National Health Commission Launches Community Hospital Pilot Program in 20 Provinces and Municipalities

Recently, the Department of Primary Health Care issued the “Notice of the General Office of the National Health Commission on Launching Pilot Programs for Community Hospital Construction.” To implement the spirit of the 19th National Congress of the Communist Party of China and the strategic deployment of the Healthy China Initiative, and to meet the public’s demand for basic medical and health services, pilot programs for community hospital construction are proposed in the following eligible districts.

Specifically, the current pilot regions include the following 20 provinces, municipalities, and autonomous regions: Hebei Province, Shanxi Province, Inner Mongolia Autonomous Region, Heilongjiang Province, Jiangsu Province, Anhui Province, Jiangxi Province, Shandong Province, Henan Province, Hubei Province, Hunan Province, Guangdong Province, Guangxi Zhuang Autonomous Region, Hainan Province, Chongqing Municipality, Sichuan Province, Yunnan Province, Shaanxi Province, Gansu Province, and Qinghai Province.

What are the main tasks of the pilot program? What is its significance?

I. Significance of the Pilot Program

Launching pilot programs for the construction of community hospitals is a powerful lever to enhance the capacity of primary healthcare services, a significant measure to advance the development of a tiered diagnosis and treatment system, and an intrinsic requirement for building a high-quality and efficient healthcare service system.

Promoting pilot programs for the development of community hospitals helps to reasonably expand the service functions of primary healthcare, enhances the influence and social status of primary healthcare institutions, boosts the professional confidence and sense of belonging among grassroots health workers, and improves residents’ trust in and utilization of primary healthcare facilities.

II. Pilot Principles

(I) Adhere to the principles of centering on residents’ health, taking development as the main thread, and meeting the public’s basic needs for medical and health services as the starting point, so as to further enhance the public’s trust in and sense of gain from primary healthcare institutions.

(2) Adhere to the principle of starting with pilot programs and expanding steadily. While demonstrating courage in innovation and accountability by launching community hospital pilots, ensure a prudent and orderly approach with sustained effort. Establish facilities only when they meet maturity standards, prioritizing quality over quantity.

(3) Adhere to the functional orientation of combining prevention and treatment in community hospitals and their public welfare nature. After being additionally designated as a “Community Hospital,” their operational nature shall remain unchanged, and existing levels of fiscal compensation and preferential policies shall not be reduced or diminished.

III. Pilot Scope

(1) Taking into account the economic and social development of different regions and the level of grassroots development, on the basis of voluntary application,Pilot programs were launched in 2019 across 20 provinces (autonomous regions and municipalities), including Hebei, and steadily advanced in 2020 on the basis of summary evaluations.

(2) The scope of the pilot program within each province shall be determined by the respective provincial authorities based on local conditions; the pilot may be conducted in a single prefecture-level city or across the entire province.

(3) Pilot institutions shall primarily consist of community health service centers, with encouragement for township health centers that meet the necessary conditions to carry out pilot programs.

IV. Selection Criteria for Pilot Institutions

In principle, primary healthcare institutions in pilot areas that meet the following criteria are eligible to apply for designation as pilot institutions:

(1) District- and county-level Party committees and governments attach importance to and support the development of community hospitals, increase financial investment, deepen institutional and mechanistic reforms, and create a favorable environment for such development; in particular, regular fiscal appropriations shall not be reduced after community hospitals are officially designated as such.

(II) Primary healthcare institutions possess strong service capabilities and serve a population of a certain scale, with no fewer than 30 actually open beds, a bed occupancy rate of no less than 75%, and a gross floor area of clinical buildings of no less than 3,000 square meters.

(3) Strengthen coordination with the “High-Quality Services at the Grassroots Level” campaign. Institutions that meet the recommended criteria set forth in the Service Capability Standards for Community Health Centers (2018 Edition) and the Service Capability Standards for Township Health Centers (2018 Edition) shall be given priority as pilot institutions.

V. Main Construction Tasks

Community Health Service Centers and Township Health Centers serving as pilot sites primarily carry out development in the following areas:

(1) Addressing weaknesses and improving the setup of clinical departments and equipment allocation.

First, in terms of clinical departments, on the basis of the departmental setup requirements in the Basic Standards for Community Health Service Centers, at least five secondary-discipline departments shall be established from among the following specialized departments: internal medicine, surgery, gynecology, pediatrics, stomatology, ophthalmology, otolaryngology, psychiatry (psychology), palliative care (hospice care), and hemodialysis. Where conditions permit, some tertiary-discipline departments may also be established.

Second, in departments such as medical technology, at a minimum, establish a Department of Clinical Laboratory (Laboratory), Department of Medical Imaging, Electrocardiogram (ECG) Room, and Western (Chinese) Pharmacy. Facilities with appropriate conditions may also set up functional examination rooms such as a Gastroscopy Room. Services for departments including diagnostic imaging and clinical laboratory testing may be provided by third-party institutions or higher-level medical institutions within the medical consortium.

Third, in other departments, it shall be equipped with a treatment room, an injection room, an infusion room, a procedure room, and an observation room. A Department of Transfusion Medicine or a blood bank shall be established in accordance with relevant regulations and clinical blood use requirements. Meanwhile, the following administrative departments shall be established at a minimum: a General Office (Party Building Office), a Medical Affairs Department (Quality Management Department), a Nursing Department, a Hospital Infection Control Department, a Public Health Management Department, and a Finance and Assets Department. Where conditions permit, an Information Technology Department, a Medical Records Room, and other facilities may also be established.

Fourth, equip facilities with devices corresponding to the diagnostic and therapeutic specialties offered, and gradually achieve homogenization of services.。

(2) Focus on key areas to enhance the capacity of basic medical services.

First, enhance the diagnostic and therapeutic capabilities for common and frequently occurring diseases in outpatient settings, provide services for the diagnosis, treatment, rehabilitation, and nursing care of general diseases, and encourage the establishment of specialized departments tailored to public needs.

Second, strengthen the construction of inpatient wards and rationally allocate beds, with a recommended configuration of 1.0–1.5 beds per 1,000 population served. Community hospitals should primarily provide beds for geriatric care, rehabilitation, nursing, and palliative care. Where conditions permit, they are encouraged to establish beds for internal medicine, surgery, gynecology, and pediatrics, as well as to offer home hospital beds, thereby continuously improving bed utilization efficiency.

Third, enhance the capacity of Traditional Chinese Medicine (TCM) services and medical rehabilitation, promote comprehensive TCM service models, widely disseminate and apply appropriate TCM technologies, and provide the public with TCM-specific services.

Fourth, strengthen the construction of medical quality, take medical quality and safety as the bottom line, implement the core systems of medical quality and safety, standardize medical practices, and strictly manage internal operations of healthcare institutions.

5. Actively participate in the development of medical consortiums to facilitate the downward flow of high-quality medical resources, strengthen support from tertiary hospitals within the consortium for primary healthcare institutions in terms of resources and technology, and improve the quality of primary healthcare services. Encourage the establishment of joint wards with tertiary hospitals within the medical consortium.

(3) Deepen reforms and enhance the comprehensive service level within the jurisdiction.

First, strengthen the integration of prevention and treatment, implement the National Basic Public Health Services Program in accordance with service standards, promote the integrated development of prevention, treatment, and management for major chronic diseases, and gradually achieve standardized management.

Second, leverage the demonstrative and benchmarking role of community hospitals by undertaking functions such as regional primary healthcare management (physical examination) centers, rehabilitation and nursing centers, hospice and long-term care centers, and primary healthcare personnel training centers, thereby reflecting the agglomeration effect of regional primary healthcare resources.

Third, promote reform and innovation to optimize grassroots operational mechanisms. Implement healthcare reform policies regarding institutional compensation, personnel recruitment, and performance-based assessment and distribution, thereby fostering a dynamic operational environment that motivates medical staff and further earns residents’ recognition and trust. Fourth, strictly comply with national laws, regulations, rules, and technical standards; establish and improve various institutional systems, including those for grassroots party organization development and hospital financial management.

VI. Work Procedures and Naming Principles

Primary healthcare institutions participating in the community hospital pilot program shall be developed in accordance with established construction requirements. Upon passing evaluation by the provincial-level health administrative department, they may display a “Community Hospital” sign. In principle, the second name shall adopt the format of “XX County (City/District) XX Community Hospital,” “XX County (City/District) No. X Hospital,” or “XX Branch of XX County (City/District) XX Hospital”; the term “Community” may be omitted. The primary names of community health service centers and township health centers shall remain unchanged.

After being officially designated as a community hospital, the facility may perform Level 1 and Level 2 surgeries. Those assessed to meet the standards of a secondary-level hospital may perform Level 3 and lower-level surgeries. Community hospitals performing surgical procedures must establish operating rooms and an anesthesiology department; pathological diagnosis services may be provided by third-party institutions or higher-level medical institutions within the same medical consortium.

VII. Schedule

(1) Launch pilot programs.Pilot provinces shall determine the scope and areas of pilot programs within their respective provinces (autonomous regions, and municipalities) based on local conditions, and study and formulate implementation plans and scopes for the 2019 pilot work. By April 10, 2019, all pilot provinces shall submit their implementation plans for the pilot work and the list of pilot areas to our Commission for record-filing.

(II) Organization and Implementation.Pilot regions shall select pilot institutions in accordance with the implementation plan and on a voluntary basis, and guide these institutions in completing the primary construction tasks. The provincial health administrative departments are responsible for supervising, guiding, and evaluating the pilot work; conducting operational monitoring of the pilot work in terms of institutional operations, service delivery, and public satisfaction; and coordinating with relevant departments to secure supportive policies for the pilot regions and institutions.

(3) Assessment and Listing.Provincial health administrative departments shall organize experts to evaluate pilot institutions by October 31, 2019. For primary healthcare institutions that have completed construction tasks and met the standards, the health administrative department with the corresponding approval authority shall, in accordance with the relevant provisions of the Regulations on the Administration of Medical Institutions, promptly endorse the name “Community Hospital” on their Medical Institution Practice License and hang a Community Hospital signboard. By November 30, 2019, all pilot provinces shall submit summaries of their community hospital construction pilot work to this Commission.

VIII. Work Requirements

(I) Unify thinking and raise awareness. Health commissions at all levels must fully recognize the significant importance of launching pilot programs for community hospital construction, strengthen leadership, meticulously organize implementation, and ensure that pilot work proceeds smoothly and in an orderly manner. Pilot institutions must seize opportunities, enhance management, boldly explore new approaches, innovate proactively, and strive to achieve tangible results.

(II) Improve working mechanisms. Pilot work shall, in principle, be organized and implemented at the county (city, district) level. Health departments in pilot areas shall, under the leadership of local governments, formulate implementation plans for the pilots and initiate pilot activities. Provincial-level health administrative departments shall be responsible for supervising, guiding, assessing, and evaluating the pilot work. In accordance with the objectives of the pilots and the requirements for deepening healthcare system reform, relevant departments shall be coordinated to secure supportive policies for pilot areas and institutions, allow pilot medical institutions to independently adjust the proportion of basic and performance-based incentive compensation, increase the share of performance-based incentive compensation, and regularly report progress on pilot implementation to our Commission.

(3) Timely Summary and Promotion. Given that the pilot program for community hospital construction covers a broad scope, attracts significant attention from society and the public, and faces considerable disparities in the foundational conditions of primary healthcare institutions across different regions, all localities must adhere to the principles of emancipating the mind and seeking truth from facts. They shall promptly study and resolve difficulties and challenges encountered during the pilot implementation, thereby accumulating valuable experience for establishing and improving a primary healthcare service system that aligns with the medical and health needs of the population. In cases where existing policy measures in pilot regions are inconsistent with this Notice, the provisions of this Notice shall prevail. The National Health Commission will organize guidance and inspections on the progress of the pilot work at appropriate times.