Five Ministries Issue Guidelines to Promote Standardized and Regulated Clinic Development

On May 13, the National Health Commission, the National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, and the National Healthcare Security Administration jointly formulated the “Opinions on Launching Pilot Programs to Promote the Development of Clinics” (hereinafter referred to as the “Opinions”).

Promoting the healthy development of clinics is a significant measure to deepen the “decentralization, control, and service” reforms in the medical sector and improve the medical service system. It holds great importance for attracting high-quality medical resources to grassroots levels and meeting the public’s multi-level and diverse needs for medical services. The main objectives outlined in the “Opinions” are to comprehensively enhance the standardization and normalization of clinics, enable them to play a greater role in providing diagnosis and treatment services for common and frequently occurring diseases as well as family doctor contract services at the grassroots level, foster the emergence of more high-quality and high-standard clinics, and serve as an important supplement to the public medical service system.

Pilot Arrangements: From 2019 to 2020, pilot work to promote the development of clinics was carried out in ten cities, including Beijing, Shanghai, Shenyang, Nanjing, Hangzhou, Wuhan, Guangzhou, Shenzhen, Chengdu, and Xi’an. Policies on clinic establishment and management were improved based on pilot experience and then rolled out nationwide.

The “Opinions” propose a series of innovative reform measures, including lifting restrictions on clinic establishment imposed by medical institution setting plans and replacing the approval-based system for clinic establishment with a filing-based management system; encouraging qualified physicians to establish specialty or general practice clinics on a full-time or part-time basis; requiring clinics to establish information systems to record diagnosis and treatment data and upload such data to the healthcare service supervision information system; encouraging the inclusion of clinics in the development of medical consortiums, supporting the scaled and group-based development of clinics to form standardized and normalized management and service models; and encouraging governments to include eligible clinics in the scope of medical institutions eligible to provide family doctor contracted services through government purchase of services.

What are the background and catalyst for the launch of the “Opinions,” and how should they be interpreted?

Currently, there are a total of registered and operational units across China.Nearly 220,000 Clinics, with an average of over 7,000 clinics per province. The average number of practicing staff per clinic is 2.6, including 1.4 physicians and 1.2 nurses on average. Diagnosis and treatment services for common and frequently occurring diseases in internal medicine, stomatology, traditional Chinese medicine (TCM) internal medicine, TCM surgery, orthopedics, and gynecology account for more than 90% of clinic operations, playing a significant role in primary healthcare services.

However, the development of clinics faces major challenges, including shortages of human resources, limited capacity to deliver medical services, and difficulties in industry regulation. Further clarifying the role and functional positioning of clinics, and leveraging their important function within the healthcare service system, is a key component of adhering to the people-centered development philosophy, implementing the Healthy China strategy, and promoting high-quality development of the healthcare sector. This holds significant importance for enhancing the overall efficiency of medical services and meeting the multi-level and diverse healthcare needs of the population. Therefore, it is necessary to further improve policy measures to promote the healthy development of clinics.

"The Opinion" consists of five parts:

Part I: General Requirements. This section clarifies the guiding principles and work objectives for promoting the development of clinics. A two-year pilot program for clinic establishment will be launched in ten cities, including Beijing, Shenyang, Shanghai, Nanjing, Hangzhou, Wuhan, Guangzhou, Shenzhen, Chengdu, and Xi’an. Policies on clinic construction and management will be refined based on the experience gained from these pilots.

Part II: Optimize policies for clinic practice licensing. Streamline the market entry procedures for clinics, and remove planning restrictions on the establishment of clinics.Clinics Shift from Licensing to Filing-Based Management. Revise the basic standards for clinics, shifting the focus of review from hardware such as equipment and facilities toReview of Physician Qualifications and Competencies. Meanwhile, physicians who have practiced in medical institutions for at least five years and obtained intermediate or higher professional titles are encouraged to establish specialized clinics on a full-time or part-time basis.

Part III: Enhancing the Quality of Medical Services in Clinics. Encourage the inclusion of clinics inMedical ConsortiumConstruction,Support the Scaled and Group-Based Development of Clinics, to establish standardized and normalized management and service models. Governments are encouraged to include eligible clinics in the roster of medical institutions authorized to provide family doctor contract services through government procurement of services.

Encourage clinics to provide basic medical and health services. For clinics providing such services, implement subsidy policies in areas such as personnel training that are equivalent to those for government-run primary healthcare institutions. Localities with the necessary conditions may provide appropriate support for development and construction expenditures, including infrastructure and equipment procurement, related to the provision of basic medical and health services by these clinics. Create a favorable professional development environment for physicians working full-time at clinics, and further improve price-setting, health insurance, and other relevant policies conducive to clinic development.

Part IV: Strengthening Industry Supervision. Innovate regulatory methods, with specific requirements for implementing information-based supervision of clinics. Meanwhile, it is requiredClinic Establishes Electronic Medical Record System, standardize the documentation and management of medical records to ensure the quality of care and patient safety in clinics. Emphasize strengthening the practice management of clinic physicians.

Part V: Safeguarding Organizational Implementation. This section clarifies departmental responsibilities and sets forth requirements in two key areas—strengthening organizational leadership and conducting thorough evaluation and summary—to provide supportive safeguards for the solid advancement of pilot initiatives.

First, streamline the access procedures. Remove restrictions imposed by healthcare institution establishment plans on clinics, and replace the approval system for clinic establishment with a filing-based management system. Entities establishing clinics shall file with the county- or district-level health administrative department where the clinic is located; upon issuance of the Medical Institution Practice License, they may commence practice activities. Chain or group-operated clinics operating across administrative regions shall be uniformly filed with the next higher-level health administrative department, while those operating across provincial-level administrative regions shall be separately filed with the health administrative departments of the respective provinces.

Second, adjust the establishment standards. Emphasize that the functional positioning of clinics is to provide diagnosis and treatment services for common and frequently occurring diseases, as well as family doctor contract services, ensuring that service capability and quality safety are the foundation and prerequisite for clinic establishment. Therefore, the review process for clinic establishment will be changed from the previousThe focus of review has shifted from hardware, such as equipment and facilities, to the verification of physicians’ qualifications and competencies., requiring physicians practicing in clinics (excluding traditional Chinese medicine clinics) to hold a professional title at the intermediate level or above.

Third, stimulate the vitality of existing resources. Encourage eligible physicians to establish specialty or general practice clinics on a full-time or part-time basis. Encourage physicians from different specialties to form appropriately sized partnership-based physician groups and operate joint specialty clinics. Encourage non-governmental entities to establish chain and group-affiliated clinics.Encourage clinics to join medical consortia, establish collaborative relationships with member units within the medical consortium, as well as independently established medical laboratory centers, medical imaging centers, sterile supply centers, and pathology centers, to achieve the sharing of medical resources.

Fourth, innovate regulatory methods. Clinics are explicitly required to establish information systems to record diagnosis and treatment data and upload such data to the medical service supervision information system. Clinics shall be incorporated into the local medical quality control system. Leveraging the information-based regulatory platform, supervision over clinic operations and medical services will be strengthened to achieve real-time monitoring and ensure the quality and safety of medical care. Pilot cities are encouraged to include the operational status of clinics in the personal credit records of their principal persons-in-charge, thereby integrating them into the personal credit system and establishing a long-term mechanism for joint disciplinary action.

First, foster synergistic efforts. The promotion of clinic reform and development shall be integrated as a key component in deepening the “decentralization, control, and service” reforms, advancing healthcare system reform, and encouraging privately-run medical institutions. Inter-departmental communication and collaboration should be strengthened, and supporting policy measures improved. The Opinion requires that by the end of June 2019, provincial health administrative departments in pilot cities, in conjunction with departments of development and reform, finance, human resources and social security, and healthcare security, shall issue specific implementation plans. By the end of September 2019, all pilot cities shall launch their pilot programs.

Second, conduct thorough evaluation, summary, and promotion. Timely assess the pilot programs, strengthen work guidance and supervisory evaluations, promote advanced experiences from pilot regions when appropriate, and formulate and introduce policy measures to foster the development of clinics across China.

Source: Bureau of Medical Administration and Hospital Management

Policy Interpretation of the "Guiding Opinions on Launching Pilot Programs to Promote the Development of Clinics"

Notice on Issuing the Opinions on Launching Pilot Programs to Promote the Development of Clinics