State Council General Office Issues Key Tasks for Deepening Medical and Health System Reform in 2019

VCBeat (WeChat: vcbeat) has learned that on June 4, the General Office of the State Council issued the “Key Tasks for Deepening Healthcare System Reform in 2019” (hereinafter referred to as the “Tasks”).

“The Tasks” points out that we should take Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era as our guide, fully implement the spirit of the 19th National Congress of the Communist Party of China and its Second and Third Plenary Sessions, earnestly carry out the decisions and deployments of the CPC Central Committee and the State Council on implementing the Healthy China Strategy and deepening the reform of the medical and health system, adhere to people-centered health, uphold the principles of ensuring basic coverage, strengthening primary care, and establishing robust mechanisms, closely focus on shifting from disease-centered care to people-centered health, implement prevention-first strategies, strengthen disease prevention and health promotion, closely address the difficulties and high costs of accessing medical care, deepen the coordinated reforms of medical services, medical insurance, and pharmaceuticals, and unswervingly promote the effective implementation of healthcare reforms to benefit the people.

“The Tasks” specifies key work priorities in two areas:

1. Documents to be studied and formulated, covering 15 documents on key areas including the Healthy China Initiative, promoting the healthy and standardized development of privately run medical institutions, the list of drugs encouraged for generic production, standardizing the use of medical consumables, further deepening healthcare reform with centralized drug procurement and utilization as a breakthrough point, medication management in medical institutions, pricing and medical insurance reimbursement for internet-based diagnosis and treatment, reform of the professional title system for health technical personnel, establishing and improving the elderly health service system, performance evaluation of public medical institutions at secondary level and below, strengthening the management of the physician workforce, management of medical consortia, reform of the compensation system in public hospitals, improvement of the individual accounts under the employee basic medical insurance, and supervision of the use of medical security funds.

Second, we must advance the implementation of key tasks, focusing primarily on addressing the difficulties and high costs of accessing medical care and strengthening hospital management, with 21 specific measures proposed.To address the difficulty of accessing medical care, key initiatives have been proposed, including advancing the construction of National Medical Centers and Regional Medical Centers, promoting tiered diagnosis and treatment through the orderly development of medical consortia, deepening reforms to streamline administration, delegate power, and improve services to support private healthcare provision, fostering the development of “Internet + Healthcare,” coordinating comprehensive healthcare reforms at the county level, implementing the Healthy China Action, and strengthening the prevention and control of major diseases such as cancer. To alleviate the high cost of medical care, priority tasks include piloting centralized volume-based procurement and use of pharmaceuticals organized at the national level, advancing reforms for high-value medical consumables, consolidating and improving the National Essential Medicines System, reforming health insurance payment methods, refining compensation mechanisms for public hospitals, deepening comprehensive reforms of public hospitals, and thoroughly implementing health-focused poverty alleviation programs. To strengthen hospital management, key measures include conducting performance evaluations for public hospitals and further improving medical services.

“The Tasks” emphasizes that all regions and relevant departments must strengthen leadership, adopt effective measures, demonstrate courage in assuming responsibilities, and complete all assigned tasks on time and with high quality. Proactive release of information on reform policies should be ensured to fully disseminate such information, promote best practices, and build consensus on reforms. “The Tasks” also specifies the departments responsible for each reform initiative and sets timelines and progress requirements for the formulation of necessary policy documents.

The following outlines the core content of the document—Key Tasks for Deepening the Reform of the Medical and Healthcare System in 2019:

In 2019, the work of deepening the reform of the medical and healthcare system shall 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 Communist Party of China and the Second and Third Plenary Sessions of the 19th Central Committee, conscientiously carry out the decisions and deployments of the CPC Central Committee and the State Council on implementing the Healthy China Strategy and deepening the reform of the medical and healthcare system, adhere to putting people’s health at the center, uphold the principles of ensuring basic coverage, strengthening primary care, and establishing robust mechanisms, closely focus on shifting from a disease-treatment-centered approach to a people’s-health-centered approach, implement the principle of prevention first, strengthen disease prevention and health promotion, closely address the difficulties and high costs associated with accessing medical care, deepen the coordinated reforms of medical services, medical insurance, and pharmaceuticals, and unswervingly promote the effective implementation of healthcare reforms to benefit the public.

1. Formulate the Opinions on Implementing the Healthy China Initiative, the Healthy China Initiative (2019–2030), and the Plan for Organization, Implementation, and Assessment of the Healthy China Initiative. (The National Health Commission is responsible; to be completed by the end of June 2019.)

2. Formulate promotionPrivate HealthcarePolicy documents for sustained, healthy, and standardized development. (Jointly led by the National Health Commission and the National Development and Reform Commission; to be completed by the end of June 2019.)

3. Release of IncentivesList of Generic Drugs. (To be completed by the National Health Commission by the end of June 2019)

4. Develop Further Standardized GuidelinesUse of Medical Consumablespolicy documents. (To be completed by the National Health Commission by the end of August 2019.)

5. FormulateCentralized Drug Procurement and Use as a BreakthroughPolicy documents to further deepen healthcare reform. (The Secretariat of the State Council Leading Group for Healthcare Reform is responsible; to be completed by the end of September 2019.)

6. Formulate administrative measures for medication use in medical institutions. (Responsible agency: National Health Commission of the People's Republic of China; to be completed by the end of September 2019)

7. FormulationInternet Diagnosis and Treatment: Fees and Medical Insurance Paymentpolicy documents. (The National Healthcare Security Administration is responsible; to be completed by the end of September 2019.)

8. Formulate guiding opinions on deepening the reform of the professional title system for health professionals. (Responsible department: Ministry of Human Resources and Social Security; to be completed by the end of September 2019)

9. Formulate guiding opinions on establishing and improving the health service system for the elderly. (Responsible department: National Health Commission; to be completed by the end of September 2019)

10. Formulate performance assessment measures for public medical institutions at the secondary level and below. (Responsible agency: National Health Commission; to be completed by the end of November 2019)

11. Formulate measures to strengthen the management of the physician workforce. (Responsible agency: National Health Commission; to be completed by the end of November 2019)

12. FormulationMeasures for the Administration of Medical Consortia. (To be completed by the National Health Commission of China by the end of November 2019)

13. Formulate guiding documents for the reform of the compensation system in public hospitals. (The Ministry of Human Resources and Social Security is responsible; to be completed by the end of December 2019.)

14. Formulate policy documents to improve the personal account system of the employee basic medical insurance. (The National Healthcare Security Administration is responsible; to be completed by the end of December 2019.)

15. Formulate regulations on the supervision of the use of medical security funds. (The National Healthcare Security Administration is responsible for submitting them to the State Council by the end of December 2019.)

The above tasks list only the lead departments, not the participating departments.

16. Implement the Healthy China Initiative, mobilize individuals, the government, and the entire society to jointly popularize health knowledge and carry out health promotion, striving to ensure that the public remains disease-free, suffers from fewer diseases, and enjoys a longer healthy life expectancy. (The National Health Commission is the lead agency, with other relevant departments participating; the first-listed department is the lead agency, as applies hereinafter.)

17. Increase support for medical institutions in delivering public health services and establish a funding guarantee mechanism for public health services provided by medical institutions. (Responsibility: Ministry of Finance, National Health Commission, National Administration of Traditional Chinese Medicine) Evaluate the implementation of basic public health service programs and promote improvements in the efficiency of fund utilization. (Responsibility: National Health Commission, Ministry of Finance)

18. Accelerate ProgressReform of the Disease Prevention and Control System, refine the functional positioning of disease prevention and control institutions at all levels, continuously promote institutional and mechanistic innovation in maternal and child health care institutions and blood station service systems, deepen reforms in grassroots operational mechanisms, permit eligible regions to implement both full fiscal guarantee policies and the “Two Permissibles” requirements, and gradually establish a new operational mechanism that integrates safeguards with incentives. Strengthen vaccination management and strictly enforce operational protocols such as the “Three Checks and Seven Verifications.” (Responsibility lies with the National Health Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, the General Administration of Customs, and the National Administration of Traditional Chinese Medicine.)

19. Strengthen cancer prevention and control, advance preventive screening and early diagnosis and treatment, accelerate the registration and approval of new anti-cancer drugs both domestically and internationally, and facilitate temporary import channels for clinically urgent anti-cancer medications. Carry out effective prevention and control efforts for endemic diseases, occupational diseases, HIV/AIDS, tuberculosis, and other conditions. (Responsible entities: National Health Commission, National Development and Reform Commission, Ministry of Finance, Ministry of Human Resources and Social Security, General Administration of Customs, National Administration of Traditional Chinese Medicine, National Medical Products Administration, etc.)

20. Steadily AdvanceNational Pilot Program for Centralized Procurement and Use of Pharmaceuticals: Strengthening Monitoring of the Quality of Awarded Drugs, Priority Utilization by Public Medical Institutions in Pilot Regions, Payment Settlement, and Production of Awarded Drugs and Active Pharmaceutical Ingredients, and ensure proper usage, quality assurance, stable supply, and timely payment collection. Conduct pilot evaluations, carefully summarize pilot experiences, and promptly implement the initiatives nationwide. (The Ministry of Industry and Information Technology, the National Health Commission, the National Healthcare Security Administration, and the National Medical Products Administration shall each take the lead in accordance with their respective responsibilities; the same applies hereinafter.)

21. Supervise and guide localities to establish mechanisms conducive toA Dynamic Adjustment Mechanism for Medical Service Prices in Public Hospitals to Rationalize Price Ratios and Optimize Revenue Structure. According to“Total cost control, structural adjustment, selective increases and decreases, and gradual implementation” principle for the dynamic adjustment of medical service prices. (The National Healthcare Security Administration, the National Health Commission, and the National Administration of Traditional Chinese Medicine are responsible.) Deepen the reform of the compensation system in public hospitals, implement the “two permits” requirement, and promote a reasonable ratio of personnel expenditure to operational expenditure in public hospitals. (The Ministry of Human Resources and Social Security, the Ministry of Finance, the National Health Commission, the National Healthcare Security Administration, and the National Administration of Traditional Chinese Medicine are responsible.)

22. Continued DeepeningComprehensive Reform of Public Hospitals: Continuing Demonstration and Effectiveness Evaluation. Pilot programs will be advanced in selected hospitals to establish and improve the modern hospital management system. (Responsibility: National Health Commission, National Development and Reform Commission, Ministry of Education, Ministry of Finance, Ministry of Human Resources and Social Security, National Healthcare Security Administration, and National Administration of Traditional Chinese Medicine) Government funding policies for public hospitals shall be improved. Central financial subsidy funds shall be allocated based on factors such as the results of comprehensive reform evaluations of public hospitals. (Responsibility: Ministry of Finance, National Health Commission, and National Administration of Traditional Chinese Medicine)

23. Establish a nationalPerformance Appraisal Information System for Public Hospitals: Comprehensively Implement Performance Appraisal for Tertiary Public Hospitals in Accordance with the Principle of Territorial Jurisdiction, and the assessment results shall be disclosed to the public through appropriate channels. Efforts shall be made to promote performance assessments for public medical institutions at the secondary level and below. Strengthen medication management in medical institutions, and standardize drug use in accordance with the principle of prioritizing oral administration over intramuscular injection, and intramuscular injection over intravenous infusion. (Responsible entities: National Health Commission, National Development and Reform Commission, Ministry of Finance, Ministry of Human Resources and Social Security, National Healthcare Security Administration, and National Administration of Traditional Chinese Medicine)

24. Establish rules for the Unique Device Identification (UDI) system for medical devices. Gradually unify the classification and coding of high-value medical consumables covered by national medical insurance. Conduct targeted governance on high-value medical consumables with relatively high unit prices and resource consumption shares. Reform and improve procurement policies for medical consumables. (The National Health Commission, the National Healthcare Security Administration, and the National Medical Products Administration shall be responsible respectively.) Abolish markups on medical consumables in public medical institutions, improve compensation policies for these institutions, and appropriately address the compensation for the reasonable income loss incurred by public medical institutions due to the elimination of such markups. (The National Healthcare Security Administration, the National Health Commission, and the Ministry of Finance shall be responsible.)

25. Improve the monitoring and early warning mechanism for drug shortages, and ensure the supply of drugs that are clinically essential, prone to shortage, and have poor substitutability by strengthening reserves, implementing centralized procurement, and designating production facilities. Summarize and evaluate local explorations and practices that reflect the value of pharmaceutical care services. (The National Development and Reform Commission, the Ministry of Industry and Information Technology, the National Health Commission, the National Healthcare Security Administration, and the National Administration of Traditional Chinese Medicine shall be respectively responsible, with the participation of the National Medical Products Administration and other relevant departments.)

26. Consolidate and Improve the NationalEssential Medicines System, clarify the usage proportions of essential medicines in public medical institutions at all levels and types on a provincial basis, and establish incentive and constraint mechanisms to prioritize their use. (The National Health Commission, the National Healthcare Security Administration, and other relevant departments are responsible.) Improve the dynamic adjustment mechanism for the National Reimbursement Drug List, and prioritize the inclusion of eligible therapeutic drugs from the National Essential Medicines List into the reimbursement list in accordance with established procedures. Include outpatient medications for chronic conditions such as hypertension and diabetes in the medical insurance reimbursement coverage. (The National Healthcare Security Administration is responsible.)

27. AccelerateAdvance the reform of medical insurance payment methods, pilot the Diagnosis-Related Groups (DRG) payment system, and continue to promote the reform of a diversified, composite medical insurance payment model primarily based on disease types.Expand the pilot programs for the long-term care insurance system. (To be led by the National Healthcare Security Administration, the Ministry of Finance, the National Health Commission, and the National Administration of Traditional Chinese Medicine, among others.) Accelerate the development of commercial health insurance and improve the regulatory framework for commercial health insurance. (To be led by the China Banking and Insurance Regulatory Commission.) Expedite the implementation and improvement of policies for direct settlement of cross-provincial medical expenses incurred outside one’s home province, so that patients seeking medical care away from home can use their social security cards for treatment and immediate settlement at all designated hospitals as soon as possible, thereby providing genuine convenience to the mobile population and elderly individuals who have relocated with their families. (To be led by the National Healthcare Security Administration and the Ministry of Finance.)

28. Steadily AdvanceConstruction of National Medical Centers and Regional Medical Centers: Selecting High-Level Hospitals to Support the Development of Regional Medical Centers, Promoting Optimized Resource Allocation, and Enhancing Healthcare Services in Regions with a Shortage of High-Quality Medical Resources, Such as Central and Western China. Comprehensive reforms of the medical and health care system shall be implemented at regional medical centers, with bold exploration of innovations in management systems and operational mechanisms; all relevant departments shall provide strong support. (The National Development and Reform Commission, the National Health Commission, and the Secretariat of the State Council Leading Group for Medical Reform shall each take responsibility, with participation from the Ministry of Education, the Ministry of Human Resources and Social Security, the National Healthcare Security Administration, the National Administration of Traditional Chinese Medicine, and others.)

29. Focusing on Discipline Development,Enhance the comprehensive capabilities of 500 county-level general hospitals and 500 county-level traditional Chinese medicine hospitals. (The National Health Commission, the National Development and Reform Commission, and the National Administration of Traditional Chinese Medicine are responsible.) Guide localities to use disease types as a lever to clarify the responsibilities and functional positioning of medical institutions at different levels and categories, establish mechanisms for division of labor and collaboration, and promote tiered diagnosis and treatment. Encourage tertiary hospitals to proactively adjust the structure of outpatient disease types and gradually expand the range of diseases covered by day surgery. (The National Health Commission, the National Administration of Traditional Chinese Medicine, etc., are responsible.) Focus on establishing urban medical groups in 100 cities and county-level medical consortia in 500 counties.Guide the orderly development of medical consortia, particularly medical communities; encourage healthcare institutions at all levels and of all types, including privately run ones, to participate on an equal footing and engage in moderate competition; promote the downward flow of high-quality medical resources; and prevent issues such as large hospitals engaging in “territorial expansion” and “siphoning” patients.Conduct an evaluation of the development of medical consortia. (Responsible entities: National Health Commission, National Healthcare Security Administration, National Administration of Traditional Chinese Medicine, and the Secretariat of the State Council Leading Group for Medical Reform)

30. Continuously deepen the “streamline administration, delegate power, and improve services” reform in the health sector, optimize approval services, and eliminate discriminatory policies,Treat privately operated medical institutions equally and provide them with support. Encourage and support social forces in establishing clinics, and increase government procurement of services.Strengthen supervision across the entire healthcare sector to ensure the quality and safety of medical care. (Responsible entities: National Health Commission, National Development and Reform Commission, National Administration of Traditional Chinese Medicine, etc.)

31. TissueLaunch the Construction of Provincial Demonstration Zones for "Internet + Healthcare", supporting pilot initiatives and experience accumulation. ContinueAdvance the development of the National Health Information Platform and provincially coordinated regional platforms.. Upgrade and enhance the telemedicine network. Guide localities in the orderly development of “Internet + Healthcare” services, ensuring medical and data security. Timely summarize and evaluate the pilot programs for “Internet + Nursing Services,” and expeditiously establish standardized and robust regulatory frameworks.Advancing the Development of Information Platforms for Traditional Chinese Medicine Halls at the Grassroots Level. (The National Development and Reform Commission, the Ministry of Industry and Information Technology, the National Health Commission, the National Healthcare Security Administration, and the National Administration of Traditional Chinese Medicine shall each be responsible for their respective areas, with the participation of the China Banking and Insurance Regulatory Commission.)

32. Strengthen the coordination between medical education and practice, improve training models, and promote the organic integration of standardized residency training with master’s professional degree graduate education. When expanding enrollment this year, secondary and higher vocational institutions should prioritize increasing admissions for majors such as rehabilitation, nursing, elderly care, and domestic services, while reducing enrollment in clinical medicine programs, thereby optimizing the structure of medical major admissions and enhancing the quality of talent cultivation. (Responsible entities: Ministry of Education, National Health Commission, Ministry of Human Resources and Social Security, etc.)

33. Deepen the implementation of health-focused poverty alleviation. Relevant funds and policies will be further tilted toward areas with extreme poverty. The number of major diseases subject to centralized treatment for the impoverished population has been expanded to 25, and the cap on critical illness insurance for registered impoverished individuals has been abolished. Localities are encouraged to study and propose support policies for residents whose income levels are slightly higher than those of registered impoverished households. Strengthen capacity building at county-level hospitals in poverty-stricken areas and promote paired assistance between urban and rural hospitals. Support and encourage measures such as tuition-free targeted training of medical students for rural areas, special post programs for general practitioners, “county-managed, township-used” staffing, and “township-hired, village-used” staffing, with a focus on addressing the shortage of qualified doctors in some township health centers and village clinics. (Responsible entities: National Health Commission, National Development and Reform Commission, Ministry of Education, Ministry of Finance, Ministry of Human Resources and Social Security, National Healthcare Security Administration, State Council Leading Group Office of Poverty Alleviation and Development, China Disabled Persons’ Federation, etc.)

34. Support the inheritance, innovation, and development of Traditional Chinese Medicine (TCM), and leverage its significant role in preventive treatment of disease, treatment of major diseases, and disease rehabilitation. Improve the TCM service system and medical insurance payment policies tailored to the characteristics of TCM; promote the research, utilization, and living transmission of classical TCM texts; establish a scientific research and innovation system including key laboratories; and deeply implement pilot programs for clinical collaboration between traditional Chinese and Western medicine in the treatment of major and difficult diseases. Strengthen quality management of TCM medicinal materials, promote the establishment of a full-chain quality traceability system, and reform and improve the registration management of traditional Chinese medicines. Enhance the training of TCM professionals by integrating institutional education with apprenticeship-based education, and improve evaluation and incentive mechanisms such as professional title assessment and appointment. (Responsible entities: National Administration of Traditional Chinese Medicine, National Development and Reform Commission, Ministry of Education, Ministry of Science and Technology, Ministry of Industry and Information Technology, Ministry of Human Resources and Social Security, Ministry of Agriculture and Rural Affairs, Ministry of Commerce, National Health Commission, National Healthcare Security Administration, National Medical Products Administration, Health Bureau of the Logistics Support Department of the Central Military Commission, China Disabled Persons’ Federation, etc.)

35. In-depth ImplementationAction Plan for Further Improving Medical ServicesAt least 50% of hospitals at Level II and above shall provide online services such as time-slot appointment scheduling, intelligent patient guidance and triage, waiting notifications, query of laboratory and examination results, in-clinic settlement, and mobile payment. Pilot programs for the development of community hospitals shall be launched. (Responsible entities: National Health Commission, National Administration of Traditional Chinese Medicine)

36. Promote County-Level Comprehensive Healthcare Reform in a Coordinated Manner, and Strengthen Integrated Innovation in Reforms Covering Medical Services, Health Insurance, Pharmaceuticals, and Public HealthPilot provinces for comprehensive healthcare reform shall select one or two counties (cities, districts) with strong reform awareness and sound foundational conditions to carry out pilot programs. A plan shall be proposed to establish a high-quality and efficient healthcare service system with Chinese characteristics. (Responsible entities: National Health Commission, National Development and Reform Commission, Ministry of Finance, Ministry of Human Resources and Social Security, National Healthcare Security Administration, National Administration of Traditional Chinese Medicine, National Medical Products Administration, etc.)

Source:Chinese Government Website