深化医药卫生体制改革 促进卫生事业科学发展 Deepen the reform of the medical care system to promote health science development
张茅

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    党的十六大以来，在科学发展观指导下，我国医药卫生事业取得了显著成就。2010年我国人均期望寿命达到73.5岁，2011年我国孕产妇死亡率和婴儿死亡率分别下降到26.1/10万和12.1‰，接近中等发达国家水平。特别是2009年4月党中央、国务院全面深化医药卫生体制改革启动实施以来，我国基本医疗保障覆盖面从2008年的87%提高到2011年的95%以上，全民医保框架基本建立，为近13亿居民构建了抵御疾病经济风险的安全屏障。2011年，全国医疗卫生机构诊疗62.71亿人次，入院人数1.5亿，达到历史最高水平。总结卫生事业发展取得的成绩，关键在于深入贯彻落实科学发展观，坚持走中国特色卫生发展道路，正确处理卫生事业与经济社会事业协调发展的关系，正确处理影响卫生事业科学发展的若干重要关系，努力探索出医改这一世界性难题的中国式解决办法。

    Since the 16 th CPC national congress，Under the guidance of the scientific concept，Our medical health service has accomplished remarkable achievements。In 2010, average life expectancy in 73.5 years，In 2011, the maternal mortality rate and infant mortality rates were down to 26.1/10 and 12.1 per thousand，Close to the level of moderately developed countries。Especially in April 2009, the party central committee、The state council comprehensively deepen medicine and health system reform since the implementation of start，In the basic medical insurance coverage from 2008 to 87% in 2011 and above，A basic framework of universal coverage，For nearly 1.3 billion residents constructed to fight disease economic risk security barrier。2011 years，The national health care institutions diagnosis and treatment and 6.271 billion passengers，The number was 150 million，Hit a record high。Summarizes the achievements of health development，The key is to thoroughly apply the scientific outlook on development，Adhere to the Chinese characteristic health development road，Correctly handle the health and economic society coordinated development of the business relationship，Correctly handle the influence of the development of health science several important relationship，To try to find out the cure of the Chinese style of worldwide problem solution。

    

    一、坚持科学发展理念，统筹推进卫生事业与经济社会事业协调发展 a、Adhere to the scientific development concept，Promote health plan as a whole to economic and social harmonious development business

    卫生事业是社会公益性事业，体现着人民群众最关心、最直接、最现实的利益诉求，承担着维护和促进人民健康的光荣使命。党和政府历来高度重视卫生工作，努力维护人民群众身心健康。2003年，党中央总结抗击非典的重要启示和新中国成立以来特别是改革开放20多年的经验，提出了科学发展观重大战略思想，统筹解决经济社会发展“一条腿长，一条腿短”的问题，把卫生事业置于经济社会发展全局中统筹谋划、积极推进。新医改确立了到2020年建立健全覆盖城乡居民的基本医疗卫生制度，实现人人享有基本医疗卫生服务的奋斗目标，确立了把基本医疗卫生制度作为公共产品向全民提供的基本理念。这是我国医疗卫生事业发展从观念到体制的重大变革，是贯彻落实科学发展观的本质要求。

    Health is the social public welfare undertakings，Embodies the greatest concern to the people、The most direct、The most realistic interest demand，Responsible for maintenance and promote the glorious mission to people's health。The party and the government always attaches great importance to health work，Strive to safeguard people's physical and mental health。2003 years，Summary of the party central committee in the fight against SARS and an inspiration to the reform and opening up, especially since the founding of more than 20 years of experience，Proposed the scientific concept of development strategic thoughts，As a whole solve economic social development“A long legs，A short legs”problems，The health service in economic and social development of the country as a whole in the plan、Actively promote。New cure of the established in 2020 to establish and perfect the covering both urban and rural residents of basic medical health system，Realize everyone will have access to basic medical and health services's goal，Established the basic medical health system, as to the public products provide the basic ideas。This is our medical health service development from the conception of the system of the revolution，To implement the scientific development concept is the essential requirements。

    实践证明，经济社会事业的持续发展，消费结构的转变升级和广大居民健康需求的不断增长，为卫生事业发展提供了前进动力和不竭源泉，也为深化医改奠定了坚实的物质基础；虽然区域间、城乡间经济发展差距难以在短期内大幅度缩小，但通过实施包括卫生在内的公共服务均等化措施，能较快缩小区域和城乡之间社会事业的发展差距，有效维护社会公平公正；卫生事业的科学发展，居民健康水平的大幅提高，既为经济社会发展提供了大量高素质的劳动力，又缓解了群众看病就医的后顾之忧，增强了居民消费信心，从而为扩大内需、转变经济发展方式、实现经济社会又好又快发展起到重要的支撑作用。

    Practice proves，The cause of economic and social sustainable development，The change of consumption structure upgrade and citizens health demand is growing，For health service development provides motivation and an inexhaustible source，Also is the deepening laid the solid material medical foundation；Although regional、Between urban and rural economic development gap in the short term to shrink dramatically，But through the implementation, including sanitation equal public services measures，Can narrow the area between urban and rural areas and rapid development of the cause of the social gap，Effective safeguard social fairness；The scientific development of the health service，Residents health level much of the increase，For both economic and social development provides a number of high-quality workforce，And the masses of the hospital to ease the trouble back at home，To enhance the consumer confidence，Thus for the expansion of domestic demand、Transformation of the mode of economic development、Realize the sound and rapid eco-social development, has played an important role of the support。

   

    二、坚持公共医疗卫生的公益性质，统筹发挥政府主导与市场机制作用  two、Insist on the health of the public welfare nature，As a whole the government play the leading role and the market mechanism

    如何发挥好政府主导和市场机制的作用，是我们多年来努力探索的重大问题。新医改提出“保基本，强基层，建机制”的基本原则，明确了医疗卫生事业的公益性质，突出了政府在医疗卫生事业中的主导作用，有效弥补了医疗卫生领域“市场失灵”的问题，切实维护了基本医疗卫生的公益性，促进了社会公平公正。

    How to play a good government leading and the function of the market mechanism，Is our many years to try to explore major issues。Put forward new medical“The basic，Strong grassroots，Built mechanism”The basic principles of the，Clear the medical and health services of public welfare in nature，Prominent government in medical and health services in the leading role，Effective make up for the medical and health fields“Market failure”problems，Protect the basic medical and health of the public benefits，Promote social fairness。

    新医改三年来，公共财政前所未有地加大卫生投入，全国财政医疗卫生累计支出15166亿元。政府在优化资源配置和利用、加强对贫困地区及薄弱领域和环节的支持力度等方面充分发挥了主导作用，“保基本”的职责得到进一步加强。经过多年努力，世界上最大的基本医疗保障安全网得以建立，基本药物制度在政府办基层医疗卫生机构全面实施，城乡基层医疗卫生服务体系更加健全，服务能力大幅提高，公立医院改革试点有序推进。

    New cure of the three years，Public finance an unprecedented increase health investment，The national financial health accumulative total spending 1.5166 trillion yuan。The government in optimizing the allocation of resources and use、Strengthen the poverty-stricken areas and weak areas and link to fully support on the play a leading role，“The basic”Further strengthen the duty。After many years of hard work，The world's largest basic medical insurance safety net be established，Basic drugs in the system of government medical and health institutions comprehensive implementation，Urban and rural medical and health service system more perfect，Service capacity increase，Public hospital reform pilot pushed forward。

    新医改注重发挥市场机制的重要作用，通过引入市场机制，构建起医疗卫生机构内部竞争性的用人机制、激励性的分配机制和规范性的药品采购机制，调动了医务人员的积极性，提高了运行效率；扩充医疗资源供给，弥补政府资源的不足，初步构建了以公立医疗机构为主导、非公立医疗机构为补充的医疗服务体系，以满足人民群众多层次、多样化的医疗服务需求。民办医疗机构数量从2005年的3220家，增加到2011年的8440家，年均增速为17.4%。2011年民办医院诊疗人次2.06亿，占全国诊疗人次总数的9.1%。

    New medical attention to the market mechanism to play the important role，By introducing market mechanism，Constructing the medical and health institutions internal competitive mechanism of employing、The distribution of incentive mechanism and normative drug procurement mechanism，Mobilize the enthusiasm of the medical staff，Improve the operation efficiency；Expand medical resources supply，Make up the deficiency of the government resources，Initially built to public medical institutions as the leading、A public medical institution of medical service system for added，To satisfy the people's levels、The diversity of medical service needs。Run by the number of medical institutions from 2005 in 3220，Increased to 2011 years of 8440，At an annual average rate of 17.4%。In 2011, run by the hospital diagnosis people 206 million，Accounts for the diagnosis and treatment and 9.1% of the total number of people。

    

    三、坚持以农村为重点，统筹城乡和区域卫生事业协调发展 three、Adhere to the countryside as a key，Coordination of urban and rural and regional health coordinated development

    在卫生资源配置、卫生服务利用、居民健康水平等方面，我国城乡、区域和群体之间存在着明显差异，大部分卫生资源集中在大城市，高新技术、优秀卫生人才基本上集中在城市的大医院，农村和城市基层卫生服务能力较为薄弱，城乡居民在享有卫生服务及主要健康指标方面均存在较大差距，实现公共卫生和医疗服务均等化面临诸多挑战。

    In the health resources、Health services utilization、Residents health level，In urban and rural areas in China、Regional and there exists a significant difference between groups，Most of the health resources concentrated in the big city，High and new technology、Good health personnel basically focuses on urban hospitals，The rural and urban basic health service ability are weak，Urban and rural residents in the health service and major health index, are a great disparity，Realize the public health and medical service equal access to face the challenges。

    新医改通过改善和优化卫生资源配置结构，着力缩小城乡、区域和群体间的差距，以卫生事业的均衡发展促进城乡之间经济社会的均衡发展。一是明显加大了对中西部地区和欠发达地区的财政支持力度，逐步完善了医疗卫生资源区域、城乡间优化调整的政策措施。二是加强对欠发达地区人才、技术、政策、管理、资金等方面的扶持力度。三年来，中央财政投入470多亿元，用于支持2233个县级医院、6213个乡镇卫生院和2.5万个村卫生室的基础设施建设。三是加大城市优质资源对农村地区和基层的支持力度，推动建立公立医院与基层医疗卫生机构分工协作机制。通过建立医院间的远程会诊、组建医疗集团和医疗联合体等多种形式，促进优质医疗资源下到基层，并充分发挥其辐射带动作用和倍增效应。

    Through the improvement and optimization of new medical health resource allocation structure，Narrowing of focus on the、Area and the gap between the groups，To promote the health of balanced development between urban and rural areas the balanced development of the economic society。One is significantly increased the to the Midwest and less developed areas of financial support，Improved step by step to the medical and health resources area、Between urban and rural areas to optimize the policy measures。Two is to strengthen the underdeveloped areas, talent、technology、policy、management、The fund, the support strength。Three years，The central financial investment more than 470 yuan，Used to support 2233 county hospital、6213 rural hospitals and 25000 village clinic infrastructure construction。Three is to increase quality resources to rural area city and grassroots support，Promote the establishment of a public hospital and basic medical and health institutions division of labor cooperation mechanism。By establishing the remote consultation among hospitals、Medical group and a variety of forms such as medical association，Promote quality medical resources to a primary，And give full play to its role in driving the radiation and multiply effect。

    缩小差距关键在人才。新医改更加注重欠发达地区卫生人才的培养，三年来累计为中西部地区农村免费培养医学生1万余人。中央财政投入专项补助经费2.1亿元，安排3.6万名基层医疗卫生机构在岗人员参加全科医生转岗培训，并为乡镇卫生院、村卫生室和社区卫生服务机构在岗培训医疗卫生人员253万人次。2011年，乡镇卫生院人员数达到120万，比2005年增长18.7%，其中大专以上学历人员比重从23%提高到40%。

    The key to narrow the gap in talent。New cure of paying more attention to the less developed areas health personnel training，Three years accumulated in the rural areas of the Midwest free medical students' 10000 more than person。The central financial investment special subsidies 210 million yuan，Arrange 36000 grassroots medical and health institutions on-the-job personnel to participate in the general practitioner job-transfer training，And for rural hospitals、Village clinic and the community medical service on-the-job training medical staff 2.53 million people。2011 years，The new staff number to 1.2 million，A 18.7% increase over 2005，College degree or above in the proportion of people increased from 23% to 40%。

    随着医改深入推进，医疗卫生领域城乡和区域统筹发展的步伐明显加快，长期存在的城乡二元结构和地区间健康水平差异正在逐步缩小。孕产妇死亡率城乡之比由2008年的1:1.24缩小为2011年的1:1.05；婴儿死亡率城乡之比由1:2.83下降到1:2.53。农村住院分娩率西部地区与东部地区的差距由2003年的34%下降到2010年的2%。

    With advanced medical，Medical health field and the development of urban and rural areas as a whole quickened significantly，The long-term existence of the urban and rural structure and regional health level difference is gradually narrowing。The maternal mortality rate plunged by 2008 years of urban and rural than 1:1. 24 shrink to 2011 in 1:1.05；Infant mortality ratio of the urban and rural areas by 2-1. 83 down to 2-1. 53。In western regions with the results in eastern gap from 34% in 2003 to 2% in 2010。

  

    四、坚持发挥中医药特色优势，统筹中西医协调发展   four、Adhere to the play special advantage of Chinese medicine，As a whole the coordinated development of Chinese and western medicine

    中医药是中华民族的瑰宝。实践证明，中医与西医优势互补、相互促进，共同维护和增进人民健康，已经成为中国特色医疗卫生事业的显著特征和独特优势。但是，目前中医也面临着扶持力度不够、服务领域缩小、优势特色淡化等困难和问题。

    Traditional Chinese medicine is the treasure of the Chinese nationality。Practice proves，Traditional Chinese medicine and western medicine advantages、Promote each other，Maintain and promote common people's health，Has become Chinese characteristic feature of public health care and unique advantages。but，Traditional Chinese medicine also currently facing the support strength is not enough、Service field narrowed、Characteristic advantage such as desalination difficulties and problems。

    作为深化医改的重要配套文件，国务院2009年出台了《关于扶持和促进中医药事业发展的若干意见》，系统提出了中医药事业发展的指导思想、基本原则和主要任务。各级党委政府对扶持促进中医药事业发展的认识明显提高，对中医药工作的支持力度进一步加大，中医药服务越来越受到广大群众的欢迎和认可，中医药在防治疾病、促进健康方面的作用明显增强。

    As a deepening of the important supporting documents cure，In 2009, the state council issued《About support and promote the development of traditional Chinese medicine some opinions》，The system of the development of traditional Chinese medicine put forward the guiding thought、The basic principles and main task。Party committees at all levels to support the development of Chinese medicine in the know obviously improved，Work in Chinese medicine support further increase，Traditional Chinese medicine service more and more get the welcome of the masses and recognition，Traditional Chinese medicine in the prevention and cure of diseases、Promote the health of the role of obvious enhancement。

    新医改注重中医药基础设施、人才培养、特色优势、学科发展等方面建设，初步形成了中医药医疗、保健、教育、科研、产业、文化“六位一体”全面协调发展的格局。注重发挥医保政策的引导作用，提高中医药报销比例，促进中医药服务利用。在2009年颁布的国家基本药物目录中，中成药所占比例达到1/3，中药饮片也首次纳入其中。加快基层中医药服务网络建设，重点抓好县级公立中医医院改造和乡镇卫生院、社区卫生服务中心的中医科、中药房建设。三年来，中央安排专项资金56.7亿元，完成382所县级中医医院建设项目投资计划，安排42.1亿元支持1960所市县级中医医院、民族医医院建设。中医药预防保健服务和健康管理内容已纳入国家基本公共卫生服务项目范围，推动中医药“进乡村、进社区、进家庭”，大力实施中医“三名”（名医、名科、名院）工程。过去5年，中医师占医师队伍的比重从10.3%提高到12.2%。

    Pay attention to Chinese medicine cure of the new infrastructure、Personnel training、Special advantage、Development of the discipline construction, etc，Initially formed Chinese medicine health care、Health care、education、Scientific research、industry、culture“Six one”The pattern of the comprehensive and coordinated development。Pay attention to play the medicare policy guidance，Improve the reimbursement ratio of Chinese medicine，Use of Chinese medicine in service。In 2009 the country issued basic drugs in the directory，Traditional Chinese medicine to one-third proportion，Chinese medicine yinpian also included in the first time。To speed up the construction of traditional Chinese medicine service network，Concentrate on traditional Chinese medicine at the county level public hospital reform and rural hospitals、Community health service center in general、Currently construction。Three years，The central arrange special fund 5.67 billion yuan，Complete 382 Chinese medicine hospital at the county level of project investment plan，Arrange 4.21 billion yuan support 1960 ShiXianJi TCM hospital、National medical hospital construction。Traditional Chinese medicine preventive care service and health management content has incorporated into the state public health service project scope basic，Promote traditional Chinese medicine“Into the country、Into the community、Into family”，Energetically carry out traditional Chinese medicine“three”（Famous doctors、Name,、MingYuan）engineering。Over the past five years，The proportion of team of TCM doctor doctors increased from 10.3% to 12.2%。

   

    五、坚持预防为主，统筹公共卫生和医疗服务体系发展  five、Adhere to the prevention，Overall public health and medical service system development

    坚持预防为主，是我们一贯的卫生工作方针，也是最经济、最有效的健康策略。但是，受多种因素影响，长期以来预防为主的卫生工作方针没有得到很好落实，不同程度地存在重治疗、轻预防的问题。

    Adhere to the prevention，Is our consistent health work policy，Is the most economical、The most effective health strategy。but，By many factors，Long prevention health working policy not to obtain the very good implementation，Exist to varying degrees heavy treatment、The prevention of light。

    当前，我国经济社会发展进入新阶段，人民群众生活方式发生很大变化，健康问题变得更为复杂。尤其值得关注的是，我国现有2亿多高血压病人、9000多万糖尿病病人，每年有200万人死于心脑血管疾病、190万人死于恶性肿瘤，慢性非传染性疾病已经成为我国居民的主要死因。在新医改中，我们坚持把加强公共卫生服务体系建设放在首位，用制度建设落实预防为主的方针。在防治策略上，坚持传染病与慢性非传染性疾病防治并重；在防治机构上，坚持依靠专业公共卫生机构和医疗服务机构及医学科研机构并重；在防治方式上，坚持社会动员和全员参与；在防治重心上，坚持以基层医疗卫生机构为基础，主要发挥全科医生的作用，实现城乡居民的全面健康管理。针对新时期人民群众健康状况的新特征，国家启动实施包括建立健康档案、高血压、糖尿病管理等10大类41项国家基本公共卫生服务项目，基本公共卫生服务补助经费逐步提高到2011年的人均25元。此外，针对重点人群和重点区域的重大公共卫生服务项目顺利实施，累计完成乙肝疫苗补种6700万人，分别对1169万、146万名农村适龄妇女免费进行了宫颈癌、乳腺癌检查，对2356万名育龄妇女免费补服了叶酸等。

    The current，China's economic and social development to enter a new stage，People's way of life change greatly，Health problems become more complicated。Especially notable is，Our country's existing more than 200 million hypertension patients、More than 9000 patients with diabetes，Every year 2 million people died from disease of heart head blood-vessel、1.9 million people died in malignant tumors，Chronic non-communicable diseases of the residents of our country has become a leading cause of death。In the cure of the new，We insist on the strengthening of the public health service system construction in the first place，With the system construction implement the policy of prevention。In the control strategy，Insist on infectious disease and chronic non-communicable disease prevention and cure pay equal attention to；In control of the agency，Adhere to rely on the professional public health institutions and medical services and medical research institutions pay equal attention to；In control on the way，Insist on social mobilization and full participation；Focus on prevention，Adhere to the basic medical and health institutions as the foundation，The main play the role of the general practitioner，Realization of urban and rural residents overall health management。According to people's health in the new period of new features，Countries including establish healthy start implementing files、High blood pressure、Diabetes management 10 categories 41 countries such as basic public health service project，Basic public health service gradually increase subsidies to 2011 the per capita 25 yuan。In addition，For key crowd and the key areas of major public health service project implementation，Has been finished second liver vaccine reseed 67 million people，Of 11.69 million respectively、1.46 million rural women the school-age free cerical cancer、Breast cancer check，Of 23.56 million women of child-bearing age taking folic acid, for free。

    通过三年多的努力，新医改提高了专业公共卫生机构的服务能力，转变了基层医疗卫生机构的服务模式，加强了全民健康教育和健康促进等综合措施，有效提高了对慢性非传染性疾病的干预、控制和管理水平。同时，新医改进一步完善了结构合理、覆盖城乡的医疗服务体系，既加强区域性医学中心建设，培育一大批融医疗、教学、科研为一体的高水平、高层次的医疗服务机构，也强调基层医疗卫生机构的基础性地位和作用，逐步建立起以居民健康为中心，预防、治疗、保健、康复、健康教育与促进等相结合的综合服务模式。我们还采取有效措施，使人民群众尽量“少得病”、“不得病”。

    Through more than three years of hard work，The new improved medical professional public health service ability，Change the basic-level medical health service mode，To strengthen the national health education and health promotion, and other comprehensive measures，Effective improve the chronic non-communicable diseases intervention、Control and management level。At the same time，New cure of further improving the structure is reasonable、Covering both urban and rural medical service system，Both strengthen regional medical center construction，Cultivate a large number of melting medical treatment、teaching、Research for the integration of high level、High-level medical services，Also emphasize the medical and health institutions of the basic status and role，Build up to people as the center，prevention、treatment、Health care、rehabilitation、Health education and promote the combination of comprehensive services such as mode。We also take effective measures，As far as possible to the people“Less sick”、“Don't become sick”。

    虽然我国卫生事业和医改工作取得了巨大成就，但我国医疗资源总体供给短缺、特别是优质资源难以满足群众需求的状况没有改变，医疗卫生资源配置不合理、城乡和区域不平衡的矛盾依然存在。我们要继续深入贯彻落实科学发展观，按照中央确定的深化医改的基本理念、基本原则和基本路径，加快健全全民医保体系，进一步完善基本药物制度和基层医疗卫生机构运行新机制建设，积极推进公立医院改革，统筹开展深化医改各项工作，以优异的成绩迎接党的十八大胜利召开！    （作者：卫生部党组书记、副部长）　　 

    Although our country's public health care and medical work made great achievements，But China's medical resources overall supply shortages、Especially high quality resources to meet the demand of the masses conditions have not changed，Medical health resource configuration is not reasonable、Urban and rural and regional imbalance between still exists。We will continue to thoroughly apply the scientific outlook on development，According to the central determine the basic idea of the cure of the deepening、The basic principles and basic path，To speed up improvement of the national health insurance system，To further improve the system of basic drugs and the medical and health institutions operation mechanism construction，Actively promote the reform of public hospitals，Carry out all work of the cure of the plan as a whole to deepen，Excellent grades to meet the party's big victory at 18！    （The author：Health BuDangZu scribe、Vice minister）