The “Key Tasks for the Second Half of 2020 in Deepening the Reform of the Medical and Healthcare System” has been approved by the State Council and is hereby circulated to you. Please implement it conscientiously in light of your specific circumstances.

General Office of the State Council

July 16, 2020

(This document is publicly released.)

In recent years, particularly since the Third Plenary Session of the 18th CPC Central Committee, China’s reform of the medical and health care system has continued to deepen, leading to sustained improvements in the health status of the people and in the equity and accessibility of basic medical and health services. Since the outbreak of the COVID-19 pandemic, the medical and health care system has stood the test and played a vital role in securing victory in the battle against the epidemic. In the second half of 2020, efforts to deepen the reform of the medical and health care system should be guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, fully implement the spirit of the 19th National Congress of the CPC and the Second, Third, and Fourth Plenary Sessions of the 19th CPC Central Committee, carry out the decisions and arrangements of the Party Central Committee and the State Council, adhere to the people-centered development philosophy, uphold the principles of ensuring basic services, strengthening primary-level healthcare, and establishing sound institutional mechanisms, coordinate and advance the deepening of medical reform with work related to the prevention and control of COVID-19, place prevention at a more prominent position, address shortcomings, close loopholes, and reinforce weak areas, continue to shift the focus from disease treatment to people’s health, deepen the coordinated reform of medical services, medical insurance, and pharmaceuticals, persist in tackling the difficulties and high costs of accessing medical care, and provide strong support for winning the people’s war, overall war, and blocking operation against the epidemic, thereby safeguarding the lives and health of the people.

I. Strengthening the Public Health System

(1) Reform and improve the disease prevention and control system. Optimize and refine the functional arrangements of disease prevention and control institutions and enhance their basic infrastructure. Improve the mechanism for collaboration between medical and preventive services, strengthen the disease prevention and control responsibilities of medical institutions at all levels, bolster the capacity of public hospitals to treat infectious diseases, and promote the seamless flow of personnel, information, and resources among medical and preventive institutions. Reinforce the disease prevention and control responsibilities of township health centers and community health service centers, and establish and improve the coordinated working mechanisms between disease prevention and control institutions and urban and rural communities. Strengthen capacity-building for the prevention and control of infectious diseases at ports of entry. (The National Health Commission and the General Administration of Customs are each responsible; the National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, the National Administration of Traditional Chinese Medicine, and other relevant departments shall participate. “Each responsible” means that each department shall take the lead in accordance with its respective duties; the same applies hereinafter.)

(2) Enhance the infectious disease surveillance and early-warning system. Implement a first-contact responsibility system for reporting infectious diseases, improve the monitoring mechanisms for diseases of unknown etiology and unusual health events, promote the establishment of an intelligent, multi-point trigger mechanism for early warning, strengthen the exchange of infectious disease surveillance and early-warning information between military and civilian sectors as well as among different government departments, and advance the sound development of a multi-channel surveillance and early-warning mechanism. (The National Health Commission, the General Administration of Customs, the State Administration of Traditional Chinese Medicine, the Health Bureau of the Logistics Support Department of the Central Military Commission, and other relevant departments shall be responsible, with participation from all related departments.)

(3) Improve the public health emergency supplies guarantee system. Increase the number of medical facilities for epidemic prevention and treatment, as well as mobile laboratories. Adhere to the equal emphasis on traditional Chinese medicine and Western medicine, and strengthen capacity building for the prevention and control of public health emergencies and for emergency medical rescue in response to sudden events. Enhance stockpiles of pharmaceuticals and medical protective supplies, upgrade nucleic acid testing capabilities, promote the renovation of fever clinics in medical institutions, and ensure full implementation of the “three zones and two channels” requirements. Increase investment in research and development of vaccines, therapeutic drugs, and rapid diagnostic technologies. (The National Development and Reform Commission, the Ministry of Science and Technology, the Ministry of Industry and Information Technology, the Ministry of Finance, the National Health Commission, the State-owned Assets Supervision and Administration Commission of the State Council, the General Administration of Customs, and the National Administration of Traditional Chinese Medicine are each responsible; relevant departments shall participate.)

(4) Effectively carry out COVID-19 prevention and control during the autumn and winter seasons. Provide guidance to all localities to formulate specific plans in advance, strengthen personnel training and emergency drills, ensure that the “four-party responsibility” is fully implemented, and rigorously implement the “five essentials and three stricts” (namely, having protective guidelines, having prevention and control management systems and designated persons in charge, having protective supplies and equipment, having medical support, and having arrangements for isolation and transport; strictly managing the setup of fever clinics; conducting epidemiological investigations with utmost seriousness; and strictly preventing nosocomial infections). Establish and improve a tiered, layered, and triage-based mechanism for the treatment of major infectious diseases and other public health emergencies. Promote local authorities in providing long-term prescription services for patients with chronic diseases. (The National Health Commission, the National Development and Reform Commission, the Ministry of Finance, the State Administration of Traditional Chinese Medicine, and other relevant departments are responsible; the department listed first is the lead agency, the same applies hereinafter.)

(5) Strengthen the public health workforce. Enhance the development of disciplines related to public health and the cultivation of reserve talent. Intensify training for clinical physicians, including general practitioners, in public health knowledge such as epidemiology. Pilot provinces for comprehensive medical reform and other qualified regions should intensify their efforts to explore and improve mechanisms for the recruitment and deployment of public health personnel, their remuneration and benefits, performance assessment and evaluation, and incentive systems. (The Ministry of Education, the Ministry of Human Resources and Social Security, the National Health Commission, the National Administration of Traditional Chinese Medicine, and the Secretariat of the State Council Leading Group for Medical Reform shall be responsible, with the participation of the Ministry of Finance and other relevant departments.)

II. Deeply Implement the Healthy China Initiative

(6) Continuously improve the production and living environment and promote healthy, civilized lifestyles. Enhance the mechanism for public health education and science communication. Carry out in-depth improvements to the rural living environment. Revise and refine the technical guidelines for COVID-19 prevention and control in agricultural markets. Advance the standardization of agricultural markets by clarifying functional zoning and layout, and strengthening standardized management as well as oversight and law enforcement. Push forward the revision of the General Rules on Nutrition Labeling for Prepackaged Foods. Formulate guiding documents for deepening the Patriotic Health Campaign in the new era. (The Ministry of Ecology and Environment, the Ministry of Agriculture and Rural Affairs, the Ministry of Commerce, the National Health Commission, and the State Administration for Market Regulation shall each assume responsibility accordingly.)

(7) Strengthen health promotion among key population groups. Conduct national evaluation and assessment of comprehensive myopia prevention and control among children and adolescents. Comprehensively strengthen and improve physical education, health care, and health education in schools. Expand the scope of pilot programs for institutional innovation in maternal and child health care institutions. Develop management guidelines for integrated medical–elderly care institutions. Enhance the provision of at-home medical and health services for older adults. Implement a project to enhance community-based integrated medical–elderly care capabilities. (The Ministry of Education and the National Health Commission are each responsible; the National Development and Reform Commission, the Ministry of Civil Affairs, the General Administration of Sport, and the State Administration of Traditional Chinese Medicine shall participate.)

(8) Enhance the prevention and control of chronic diseases. Improve public health service programs. Use the management of chronic diseases such as hypertension and diabetes as a breakthrough point to strengthen the integration of prevention and treatment at the primary care level. Take early screening and intervention for cardiovascular and cerebrovascular diseases, cancer, and pneumoconiosis as entry points to promote the integration of functions between disease prevention and control institutions and medical institutions. Develop guidelines on cancer prevention and screening (popular science edition). Advance pilot projects for building a social psychological services system. (The National Health Commission, the Ministry of Finance, the State Administration of Traditional Chinese Medicine, and other relevant departments are responsible.)

(9) Strengthen prevention and control of infectious diseases, endemic diseases, occupational diseases, and other health threats. Effectively carry out influenza prevention and control during the winter and spring seasons. Achieve the goal of malaria elimination, control and eliminate the harm caused by key endemic diseases such as Kashin-Beck disease and schistosomiasis, and bring echinococcosis under basic control. Promote initiatives to recognize and promote occupational health champions. (Responsible: National Health Commission, National Administration of Traditional Chinese Medicine)

III. Deepening the Comprehensive Reform of Public Hospitals

(10) Improve the performance appraisal mechanisms for medical and health institutions and healthcare professionals. Refine the performance appraisal system for tertiary public hospitals, launch performance appraisals for secondary public hospitals, and advance performance appraisals for maternal and child health institutions. Incorporate disease prevention and control, public health emergency response, and health promotion and education into the scope of performance assessment. Promote transparency in the financial operations of public hospitals. Advance pilot programs for establishing and improving modern hospital management systems, and carry out in-depth demonstration projects and performance evaluations for comprehensive reform of public hospitals. Formulate policy documents to promote the high-quality development of public hospitals. (The National Health Commission and the National Administration of Traditional Chinese Medicine are each responsible; the Ministry of Human Resources and Social Security and other relevant departments shall participate.)

(11) Establish and improve the mechanism for the dynamic adjustment of medical service prices. Provide guidance to all provinces to design a comprehensive dynamic adjustment mechanism along the following basic framework: setting trigger conditions; conducting assessments to determine when adjustments should be implemented; allowing for both price increases and decreases; ensuring seamless alignment with basic medical insurance payments; and carrying out ongoing monitoring, evaluation, and performance assessment. During window periods when drug and medical consumable costs are reduced—such as through centralized procurement of drugs and consumables and the elimination of markups on medical consumables—promptly conduct price adjustment assessments, and, once the trigger conditions are met, implement price adjustments in a prudent and orderly manner. Promote the refinement of the access system for medical service items and expedite the review and approval of new medical service pricing items. Monitor public medical institutions’ medical service prices, costs, expenditures, revenue distribution, and the operation of reform initiatives, using this information as the foundation for implementing dynamic adjustments to medical service prices. Strengthen cost accounting for medical services provided by public medical institutions. (The National Health Commission, the National Healthcare Security Administration, and the State Administration of Traditional Chinese Medicine shall each assume responsibility for specific aspects of this task.)

(12) Deepen reform of the compensation system and staffing management. Implement the “two allowances” requirements, comprehensively roll out the reform of the compensation system in public hospitals, provide guidance to local authorities on refining the methods for determining the total compensation budget for public hospitals, conducting internal performance assessments, and allocating income, and establish and improve an operational mechanism that combines guarantees with incentives for medical and health institutions. Coordinate and make efficient use of staffing resources in the medical and health sector, with a particular focus on strengthening staffing allocations for public hospitals, primary-level medical and health institutions, and public health institutions at all levels, including disease prevention and control agencies. (The Central Institution Organization Commission and the Ministry of Human Resources and Social Security are each responsible; the Ministry of Finance, the National Health Commission, the National Healthcare Security Administration, and the State Administration of Traditional Chinese Medicine shall participate.)

(13) Implement the government’s policies on investment in the capital construction and equipment procurement of public hospitals that comply with regional health planning, and increase support for traditional Chinese medicine hospitals and infectious disease hospitals. Actively yet prudently advance the resolution of eligible long-term debts of public hospitals; strictly prohibit borrowing for construction projects and over-standard renovations; and hold public hospitals strictly accountable for any violations involving unauthorized borrowing. (The National Development and Reform Commission, the Ministry of Finance, the National Health Commission, and the State Administration of Traditional Chinese Medicine are each responsible for their respective areas of work.)

IV. Deepening Reform of the Medical Security System

(14) Enhance the level of basic medical security. Increase the per capita fiscal subsidy for urban and rural resident medical insurance by RMB 30, and steadily raise individual contribution rates. Improve the mechanism for covering medical treatment costs during major epidemics. Launch a pilot program for direct inter-provincial settlement of outpatient expenses. (Responsible: National Healthcare Security Administration and Ministry of Finance)

(15) Advance reform of the medical insurance payment system. Carry out national pilot programs for diagnosis-related group (DRG) payment and disease-specific payment. Improve the consultation and negotiation mechanisms between medical insurance administrative agencies and medical institutions, and appropriately set and dynamically adjust the overall budgetary cap for medical insurance funds. Where conditions permit, increase the advance allocation of revolving funds to alleviate the financial burden on medical institutions of having to make upfront payments. Explore implementing global budgeting for closely integrated healthcare consortia, strengthen supervision and performance assessment, allow surplus funds to be retained by the consortium, and ensure that reasonable excess expenditures are shared in an appropriate manner. Formulate guiding opinions on establishing payment standards for drugs covered by medical insurance. (Responsible: National Healthcare Security Administration, National Health Commission, and National Administration of Traditional Chinese Medicine.)

(16) Strengthen management of the basic medical insurance fund and improve the regulatory mechanism. Implement big-data–based intelligent monitoring of medical insurance, promote the application of technologies such as video surveillance and facial recognition, and explore the implementation of province-level centralized monitoring. Advance “Internet Plus” medical security, accelerate the development of a nationally unified medical security information platform, and ensure seamless integration with the national integrated government services platform. (Responsible: National Healthcare Security Administration)

(17) Accelerate the development of commercial health insurance. Encourage commercial insurance institutions to offer comprehensive health insurance products and services that provide multiple layers of coverage, including medical care, illness, rehabilitation, long-term care, and maternity benefits. Actively engage social entities in the administration and delivery of healthcare security services. (The National Healthcare Security Administration and the China Banking and Insurance Regulatory Commission shall be responsible, respectively.)

V. Improving the Pharmaceutical Supply Assurance System

(18) Improve policies on the procurement of pharmaceuticals and medical consumables. Gradually expand the scope of drugs subject to national centralized procurement and use, and launch pilot programs for the centralized procurement of high-value medical consumables. Encourage medical insurance administrative agencies to settle drug payments directly with pharmaceutical manufacturers or distributors. Provide guidance to local authorities to ensure full implementation of policies governing the procurement, distribution, and use of winning-bid drugs and high-value medical consumables. Formulate policy documents to reform and improve the drug procurement mechanism. Provide guidance to local authorities to refine policies related to centralized procurement and medical insurance reimbursement for COVID-19 testing. (The National Healthcare Security Administration and the National Health Commission are each responsible; the Ministry of Finance and the National Medical Products Administration shall participate.)

(19) Promote the scientific and rational use of medicines. Implement monitoring of rational drug use, regularly publish monitoring results, and encourage medical institutions to optimize and standardize their drug-use structures, with a focus on prioritizing the procurement and use of National Essential Medicines. Ensure compliance with requirements such as “oral administration preferred over intramuscular injection, and intramuscular injection preferred over intravenous infusion.” Strengthen the development of the National Drug Use Monitoring Platform. Advance comprehensive clinical evaluations of drugs, and launch pilot programs for comprehensive clinical evaluations of essential medicines for major diseases. Formulate the second batch of the Catalogue of Drugs Encouraged for Generic Production. (Responsible: National Health Commission, National Administration of Traditional Chinese Medicine)

(20) Strengthen oversight of the use of pharmaceuticals and medical consumables. Gradually establish and improve an information-based traceability system for pharmaceuticals, achieving “one product, one code” for vaccines and for drugs subject to national centralized procurement and use. Select certain high-value medical consumables and other key product categories to implement unique device identification for medical devices. Build a nationally unified and open centralized drug procurement market, with standardized criteria and functional specifications, and promote the use of medical insurance drug coding. Gradually standardize the classification and coding of high-value medical consumables under the national medical insurance system, and explore the implementation of coordinated and standardized coding across the registration, procurement, and use stages of such consumables. (The National Healthcare Security Administration and the National Medical Products Administration are each responsible; the National Health Commission and other relevant departments shall participate.)

(21) Ensure the stable supply and price stability of shortage drugs. Advance the development of a multi-source information collection platform for shortage drugs and a inter-agency collaborative monitoring mechanism. Implement a reporting system for production halts of shortage drugs and a list-based management system. Establish and improve a regular monitoring and early-warning mechanism for drug and medical consumable prices, strengthen dynamic monitoring of domestic procurement prices, and track international prices. Intensify law enforcement against monopolistic and other illegal practices involving active pharmaceutical ingredients and imported drugs. (The Ministry of Industry and Information Technology, the National Health Commission, the State Administration for Market Regulation, the National Healthcare Security Administration, and the National Medical Products Administration are each responsible; the National Administration of Traditional Chinese Medicine shall participate.)

VI. Coordinated Advancement of Key Reforms

(22) Continue to advance the development of regional medical centers, promote the expansion and downward distribution of high-quality medical resources and their balanced allocation, and establish management systems and operational mechanisms that are commensurate with the functions of regional medical centers. (The National Development and Reform Commission, the National Health Commission, the State Administration of Traditional Chinese Medicine, and the Secretariat of the State Council Leading Group for Healthcare Reform shall each assume responsibility for this task.)

(23) Promote tiered diagnosis and treatment and the development of information technology in the medical and health sectors. Fully advance the construction of community hospitals, refine and effectively implement family-doctor contract services, enhance the capacity of medical services in urban and rural communities, improve the tiered diagnosis-and-treatment system, and strengthen primary-level health and disease-prevention efforts. Deepen comprehensive medical reform at the county level, pilot closely integrated county-level medical consortia, and promote the integration of county- and township-level healthcare services as well as rural healthcare services. Implement policies that provide multi-channel subsidies for the income of rural medical and health personnel. Accelerate the development of “Internet Plus Healthcare,” improve the national platform for public health information, promote the application of next-generation information technologies in the medical and health fields, and facilitate the transformation of medical and health management and service delivery models. Support the sustained, healthy, and standardized development of privately run medical institutions. Provide support to medical institutions affected by the pandemic. Formulate opinions on comprehensively establishing a high-quality, efficient medical and health service system with Chinese characteristics. (The National Development and Reform Commission, the Ministry of Finance, the Ministry of Human Resources and Social Security, the National Health Commission, the National Healthcare Security Administration, the State Administration of Traditional Chinese Medicine, and the Secretariat of the State Council Leading Group for Medical Reform are each responsible for specific aspects of this work.)

(24) Promote the revitalization and development of traditional Chinese medicine. Vigorously advance the integrated model of traditional Chinese and Western medicine in general hospitals, infectious disease hospitals, specialized hospitals, and other institutions, and incorporate the implementation of this model into hospital accreditation and performance evaluation. Accelerate the establishment of evidence-based medicine centers for TCM, launch the construction of national TCM medical centers and regional TCM medical centers, conduct pilot projects for the development of “classic TCM wards,” enhance the emergency response and treatment capabilities of TCM hospitals, and leverage the unique role of TCM in the treatment of major epidemics. Select and publish a list of TCM-advantaged diseases and clinical treatment programs, and encourage and guide medical and health institutions to provide TCM services. Strengthen the capacity of county- (and city-) level TCM medical services and personnel development, and strive to achieve full coverage of county-run TCM medical institutions. When adjusting medical service prices, give priority to those that reflect the value of technical and labor services, and support the inheritance, innovation, and development of TCM. Formulate policies and measures to accelerate the distinctive development of TCM. (The National Administration of Traditional Chinese Medicine, the National Development and Reform Commission, the National Health Commission, and the National Healthcare Security Administration are each responsible for their respective tasks.)

(25) Solidly advance health-related poverty alleviation. Thoroughly address the most salient issues related to ensuring access to basic medical services, and strengthen policy support for talent development and capacity building in health and hygiene in impoverished areas. Ensure that medical security for rural impoverished populations is provided in accordance with regulations. Increase guidance and support for deeply impoverished areas such as the “Three Regions and Three Prefectures,” and intensify efforts to prevent and control major infectious and endemic diseases. Improve nutrition and other related problems in impoverished areas. (Responsible: National Health Commission, National Development and Reform Commission, Ministry of Education, Ministry of Finance, National Healthcare Security Administration, State Administration of Traditional Chinese Medicine, State Council Leading Group Office of Poverty Alleviation, etc.)

(26) Improve the coordination and oversight mechanisms for comprehensive regulation of the health care sector. Launch pilot programs on “credit-based + comprehensive regulation.” Formulate policy documents on accountability and oversight mechanisms for comprehensive regulation in the health care sector. Develop several regulations to strengthen the construction of the health supervision system and promote the standardization of supervisory institutions. Further standardize medical practices and promote the rational use of medical examinations. (The National Health Commission, the National Administration of Traditional Chinese Medicine, and other relevant authorities are responsible.)

All local authorities and relevant departments must strengthen the concept of “grand health” and “holistic health,” earnestly enhance systematic planning and organizational leadership for deepening medical reform, incorporate the completion of medical-reform tasks as a key component of government performance assessments under target management, and coordinate efforts to ensure both routine epidemic prevention and control and the comprehensive advancement of medical reform. Further promote the experiences of Fujian Province and Sanming City in medical reform. Establish an evaluation and adjustment mechanism for pilot provinces undertaking comprehensive medical reform. The Secretariat of the State Council Leading Group for Medical Reform shall strengthen overall coordination, conduct monitoring and evaluation, maintain a task ledger and issue quarterly reports, and carry out an assessment of the 13th Five-Year Plan for Medical Reform. Intensify publicity and guidance on medical reform, promptly interpret policies and measures, and build broad consensus on reform.