestly enhance systematic planning and organizational leadership for deepening healthcare reform, incorporate the completion of healthcare reform tasks as a key component of government target management and performance evaluation, and coordinate routine epidemic prevention and control with efforts to deepen healthcare reform. Further promote the healthcare reform experiences of Fujian Province and Sanming City. Establish mechanisms for evaluating and adjusting pilot provinces engaged in comprehensive healthcare reform. The Secretariat of the State Council’s Leading Group for Healthcare Reform shall strengthen overall coordination, conduct monitoring and evaluations, maintain a task ledger with quarterly reports, and carry out an assessment of the 13th Five-Year Plan for Healthcare Reform. Strengthen publicity and guidance on healthcare reform, promptly interpret policy measures, and build consensus on reform.