《中國的醫(yī)療衛(wèi)生事業(yè)》白皮書(漢英對照版)

《中國的醫(yī)療衛(wèi)生事業(yè)》白皮書WhitePaper:MedicalandHealthServicesinChina中華人民共和國國務院新聞辦公室26日發(fā)表《中國的醫(yī)療衛(wèi)生事業(yè)》白皮書。全文如下：TheStateCouncilInformationOfficeofthePeople'sRepublicofChinaonWednesdaypublishedawhitepaperonthemedicalandhealthservicesinChina.Followingisthefulltextofthewhitepaper:中國的醫(yī)療衛(wèi)生事業(yè)（2012年12月）中華人民共和國國務院新聞辦公室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、婦女兒童健康權益保護\o""V.ProtectingWomenandChildren'sRighttoHealth六、中醫(yī)藥發(fā)展\o""VI.DevelopmentofTraditionalChineseMedicine七、衛(wèi)生國際合作\o""VII.InternationalMedicalandHealthcareCooperation結束語\o""Conclusion前言Foreword健康是促進人的全面發(fā)展的必然要求。提高人民健康水平，實現(xiàn)病有所醫(yī)的理想，是人類社會的共同追求。在中國這個有著13億多人口的發(fā)展中大國，醫(yī)療衛(wèi)生關系億萬人民健康，是一個重大民生問題。Goodhealthisaprerequisiteforpromotingall-rounddevelopmentoftheperson.Anditisacommonpursuitofhumansocietiestoimprovepeople'shealthandensuretheirrighttomedicalcare.ForChina,alargedevelopingcountry,medicalandhealthcareisofvitalimportancetoitspopulationofover1.3billion,andisamajorissueconcerningitspeople'swellbeing.中國高度重視保護和增進人民健康。憲法規(guī)定，國家發(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，保護人民健康。圍繞憲法，中國逐步形成了相對完善的衛(wèi)生法律法規(guī)體系。Chinapaysgreatattentiontoprotectingandimprovingitspeople'shealth.AstheConstitutionstipulates,"Thestatedevelopsmedicalandhealthservices,promotesmodernmedicineandtraditionalChinesemedicine...,allfortheprotectionofthepeople'shealth."Basedonthisconstitutionalstipulation,Chinahasputinplaceacompletesystemoflawsandregulationsconcerningmedicalandhealthservices.多年來，中國堅持“以農村為重點，預防為主，中西醫(yī)并重，依靠科技與教育，動員全社會參與，為人民健康服務，為社會主義現(xiàn)代化建設服務”的衛(wèi)生工作方針，努力發(fā)展具有中國特色的醫(yī)療衛(wèi)生事業(yè)。經過不懈努力，覆蓋城鄉(xiāng)的醫(yī)療衛(wèi)生服務體系基本形成，疾病防治能力不斷增強，醫(yī)療保障覆蓋人口逐步擴大，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，保障每個居民都能享有安全、有效、方便、價廉的基本醫(yī)療衛(wèi)生服務，中國深入推進醫(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。從反映國民健康狀況的重要指標看，中國居民的健康水平已處于發(fā)展中國家前列。2010年人均期望壽命達到74.8歲，其中男性72.4歲，女性77.4歲。孕產婦死亡率從2002年的51.3/10萬下降到2011年的26.1/10萬。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‰，提前實現(xiàn)聯(lián)合國千年發(fā)展目標。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)生服務體系。包括疾病預防控制、健康教育、婦幼保健、精神衛(wèi)生、衛(wèi)生應急、采供血、衛(wèi)生監(jiān)督和計劃生育等專業(yè)公共衛(wèi)生服務網絡，以及以基層醫(yī)療衛(wèi)生服務網絡為基礎、承擔公共衛(wèi)生服務功能的醫(yī)療衛(wèi)生服務體系。二是醫(yī)療服務體系。在農村建立起以縣級醫(yī)院為龍頭、鄉(xiāng)鎮(zhèn)衛(wèi)生院和村衛(wèi)生室為基礎的農村三級醫(yī)療衛(wèi)生服務網絡，在城市建立起各級各類醫(yī)院與社區(qū)衛(wèi)生服務機構分工協(xié)作的新型城市醫(yī)療衛(wèi)生服務體系。三是醫(yī)療保障體系。這個體系以基本醫(yī)療保障為主體、其他多種形式補充醫(yī)療保險和商業(yè)健康保險為補充?；踞t(yī)療保障體系包括城鎮(zhèn)職工基本醫(yī)療保險、城鎮(zhèn)居民基本醫(yī)療保險、新型農村合作醫(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、農村人口和城鄉(xiāng)困難人群。四是藥品供應保障體系。包括藥品的生產、流通、價格管理、采購、配送、使用。近期重點是建立國家基本藥物制度。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)生籌資結構不斷優(yōu)化。衛(wèi)生籌資來源包括政府一般稅收、社會醫(yī)療保險、商業(yè)健康保險和居民自費等多種渠道。2011年，中國衛(wèi)生總費用達24345.91億元人民幣，同期人均衛(wèi)生總費用為1806.95元人民幣，衛(wèi)生總費用占國內生產總值的比重為5.1%。按可比價格計算，1978—2011年，中國衛(wèi)生總費用年平均增長速度為11.32%。個人現(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)的風險保護水平和再分配作用不斷提高。2011年，醫(yī)院、門診機構費用為18089.4億元人民幣，公共衛(wèi)生機構費用為2040.67億元人民幣，分別占衛(wèi)生總費用的71.74%和8.09%。醫(yī)院費用中，城市醫(yī)院、縣醫(yī)院、社區(qū)衛(wèi)生服務中心、鄉(xiāng)鎮(zhèn)衛(wèi)生院費用分別占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，全國醫(yī)療衛(wèi)生機構達95.4萬個(所)，與2003年比較，醫(yī)療衛(wèi)生機構增加14.8萬個(所)。執(zhí)業(yè)(助理)醫(yī)師246.6萬人，每千人口執(zhí)業(yè)(助理)醫(yī)師數由2002年的1.5人增加到1.8人。注冊護士224.4萬人，每千人口注冊護士數由2002年的1人增加到1.7人。醫(yī)療衛(wèi)生機構床位數516萬張，每千人口醫(yī)療衛(wèi)生機構床位數由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)生服務利用狀況顯著改善。2011年，全國醫(yī)療機構診療人次由2002年的21.5億人次增加到62.7億人次，住院人數由2002年的5991萬人增加到1.5億人。中國居民到醫(yī)療衛(wèi)生機構年均就診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分鐘內可到達醫(yī)療機構住戶比例，由2003年的80.7%提高到2011年的83.3%，其中農村地區(qū)為80.8%。醫(yī)療質量管理和控制體系不斷完善。建立無償獻血制度，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經過多年努力，中國衛(wèi)生事業(yè)取得顯著發(fā)展成就，但與公眾健康需求和經濟社會協(xié)調發(fā)展不適應的矛盾還比較突出。特別是隨著中國從計劃經濟體制向市場經濟體制的轉型，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，成為中國政府面臨的一個重大問題。從20世紀80年代開始，中國啟動醫(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。2009年3月，中國公布《關于深化醫(yī)藥衛(wèi)生體制改革的意見》，全面啟動新一輪醫(yī)改。改革的基本理念，是把基本醫(yī)療衛(wèi)生制度作為公共產品向全民提供，實現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務，從制度上保證每個居民不分地域、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。改革的基本原則是保基本、強基層、建機制。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)改是一項涉及面廣、難度大的社會系統(tǒng)工程，在中國這樣一個人口多、人均收入水平低、城鄉(xiāng)區(qū)域差距大的發(fā)展中國家，深化醫(yī)改是一項十分艱巨復雜的任務。三年多來，中國政府大力推進醫(yī)藥衛(wèi)生服務與經濟社會協(xié)調發(fā)展，積極破解醫(yī)改這一世界性難題。通過艱苦努力，中國的新一輪醫(yī)改取得積極進展。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、城鎮(zhèn)居民基本醫(yī)療保險、新型農村合作醫(yī)療參保人數超過13億，覆蓋面從2008年的87%提高到2011年的95%以上，中國已構建起世界上規(guī)模最大的基本醫(yī)療保障網?；I資水平和報銷比例不斷提高，新型農村合作醫(yī)療政府補助標準從最初的人均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，政策范圍內住院費用報銷比例提高到70%左右，保障范圍由住院延伸到門診。推行醫(yī)藥費用即時結算報銷，居民就醫(yī)結算更為便捷。開展按人頭付費、按病種付費和總額預付等支付方式改革，醫(yī)保對醫(yī)療機構的約束、控費和促進作用逐步顯現(xiàn)。實行新型農村合作醫(yī)療大病保障，截至2011年，23萬患有先天性心臟病、終末期腎病、乳腺癌、宮頸癌、耐多藥肺結核、兒童白血病等疾病的患者享受到重大疾病補償，實際補償水平約65%。2012年，肺癌、食道癌、胃癌等12種大病也被納入農村重大疾病保障試點范圍，費用報銷比例最高可達90%。實施城鄉(xiāng)居民大病保險，從城鎮(zhèn)居民醫(yī)?；稹⑿滦娃r村合作醫(yī)療基金中劃出大病保險資金，采取向商業(yè)保險機構購買大病保險的方式，以力爭避免城鄉(xiāng)居民發(fā)生家庭災難性醫(yī)療支出為目標，實施大病保險補償政策，對基本醫(yī)療保障補償后需個人負擔的合規(guī)醫(yī)療費用給予保障，實際支付比例不低于50%，有效減輕個人醫(yī)療費用負擔。建立健全城鄉(xiāng)醫(yī)療救助制度，救助對象覆蓋城鄉(xiāng)低保對象、五保對象，并逐步擴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年全國城鄉(xiāng)醫(yī)療救助8090萬人次。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.——基本藥物制度從無到有。初步形成了基本藥物遴選、生產供應、使用和醫(yī)療保險報銷的體系。2011年，基本藥物制度實現(xiàn)基層全覆蓋，所有政府辦基層醫(yī)療衛(wèi)生機構全部配備使用基本藥物，并實行零差率銷售，取消了以藥補醫(yī)機制。制定國家基本藥物臨床應用指南和處方集，規(guī)范基層用藥行為，促進合理用藥。建立基本藥物采購新機制，基本藥物實行以省為單位集中采購，基層醫(yī)療衛(wèi)生機構基本藥物銷售價格比改革前平均下降了30%。基本藥物全部納入基本醫(yī)療保障藥品報銷目錄。有序推進基本藥物制度向村衛(wèi)生室和非政府辦基層醫(yī)療衛(wèi)生機構延伸。藥品生產流通領域改革步伐加快，藥品供應保障水平進一步提高。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)生服務體系進一步健全。加大政府投入，完善基層醫(yī)療衛(wèi)生機構經費保障機制，2009—2011年，中央財政投資471.5億元人民幣支持基層醫(yī)療機構建設發(fā)展。采取多種形式加強基層衛(wèi)生人才隊伍建設，制定優(yōu)惠政策，為農村和社區(qū)培養(yǎng)、培訓、引進衛(wèi)生人才。建立全科醫(yī)生制度，開展全科醫(yī)生規(guī)范化培養(yǎng)，安排基層醫(yī)療衛(wèi)生機構人員參加全科醫(yī)生轉崗培訓，組織實施中西部地區(qū)農村訂單定向醫(yī)學生免費培養(yǎng)等。實施萬名醫(yī)師支援農村衛(wèi)生工程，2009—2011年，1100余家城市三級醫(yī)院支援了955個縣級醫(yī)院，中西部地區(qū)城市二級以上醫(yī)療衛(wèi)生機構每年支援3600多所鄉(xiāng)鎮(zhèn)衛(wèi)生院，提高了縣級醫(yī)院和鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)療技術水平和管理能力。轉變基層醫(yī)療服務模式，在鄉(xiāng)鎮(zhèn)衛(wèi)生院開展巡回醫(yī)療服務，在市轄區(qū)推行社區(qū)全科醫(yī)生團隊、家庭簽約醫(yī)生制度，實行防治結合，保障居民看病就醫(yī)的基本需求，使常見病、多發(fā)病等絕大多數疾病的診療在基層可以得到解決。經過努力，基層醫(yī)療衛(wèi)生服務體系不斷強化，農村和偏遠地區(qū)醫(yī)療服務設施落后、服務能力薄弱的狀況明顯改變，基層衛(wèi)生人才隊伍的數量、學歷、知識結構出現(xiàn)向好趨勢。2011年，全國基層醫(yī)療衛(wèi)生機構達到91.8萬個，包括社區(qū)衛(wèi)生服務機構2.6萬個、鄉(xiāng)鎮(zhèn)衛(wèi)生院3.8萬所、村衛(wèi)生室66.3萬個，床位123.4萬張。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)生服務均等化水平明顯提高。國家免費向全體居民提供國家基本公共衛(wèi)生服務包，包括建立居民健康檔案、健康教育、預防接種、0—6歲兒童健康管理、孕產婦健康管理、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)生事件報告和處理、衛(wèi)生監(jiān)督協(xié)管等10類41項服務。針對特殊疾病、重點人群和特殊地區(qū)，國家實施重大公共衛(wèi)生服務項目，對農村孕產婦住院分娩補助、15歲以下人群補種乙肝疫苗、消除燃煤型氟中毒危害、農村婦女孕前和孕早期補服葉酸、無害化衛(wèi)生廁所建設、貧困白內障患者復明、農村適齡婦女宮頸癌和乳腺癌檢查、預防艾滋病母嬰傳播等，由政府組織進行直接干預。2011年，國家免疫規(guī)劃疫苗接種率總體達到90%以上，全國住院分娩率達到98.7%，其中農村住院分娩率達到98.1%，農村孕產婦死亡率呈逐步下降趨勢。農村自來水普及率和衛(wèi)生廁所普及率分別達到72.1%和69.2%。2009年啟動“百萬貧困白內障患者復明工程”，截至2011年，由政府提供補助為109萬多名貧困白內障患者實施了復明手術。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。從2010年起，在17個國家聯(lián)系試點城市和37個省級試點地區(qū)開展公立醫(yī)院改革試點，在完善服務體系、創(chuàng)新體制機制、加強內部管理、加快形成多元化辦醫(yī)格局等方面取得積極進展。2012年，全面啟動縣級公立醫(yī)院綜合改革試點工作，以縣級醫(yī)院為龍頭，帶動農村醫(yī)療衛(wèi)生服務體系能力提升，力爭使縣域內就診率提高到90%左右，目前已有18個省(自治區(qū)、直轄市)的600多個縣參與試點。完善醫(yī)療服務體系，優(yōu)化資源配置，加強薄弱區(qū)域和薄弱領域能力建設。區(qū)域醫(yī)學中心臨床重點?？坪涂h級醫(yī)院服務能力提升，公立醫(yī)院與基層醫(yī)療衛(wèi)生機構之間的分工協(xié)作機制正在探索形成。多元化辦醫(yī)格局加快推進，鼓勵和引導社會資本舉辦營利性和非營利醫(yī)療機構。截至2011年，全國社會資本共舉辦醫(yī)療機構16.5萬個，其中民營醫(yī)院8437個，占全國醫(yī)院總數的38%。在全國普遍推行預約診療、分時段就診、優(yōu)質護理等便民惠民措施。醫(yī)藥費用過快上漲的勢頭得到控制，按可比價格計算，在過去三年間，公立醫(yī)院門診次均醫(yī)藥費用和住院人均醫(yī)藥費用增長率逐年下降，2011年比2009年均下降了8個百分點，公立醫(yī)院費用控制初見成效。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