Deepening Medical Reform for the Benefit of All

II. Main Concepts of the Reform of the Medical and Health Care System

Over the past two years, we have determined the direction of the reform, clarified thoughts regarding the reform and learned useful lessons. To sum up, we have adhered to three issues.

First, we adhered to the basic concept of providing a basic medical and health care system as a public good to all people. Oriented as they are to the entire population, public heath care and basic medical care exhibit definite non-profit features. When pressing ahead with the reform, we must aim at safeguarding the demands of rural and urban residents for basic health care services. We must also maintain the non-profit nature of public medical and health care, stick to the principle of prioritizing prevention, emphasizing rural areas, and laying equal stress on traditional Chinese medicine and western medicine. Furthermore, we must shore up the role of government and investment, improve various mechanisms and systems, enhance supervision and administration, make institutional innovations, encourage the participation of non-government sectors and establish a basic medical and health care system that covers residents in both rural and urban areas.

Second, we adhered to the basic principle of safeguarding basic demands, enhancing grassroots construction and creating a sound mechanism.

Safeguarding basic demands refers to improving the standard of people's health and safeguarding their demands for basic medical and health care services. To meet this goal, we must be dedicated and prudent. We should establish reasonable security standards, provide effective security services and gradually improve the quality of these services. Take, for examples, the new rural cooperative medical system, the medical insurance system for urban residents and the medical insurance system for urban employees, the establishment of these three systems has led to wider basic medical security coverage, higher government subsidy for individuals and increased inpatient reimbursement. They reflect the principle of safeguarding basic demands, widening coverage and maintaining sustainability. In addition to safeguarding basic demands, we must promote the development of non-basic services, give full play to market mechanisms and encourage non-government sectors to offer optional, customized services in order to satisfy patients' different demands on all levels. These will help channel non-government funds into the health care sector and enable the government to focus on basic services.

Enhancing grassroots construction refers to enhancing the service capacity of grassroots medical and health care institutions and improving the basic medical and health care network. Currently in China, grassroots medical and health care intuitions remain incompetent and minor illnesses are sometimes mistaken for more serious conditions. The weak capacity of grassroots units has deterred some people from going to hospitals, due to the difficulty and expense involved. The international experience informs us that making grassroots units the focus of medical and health care services will reflect the principle of putting prevention first, thereby keeping people from getting sick and facilitating disease treatment. It will also exert an effective control on medical care expenses. To enhance grassroots construction, we must work from the bottom upwards, invest more money and materials in grassroots institutions, encourage more talented people to work in them and provide more advanced technologies for such institutions. Furthermore, we should clarify the functions and service modes of grassroots institutions, help them to establish a smooth service relationship with residents and help them play a leading role in health management and the treatment of both common and frequently occurring diseases. Measures should be taken to enhance grassroots construction, increase medical care reimbursement at grassroots level and improve publicity and advice services. This will ensure that medical services are available in more villages and communities and will make grassroots institutions people's first choice when they get sick.

Creating a sound mechanism refers to the construction of a medical and health care system that is not-for-profit, able to enhance service capacity and conducive to increasing service efficiency. A well-established mechanism will have a fundamental and sustainable effect on the overall development of the medical and health care industry. Institutional innovations are unavoidable if we want to safeguard basic demands and enhance grassroots construction. During the reform, we must make institutional arrangements to develop basic medical and health care services and address the relationship between the government and the market, equality and efficiency and incentive and restraining. This will mobilize all positive forces, maintain the non-profit nature of public medical and health care and promote the standardized and effective operation of the medical and health care system. We must improve the basic medical security system, essential medicine system and other new frameworks and systems. We must also establish new operation mechanisms for grassroots medical and health care institutions and public hospitals and enhance the grassroots medical care system, basic public health care system and other new service systems. We should take steps to effectively reinforce legislation in this field and guarantee a sustainable and healthy development of the health care industry. The deepening of the reform of the medical and health care system offers us a unique opportunity to better combine increased investment with system construction, work even harder to build up a sound mechanism and gradually establish a basic medical and health care system covering both rural and urban areas. It is essential that we seize this opportunity.

Third, we adhered to a basic approach, which consisted of making overall plans, highlighting key issues and making steady progress. The reform of the medical and health care system is a massive and complicated project. It must be implemented in a practical and progressive manner due to the fact that China will stay in the primary stage of socialism for a long period of time. First, we aimed to make steady progress from safeguarding basic demands to forming a structure featuring diversified hospital sponsorship. At the beginning of the reform process, we mainly focused on laying a solid foundation and took key reform measures to effectively remedy the problems which exist in the basic medical security system, essential medicine system, basic medical care system, basic public health care system and other systems. Only when the basic demands of rural and urban residents are met, can we make more effective use of the market in relation to non-basic areas, gradually form a structure featuring diversified hospital sponsorship and better address people's demands for diversified medical and health care services. Second, we aimed to make steady progress from enhancing grassroots construction to reforming our leading hospitals. Grassroots medical and health care institutions serve people directly. Introducing the reform at grassroots level will prove invaluable in solving the problems caused by the relatively backward medical and health care services in villages and communities. It will also serve to strengthen weak links, help with curing diseases, improve people's access to doctors, ease the burden on large urban hospitals and ensure a favorable climate for the reform of public hospitals. Additionally, we have actively carried out pilot reforms in county-level hospitals and major urban hospitals and will fully implement the reform after we have digested the lessons of the pilot reforms. This plan began with the safeguarding of people's basic demands and enhancing grassroots construction. It will eventually bring about the mutual stimulation and common development of grassroots medical and health care institutions, public hospitals and hospitals with diversified sponsorship. This will be conducive to the positive and steady progress of the reform of the medical and health care system.

In order to deepen the reform of the medical and health care system, we need to keep the overall situation in mind and highlight the key issues. Breakthroughs in the five major reform tasks will further promote the reform of the medical and health care system. Take the construction of an essential medicine system as an example, it is regarded as the major task of the overall reform and the key aspect of the reform at grassroots level. It will boost the development of grassroots institutions and play a positive role in helping to establish a new medicine supply system. Meanwhile, we should be aware that all reforms have different focuses at different periods. Take the construction of a basic medical security system as an example. In the early days, its major task was to ensure that more people were covered. Currently, its focus is to improve security standards. In the future, it will aim to promote institutional innovations, improve handling services and promote other reform measures. Only when we identify the key issues and determine the correct starting point, can we get twice the result with half the effort and magnify the effects of the overall reform.

The reform of the medical and health care system is complicated. It requires an overall plan and a systematic arrangement. In the early days of the reform, the central government drew up a blueprint for deepening the reform up to 2020 and developed a short-term program to implement key reform tasks. First, they clarified the direction and methods of the reform and played a positive role on promoting the continuous development of the reform. Additionally, they brought real benefits to the people, stimulated enthusiasm among medical professionals, ensured that the reform could be easily understood by regulators, provided a key for the government to carry out the reform and ensured that rapid achievements were made. At the same time, during the implementation of the five major reform tasks, we insisted on balancing urban and rural development and development in different regions. We also took account of the interests of both suppliers and customers and stressed the importance of integrating prevention, treatment and rehabilitation. Furthermore, we correctly handled the relationship between the government, medical and health care institutions, pharmaceutical enterprises, medical workers and patients. These measures reflect the strategy of pursuing long-term and short-term goals and promoting comprehensive development.

To carry out the comprehensive reform of the medical and health care system, we must integrate infrastructure and system constructions. In the reform, infrastructure construction is the basis and system construction is the final aim. Increasing government investment, enhancing infrastructure construction, improving the grassroots system and offering basic services are the key planks of the reform. Improving administrative systems, enhancing operation mechanisms and optimizing the overall hospital environment are also central to the reform. Improving the medical and health care system requires that we strengthen infrastructure construction: "A workman must sharpen his tools if he wants to do his work well." Without a suitable infrastructure and sound environment, we can't ensure that people's needs are met in terms of gaining access to doctors in their neighborhoods. However, if we only focus on constructing buildings and buying equipment and neglect the cultivation of human resources, we won't be able to improve service capacity, even if we ensure that we have the best equipment. During the reform, we have enhanced infrastructure construction and the cultivation of well-trained medical and health care professionals, given prominence to human resource development and accelerated the training of general practitioners. These measures have led to the balanced development of the medical and health care industry and brought real benefits to the people.