《中國(guó)的醫(yī)療衛(wèi)生事業(yè)》白皮書(shū)(漢英對(duì)照版)

《中國(guó)的醫(yī)療衛(wèi)生事業(yè)》白皮書(shū)WhitePaper:MedicalandHealthServicesinChina中華人民共和國(guó)國(guó)務(wù)院新聞辦公室26日發(fā)表《中國(guó)的醫(yī)療衛(wèi)生事業(yè)》白皮書(shū)。全文如下：TheStateCouncilInformationOfficeofthePeople'sRepublicofChinaonWednesdaypublishedawhitepaperonthemedicalandhealthservicesinChina.Followingisthefulltextofthewhitepaper:中國(guó)的醫(yī)療衛(wèi)生事業(yè)（2012年12月）中華人民共和國(guó)國(guó)務(wù)院新聞辦公室MedicalandHealthServicesinChina

(December2012)InformationOfficeoftheStateCouncilThePeople'sRepublicofChina目錄Contents前言\o""Foreword一、衛(wèi)生基本狀況\o""I.BasicConditions二、醫(yī)藥衛(wèi)生體制改革\o""II.ReformofMedicalandHealthcareSystems三、傳染病防治與衛(wèi)生應(yīng)急\o""III.InfectiousDiseasePreventionandTreatment,andHealthEmergencyManagement四、慢性非傳染性疾病防治\o""IV.PreventionandTreatmentofChronicNon-communicableDisorders五、婦女兒童健康權(quán)益保護(hù)\o""V.ProtectingWomenandChildren'sRighttoHealth六、中醫(yī)藥發(fā)展\o""VI.DevelopmentofTraditionalChineseMedicine七、衛(wèi)生國(guó)際合作\o""VII.InternationalMedicalandHealthcareCooperation結(jié)束語(yǔ)\o""Conclusion前言Foreword健康是促進(jìn)人的全面發(fā)展的必然要求。提高人民健康水平，實(shí)現(xiàn)病有所醫(yī)的理想，是人類(lèi)社會(huì)的共同追求。在中國(guó)這個(gè)有著13億多人口的發(fā)展中大國(guó)，醫(yī)療衛(wèi)生關(guān)系億萬(wàn)人民健康，是一個(gè)重大民生問(wèn)題。Goodhealthisaprerequisiteforpromotingall-rounddevelopmentoftheperson.Anditisacommonpursuitofhumansocietiestoimprovepeople'shealthandensuretheirrighttomedicalcare.ForChina,alargedevelopingcountry,medicalandhealthcareisofvitalimportancetoitspopulationofover1.3billion,andisamajorissueconcerningitspeople'swellbeing.中國(guó)高度重視保護(hù)和增進(jìn)人民健康。憲法規(guī)定，國(guó)家發(fā)展醫(yī)療衛(wèi)生事業(yè)，發(fā)展現(xiàn)代醫(yī)藥和傳統(tǒng)醫(yī)藥，保護(hù)人民健康。圍繞憲法，中國(guó)逐步形成了相對(duì)完善的衛(wèi)生法律法規(guī)體系。Chinapaysgreatattentiontoprotectingandimprovingitspeople'shealth.AstheConstitutionstipulates,"Thestatedevelopsmedicalandhealthservices,promotesmodernmedicineandtraditionalChinesemedicine...,allfortheprotectionofthepeople'shealth."Basedonthisconstitutionalstipulation,Chinahasputinplaceacompletesystemoflawsandregulationsconcerningmedicalandhealthservices.多年來(lái)，中國(guó)堅(jiān)持“以農(nóng)村為重點(diǎn)，預(yù)防為主，中西醫(yī)并重，依靠科技與教育，動(dòng)員全社會(huì)參與，為人民健康服務(wù)，為社會(huì)主義現(xiàn)代化建設(shè)服務(wù)”的衛(wèi)生工作方針，努力發(fā)展具有中國(guó)特色的醫(yī)療衛(wèi)生事業(yè)。經(jīng)過(guò)不懈努力，覆蓋城鄉(xiāng)的醫(yī)療衛(wèi)生服務(wù)體系基本形成，疾病防治能力不斷增強(qiáng)，醫(yī)療保障覆蓋人口逐步擴(kuò)大，衛(wèi)生科技水平日益提高，居民健康水平明顯改善。Overtheyears,ChinahasworkedhardtodevelopitsmedicalandhealthserviceswithChinesecharacteristicsinaccordancewiththepolicyof"makingruralareasthefocusofourwork,puttingdiseasepreventionfirst,supportingbothtraditionalChinesemedicineandWesternmedicine,relyingonscience,technologyandeducation,andmobilizingthewholeofsocietytojointheefforts,improvingthepeople'shealthandservingsocialistmodernization."Thankstounremittingeffortsthathavebeenmade,medicalandhealthcaresystemscoveringbothurbanandruralresidentshavetakenshape,thecapabilitiesofdiseasepreventionandcontrolhavebeenenhanced,thecoverageofmedicalinsurancehasexpanded,continuousprogresshasbeenmadeinmedicalscienceandtechnology,andthepeople'shealthhasbeenremarkablyimproved.

為建立起覆蓋城鄉(xiāng)居民的基本醫(yī)療衛(wèi)生制度，保障每個(gè)居民都能享有安全、有效、方便、價(jià)廉的基本醫(yī)療衛(wèi)生服務(wù)，中國(guó)深入推進(jìn)醫(yī)藥衛(wèi)生體制改革，取得了重要階段性成效。Toputintoplacebasicmedicalandhealthcaresystemscoveringbothurbanandruralresidents,andensurethateveryresidenthasaccesstosafe,effective,convenientandaffordablebasicmedicalandhealthservices,Chinahaskeptadvancingthereformofitsmedicalandhealthcaresystem,andmadeimportantachievementsinthecurrentstage.一、衛(wèi)生基本狀況I.BasicConditions居民健康狀況不斷改善。從反映國(guó)民健康狀況的重要指標(biāo)看，中國(guó)居民的健康水平已處于發(fā)展中國(guó)家前列。2010年人均期望壽命達(dá)到74.8歲，其中男性72.4歲，女性77.4歲。孕產(chǎn)婦死亡率從2002年的51.3/10萬(wàn)下降到2011年的26.1/10萬(wàn)。嬰兒死亡率及5歲以下兒童死亡率持續(xù)下降，嬰兒死亡率從2002年的29.2‰下降到2011年的12.1‰，5歲以下兒童死亡率從2002年的34.9‰下降到2011年的15.6‰，提前實(shí)現(xiàn)聯(lián)合國(guó)千年發(fā)展目標(biāo)。Thepeople'shealthhasbeenimproved.Judgingfromimportantindicatorsthatgiveexpressiontonationalhealth,thehealthoftheChinesepeopleisnowamongthetopindevelopingcountries.In2010,thelifeexpectancywas74.8years-72.4yearsformalesand77.4yearsforfemales;thematernalmortalityratewentdownfrom51.3per100,000in2002to26.1per100,000in2011;theinfantmortalityrateandthemortalityrateofchildrenundertheageoffivehavekeptdropping,withtheformergoingdownfrom29.2perthousandin2002to12.1perthousandin2011,andthelatter,from34.9perthousandto15.6perthousand,attainingaheadofscheduletheUNMillenniumDevelopmentGoalinthisregard.

建立起覆蓋城鄉(xiāng)的醫(yī)療衛(wèi)生體系。一是公共衛(wèi)生服務(wù)體系。包括疾病預(yù)防控制、健康教育、婦幼保健、精神衛(wèi)生、衛(wèi)生應(yīng)急、采供血、衛(wèi)生監(jiān)督和計(jì)劃生育等專(zhuān)業(yè)公共衛(wèi)生服務(wù)網(wǎng)絡(luò)，以及以基層醫(yī)療衛(wèi)生服務(wù)網(wǎng)絡(luò)為基礎(chǔ)、承擔(dān)公共衛(wèi)生服務(wù)功能的醫(yī)療衛(wèi)生服務(wù)體系。二是醫(yī)療服務(wù)體系。在農(nóng)村建立起以縣級(jí)醫(yī)院為龍頭、鄉(xiāng)鎮(zhèn)衛(wèi)生院和村衛(wèi)生室為基礎(chǔ)的農(nóng)村三級(jí)醫(yī)療衛(wèi)生服務(wù)網(wǎng)絡(luò)，在城市建立起各級(jí)各類(lèi)醫(yī)院與社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)分工協(xié)作的新型城市醫(yī)療衛(wèi)生服務(wù)體系。三是醫(yī)療保障體系。這個(gè)體系以基本醫(yī)療保障為主體、其他多種形式補(bǔ)充醫(yī)療保險(xiǎn)和商業(yè)健康保險(xiǎn)為補(bǔ)充。基本醫(yī)療保障體系包括城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)、新型農(nóng)村合作醫(yī)療和城鄉(xiāng)醫(yī)療救助，分別覆蓋城鎮(zhèn)就業(yè)人口、城鎮(zhèn)非就業(yè)人口、農(nóng)村人口和城鄉(xiāng)困難人群。四是藥品供應(yīng)保障體系。包括藥品的生產(chǎn)、流通、價(jià)格管理、采購(gòu)、配送、使用。近期重點(diǎn)是建立國(guó)家基本藥物制度。Medicalandhealthcaresystemscoveringbothurbanandruralresidentshavebeenputinplace.Ofthesesystems,thefirstisthepublichealthservicesystem,whichcoversdiseasepreventionandcontrol,healtheducation,maternityandchildcare,mentalhealth,healthemergencyresponse,bloodcollectionandsupply,healthsupervision,familyplanningandsomeotherspecializedpublichealthservices,andamedicalandhealthcaresystembasedoncommunity-levelhealthcarenetworksthatprovidespublichealthservices.Thesecondisthemedicalcaresystem.Intheruralareas,itreferstoathree-levelmedicalservicenetworkthatcomprisesthecountyhospital,thetownshiphospitalsandvillageclinics,withthecountyhospitalperformingtheleadingrole,andtownshiphospitalsandvillageclinicsserviceatthebase.Andinthecitiesandtowns,itreferstoanewtypeofurbanmedicalhealthservicesystemthatfeaturesdivisionofresponsibilitiesaswellascooperationamongvarioustypesofhospitalsatalllevelsandcommunityhealthcarecenters.Thethirdisthemedicalsecuritysystem.Thissystemcomprisesmainlythebasicmedicalsecurity,supportedbymanyformsofsupplementarymedicalinsuranceandcommercialhealthinsurance.Thebasicmedicalsecuritysystemcoversbasicmedicalinsuranceforworkingurbanresidents,basicmedicalinsurancefornon-workingurbanresidents,anewtypeofruralcooperativemedicalcareandurban-ruralmedicalaid,whichcover,respectively,theemployedurbanpopulation,unemployedurbanpopulation,ruralpopulationandpeoplesufferingfromeconomicdifficulties.Andthefourthisthepharmaceuticalsupplysystem,whichcoverstheproduction,circulation,pricecontrol,procurement,dispatchinganduseofpharmaceuticals.Therecentworkisfocusedonestablishinganationalsystemforbasicdrugs.衛(wèi)生籌資結(jié)構(gòu)不斷優(yōu)化。衛(wèi)生籌資來(lái)源包括政府一般稅收、社會(huì)醫(yī)療保險(xiǎn)、商業(yè)健康保險(xiǎn)和居民自費(fèi)等多種渠道。2011年，中國(guó)衛(wèi)生總費(fèi)用達(dá)24345.91億元人民幣，同期人均衛(wèi)生總費(fèi)用為1806.95元人民幣，衛(wèi)生總費(fèi)用占國(guó)內(nèi)生產(chǎn)總值的比重為5.1%。按可比價(jià)格計(jì)算，1978—2011年，中國(guó)衛(wèi)生總費(fèi)用年平均增長(zhǎng)速度為11.32%。個(gè)人現(xiàn)金衛(wèi)生支出由2002年的57.7%下降到2011年的34.8%，衛(wèi)生籌資系統(tǒng)的風(fēng)險(xiǎn)保護(hù)水平和再分配作用不斷提高。2011年，醫(yī)院、門(mén)診機(jī)構(gòu)費(fèi)用為18089.4億元人民幣，公共衛(wèi)生機(jī)構(gòu)費(fèi)用為2040.67億元人民幣，分別占衛(wèi)生總費(fèi)用的71.74%和8.09%。醫(yī)院費(fèi)用中，城市醫(yī)院、縣醫(yī)院、社區(qū)衛(wèi)生服務(wù)中心、鄉(xiāng)鎮(zhèn)衛(wèi)生院費(fèi)用分別占64.13%、21.28%、5.17%、9.3%。Thehealthfinancingstructurehasbeenconstantlyimproved.China'shealthexpenditurecomesfromthegovernment'sgeneraltaxrevenue,socialmedicalinsurance,commercialhealthinsurance,residents'out-of-pocketspending,etc.In2011,thetotalhealthexpenditureinChinareached2,434.591billionyuan,1,806.95yuanpercapita.Thetotalexpenditureaccountedfor5.1%ofthecountry'sGDP.Incomparableprices,thehealthexpendituregrewbyanaverageannualrateof11.32%from1978to2011.Individual"out-of-pocket"spendingdeclinedfrom57.7%in2002to34.8%in2011,showingthathealthfinancingisworkingbetterintheareasofriskprotectionandre-distribution.In2011,thespendingonhospitalsandoutpatientestablishmentswas1,808.94billionyuan,andthatonpublichealthagencies,204.067billionyuan,comprising71.74%and8.09%,respectively,ofthetotalhealthexpenditure.Ofthetotalspendingonhospitals,thoseonurbanhospitals,countyhospitals,communityhealthservicecentersandtownshiphealthservicecentersstoodat64.13%,21.28%,5.17%and9.3%,respectively.衛(wèi)生資源持續(xù)發(fā)展。截至2011年底，全國(guó)醫(yī)療衛(wèi)生機(jī)構(gòu)達(dá)95.4萬(wàn)個(gè)(所)，與2003年比較，醫(yī)療衛(wèi)生機(jī)構(gòu)增加14.8萬(wàn)個(gè)(所)。執(zhí)業(yè)(助理)醫(yī)師246.6萬(wàn)人，每千人口執(zhí)業(yè)(助理)醫(yī)師數(shù)由2002年的1.5人增加到1.8人。注冊(cè)護(hù)士224.4萬(wàn)人，每千人口注冊(cè)護(hù)士數(shù)由2002年的1人增加到1.7人。醫(yī)療衛(wèi)生機(jī)構(gòu)床位數(shù)516萬(wàn)張，每千人口醫(yī)療衛(wèi)生機(jī)構(gòu)床位數(shù)由2002年的2.5張?zhí)岣叩?.8張。Healthresourceshavebeendevelopinginasustainedway.Bytheendof2011,medicalandhealthcareinstitutionsaroundthecountrytotaled954,000,anincreaseof148,000over2003.Licenseddoctors(assistants)reached2,466,000,or1.8perthousandpeople,ascomparedwith1.5perthousandpeoplein2002.Registerednursestotaled2,244,000,or1.7perthousandpeople,ascomparedwithoneperthousandpeoplein2002.Thenumberofhospitalbedsreached5160,000,or3.8perthousandpeople,ascomparedwith2.5perthou-sandpeoplein2002.醫(yī)療衛(wèi)生服務(wù)利用狀況顯著改善。2011年，全國(guó)醫(yī)療機(jī)構(gòu)診療人次由2002年的21.5億人次增加到62.7億人次，住院人數(shù)由2002年的5991萬(wàn)人增加到1.5億人。中國(guó)居民到醫(yī)療衛(wèi)生機(jī)構(gòu)年均就診4.6次，每百居民住院11.3人，醫(yī)院病床使用率為88.5%，醫(yī)院出院者平均住院日為10.3天。居民看病就醫(yī)更加方便，可及性顯著提高。15分鐘內(nèi)可到達(dá)醫(yī)療機(jī)構(gòu)住戶比例，由2003年的80.7%提高到2011年的83.3%，其中農(nóng)村地區(qū)為80.8%。醫(yī)療質(zhì)量管理和控制體系不斷完善。建立無(wú)償獻(xiàn)血制度，血液安全得到保障。Markedimprovementhasbeenseenintheutilizationofmedicalandhealthservices.In2011,medicalinstitutionsthroughoutthecountryhosted6.27billionoutpatients,ascomparedwith2.15billionin2002;andadmitted150millioninpatients,ascomparedwith59.91millionin2002.Thatyear,Chineseresidentswenttothemedicalinstitutionsformedicaltreatment4.6timesonaverage;11.3ofevery100peoplewerehospitalized;theutilizationrateofhospitalbedsreached88.5%;andthehospitalstayoftheinpatientsaveraged10.3days.Thesefiguresshowthatithasbecomeincreasinglyconvenienttoseeadoctorandmoreeasilyaccessibletogetmedicalservices.In2011,83.3%ofallhouseholds(80.8%inruralareas)couldreachmedicalinstitutionswithin15minutes,ascomparedwith80.7%in2002.Medicalservicequalitymanagementandcontrolsystemshavebeenconstantlyimproved.Asystemofblooddonationwithoutcompensationhasbeenestablished,soastoensurebloodsupplyandsafety.二、醫(yī)藥衛(wèi)生體制改革II.ReformofMedicalandHealthcareSystems經(jīng)過(guò)多年努力，中國(guó)衛(wèi)生事業(yè)取得顯著發(fā)展成就，但與公眾健康需求和經(jīng)濟(jì)社會(huì)協(xié)調(diào)發(fā)展不適應(yīng)的矛盾還比較突出。特別是隨著中國(guó)從計(jì)劃經(jīng)濟(jì)體制向市場(chǎng)經(jīng)濟(jì)體制的轉(zhuǎn)型，原有醫(yī)療保障體系發(fā)生很大變化，如何使廣大公眾享有更好、更健全的醫(yī)療衛(wèi)生服務(wù)，成為中國(guó)政府面臨的一個(gè)重大問(wèn)題。從20世紀(jì)80年代開(kāi)始，中國(guó)啟動(dòng)醫(yī)藥衛(wèi)生體制改革，并在2003年抗擊傳染性非典型肺炎取得重大勝利后加快推進(jìn)。2009年3月，中國(guó)公布《關(guān)于深化醫(yī)藥衛(wèi)生體制改革的意見(jiàn)》，全面啟動(dòng)新一輪醫(yī)改。改革的基本理念，是把基本醫(yī)療衛(wèi)生制度作為公共產(chǎn)品向全民提供，實(shí)現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務(wù)，從制度上保證每個(gè)居民不分地域、民族、年齡、性別、職業(yè)、收入水平，都能公平獲得基本醫(yī)療衛(wèi)生服務(wù)。改革的基本原則是?；尽?qiáng)基層、建機(jī)制。Withyearsofeffort,Chinahasmaderemarkableachievementsinthedevelopmentofitshealthcareundertakings,which,however,stillfallfarshortofthepublic'sdemandsforhealthcareaswellastherequirementsofeconomicandsocialdevelopment.EspeciallywhenChinaturnedfromaplannedeconomytoamarketeconomy,theoldmedicalcaresystemhasundergonegreatchanges.SoitbecameanissueofmajorimportancefortheChinesegovernmenttoprovidebetterandmoreaccessiblemedicalandhealthservicestothepublic.Inthe1980s,theChinesegovernmentinitiatedreformofthemedicalandhealthcaresystems,andspeededupthereformin2003afterasuccesswaswoninthefightagainsttheSARS.InMarch2009,theChinesegovernmentpromulgatedthe"OpinionsonDeepeningReformoftheMedicalandHealthCareSystems,"settingoffanewroundofreforminthisregard.Thebasicgoalofthisreformwastoprovidethewholenationwithbasicmedicalandhealthservicesasapublicproduct,andensurethateveryone,regardlessoflocation,nationality,age,gender,occupationandincome,enjoysequalaccesstobasicmedicalandhealthservices.Andthebasicprinciplestobefollowedinthereformweretoensurebasicservices,improvingsuchservicesatthegrass-rootslevelandestablishingtheeffectivemechanisms.醫(yī)改是一項(xiàng)涉及面廣、難度大的社會(huì)系統(tǒng)工程，在中國(guó)這樣一個(gè)人口多、人均收入水平低、城鄉(xiāng)區(qū)域差距大的發(fā)展中國(guó)家，深化醫(yī)改是一項(xiàng)十分艱巨復(fù)雜的任務(wù)。三年多來(lái)，中國(guó)政府大力推進(jìn)醫(yī)藥衛(wèi)生服務(wù)與經(jīng)濟(jì)社會(huì)協(xié)調(diào)發(fā)展，積極破解醫(yī)改這一世界性難題。通過(guò)艱苦努力，中國(guó)的新一輪醫(yī)改取得積極進(jìn)展。Medicalreformisasocialprogramthatcoversawiderangeandinvolvesdifficulttasks.AnditisahardandcomplicatedtasktodeepenthisreforminChina,adevelopingcountrywithalargepopulation,lowper-capitaincomeandawidegapbetweenurbanandruralareas.Foroverthreeyears,theChinesegovernmenthasworkedhardtostrikeabalancebetweenimprovingmedicalandhealthservicesononehandandeconomicandsocialdevelopmentontheother,tryingtofindasolutiontothisworldwideproblem.Thankstothepersistenteffortsmade,Chinahasmadepositiveprogressinthisnewroundofmedicalreform.——基本醫(yī)療保障制度覆蓋城鄉(xiāng)居民。截至2011年，城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)、城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)、新型農(nóng)村合作醫(yī)療參保人數(shù)超過(guò)13億，覆蓋面從2008年的87%提高到2011年的95%以上，中國(guó)已構(gòu)建起世界上規(guī)模最大的基本醫(yī)療保障網(wǎng)?；I資水平和報(bào)銷(xiāo)比例不斷提高，新型農(nóng)村合作醫(yī)療政府補(bǔ)助標(biāo)準(zhǔn)從最初的人均20元人民幣，提高到2011年的200元人民幣，受益人次數(shù)從2008年的5.85億人次提高到2011年的13.15億人次，政策范圍內(nèi)住院費(fèi)用報(bào)銷(xiāo)比例提高到70%左右，保障范圍由住院延伸到門(mén)診。推行醫(yī)藥費(fèi)用即時(shí)結(jié)算報(bào)銷(xiāo)，居民就醫(yī)結(jié)算更為便捷。開(kāi)展按人頭付費(fèi)、按病種付費(fèi)和總額預(yù)付等支付方式改革，醫(yī)保對(duì)醫(yī)療機(jī)構(gòu)的約束、控費(fèi)和促進(jìn)作用逐步顯現(xiàn)。實(shí)行新型農(nóng)村合作醫(yī)療大病保障，截至2011年，23萬(wàn)患有先天性心臟病、終末期腎病、乳腺癌、宮頸癌、耐多藥肺結(jié)核、兒童白血病等疾病的患者享受到重大疾病補(bǔ)償，實(shí)際補(bǔ)償水平約65%。2012年，肺癌、食道癌、胃癌等12種大病也被納入農(nóng)村重大疾病保障試點(diǎn)范圍，費(fèi)用報(bào)銷(xiāo)比例最高可達(dá)90%。實(shí)施城鄉(xiāng)居民大病保險(xiǎn)，從城鎮(zhèn)居民醫(yī)保基金、新型農(nóng)村合作醫(yī)療基金中劃出大病保險(xiǎn)資金，采取向商業(yè)保險(xiǎn)機(jī)構(gòu)購(gòu)買(mǎi)大病保險(xiǎn)的方式，以力爭(zhēng)避免城鄉(xiāng)居民發(fā)生家庭災(zāi)難性醫(yī)療支出為目標(biāo)，實(shí)施大病保險(xiǎn)補(bǔ)償政策，對(duì)基本醫(yī)療保障補(bǔ)償后需個(gè)人負(fù)擔(dān)的合規(guī)醫(yī)療費(fèi)用給予保障，實(shí)際支付比例不低于50%，有效減輕個(gè)人醫(yī)療費(fèi)用負(fù)擔(dān)。建立健全城鄉(xiāng)醫(yī)療救助制度，救助對(duì)象覆蓋城鄉(xiāng)低保對(duì)象、五保對(duì)象，并逐步擴(kuò)大到低收入重病患者、重度殘疾人、低收入家庭老年人等特殊困難群體，2011年全國(guó)城鄉(xiāng)醫(yī)療救助8090萬(wàn)人次。Thebasicmedicalcaresystemscoverbothurbanandruralresidents.By2011,morethan1.3billionpeoplehadjoinedthethreebasicmedicalinsuranceschemesthatcoverbothurbanandruralresidents,i.e.,thebasicmedicalinsuranceforworkingurbanresidents,thebasicmedicalinsurancefornon-workingurbanresidents,andthenewtypeofruralcooperativemedicalcare,withtheirtotalcoveragebeingextendedfrom87%in2008to95%in2011.ThissignaledthatChinahasbuilttheworld'slargestnetworkofbasicmedicalsecurity.Medicalcarefinancingandthereimbursableratioofmedicalcostshavebeenraised,andthegovernmentsubsidystandardsforthenewruralcooperativemedicalcaresystemwereincreasedfrom20yuanatthebeginningto200yuanperpersonperyearin2011,benefiting1.315person/timesin2011asagainst585person/timesin2008.Thereimbursementrateforhospitalizationexpensescoveredbyrelevantpolicieshasbeenraisedtoaround70%,andtherangeofreimbursableexpenseshasbeenexpandedtoincludeoutpatientexpenses.Real-timereimbursementhasbeenadoptedformedicalexpenses,makingitmoreconvenientforpeopletohavetheirmedicalcostssettled.Reformhasbeencarriedoutinrespectoftheformsofpaymenttoincludepaymentbyperson,paymentbydiseaseandtotalamountpre-payment,enablingmedicalinsurancetoplayabetterrestrictiveroleovermedicalinstitutionsaswellastocontrolexpensesandcompelthemedicalinstitutionstoimprovetheirefficiency.Criticalillnessinsurancehasbeenincludedinthenewtypeofruralcooperativemedicalcaresystem.By2011,some230,000patientsofcongenitalheartdisease,advancedrentaldiseases,breastcancer,cervicalcancer,multidrug-resistanttuberculosisandchildhoodleukemiahadbeengrantedsubsidiesformajorandseriousdiseases,withtheactualsubsidiesaccountingfor65%oftheirtotalexpenses.In2012,lungcancer,esophaguscancer,gastriccancerandeightothermajordiseaseswereincludedintheruralpilotprogramofinsuranceforthetreatmentofmajordiseases,andthereimbursementratereachedashighas90%.Criticalillnessinsurancehasbeenintroducedforbothurbanandruralresidents,inwhichcertainamountsofmoneyareearmarkedinthemedicalinsurancefundfornon-workingurbanresidentsandthatofthenewtypeofruralcooperativemedicalcaretobuycriticalillnessinsurancepoliciesfromcommercialinsurancecompanies,aimingtorelieveurbanandruralfamiliesoftheheavyburdenofcatastrophicmedicalspending.Thepolicyofsubsidyforcriticalillnessinsurance,whichcoversnolessthan50%oftheactualmedicalcosts,providesaguaranteeforthecompliancecoststobeshoulderedbytheindividualafterreimbursementfromthebasicmedicalinsurance.Thishaseffectivelyreducedthefinancialburdenofindividuals.Anurban-ruralmedicalassistancesystemhasbeenestablishedandimproved,whichatfirstcoveredurbanandruralsubsistenceallowancerecipientsandchildlessandinfirmruralresidentswhoreceivetheso-called"fiveguarantees,"andisnowextendedtocoverthosewhoareseverelyillandhavelowcomes,theseverelydisabled,seniorcitizensfromlow-incomefamilies,andsomeothergroupswithspecialdifficulties.In2011,theurban-ruralmedicalassistancewasgrantedto80.90millioncasesacrossthecountry.——基本藥物制度從無(wú)到有。初步形成了基本藥物遴選、生產(chǎn)供應(yīng)、使用和醫(yī)療保險(xiǎn)報(bào)銷(xiāo)的體系。2011年，基本藥物制度實(shí)現(xiàn)基層全覆蓋，所有政府辦基層醫(yī)療衛(wèi)生機(jī)構(gòu)全部配備使用基本藥物，并實(shí)行零差率銷(xiāo)售，取消了以藥補(bǔ)醫(yī)機(jī)制。制定國(guó)家基本藥物臨床應(yīng)用指南和處方集，規(guī)范基層用藥行為，促進(jìn)合理用藥。建立基本藥物采購(gòu)新機(jī)制，基本藥物實(shí)行以省為單位集中采購(gòu)，基層醫(yī)療衛(wèi)生機(jī)構(gòu)基本藥物銷(xiāo)售價(jià)格比改革前平均下降了30%。基本藥物全部納入基本醫(yī)療保障藥品報(bào)銷(xiāo)目錄。有序推進(jìn)基本藥物制度向村衛(wèi)生室和非政府辦基層醫(yī)療衛(wèi)生機(jī)構(gòu)延伸。藥品生產(chǎn)流通領(lǐng)域改革步伐加快，藥品供應(yīng)保障水平進(jìn)一步提高。Abasicsystemofdrugshasbeendevelopedfromscratch.Asystemfortheselection,production,supplyanduseofbasicdrugs,andcoveroftheminmedicalinsurancehasbeenputintoplace.In2011,thecoverageofthissystemwasextendedtoallgrass-rootsmedicalandhealth-careinstitutionsrunbythegovernment,wherethesedrugsweresoldatzeroprofit,practicallyeliminatingthepracticeofhospitalssubsidizingtheirmedicalserviceswithdrugsales.Anationalguidelinefortheclinicalapplicationofbasicdrugsandaformularyhavebeendrawnuptoensurethatbasicdrugsareusedaccordingtodueproceduresatgrass-rootsmedicalinstitutions.Anewmechanismhasbeenestablishedfortheprocurementofbasicdrugs,underwhichthebasicdrugsaretobepurchasedbyprovinces.Asaresult,thepricesofbasicdrugsatgrass-rootsmedicalandhealthcareinstitutionshavedroppedby30%onaverage,ascomparedwiththosebeforethereform.Thebasicdrugshaveallbeenincludedinthelistofreimbursabledrugscoveredbybasicmedicalinsurance.Also,effortshavebeenmadetosupplybasicdrugsinanorderlywaytovillageclinicsandnon-governmentalmedicalinstitutionsatthegrass-rootslevel.Thestepsofreformhavebeenquickenedindrugproductionandcirculation,andthesupplyofdrugshasbeenbetterensured.——城鄉(xiāng)基層醫(yī)療衛(wèi)生服務(wù)體系進(jìn)一步健全。加大政府投入，完善基層醫(yī)療衛(wèi)生機(jī)構(gòu)經(jīng)費(fèi)保障機(jī)制，2009—2011年，中央財(cái)政投資471.5億元人民幣支持基層醫(yī)療機(jī)構(gòu)建設(shè)發(fā)展。采取多種形式加強(qiáng)基層衛(wèi)生人才隊(duì)伍建設(shè)，制定優(yōu)惠政策，為農(nóng)村和社區(qū)培養(yǎng)、培訓(xùn)、引進(jìn)衛(wèi)生人才。建立全科醫(yī)生制度，開(kāi)展全科醫(yī)生規(guī)范化培養(yǎng)，安排基層醫(yī)療衛(wèi)生機(jī)構(gòu)人員參加全科醫(yī)生轉(zhuǎn)崗培訓(xùn)，組織實(shí)施中西部地區(qū)農(nóng)村訂單定向醫(yī)學(xué)生免費(fèi)培養(yǎng)等。實(shí)施萬(wàn)名醫(yī)師支援農(nóng)村衛(wèi)生工程，2009—2011年，1100余家城市三級(jí)醫(yī)院支援了955個(gè)縣級(jí)醫(yī)院，中西部地區(qū)城市二級(jí)以上醫(yī)療衛(wèi)生機(jī)構(gòu)每年支援3600多所鄉(xiāng)鎮(zhèn)衛(wèi)生院，提高了縣級(jí)醫(yī)院和鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)療技術(shù)水平和管理能力。轉(zhuǎn)變基層醫(yī)療服務(wù)模式，在鄉(xiāng)鎮(zhèn)衛(wèi)生院開(kāi)展巡回醫(yī)療服務(wù)，在市轄區(qū)推行社區(qū)全科醫(yī)生團(tuán)隊(duì)、家庭簽約醫(yī)生制度，實(shí)行防治結(jié)合，保障居民看病就醫(yī)的基本需求，使常見(jiàn)病、多發(fā)病等絕大多數(shù)疾病的診療在基層可以得到解決。經(jīng)過(guò)努力，基層醫(yī)療衛(wèi)生服務(wù)體系不斷強(qiáng)化，農(nóng)村和偏遠(yuǎn)地區(qū)醫(yī)療服務(wù)設(shè)施落后、服務(wù)能力薄弱的狀況明顯改變，基層衛(wèi)生人才隊(duì)伍的數(shù)量、學(xué)歷、知識(shí)結(jié)構(gòu)出現(xiàn)向好趨勢(shì)。2011年，全國(guó)基層醫(yī)療衛(wèi)生機(jī)構(gòu)達(dá)到91.8萬(wàn)個(gè)，包括社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)2.6萬(wàn)個(gè)、鄉(xiāng)鎮(zhèn)衛(wèi)生院3.8萬(wàn)所、村衛(wèi)生室66.3萬(wàn)個(gè)，床位123.4萬(wàn)張。Urbanandruralgrass-rootslevelmedicalandhealthserviceshavebeenfurtherimproved.Thegovernmenthasinvestedmoretoensurethefundingforgrass-rootsmedicalandhealthcareinstitutions.From2009to2011,thecentralgovernmentinvested47.15billionyuantosupportthebuildinganddevelopmentofgrass-rootslevelmedicalinstitutions.Diverseformshavebeenadoptedtostrengthentheranksofhealthcareworkersatthegrass-rootslevel,andpreferentialpolicieshavebeenmadetotrainandintroducecompetentpersonnelforruralandcommunityhealthcare.Asystemofgeneralpractitioners(medicalworkerswithsufficientknowledgeinallbranchesofmedicine)hasbeenestablished,underwhichgeneralpractitionersaretrainedintheregularway;grass-rootsmedicalandhealthcareworkersareenrolledintrainingcoursesforupgradingthemtogeneralpractitioners;andmedicalstudentsarespeciallytrainedfortheneedsofcentralandwesternurbanareas,forwhichtheydonothavetopaytheirtuitionfees.Aproject,knownas"tenthousanddoctorsextendingsupporttoruralmedicalcare,"hasbeenlaunched.From2009to2011,over1,100Grade-IIIurbanhospitalsextendedsupportto955ruralcounty-levelhospitalseveryyear,andurbanmedicalinstitutionsaboveGradeIIincentralandwesternChinagrantedaidtoover3,600townshiphospitalseveryyear,thushelpingimprovetheoveralltechnologicallevelandmanagementofthecountyandtownshiphospitals.Meanwhile,themodeofmedicalserviceshasbeenchanged.Touringmedicalserviceshavebeenprovidedintownshiphospitals;andintheurbandistrictsranksofgeneralpractitionershavebeenformedandasystemoffamilydoctorshasbeensetup.Preventionhasbeencombinedwiththetreatment,measureshavebeentakentoensurebasicneedsoftheresidentstoseedoctorsandmakeitpossiblethatthediagnosisandtreatmentofmostcommonlyseenandfrequentlyoccurringdiseasesareperformedatthecommunitylevel.Afteryearsofeffort,community-levelmedicalandhealthcaresystemhasbeenstrengthened;markedchangeshavetakenplacetothesituationofbackwardfacilitiesandpoorservicesinruralandremoteareas;community-levelmedicalworkershaveincreasedinnumber,andtheireducationalbackgroundandknowledgehaveimproved.In2011,thenumberofgrass-rootsmedicalandhealthcareinstitutionsacrossthecountryreached918,000,including26,000urbancommunityservicecenters,38,000townshiphospitalsand663,000villageclinics,andthenumberofhospitalbedsreached1,234,000.——基本公共衛(wèi)生服務(wù)均等化水平明顯提高。國(guó)家免費(fèi)向全體居民提供國(guó)家基本公共衛(wèi)生服務(wù)包，包括建立居民健康檔案、健康教育、預(yù)防接種、0—6歲兒童健康管理、孕產(chǎn)婦健康管理、老年人健康管理、高血壓和II型糖尿病患者健康管理、重性精神疾病患者管理、傳染病及突發(fā)公共衛(wèi)生事件報(bào)告和處理、衛(wèi)生監(jiān)督協(xié)管等10類(lèi)41項(xiàng)服務(wù)。針對(duì)特殊疾病、重點(diǎn)人群和特殊地區(qū)，國(guó)家實(shí)施重大公共衛(wèi)生服務(wù)項(xiàng)目，對(duì)農(nóng)村孕產(chǎn)婦住院分娩補(bǔ)助、15歲以下人群補(bǔ)種乙肝疫苗、消除燃煤型氟中毒危害、農(nóng)村婦女孕前和孕早期補(bǔ)服葉酸、無(wú)害化衛(wèi)生廁所建設(shè)、貧困白內(nèi)障患者復(fù)明、農(nóng)村適齡婦女宮頸癌和乳腺癌檢查、預(yù)防艾滋病母嬰傳播等，由政府組織進(jìn)行直接干預(yù)。2011年，國(guó)家免疫規(guī)劃疫苗接種率總體達(dá)到90%以上，全國(guó)住院分娩率達(dá)到98.7%，其中農(nóng)村住院分娩率達(dá)到98.1%，農(nóng)村孕產(chǎn)婦死亡率呈逐步下降趨勢(shì)。農(nóng)村自來(lái)水普及率和衛(wèi)生廁所普及率分別達(dá)到72.1%和69.2%。2009年啟動(dòng)“百萬(wàn)貧困白內(nèi)障患者復(fù)明工程”，截至2011年，由政府提供補(bǔ)助為109萬(wàn)多名貧困白內(nèi)障患者實(shí)施了復(fù)明手術(shù)。Accesstobasicpublichealthserviceshasbecomemoreequitable.Thestateprovidesallresidentswithafreepackageof41basicpublichealthservicesintencategories,includinghealthrecord,healtheducation,preventiveinoculation,healthcareforchildrenundersix,healthcareforpregnantandlying-inwomen,healthcareforelderlypeople,treatmentforhypertensionandtypeIIdiabetespatients,healthcareforseverepsychosispatients,reportingandhandlingofinfectiousdiseasesandpublichealthemergencies,andhealthcaresupervisionandcoordination.Targetingspecialdiseases,keygroupsandspecialareas,thestatehaslaunchedkeypublichealthserviceprograms,includingsubsidizingruralpregnantwomenforhospitalizedchildbirth,re-vaccinatingpeopleunder15againsthepatitisB,eliminatingfluorosiscausedbycoalburning,supplementarytakingoffolicacidbyruralwomenbeforepregnancyandintheearlystageofpregnancy,buildingsanitarytoilets,cataractremovalforpoorpatients,cervicalandbreastcancertestsforruralwomenwithineligibleage,andpreventingmother-to-childtransmissionofAIDS.In2011,theinoculationrateoftheNationalImmunizationProgram(NIP)exceeded90%;therateofhospitalizedchildbirthnationwidereached98.7%(98.1%inruralareas);andthematernitymortalityrateinruralareaskeptgoingdown.Intheruralareas,72.1%ofthepopulationhadaccesstotapwaterand69.2%hadaccesstosanitarytoilets.In2009,thegovernmentlaunchedaprogramtoprovidecataractoperationsforamillionpoorpatients,andby2011morethan1.09millionsuchpeoplehadhadsuchoperationswithgovernmentsubsidies.

——公立醫(yī)院改革有序推進(jìn)。從2010年起，在17個(gè)國(guó)家聯(lián)系試點(diǎn)城市和37個(gè)省級(jí)試點(diǎn)地區(qū)開(kāi)展公立醫(yī)院改革試點(diǎn)，在完善服務(wù)體系、創(chuàng)新體制機(jī)制、加強(qiáng)內(nèi)部管理、加快形成多元化辦醫(yī)格局等方面取得積極進(jìn)展。2012年，全面啟動(dòng)縣級(jí)公立醫(yī)院綜合改革試點(diǎn)工作，以縣級(jí)醫(yī)院為龍頭，帶動(dòng)農(nóng)村醫(yī)療衛(wèi)生服務(wù)體系能力提升，力爭(zhēng)使縣域內(nèi)就診率提高到90%左右，目前已有18個(gè)省(自治區(qū)、直轄市)的600多個(gè)縣參與試點(diǎn)。完善醫(yī)療服務(wù)體系，優(yōu)化資源配置，加強(qiáng)薄弱區(qū)域和薄弱領(lǐng)域能力建設(shè)。區(qū)域醫(yī)學(xué)中心臨床重點(diǎn)專(zhuān)科和縣級(jí)醫(yī)院服務(wù)能力提升，公立醫(yī)院與基層醫(yī)療衛(wèi)生機(jī)構(gòu)之間的分工協(xié)作機(jī)制正在探索形成。多元化辦醫(yī)格局加快推進(jìn)，鼓勵(lì)和引導(dǎo)社會(huì)資本舉辦營(yíng)利性和非營(yíng)利醫(yī)療機(jī)構(gòu)。截至2011年，全國(guó)社會(huì)資本共舉辦醫(yī)療機(jī)構(gòu)16.5萬(wàn)個(gè)，其中民營(yíng)醫(yī)院8437個(gè)，占全國(guó)醫(yī)院總數(shù)的38%。在全國(guó)普遍推行預(yù)約診療、分時(shí)段就診、優(yōu)質(zhì)護(hù)理等便民惠民措施。醫(yī)藥費(fèi)用過(guò)快上漲的勢(shì)頭得到控制，按可比價(jià)格計(jì)算，在過(guò)去三年間，公立醫(yī)院門(mén)診次均醫(yī)藥費(fèi)用和住院人均醫(yī)藥費(fèi)用增長(zhǎng)率逐年下降，2011年比2009年均下降了8個(gè)百分點(diǎn)，公立醫(yī)院費(fèi)用控制初見(jiàn)成效。Thereformofpublichospitalshasbeencarriedoninanorderlyway.In2010,theChinesegovernmentstartedpilotreformsofpublichospitalsin17state-designatedcitiesand37province-leveldistricts;andpositiveprogresshasbeenwitnessedinimprovingservices,innovatinginstitutionsandmechanisms,strengtheninginternalmanagementandspeedingupthecreationofasituationinwhichhospitalsareestablishedandrunindiversifiedforms.In2012,thegovernmentlaunchedapilotcomprehensivereformofcounty-levelpublichospitals,aimingtoimproveruralsystemofmedicalserviceswiththecountyhospitalsplayingtheleadingrole,andenabling90%ofthepopulationinacountytoseedoctors.Sofar,over600countiesin18provinces,autonomousregionsandmunicipalitiesdirectlyunderthecentralgovernmenthavebeenincludedinthisreform.Thegovernmenthasworkedhardtoimprovemedicalservices,optimizetheallocationofmedicalresources,andenhancethemedicalcapabilitiesofweakareasandweakfields.Thecapabilitiesofkeyclinicalspecialtiesinregionalmedicalcentersandcounty-levelhospitalstodelivermedicalserviceshavebeenenhanced,andthemechanismofdivisionofresponsibilitiesandcooperationbetweenpublichospitalsandcommunity-levelmedicalinstitutionsisbeingstudiedandformed.Thegovernmenthasintensifiedeffortsinthecreationofasituationofestablishingandrunninghospitalsindiversifiedforms,encouragingandguidingnon-governmentalfundstoestablishbothfor-profitandnon-profitmedicalinstitutions.By2011,therewere165,000medicalinstitutionsestablishedwithnon-governmentalinvestment,including8,437privatehospitals,accountingfor38%ofthenationaltotal.Doctor-appointmentservice,time-phasedoutpatientserviceandhigh-qualitynursingservicethatbringbenefitsandconveniencetothepeoplehavebeenintroducednationwide.Thefastpricegrowthofmedicinehasbeencontained.Incomparableprices,thegrowthratesofaverageoutpatientandinpatientcostsinpublichospitalshasdecreasedyearbyyearinthepastthreeyears,andthatof2011wentdownbyeightpercentagepointsfromthatof2009,reapingini