Guiding Opinions of the General Office of the State Council on Comprehensive Reform Pilot of Public Hospitals in the City (Guo Ban Fa (2015) No. 38)

To people’s governments of all provinces, autonomous regions and municipalities, and ministries, commissions and institutions directly under the State Council:



The comprehensive reform of public hospitals in the city is an important task to deepen the reform of the medical and health system. Since the start of reform of the public hospitals in pilot cities in 2010, all pilot cities have been actively exploring, have made obvious progress in reform, have accumulated valuable experience and have laid a foundation for expanding and deepening the reform pilots. However, public hospital reform is a long, arduous and complicated system project, and currently there are some more prominent contradictions and problems. The profit-seeking mechanism of public hospitals is to be got rid of; external administration and internal management level of public hospitals are to be improved; the personnel salary system in line with the industry characteristics is to be perfected; the structural layout is to be optimized. A reasonable medical order has not been formed yet; the burden of medical treatment on the people is still very heavy, and other problems are urgent to be solved step by step through system and mechanism reform. According to the spirit of the 18th national congress of the CPC, the second, third and fourth plenary sessions of the 18th CPC central committee, and the requirements of the Opinions of the CPC Central Committee and State Council on Deepening the Reform of the Medicine and Health Service System, and the Notice of the State Council on Printing and Issuing the Plan on Deepening the Medicine and Health Service System during the 12th Five-year Plan Period & Implementation Program (Guo Fa (2012) No. 11), and in order to strengthen guidance to the comprehensive reform pilot of public hospitals in the city (public hospitals in cities of prefecture level or higher level prefectures), the following opinions are hereby made upon the approval of the State Council.

1. General Requirements


(1) Guiding Ideology. We shall thoroughly implement the spirit of the 18th national congress of the CPC, the second, third and fourth plenary sessions of the 18th CPC central committee, focus on solving the medical treatment problem of the masses in accordance with the decision and arrangements of the CPC Central Committee and the State Council, take deepening medical reform as an important measure to protect and improve people’s livelihood, consider fairness, accessibility and the masses’ benefit as the starting point and foothold of the reform, and accelerate the reform of urban public hospitals. We should give full play to the commonweal character and main role of public hospitals, truly implement the government’s responsibility in establishing hospitals, make efforts to promote reform in the management system, compensation system, price system, personnel compilation, income distribution, medical regulation and other systems and mechanisms. We should also plan and optimize the layout of medical resources, build a reasonable medical order, promote the establishment of non-government hospitals and strengthen personnel training, and form replicable and promotable practical experience for continuing deepening the reform of public hospitals.


(2) Basic Principles


Adhere to reform linkage. We should promote the linkage among medical treatment, medical insurance and medicine; drive the simultaneous reform of public medical institutions in the region; strengthen coordination and distribution of responsibilities between public hospitals and grass-level health institutions, seek for coordinated development between public hospitals and non-government hospitals, create a good public hospital reform environment, and enhance the systemic feature, integrity and cooperativity of reform.


Adhere to classification guidance. We should clarify the functional position of public hospitals in the city; and give full play to their backbone role in providing basic medical service, diagnosis and treatment of emergency and difficult illness. Staring from reality, we should implement differentiated reform policies in terms of medical insurance payment, price adjustment, performance evaluation and other aspects to public hospitals of different regions, different levels and different types.


Adhere to exploration and innovation. On the premise of following the reform direction and principle determined by the Central Committee, we should encourage the local governments to carry forward the spirit of pioneering, to explore boldly, to be keen on innovation, to break through policy and profit barriers and to establish a realistic institution mechanism.


(3) Basic Objectives. We shall break the public hospital’s profit-seeking mechanism, implement the governments’ leadership responsibility, guarantee responsibility, management responsibility, and supervision responsibility, give full play to the market mechanism role, set up a new operation mechanism maintaining public welfare, mobilizing the initiative and protecting sustainability; build a medical service system featuring reasonable layout and coordination and distribution of responsibilities, and a medical treatment pattern of hierarchical diagnosis and treatment, so as to make it easier for the masses to see the doctor and make medical service more affordable. In 2015, we should further expand the comprehensive reform pilots of public hospitals in the city. By 2017, the urban public hospital comprehensive reform pilot shall be comprehensively carried out; a modern hospital management system shall be initially established; the medical service system ability shall be obviously improved; the medical treatment order would be improved; the proportion of ordinary outpatient visits in third-level urban hospitals in the total hospital visits of the medical institutions would be significantly reduced; unreasonable growth in medical expenses would be effectively controlled; the growing rate of total health expenses and that of the local GDP coordinate with each other; the masses’ satisfaction will rise remarkably; the medical expense burden would be reduced obviously; and generally the proportion of personal expenditures for sanitation in the total expenditures for sanitation would be reduced to below 30%.


(4) Basic Paths. We should establish a modern hospital management system, speed up the transformation of government functions; promote separation of management from enforcement; perfect the legal person governance structure and governance mechanism; reasonably define the relationship between rights and interests of the government, public hospitals, the society and the patient. We should establish a scientific public hospital compensation mechanism; take putting a stop to the mechanism of charging more for medicines to make up for low prices for medical services as the key circle, through reducing costs of drugs and consumables, canceling drug price addition, deepening reform in the medical insurance payment method, standardizing the use of drugs and medical behaviors and other measures, leave enough space, rationalize the medical service prices of public hospitals, and set up a salary system in line with the characteristics of the medical industry. We should also build a service system under coordinated development, take the construction of basic service ability as the foundation and the coordination and distribution of responsibilities as support, comprehensively apply the measures of law, social insurance, administration and market, optimize the resource allocation and guide reasonable medical treatment.


We should take the reform of the management system, operating mechanism, service price adjustment, medical insurance payment, personnel management, income distribution, etc. as the key tasks. Relevant national and provincial departments should strengthen the guidance, give policy support and delegate relevant authorities to pilot cities.


2. Make a Reform in the Management System of the Public Hospital

(5) Establish an efficient state-owned hospital system. We should separate government from the institutions, reasonably define the government’s supervision responsibility as the investor and the independent operation and management rights of public hospitals as a public institution. We should actively explore the multiple forms of effectively realizing separation of management from enforcement in public hospitals, clarify the management rights and duties of the government and relevant departments, and build a power operating mechanism in which decision-making, enforcement, and supervision are divided but restrict each other. We should also establish a coordinated, unified and efficient hospital operation system. All pilot cities can incorporate a management committee led by the government personnel and composed of relevant government departments, some deputies to the people’s congress, CPPCC members and other stakeholders, which shall fulfill the government’s function of establishing hospitals, shall be responsible for the formulation of the public hospital’s development planning, constitutions, the implementation of major projects, financial investment, operation supervision, performance evaluation and so on, and shall clarify the offices to undertake the daily work of the committee.


Competent administrative departments at all levels should make innovation in the management method, transform from direct management of public hospitals to industry management, strengthen the development, supervision and guidance of policies and regulations, industry planning, standards and specifications. The health and family planning departments and education sector should actively explore the reform in the management system of college and university affiliated hospitals.


(6) Implement the autonomy of public hospitals. We should improve the legal person governance structure and governance mechanism of public hospitals, and put the public hospitals’ autonomies including personnel management, internal allocation, and operation management into practice. We should take effective forms to establish internal decision-making and restrictive mechanisms in public hospitals, adopt group discussion in the case of major decision-making, appointment and removal of important leaders, implementation of major projects and the use of large sums of funds, and execute according to the established procedures. We also should implement opening hospital information, give play to the function of the employees’ assembly, and strengthen democratic management. Moreover, we shall complete the hospital president selection and appointment system, encourage the implementation of hospital president appointment system, highlight professional management ability, and promote the construction of professionalization. We should bring into effect the target responsibility assessment and accountability system during the term of office of hospital presidents. For public hospitals with diversified assets and trusteeship and medical consortiums, a hospital level council can be set up.


(7) Establish a public welfare-oriented assessment mechanism. The health and family planning department or special public hospital management institution shall develop a performance evaluation index system highlighting functional positioning, fulfilling of responsibilities, cost control, operation performance, financial management, cost control, social satisfaction and other assessment indicators, organize public hospital performance assessment regularly as well as hospital president annual and on-duty target responsibility assessment, and the results shall be published to the society. Moreover, the assessment results shall be linked up with the hospital’s financial aid, medical insurance payment, total wages, hospital president’s salary, appointment and removal, rewards and punishments, etc., then an incentive and constraint mechanism shall be formed.


(8) Strengthen the fine management of public hospitals. We should reinforce the hospital’s financial accounting management, strengthen cost accounting and control, and implement the third-level public hospital chief accountant system. We should promote the socialization of public hospital logistics service; strengthen medical quality management and control, and standardize clinical examination, diagnosis, treatment, and use of drugs and implanted (interventional) medical devices. We should comprehensively carry out convenience-for-people and people-benefit services, strengthen the appointment and individual diagnosis management, constantly optimize the medical service process, and improve the patient’s medical environment and medical service experience. We should deeply develop quality nursing service; optimize the practical environment, respect medical staff’s work, safeguard the legitimate rights and interests of medical personnel; improve the mediation mechanism, encourage the medical institution and physicians to purchase medical liability insurances and other medical practical insurances, and build a harmonious doctor-patient relationship.


(9) Perfect the multiple-side supervision mechanism. We should strengthen the medical service supervision function of the health and family-planning department (including TCM management departments), unify the planning, access and supervision, and establish a localized and industry management system. We should intensify accounting supervision over the hospital’s economic operation and financial activities, and strengthen supervision through auditing. We should strengthen publication of hospital information, establish a regular announcement system, use the credit system to collect data, and focus on disclosing the financial situation, performance appraisal, quality safety, price, medical expenses and other information. Relevant information of second-level or higher level public hospitals shall be published to the society every year. Moreover, we should give full play to the role of medical industry associations, academies and other social organizations, strengthen industry self-regulation and supervision and professional ethics construction, guide the medical institutions to operate according to law and regulate themselves strictly. We also shall give play to the supervision role of the NPC, supervisory organs, auditing body, and the society; explore third-party professional organizations’ evaluation to public hospitals and strengthen social supervision.

3. Establish a new operation mechanism of public hospitals


(10) Put a stop to the mechanism of charging more for medicines to make up for low prices for medical services. All public hospitals in pilot cities shall promote separation of clinic from pharmacy, actively explore a variety of effective ways to reform the mechanism of charging more for medicines to make up for low prices for medical services and cancel drug price addition (excluding Chinese herbal pieces). We should change the compensation channels of public hospitals including service charge, drug price addition income and government subsidies into service charge and government subsidies two channels. We shall establish a scientific and reasonable compensation mechanism through adjusting the price of medical service, increasing government investment, reforming the payment method, reducing the operation costs of hospitals, and other measures. Expenses used in the storage and management of medicines, loss of medicines, etc. in the hospital shall be listed in the hospital’s operation cost and be compensated. We should adopt comprehensive measures to cut off the profit chain between the hospital, medical personnel and drugs, improve the medical expense control system, and strictly control the unreasonable growth of medical expenses. With the methods of mass-based control and structure adjustment, we shall change the income structure of public hospitals, improve the proportion of income of technical service in business income, reduce the income proportions of medicines and healthcare materials and ensure the benign operation and development of public hospitals. We should strive to have the proportion of medicine income (excluding Chinese herbal pieces) in that of public hospitals in pilot cities reduce to about 30% in general by 2017 and the expense on healthcare materials consumed in every 100 yuan of medical income (excluding medicine income) down to below 20 yuan.


(11) Reduce the costs of medicines and medical supplies. We shall reform the supervision methods of drug prices and standardize the price behavior of high-value medical consumables. We should reduce the circulation links of medicine and medical consumables and standardize the circulation operation and enterprises’ self pricing behavior. Moreover, we should fully implement the Guiding Opinions of the General Office of the State Council on the Improvement of the Public Hospitals Centralized Procurement of Drugs (Guo Ban Fa [2015] No. 7), allow pilot cities to complete procurement independently on the provincial centralized drug procurement platform with a city as the unit on the premise of upholding the principle of facilitating to putting a stop to the mechanism of charging more for medicine price to make up for low prices for medical services, reducing the false high price of medicines, preventing and restraining corruptions, and promoting pharmaceutical production and circulation as well as enterprise combination and reorganization. The transaction price in pilot cities shall not be higher than the provincial tender price. If the transaction price in the pilot city is obviously lower than the provincial tender price, then the provincial tender price should be adjusted according to the transaction price in the pilot city. According to reality, we can encourage inter-provincial, cross-regional, and specialized hospital cooperative purchasing. High-value medical supplies must be purchased through the sunshine purchase of the provincial centralized procurement platform and transacted openly online. We encourage purchasing domestic high-value medical supplies on the premise of ensuring quality. Moreover, we should strengthen drug quality and safety supervision, be strict with market access and drug registration approval, so as to guarantee the supply, distribution and quality safety of drugs. We should take a variety of forms to promote the separation of medical service and drugs. Patients can choose to purchase medicine from the outpatient pharmacy or in retail pharmacies with the prescription at will. We also should reinforce the rational use of drugs and prescription supervision, take prescription negative list management, prescription comment and other methods to control the unreasonable use of antibacterial drugs, and strengthen intervention over the clinical use of hormones, antitumor drugs and excipients drugs.


(12) Rationalize the price of medical services. On the premise of ensuring the positive operation of public hospitals, medical insurance funds can afford, and the overall burden of the masses does not increase, the pilot city should work out the reform plan on the medical service price of public hospitals in 2015. While reducing costs of drugs and medical supplies and cancel drug price addition, pilot cities should, through scientific calculation, lower down the examination and treatment price when using large medical equipment, reasonably adjust and raise the price of the medical service that reflects the technical work value of medical staff, especially the price of diagnosis, surgery, nursing, beds, Traditional Chinese Medicine, and other service items. For the reform of price formation mechanism, we should phase down the quantity of medical service items pricing by item, actively explore pricing by disease and by service unit. We should gradually straighten out the price rations between different levels of medical institutions and medical service items, and establish a price dynamic adjustment mechanism based on structure changes of costs and income. The examination price with large equipment invested by government in the public hospital shall be set by the cost after deducting the depreciation; for large equipment purchased with loans or collected money in line with the planning and relevant policies, the government shall buy back with the price after deducting depreciation, and the examination price shall be reduced in the period when there is difficulty in repurchase. Policies about medical service price, medical insurance payout, hierarchical diagnosis and treatment, etc. should link up each other. We should strengthen supervision over medical price, establish a price monitoring and early warning mechanism, and timely prevent price changes. We also should intensify investigation and punishment over price monopoly, fraud and other violations.


(13) Implement the government’s investment responsibility. Governments at all levels should put into practice the investment in the basic construction of public hospitals in line with the regional health planning, equipment procurement, development of key disciplinary areas, personnel training, expense for retirees in line with the national policy, subsidies to policy-rated losses, etc.; give specific grants to the public health tasks undertaken by public hospitals, and guarantee the expenditures for public services designated by the government including first aid, disaster relief, foreign aid, rural support, border area support, and partner assistance between urban and rural hospitals. Governments at all levels should also put into practice the preferential policies invested to institutes of traditional Chinese medicine (ethnic hospitals), infectious disease hospitals, mental hospitals, occupational disease prevention and treatment hospital, maternity hospitals, children's hospitals, rehabilitation hospitals and other specialist hospitals. The governments should also reform the way of financial subsidies, strengthen the linking relationship between financial subsidies and the performance assessment results of public hospitals; and improve the government’s purchase service mechanism.


4. Strengthen medical insurance payout and monitoring role


(14) Deepen the reform of the way of medical insurance payout. We should give full play to the basic role of basic medical insurance, reinforce the budget for revenues and expenditures of medical insurance funds, establish compound payment methods including the major way of payment by type of disease, as well as payment per capita, and payment by service unit, and phase down payment by item. We should encourage the way of payment by diagnosis related group system (DRGs). In 2015, the reform of medical insurance payout should cover all the public hospitals in the region and gradually cover all medical service. We should take full into account medical service quality and safety, basic medical demands and other factors to develop clinical pathway and speed up clinical pathway management. By the end of 2015, the number of cases implementing clinical pathway management in pilot cities should reach 30% of the number of cases discharged in public hospitals; we should expand the number of disease types paid by type of disease and the coverage of in-patient paying by type of disease synchronously, and achieve the number of disease types paid by type of disease is not less than 100. We should speed up the establishment of an open and fair negotiation mechanism and risk sharing mechanism among all types of medical insurance handling institutions and designated medical institutions. We also should give full play to the regulation, guide, supervision and restriction role of various types of medical insurances over medical service behavior and expenses, effectively control the medical cost, and gradually extend the medical insurance’s service supervision over medical institutions to the supervision over medical personnel’s medical service behavior. We should utilize the professional knowledge of commercial health insurance companies, give play to the role of its third-party buyers, and help to ease the information asymmetry of doctors and patients and contradictions between doctors and patients.


(15) Gradually improve the performance of security. We should gradually improve the security level of medical insurance, and gradually narrow the gap between the proportion of in-hospital expense payment within the scope of policy and the proportion of actual in-hospital expense payment. On the basis of standardizing day surgery and traditional Chinese medicine non-drug diagnosis and treatment technology, we should gradually expand the scope of day surgeries included in medical insurance payout and the scope of TCM non-drug diagnosis and treatment technologies like medical institutions’ Chinese herbal preparations, acupuncture, and therapeutic Chinese massage, and encourage to supply and use appropriate traditional Chinese medicine service. We should establish an emergency response system for diseases; fully implement urban and rural resident critical illness insurance; promote the development of commercial health insurance; strengthen the linking among the basic medical insurance, urban and rural resident critical illness insurance, supplementary medical insurance for employees, medical assistance, commercial health insurance and a variety of other security systems, and further lighten the burden that medical expenses place on the people.

5. Establish a personnel salary system in line with the characteristics of medical industry


(16) Deepen the reform of the permanent personnel system. In the existing total amount of local personnel establishments, we should reasonably verify the total quantity of personnel establishments in public hospitals, make innovation in the personnel establishment management method of public hospitals, gradually implement the establishment filing system, and create a dynamic adjustment mechanism. In terms of post establishment, income distribution, title assessment, management, use and other aspects, we should consider the salary of personnel inside and outside the establishment as a whole and promote the reform of pension insurance system in accordance with the state regulations. We shall apply the employment system and post management system, transform identity management towards post management in terms of personnel, realize fixed establishment, fixed post but not fixed personnel, and form a flexible personnel mechanism under which the personnel can enter or exit, can be promoted or degraded. We also should put into practice the autonomy of public hospitals in employment; the hospital can recruit the urgently-needed and high-level talents in the way of investigation according to provisions and open the results.


(17) Determine the salary level of medical staff reasonably. Considering the characteristics of the medical industry like long training cycle, high occupational risk, high technical difficulty, and heavy responsibilities, relevant state departments should speed up the study and development of a salary system reform program in line with medical and health industry characteristics. Before the introduction of the program, pilot cities can explore and develop the method of auditing the total performance-related pay of public hospitals first, focus on reflecting the value of medical staff’s technical labor service, reasonably determine the level of medical personnel’s income and establish a dynamic adjustment mechanism. The performance pay system should be improved. Public hospitals can distribute income independently according to scientific performance assessment, realize more pay for more work and higher payment for better performance, focus on shifting towards personnel in the clinical front line, business backbone, key positions and personnel supporting the grass level and making outstanding contributions, and open the distance of income reasonably.


(18) Strengthen performance assessment of medical personnel. Public hospitals are responsible for internal assessment, rewards and punishments, highlight post work amount, service quality, behavioral norms, technical skills, medical ethics and patient satisfaction, and link the assessment results with the medical staff’s positions, job promotion and personal salary. We should improve the medication management of public hospitals, and strictly control the unreasonable use of high-value medical supplies. It’s strict forbidden to set up income-generating targets for medical personnel. The personal remuneration of medical personnel should not be linked to the business income of the hospital such as drugs, consumables and large medical examinations.

6. Build a service system coordinating with the development of various medical institutions


(19) Optimize the planning layout the urban public hospitals. We should, according to the requirements of the Notice of the General Office of the State Council on Printing and Issuing the Planning Brief of the National Medical and Health Service System (2015-2020) (Guo Ban Fa [2015] No. 14), the allocation of health resources of the province (autonomous region, municipality), and combine the changes in service population, service radius, urbanization development level and people’s demand for medical service, work out the regional health planning, talent team planning and medical institution setup planning. The national and provincial health and family planning departments as well as relevant departments should strengthen guidance and coordination, and bring the medical and health resources of all aspects and all levels in the region into the plan for consideration. We should take planning implementation circumstances as the foundation of hospital construction, financial investment, performance assessment, medical insurance payout, personnel allocation, and bed setting, strengthen the constraint force of planning and publish the executive circumstance of the planning to the society regularly. We should control the size of the hospital bed, construction standard and large medical equipment configuration; and adopt comprehensive measures to gradually compress the size of the beds of public hospitals exceeding the size standard. Public hospitals should be preferentially equipped with domestic medical equipment. It is strictly prohibited that public hospitals are built with debt financing and decorated exceeding the standard. The size of special medical service in public hospitals should be controlled and the proportion of providing special medical service shall not exceed 10% of the total medical service.


(20) Promote the social force to participate in the reform of public hospitals. In accordance with the regional health planning and the plan for establishing medical institutions, we should control the quantity, layout and structure of public hospitals, encourage enterprises, charities, foundations, commercial insurance institutions and other social forces to establish hospitals, and expand the total amount of health resources. We encourage using a lot of ways including relocation, integration and transformation to transform some secondary urban hospitals into community health services, specialized hospitals, elderly care and rehabilitation institutions, etc. We encourage the social force to invest in medical service by funding the establishment of new hospitals, participation, restricting and other forms, and preferentially support the establishment of non-profit medical organizations. Cities with rich public hospital resources can choose some public hospitals to introduce social capital for restructuring pilot, strengthen assessment to the tangible and intangible assets, prevent erosion of state assets, adhere to being standard, orderly, and forceful in supervision, ensure to be open, fair and just, and safeguard the legitimate rights and interests of the staff.

(21) Strengthen the labor division and collaboration mechanism. We should guide public hospitals at all levels and grass-roots medical organizations to establish a labor division and collaboration mechanism with clear objectives and well-defined rights and responsibilities, and strengthen communication and collaboration between public hospitals and professional public health institutions. We should take improving the grass-roots health service ability as the direction, business, technology, management and assets as links, explore the establishment of all kinds of labor division and collaboration mode including medical consortium, perfect the management operation mechanism and guide orderly competition. On the premise of unifying the quality control standard, we shall put into practice the mutual recognition of medical examination results of the same level medical institutions. We also can explore, integrate and utilize the existing resources, set up specialized medical institutions for medical imaging, pathological diagnosis and medical examination, and promote sharing of large medical equipment among medical institutions.


(22) Strengthen training of personnel team and improve service ability. We should promote the development of medicine, education and research in coordination. In 2015, pilot cities should carry out standardized training of resident physicians. In principle, clinicians with a bachelor or higher academic degree in the new medical positions of all urban public hospitals shall receive standardized training for resident physicians. We should also actively expand the training scale in general medicine, pediatrics, psychiatry, and other urgently-needed specialties. We should also promote third-level general hospitals to set up the department of general family medicine; promote the establishment of standardized specialist physician training system; and strengthen the cultivation of backbone doctors and the construction of key clinical departments in public hospitals. We also should reinforce the target and effectiveness of continuing education, make innovation in the education mode and management method, and strengthen education of comprehensive occupational quality as well as the training of business skills. Furthermore, we should strengthen the occupational training of presidents for public hospitals, explore and establish a demand-oriented and medical ethics, ability and performance-based talent evaluation system.

7. Promote the establishment of a hierarchical diagnosis and treatment system


(23) Build a hierarchical medical service mode. Promote the focus of medical and health work down forward and the “sink” of medical and health resources. In accordance with the requirements of the policy that the state shall establish a hierarchical diagnosis and treatment system, and build a hierarchical diagnosis and treatment mode featuring initial diagnosis at grass-roots hospitals, two-way referral, separated treatment of acute and chronic diseases, and upper and lower linkage. We should put into practice the initial diagnosis at grassroots hospitals, which provide basic medical and referral services. We should focus on playing the role of general medical practitioners and promote the service contract signing of general medical practitioners. We shall gradually increase the source of the appointment numbers and referral service numbers through grass-roots medical and health institutions and general medical practitioners, and the superior hospitals shall provide preferential reception, examination, in-hospital and other services to patients appointed or transferred by grass-roots hospitals and general medical practitioners. By the end of 2015, the proportion of appointments and referrals in the outpatient visits of public hospitals would be improved to 20% or more, so that the general outpatient visits in third-level hospitals shall be lowered down. We should perfect the procedure of two-way referral. All places should develop the admission and discharge standards and two-way referral standards of common diseases, realize orderly referrals among different levels and different types of medical institutions, focus on opening the channel for patients transferred to subordinate hospitals, encourage the superior hospital to give out a specific therapeutic schedule, and then the subordinate hospitals or grass-roots medical and health institutions implement treatment. We shall promote the formation of a pattern where acute and chronic diseases are treated separately; establish a scientific and reasonable labor division and collaboration mechanism among hospitals, grass-roots medical and health institutions and long-term care institutions of chronic diseases, and strengthen the docking of the purchase and use of pharmaceuticals between grass-roots medical and health institutions and public hospitals. The specialist physicians of third-level hospitals together with grass-roots general medical practitioners and nurses can form a medical team, implementing management and guidance to patients with chronic diseases or that in the recovery stage transferred to the grass-roots hospitals. We shall also promote and standardize multi-spot practice of physicians and promote the quality medical resources “sink” to the grass-roots level.


(24) Perfect the medical insurance policy adapting to hierarchical diagnosis and treatment. By the end of 2015, pilot cities should combine the promotion situation of the hierarchical diagnosis and treatment work to clarify the medical insurance payout policy driving hierarchical diagnosis and treatment. For patients that did not seek medical service according to the referral procedures, the medical insurance payout proportion shall be reduced or the medical insurance payout shall not be paid according to provisions. We should improve the medical insurance differentiation payment policy among different levels of medical institutions; open the distance of minimum deduction and payment proportion of different levels of medical institutions, and for transferred in-patients in line with provisions, the minimum deduction can be calculated continuously.

8. Accelerate the construction of medical and health information


(25) Strengthen the construction of the regional medical and health information platform. We should build a sound regional population health information platform, establish a dynamically updated standardized electronic health records and electronic medical record database, improve the technical standard and security protection system, gradually realize the coordination of residents’ basic health information and public health, medical service, medical security, drug management, integrated management and other application system business, promote the docking of such systems as medical and health, medical insurance and drug management and realize information sharing among them; and promote the establishment of a new mode combining integrated supervision, scientific decision-making and fine service. By the end of 2015, we should realize the docking of platforms of all secondary and higher level of public hospitals and over 80% basic medical and health institutions in the region with the regional platform.


(26) Promote the construction and application of the medical information system. We should strengthen the information construction of medical and health institutions and strengthen information technology standard application and data security administration. We should fully carry out the healthcare information people-benefiting action plan, provide convenience for residents in appointment of diagnosis and treatment, time-phased treatment, sharing examination results, payment during diagnosis, and real time settlement of expense that should be paid by medical insurance, and facilitate to retailed pharmacies to check the doctor prescription provided by the patient through the online information system. Relying on big data support, we shall strengthen the performance assessment and quality supervision of the medical and health service. We also should reinforce the construction of a remote medical system, and enhance the functions of remote consultation, education and other services, so as to promote the sharing of quality medical resources. By the end of 2015, we should realize docking with the national drug electronic monitoring platform, positively carry out the verification notes and write off of drug electronic supervision codes; all pilot cities should basically complete the information standard construction of all hospitals of secondary or higher levels, and about 60% basic medical and health institutions should establish a remote medical information system with the superior hospital.

9. Strengthen the organization and implementation


(27) Clarify the schedule. Governments in the pilot areas should combine with the actual situation and introduce the specific implementation program of the reform. The government should make clear the route map and time schedule of the reform, grasp the key tasks of reform, priorities, the way of propulsion, and achieve scientific measurement, classified policy implementation, practical operation and breakthrough. We should establish a national, provincial and municipal public hospital reform linkage mechanism in the pilot region, and ensure all public hospitals in the pilot region are included in the reform scope for overall propulsion. Counties and county-level cities in the area under administration should promote the reform according to the requirements of the country’s policy about county-level public hospitals. Comprehensive medical reform           pilot provinces should give top priority to the reform of urban public hospitals; strengthen organization and leadership, policy guidance and supervision over it; make new breakthrough in making innovation in mechanism and systems, plan and promote the comprehensive reform of medical security, medical services, drug supply, public health and supervision system, and take the lead in realizing the overall objective of medical reform.


(28) Strengthen organization security. All regions should take the reform of public hospitals as an important content of deepening reform in their places. Main leaders of pilot cities should undertake the overall responsibility and heads of each division shall under take the specific responsibility, decompose the work task around the public hospital reform policy, clarify duties of each department, and ensure the responsibilities implemented by every specific principal. The national and provincial level should also clarify the division of labor; relevant departments including health and family planning, finance, development reform, price, establishment, human resource social security, traditional Chinese medicine and education should perform their duties respectively, further emancipate the mind, strengthen support and guidance to local pilots, improve the supporting reform measures, cooperate closely and promote comprehensively.


(29) Strengthen supervision and evaluation. All provinces (autonomous regions, municipalities) should establish supervision, assessment, evaluation and accountability mechanisms to urge the pilot cities to propel the overall reform tasks, and include the public hospital reform work into the government performance assessment content of the pilot city. Relevant departments should enhance guidance to the work of urban public hospital reform pilots and develop a reform result evaluation target system. We also should explore making third-party assessment to the reform results of pilot cities; establish regular notification mechanism over the reform promotion circumstance of pilot cities and an exit mechanism, notify the provincial people’s government the regions that lag behind in the progress of reform, implement the accountability system, and take back the relevant subsidies.


(30) Make summary and publicity timely. All relevant departments should closely follow the progress of work, timely sum up experience, study and solve the problems in the reform. Relatively mature reform experience should be promoted and applied more quickly. All relevant departments should vigorously propagandize and interpret the reform policies and measures, intensity positive propaganda, rationally guide the public opinions and the masses’ expectation, build consensus, enhance confidence, and build a good atmosphere for reform. We should also do a good job in the propaganda and mobilization of medical staff, dig and broadcast advanced models, mobilize the medical staff’s enthusiasm and initiative in participating in the reform. We should also conduct policy training to leaders of governments at all levels, relevant departments and managers of public hospitals, improve their policy level and executive ability, and ensure the smooth promotion of the reform accordingly.



General Office of the State Council