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微信预约微信订阅号 党的十六大以来，我国卫生工作取得积极进展，覆盖城乡的医疗卫生服务体系基本形成，疾病防治能力不断增强，医疗保障覆盖人口逐步扩大，基本药物制度初步建立，卫生事业得到全面发展，人民群众健康水平显著提高。人均期望寿命从2000年的71.4岁提高到2010年的74.8岁。孕产妇死亡率逐年下降，从2002年的51.3/10万下降到2011年的26.1/10万。婴儿死亡率及5岁以下儿童死亡率持续下降，婴儿死亡率从2002年的29.2‰下降到2011年的12.1‰，5岁以下儿童死亡率从2002年的34.9‰下降到2011年的15.6‰，提前实现联合国千年发展目标，我国居民的健康水平已处于发展中国家前列。
一、卫生事业加快发展，深化医药卫生体制改革取得重大进展
2002年以来，经过抗击非典疫情的严峻考验，党中央提出了“以人为本”的科学发展观，将发展卫生事业放在了更加突出的位置，增加政府投入，加强公共卫生服务体系、基层医疗卫生服务体系和基本医疗保障制度建设。党的十七大确定了人人享有基本医疗卫生服务的奋斗目标，指明了坚持公共医疗卫生公益性质的根本方向，明确了建立基本医疗卫生制度的历史任务。2009年3月，中共中央、国务院做出了进一步深化医药卫生体制改革的重大决策，确定了2009--2020年卫生改革的制度框架、政策思路和目标任务，经过三年多的努力，五项重点改革统筹推进，取得了重大阶段性成效。
（一）基本医疗保障制度基本建立。2011年，城乡居民参加职工医保、城镇居民医保、新农合人数超过13亿，覆盖率达到95%以上，我国建立起世界上最大的医疗保障网。2003年起开展新型农村合作医疗制度试点并逐步在全国推广，覆盖面迅速扩大，全国参合人口从2003年的0.8亿增至2011年的8.32亿。新农合筹资力度逐年加大，医疗保障水平大幅提升。新农合人均筹资水平从2003年的30元提高到2011年的246元，受益人次数从2004年的0.76亿人次提高到2011年的13.15亿人次，政策范围内住院费用报销比例达到70%以上。新农合重大疾病保障机制初步建立，2012年上半年已有超过34万人次获得补偿。2003年和2005年分别建立了农村和城市医疗救助制度，2011年全国城乡医疗救助总人次达8887万，救助资金支出186.6亿元。
（二）基本药物制度从无到有建立起来。政府办基层医疗卫生机构全部配备使用基本药物并实施零差率销售。目前，正向村卫生室和非政府办基层医疗卫生机构延伸。基层基本药物价格比改革前平均下降30%。人事、分配、补偿和绩效考核等方面的基层医疗卫生机构运行新机制逐步建立。据调查，改革后财政和医保对基层医疗卫生机构收入的补偿比例达到72%，比改革前提高了22个百分点。
（三）基层医疗卫生服务体系建设显著加强。覆盖城乡的基层医疗卫生服务网络基本建成，基层医疗卫生机构软硬件都得到很大改善，基层服务网底功能逐步显现。医改三年来，基层医疗卫生机构的诊疗人次比改革前增加8.43亿，增长了28.5%。“小病在基层，大病去医院”的就医新秩序正在形成。
（四）基本公共卫生服务逐步均等化水平明显提高。国家免费向全体城乡居民提供10类41项基本公共卫生服务项目。针对特殊疾病、重点人群和特殊地区，国家实施重大公共卫生服务项目，惠及近2亿群众。国家支持8000多个公共卫生服务机构建设，公共卫生服务能力有效提升。
（五）公立医院改革试点有序推进。在17个国家试点城市、37个省级试点城市、超过2000家医院推进公立医院体制机制改革试点。探索建立现代医院管理制度，推进大卫生体制下的管办分开。北京、深圳等试点城市近期公立医院改革在取消药品加成、建立全新补偿、运行、监管机制上取得突破性进展和初步成效。全面推进预约挂号、双休日和节假日门诊、优质护理服务等便民惠民措施。开展临床路径管理，推行同级医疗机构检查检验结果互认，有效控制医药费用。以取消以药补医机制为关键环节，启动县级公立医院综合改革，统筹推进人事、分配、补偿、绩效考核等方面的改革，注重提升服务能力，构建基层首诊、双向转诊、上下联动、分工协作的就诊新格局。
二、卫生资源持续增长，基本医疗卫生服务公平性、可及性显著提高
（一）卫生总费用增加、筹资结构不断优化。据初步核算，2011年，全国卫生总费用达24269亿元，卫生总费用占GDP比重预计达5.1%。2002年以来，人均卫生总费用每年平均增长10.8%（按可比价格计算，下同）。2002年，我国卫生总费用中个人卫生支出比重高达57.7%，政府预算卫生支出和社会卫生支出分别仅占15.7%和26.6%。2011年个人卫生支出的比重下降到34.9%，政府预算和社会卫生支出的比重分别提高到30.4%和34.7%。这一结构性变化说明我国卫生筹资结构趋向合理，居民负担相对减轻，筹资公平性有所改善。
（二）卫生资源持续增长。2011年底，全国医疗卫生机构达95.4万个，其中：医院2.2万个、基层医疗卫生机构91.8万个。与2003年比较，医疗卫生机构增加14.8万个。每千人口执业(助理)医师数由2002年1.47人增加到2011年1.82人，每千人口注册护士数由2002年1.00人增加到1.66人。每千人口医疗卫生机构床位数由2002年的2.48张提高到2011年的3.81张。
（三）卫生服务利用状况显著改善。全国医疗机构门诊量由2002年的21.45亿人次增加到2011年的62.7亿人次；住院人数由2002年的5991万人增加到2011年的1.5亿人。居民看病就医更加方便，可及性显著提高，15分钟内可到达医疗机构住户比例从2003年的80.7%提高到2011年的83.3%。
（四）医药费用控制初见成效。2011年社区卫生服务中心次均门诊费用和人均住院费用比2008年分别下降13.5%和14.8%（可比价格计算，下同）。乡镇卫生院医药费用增长幅度下降。2011年公立医院次均门诊费用和住院费用均上涨2.2%，与前两年病人费用持续上涨6%以上相比，涨幅明显下降，公立医院费用控制初见成效。
（五）城乡间卫生发展差距逐步缩小。2003年我国城乡居民享有基本医疗保障的比例分别为55%和21%，城镇显著高于农村，2011年这一比例分别增至89%和97%，农村反超城镇。城乡居民健康指标差距也在缩小，孕产妇死亡率城乡之比由2002年的1：2.61缩小为2011年的1：1.05；婴儿死亡率城乡差距也从2002年的20.9个千分点下降到2011年8.9个千分点。
党的十六大以来是我国卫生事业改革发展更好、更快的时期，我们将再接再厉，攻坚克难，开拓进取，完成“十二五”时期卫生改革发展的各项任务，早日实现人人享有基本医疗卫生服务的目标。
Material for the press conference of the State Council Information Office I
The Reform and Development of China’s Health Sector
Since the 16th CPC National Congress
Since the 16th CPC National Congress, China’s health sector has experienced tremendous progress, including the primary formation of a health service delivery system in both urban and rural areas, enhanced capacity of diseases prevention and control, expanded coverage of health insurances, and the preliminary establishment of the Essential Drug System, all of which led to the comprehensive development of the health sector and significant improvement in the health status of the population. The average life expectancy rose from 71.4 in 2000 to 74.8 in 2010. The maternal mortality rate dropped from 51.3/100,000 in 2002 to 2.61/100,000 in 2011. The infant mortality rate decreased from 29.2‰ in 2002 to 12.1‰ in 2011, and the mortality rate of children under five fell from 34.9‰ in 2002 to 15.6‰ in 2011. The above figures demonstrate that China has successfully achieved the Millennium Development Goals ahead of schedule and becomes one of the leading developing countries in terms of the health status of the population.
1. The development of health sector is accelerating and healthcare reform has made significant progress.
After 2002, having gone through the battle against SARS, the CPC Central Committee put forward the Scientific Outlook on Development with people-centered views and gave higher priority to the development of health sector. The government increased investment in the enhancement of the public health service system, the grass-roots level health service delivery system and the basic medical insurance system.Then, the 17th CPC National Congress determined the goal of ensuring basic health services for all, defined the direction of providing public welfare in the health sector, and identified the historical task of building the essential health system. In March 2009, the Central Committee and the State Council made the decision to further strengthen the healthcare reform and determined its framework, policy and goals. After three years of hard work, we have made initial achievements in the following five aspects.
1) The basic health insurance system has been preliminarily established.In 2011, the population covered by employee insurance, resident insurance and the New Rural Cooperative Medical Scheme (NRCMS) reached 1.3 billion, over 95% of the total population, which made it the largest medical insurance network in the world.The NRCMS coverage has been expanding across the country since 2003 when the pilot was launched, with its insured population rising from 80 million in 2003 to 832 million in 2011.The fund pooled per capita for NRCMS increased from 30 yuan in 2003 to 246 yuan in 2011, benefiting 1.315 billion people in 2011, up from 76 million in 2004, with 70% in-patient expenses reimbursable within the policy. During the first 6 months, 2012 the NRCMS catastrophic disease insurance mechanism has been preliminarily established and more than 340,000 person times has been reimbursed. A medical relief system for rural and urban areas has been established in 2003 and 2005 respectively. By 2011, it has provided financial support of 18.66 billion yuan to 88.87 million person times.
2) The Essential Drug System has been established from scratch. Essential drugs without zero markup are offered in government-run grass-roots health institutions. Currently this practice is expanding to village clinics and other non-government-run grass-roots health institutions. In grass-roots level, the price of essential drugs has reduced by 30%. A new operation mechanism in grass-roots health institutions has formed in terms of personnel administration, drug distribution, government funding, and performance evaluation. Our investigation shows that after the healthcare reform, the proportion of government funding and medical insurance in the total revenue of a grass-roots health institution has reached 72%, up 22% before the reform.
3) The grass-roots health service delivery system has been significantly strengthened. A grass-roots health service network covering both urban and rural areas has been preliminarily established, with better facilities and personnel. After the three years of reform, visits to grass-roots health institutions have increased by 28.5%- 843 million. Treating minor diseases at grass-roots level and major diseases in hospitals has become a new philosophy among patients.
4) Equal access to public health services has evidently enhanced. The government provides 41 items of basic public health services in ten categories free-of-charge. Mega public health service programs promoted by the government targeting specific diseases, high-risk population and specific areas benefited 200 million people. And the building of more than 8000 public health service institutions is supported by the government, indicating an improvement of service capacity.
5) Public hospital pilot reform has been making steady progress. Pilot reform has been carried out in more than 2000 hospitals of 17 national level pilot cities and 37 provincial level pilot cities. Modern hospital administrative systems are tentatively established, which means the separation of administration and operation under the larger health system. In pilot cities such as Beijing and Shenzhen, recent public hospital reform has made some breakthrough and achieved preliminary progress in canceling drug markup, and establishing a brand new funding, operating and monitoring mechanism. Online registration, non-workday clinic service, and quality nursing are offered to residents of those cities. To effectively control medical expenses, clinical pathway is promoted, and recognition of medical examination and lab test results among hospitals at the same level is promoted. In order to eliminate subsidizing medical services with drug sales, we started to press ahead a comprehensive reform on county level public hospitals by reforming their personnel management, drug distribution, funding and performance evaluation, with a focus on enhancing service capacity, and establishing a new pattern featuring first diagnoses on grass-roots level, mutual referral between hospitals, cross-level hospital cooperation and division of labor.
2. Health resources continue to grow, and equity of and access to basic medical services have been significantly improved.
1) Total health expenditure (THE) is increasing and financing structure is optimizing. In 2011, the estimated THE reached 2426.9 billion yuan, 5.1% of GDP. Since 2002, THE per capita grows by 10.8% annually (calculate at comparable price, so are the following numbers). In 2002, out-of-pocket expenditure accounted for 57.7% of THE, while the government and social expenditure accounted for 15.7% and 26.6% of THE respectively. In 2011, percentage of out-of-pocket expenditure fell to 34.9%, while the proportion of government and social expenditure increased to 30.4% and 34.7%. This structural change indicates a more rational financing structure, a lighter burden for the residents and an improvement in the equality of funding.
2) The health resources continue to grow. By the end of 2011, there were 954,000 health institutions, including 22,000 hospitals and 918,000 grass-roots health institutions. There was an increase of 148,000 institutions compared with the figure of 2003. The number of registered (associated) doctors per thousand population increased from 1.47 in 2002 to 1.82 in 2011, registered nurses up from 1.00 in 2002 to 1.66 in 2011, and hospital beds up from 2.48 in 2002 to 3.81 in 2011.
3) The utilization of health services has grown significantly. The total outpatients number was up from 2.145 billion person times in 2002 to 6.27 billion in 2011, and the total inpatients number up from 59.91 million in 2002 to 1500 million in 2011. With more convenient access to health care services, the number of residents within 15 minutes walking distance radius has risen from 80.7% in 2003 to 83.3% in 2011.
4) Medical expense has been more effectively controlled. In 2011, the expenses for each outpatient visit and inpatient per capita in community health service centers have fallen by 13.5% and 14.8% from 2008 respectively (calculate at comparable price, so are the following numbers). The medical expenses in township hospitals are rising more slowly. In 2011, the expenses for each outpatient visit and inpatient per capita in public hospitals both rise by 2.2%, a significant smaller number comparing to 6% rise in the previous two years, indicating a better controlled public hospital expense.
5) The gap between urban and rural areas in health development is bridging. In 2003, 55% of urban residents were covered by a basic health insurance, while the rate for rural residents was only 22%. In 2011, the rates for urban and rural residents with insurance became 89% and 97%, with a larger percentage of rural population than urban population covered by medical insurance. The gap of health status between urban and rural areas is also closing, with maternal mortality rate gap falling from 1:2.61 in 2002 to 1:1.05 in 2011, and infant mortality rate gap falling from 20.9‰ in 2002 to 8.9‰ in 2011.
The decade after the 16th CPC National Congress has seen a rapid progress in our health sector. We would continue to make efforts to overcome difficulties, fulfill the tasks set by the 12th Five Year Plan, and achieve the goal of providing basic health services to all.
中国的新型农村合作医疗制度发展
国务院新闻办公室新闻发布会材料二
2012年是新农合制度实施十周年。十年来，在各级党委、政府的高度重视和正确领导下，有关部门通力合作，农民群众积极参与，新农合制度建设扎实推进，取得了显著成效。
一是实现全面覆盖，参合率稳定在较高水平。新农合制度自2003年开始试点，到2008年实现了全面覆盖，参合人口数从试点初期的0.8亿，逐年稳步增长，截至2012年6月底，参合人口达到8.12亿人，参合率达到95%以上。
二是筹资水平不断提高，保障能力逐步增强。新农合人均筹资水平由2003年的30元提高到2011年的250元。2011年，有13.15亿人次从新农合受益，次均住院补偿额为1894元。2012年，新农合政策范围内住院费用报销比例进一步提高到75%左右，最高支付限额提高到全国农民人均纯收入的8倍以上，且不低于6万。
三是确立了较为完善的符合中国国情的制度框架和运行机制。新农合建立了由政府领导，卫生部门主管，相关部门配合，经办机构运作，医疗机构服务，农民群众参与、费用补偿公开的管理运行机制；明确了以家庭为单位自愿参加，个人缴费、集体扶持和政府资助相结合的筹资机制；形成了以住院大额费用补偿为主，并逐步向门诊统筹扩展的统筹补偿模式，2011年在90%以上的地区开展了门诊统筹，参合农民受益范围更加广泛；建立了参合农民在统筹区域内自主就医、即时结报的补偿办法，2011年，已有超过2/3的省（区、市）实现新农合省市级定点医疗机构即时结报；建立了基金封闭运行机制和多方参与的监管机制；深入推进支付方式改革，2011年已有超过80%的地区开展了不同形式的支付方式改革，新农合制度合理有效控制医药费用的作用开始显现；积极推进商业保险机构参与经办新农合服务工作，探索“管办分开、政事分开”的新农合管理运行机制。
今后一个阶段，结合中央深化医改的总体部署，我们将重点推进以下几方面的工作：
一是稳步提高新农合筹资标准，2012年新农合人均筹资水平将达到300元左右，到2015年，新农合政府补助标准将提高到每人每年360元以上，个人缴费标准适当提高，并逐步探索建立与经济发展水平相适应的筹资机制。
二是加强新农合精细化管理，严格基金使用管理，加强对定点医疗机构的监管；全面推行新农合省市级定点医疗机构和村卫生室的即时结报工作，逐步推行省外异地结报；加快新农合信息化建设，结合居民健康卡的发放，快速推进“一卡通”试点工作；加强新农合与医疗救助等相关信息系统的互联互通，推行“一站式”即时结算服务。
三是推进提高重大疾病医疗保障水平试点工作，将儿童白血病、肺癌等20种疾病纳入保障范围。贯彻落实六部委《关于开展城乡居民大病保险工作的指导意见》，做好大病保险与新农合大病保障工作的衔接，优先将这20种重大疾病纳入大病保险范围。
四是加快推进新农合支付方式改革，用总额预付、按病种、按单元、按人头等支付方式替代按项目付费，控制费用，规范医疗服务行为，提高基金绩效。
五是加快推进委托有资质的商业保险机构参与新农合经办服务工作，扩大商业保险机构经办新农合的规模，建立新农合管理、经办、监管相对分离的管理运行机制。
六是认真总结新农合制度实施10年来的经验，推动《新农合管理条例》及早出台，尽快将新农合纳入法制化管理轨道。
实践证明，新农合制度符合农村实际，是现阶段农村居民基本医疗保障制度的重要实现形式。十年来，新农合制度从无到有，由小到大，对保障农民健康发挥了重要作用。作为新农合制度的主管部门，卫生部门将会同有关部门继续扎实推动新农合制度发展，促进农村居民健康水平稳步提高。
Material for the press conference of the State Council Information Office II
The Development of
China's New Rural Cooperative Medical Scheme
2012 marks the tenth anniversary of the implementation of the New Rural Cooperative Medical Scheme (NRCMS). Over the past decade, with Party Committees and governments at all levels attaching great importance to NRCMS and under their strong leadership, relevant departments have given full cooperation and farmers have actively participated in the scheme. Therefore, NRCMS has made solid progress and remarkable achievements.
First, NRCMS has almost realized universal coverage with the participation remaining stable at a high level. Since the pilot programs in 2003, NRCMS achieved a comprehensive coverage in 2008. The participation number has grown steadily every year, from 80 million in the early stage of the pilot programs to 812 million by the end of June 2012, with over 95% of the targeted population covered.
Second, the financing continues to grow and the protection level improves gradually. The per capita cost of the insurance package increased from 30 yuan in 2003 to 250 yuan in 2011. In 2011, 1.315 billion person-times benefited from NRCMS with average hospitalization compensation amounting to 1,894 yuan. In 2012, the reimbursement for hospitalization costs will reach around 75%, with an annual payment ceiling of no less than 8 times of farmer’s per capita net income (no less than 60,000 yuan).
Third, a comprehensive institutional framework and operational mechanism is established in line with China's national conditions, i.e. led by the government; in the charge of health departments; supported by relevant sectors; operated by the insurance agencies; with services provided by the health institutions; participated by farmers and transparent reimbursement of the medial costs. NRCMS is co-financed by individual contributions, farmers’ cooperatives and both central and local governments, with families participating on a voluntary basis. The coordinated compensation focuses on reimbursement for hospitalization costs and gradually expands to out-patient care. In 2011, over 90% of areas carried out out-patient compensation which benefited the farmers in a wider range. The insured farmers can choose independently the designated hospitals for treatment and get real-time reimbursement. In 2011, over 2/3 of provinces (autonomous regions or municipalities) adopted real-time reimbursement in their designated provincial and municipal hospitals. The funds are operated in closed-end mechanism and supervised by multi-sectors. In 2011, over 80% of areas carried out various payment reforms, which supported NRCMS to effectively control the medical costs. Commercial insurance agencies are encouraged to involve in the operation of NRCMS, which explores the operational mechanism of “separating supervision from operation, and separating government administration from medical institutions”.
In the next stage, integrating with the overall arrangements for deepening the reform by the central government, we will press ahead in the following aspects:
First, the financing for NRCMS should grow in a steady pace. The fund pooled per capita will reach 300 yuan by 2012. By 2015, government subsidies will reach 360 yuan per person per year. The individual contribution will grow as appropriate. A financing mechanism that suits the economic development in China will be gradually established.
Second, the NRCMS should be meticulously managed, including strict utilization of the funds and enhancing supervision on designated hospitals. Real-time reimbursement should be established in designated provincial and municipal hospitals as well as village clinics across the country. Reimbursement for medical costs outside of one’s registered province should be gradually realized. The information engineering of NRCMS should be accelerated, in combination with distributing the health cards for the residents, in order to press ahead the all-in-one-card pilot program. The information systems of NRCMS and related schemes such as the medical assistance scheme should be better synchronized, to provide one-stop real-time compensation service.
Third, the pilot program of compensation for major diseases should be promoted, including 20 diseases such as child leukemia, lung cancer etc. The Guiding Opinions on the Supplementary Insurance of Major Diseases for Urban and Rural Residents collectively issued by six ministries should be implemented. Supplementary Insurance should be well connected with NRCMS policy on the benefits for major diseases and should cover the mentioned 20 major diseases as preference.
Fourth, NRCMS payment reforms should be accelerated, in terms of using pre-payment of total medical cost, disease-based payment, service unit-based payment and capitation to replace fee-for-service. The reforms aim to control medical costs, modify health service behaviors and enhance fund performance.
Fifth, the engagement of entrusted qualified commercial insurance agencies in the operation of NRCMS should be accelerated; so as to establish an operational mechanism that to some degree separates the management, operation and supervision of NRCMS.
Sixth, the experience of the last decade should be diligently studied to facilitate the formulation of the Regulations on Administration of New Rural Cooperative Medical Scheme. The administration of NRCMS should be legislated as soon as possible.
It has been proven that NRCMS, a suitable mechanism for rural China, is an important crystallization of basic medical insurance system for rural residents in current circumstances. In the last decade, NRCMS has grown up from a new born baby and is now playing a vital role for the health of the rural residents. As the competent authority of NRCMS, the Ministry of Health will collaborate with other related ministries to continue to promote its development and steadily improve rural residents’ health status.