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1、中国内地社区卫生服务进展 Development of CHS in Mainland,卫生部妇幼保健与社区卫生司 Department of MCH and CHS, Ministry of Health 许宗余 Zongyu Xu 2006年11月12日 November 12th,2006,2,加快城市社区卫生服务发展的背景 Background of accelerating the development of CHS,人口老龄化与城市化 疾病的双重负担与疾病谱的改变 社区建设的推进与医疗保险制度的深化 医药费用过快增长,看病难、看病贵问题突出 社区卫生服务的初步成效 城市卫生服务体
2、制改革,Demographic transition to an older society and urbanization Dual threat from the non-communicable diseases and infective diseases with the transition of the disease spectrum Development in the construction of the community and institution of the medical insurance Rapid increase in the total expe
3、nditure on health with expensive and inaccessible medical care problem CHS have take effect step by step The reform of urban health system,3,社区卫生服务网络逐步发展 CHS network is taking shape,2005年底: 全国共有472个城市开展社区卫生服务 占城市总数的71.6% 全国共设置社区卫生服务中心3460个 社区卫生服务站11816个 约有10万名医生、7.3万名护士、1.5万预防保健人员 全国创建了108个社区卫生服务示范区
4、,By the end of 2005 71.6% cites in mainland (472 cities) had established CHS network 3460 CHS centers and 11816 CHS stations had been established nation-wide About 100,000 doctors, 73,000 nurses and 15,000 public health practitioner work in CHS facilities Set up 108 demonstrated districts which succ
5、eed in CHS,4,国务院印发指导意见,2006年2月,国务院印发 关于发展城市社区卫生服务的指导意见 明确了发展城市社区卫生服务的 指导思想 基本原则 工作目标 提出十二方面政策措施,In Feb of 2006, The State Council distributed The Guiding Suggestions further clarify: The guiding philosophy The basic principle The goals of urban CHS development In addition, concrete policy measures w
6、ere stipulated in 12 aspects.,5,政策措施 policy measures,1、完善社区卫生服务功能 2、建立健全社区卫生服务网络 3、构建两级城市卫生服务体系 4、加强人才队伍建设 5、完善运行机制 6、加强监督管理,Improving the function of CHS Building up wide-covered CHS network Establish two-tier urban health service system Enhance capacity building of CHS workers Rationalizing operat
7、ion mechanism Strengthening supervision and management,6,政策措施 policy measures,7、发挥中医药优势与作用 8、纳入城市经济社会发展规划 9、加大财政投入 10、发挥社区卫生服务在医疗保障中的作用 11、落实部门职责 12、加强政府领导,Make good use of the potentials of traditional Chinese medicine Integrating CHS into urban social economic development plan Foster financial sub
8、sidy policy on CHS Encourage beneficiaries of medical insurance to make full use of CHS Clarifying roles and responsibilities of the concerned departments and take into effect Enhance the leadership of the government,7,全国城市社区卫生工作会议 National Conference on Urban CHS,2006年2月2425日在北京召开 胡锦涛总书记、温家宝总理做重要批示
9、 吴仪同志作了重要讲话 卫生部、发展改革委、财政部、劳动保障部、民政部、食品药品监管局提出工作思路和措施 3个省级政府、3个省会城市政府、2个市辖区政府和2个社区卫生服务中心做了经验介绍,On Feb 24th and 25th, the State Council held national conference on urban CHS in Beijing. Both President Hu Jintao and Premier Wen Jiabao gave their instructions on CHS. And Wu Yi, vice-premier of the state
10、, attended the conference and made an important speech. Ministry of Health, National Development and Reform Committee, Ministry of Finance, Ministry of Labor and Social Security, Ministry of Civil Affairs, State Food and Drug Administration offered some more concrete policy measures on the developme
11、nt of CHS. In addition, representatives from 3 provincial governments, 3 governments of provincial capital, 2 municipal governments and 2 CHS centers introduced their successful experiences on the promotion of CHS.,8,胡锦涛总书记批示: President Hu Jintao :,发展社区卫生服务,对于缓解群众看病难、看病贵问题,为群众提供廉价、便捷的医疗保健服务,提高全社会疾病预
12、防控制水平,具有重要意义。各级党委和政府要坚持以人为本,加强领导,明确责任,狠抓落实,积极发展这项利国利民的事业,以造福人民群众。,CHS will play an irreplaceable role in relieving expensive and inaccessible medical care problems, ensuring the residents access to safe, effective, convenient and cost-effective public health and basic health services, improving the
13、ability of prevention. In order to benefit residents furthest, Governments and CPC at all levels should strengthen the guidance in CHS, and promote the development of CHS actively and responsibly.,9,温家宝总理批示 Premier Wen Jiabao :,社区卫生服务是城市公共卫生和基本医疗服务的基础。各级政府和有关部门要认真贯彻国务院关于发展城市社区卫生服务的指导意见,把发展社区卫生服务作为深化
14、城市医疗卫生体制改革的重要环节,加强领导,加大投入,改革机制,完善管理,不断改善社区卫生服务条件和水平,努力解决群众看病难、看病贵的问题,保障群众健康,促进经济社会协调发展。,Being an important component of urban health system, CHS is the fundamental to guarantee universal access to primary health care and public health. In order to relieve expensive and inaccessible medical care prob
15、lems, maintain public health and promote society harmony, Governments and CPC at all levels should effectively implement relevant national guidelines and policies, enhance the guidance to CHS, offer more financial input, reform operation mechanism, strengthen supervision and management, and improve
16、the service and condition of CHS facilities.,10,国务院城市社区卫生工作领导小组 National Leadership Group of CHS,2006年2月,成立国务院城市社区卫生工作领导小组 吴仪同志任领导小组组长,国务院办公厅、卫生部、财政部等12个相关部门为成员 领导小组办公室设在卫生部,In Feb of 2006, National Leadership Group of CHS was established, in which Vice-premier Wu Yi leads General Office of State Co
17、uncil, Ministry of Health, Ministry of Finance and 9 other ministries concerned working together for the development of CHS. There is a general office of the leadership group working in Ministry of Health.,11,研究制订配套文件工作 Supportive Policy,2006年2月以来,卫生部、中央编办、国家发展改革委、人事部、财政部、劳动保障部、国家中医药管理局等部门牵头制订了9个社区卫
18、生服务配套文件。,Since Feb of 2006,in order to fully implement the Guiding Suggestions and follow national conference on urban CHS, Ministry of Health, the State Commission Office for Public Sector Reform, National Development and Reform Committee, Ministry of Personnel, Ministry of Finance, Ministry of Civ
19、il Affairs, Ministry of Labor and Social Security and State Administration of Traditional Chinese Medicine have jointly promulgated 9 supportive policy documents.,12,一、完善社区卫生服务机构管理规则 Management rules on CHS facilities,城市社区卫生服务机构管理办法、编制标准及中心(站)基本标准。 确定了社区卫生服务机构承担的各项公共卫生和基本医疗服务职责与任务 促进服务模式转变、强化质量管理 社区
20、卫生服务中心人员编制 按每万名居民配备23名全科医师,1名公共卫生医师。 在医师总编制内配备一定比例的中医类别执业医师。 全科医师与护士的比例暂按1:1标准配备,Formulate , and . Clarify the position of CHS facilities in public health and medical service field. Promote the transition in serving pattern and enhance the management in quality. Staffing Standard of CHC 2-3 GPs and
21、1 public health practitioner for 10,000 residents Include a certain proportion of Traditional Chinese Medicine practitioners The ratio between GPs and nurses should be set at 1:1,13,二、完善社区卫生服务财政补助政策 Financial subsidy policy on CHS,明确财政投入内容:基本建设、房屋修缮、基本设备配置、人员培训以及公共卫生服务。 完善财政投入方式: 购买服务 暂不具备条件的,按照人员工资
22、和公共卫生所需经费核定; 确定财政投入主体: 市辖区和设区的市级政府承担主要投入责任 省级财政对困难城市给予转移支付支持 中央财政:从2007年起安排专项转移支付资金,对中西部地区社区基本公共卫生服务分别按社区服务人口人均3元和4元给予补助。,Define the items of finance subsidy Government should provide finance subsidy on capital construction, housing maintenance, procurement of basic equipment, staff training and pub
23、lic health services. Improve the way of finance: If conditions permits, government should pay for Public health services. If not, financial subsidy will be estimated according to salary and public health expenditure. Clarify the responsibilities of governments District and city government shall be m
24、ajor contributors of the financial subsidy,. Provincial government, through earmarked transfer payment, provides support to poor localities. Starting from 2007, central government will introduce a performance-based subsidy on CHS targeting central and western regions, RMB 3 and 4 per capita among th
25、e CHS covered population.,14,三、加强社区卫生服务人才队伍建设 Enhance capacity building of CHS workers,加强高等医学院校的全科医学和社区护理学科建设 完善全科医师、护士等卫生技术人员的任职资格制度和聘用制度 加大培训力度 实行富有活力的用人机制,Strengthen the education and subject construction of general medicine and community nursing. Complete Licensing and recruitment system for GPs
26、, nurses and other CHS workers. Supply more on-job training Implement more attractive and active personnel management,15,四、加强价格管理,促进与医疗保险的结合 Combination with medical insurance,对社区卫生服务机构实行政府指导价 在实行按服务项目收费同时,探索按合约式收费、按病种收费等收付费方式 符合条件的社区卫生服务机构纳入医疗保险定点机构。 将符合规定的社区卫生服务项目,包括家庭病床等社区特色服务项目纳入医疗保险支付范围 适当拉开医疗保
27、险基金对社区卫生服务机构和大中型医院的支付比例档次。,Implement government-instructed price in CHS facilities Apply various payment methods, except fee for service, such as case-based payment, contract-based payment, as well as negotiation payment Take qualified CHS facilities into the Medical Insurance Network Take accredite
28、d services such as family-bed which is particular into benefit package Broaden the gap of co-payment in medical insurance scheme for CHS institutions and medium and large hospitals,16,进一步明确发展方向 The way of CHS in the future,中共中央关于构建社会主义和谐社会若干重大问题的决定: 建设覆盖城乡居民的基本卫生保健制度。健全医疗卫生服务体系,重点加强农村三级卫生服务网络和以社区卫生服
29、务为基础的新型城市卫生服务体系建设。,Decision on several problems about the construction of harmonious socialistic society pointed out that: In the future, we will endeavor to set up a health system, which offer primary health care to both rural residents and urban residents. We shall further complete the health syst
30、em, especially the trilevel rural services network and the two-tier urban health system based on CHS.,17,下一步工作 Next to do,了解各地落实指导意见工作进展,总结经验,加强交流。 积极推进有关试点工作 社区卫生服务机构收支两条线管理 社区首诊制及双向转诊制度 药品政府采购、统一配送、零差率销售 加强对各地落实指导意见及配套政策有关情况进行检查、督导。,Pay more attentions on the development of CHS, enhance the commun
31、ication among various regions, disseminate good practices and experiences constantly. Make more experiments on related reforms such as: Implement separating management of revenue from expenditure Establish dual-referral system and have CHS as the gate keeper Explore concentrated procurement, universal delivery, zero markup Reinforce the supervision and guidance on implementation of the and the supportive policies,谢谢! Thank You !,
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