中國內(nèi)地社區(qū)衛(wèi)生服務(wù)進展

中國內(nèi)地社區(qū)衛(wèi)生效勞進展

DevelopmentofCHSinMainland衛(wèi)生部婦幼保健與社區(qū)衛(wèi)生司DepartmentofMCHandCHS,MinistryofHealth許宗余ZongyuXu2006年11月12日

November12th,20061.加快城市社區(qū)衛(wèi)生效勞開展的背景

BackgroundofacceleratingthedevelopmentofCHS人口老齡化與城市化疾病的雙重負擔(dān)與疾病譜的改變社區(qū)建設(shè)的推進與醫(yī)療保險制度的深化醫(yī)藥費用過快增長，看病難、看病貴問題突出社區(qū)衛(wèi)生效勞的初步成效城市衛(wèi)生效勞體制改革DemographictransitiontoanoldersocietyandurbanizationDualthreatfromthenon-communicablediseasesandinfectivediseaseswiththetransitionofthediseasespectrumDevelopmentintheconstructionofthecommunityandinstitutionofthemedicalinsuranceRapidincreaseinthetotalexpenditureonhealthwithexpensiveandinaccessiblemedicalcareproblem

CHShavetakeeffectstepbystepThereformofurbanhealthsystem

2.社區(qū)衛(wèi)生效勞網(wǎng)絡(luò)逐步開展

CHSnetworkistakingshape2005年底：全國共有472個城市開展社區(qū)衛(wèi)生效勞占城市總數(shù)的71.6%全國共設(shè)置社區(qū)衛(wèi)生效勞中心3460個社區(qū)衛(wèi)生效勞站11816個約有10萬名醫(yī)生、7.3萬名護士、1.5萬預(yù)防保健人員全國創(chuàng)立了108個社區(qū)衛(wèi)生效勞示范區(qū)Bytheendof200571.6%citesinmainland(472cities)hadestablishedCHSnetwork3460CHScentersand11816CHSstationshadbeenestablishednation-wideAbout100,000doctors,73,000nursesand15,000publichealthpractitionerworkinCHSfacilities

Setup108demonstrateddistrictswhichsucceedinCHS3.國務(wù)院印發(fā)?指導(dǎo)意見?

2006年2月，國務(wù)院印發(fā)?關(guān)于開展城市社區(qū)衛(wèi)生效勞的指導(dǎo)意見?明確了開展城市社區(qū)衛(wèi)生效勞的指導(dǎo)思想根本原那么工作目標(biāo)提出十二方面政策措施InFebof2006,TheStateCouncildistributed<theGuidingSuggestionsonUrbanCHSDevelopment>TheGuidingSuggestionsfurtherclarify:TheguidingphilosophyThebasicprincipleThegoalsofurbanCHSdevelopmentInaddition,concretepolicymeasureswerestipulatedin12aspects.4.政策措施policymeasures1、完善社區(qū)衛(wèi)生效勞功能2、建立健全社區(qū)衛(wèi)生效勞網(wǎng)絡(luò)3、構(gòu)建兩級城市衛(wèi)生效勞體系4、加強人才隊伍建設(shè)5、完善運行機制6、加強監(jiān)督管理ImprovingthefunctionofCHSBuildingupwide-coveredCHSnetworkEstablishtwo-tierurbanhealthservicesystemEnhancecapacitybuildingofCHSworkers

RationalizingoperationmechanismStrengtheningsupervisionandmanagement

5.政策措施policymeasures7、發(fā)揮中醫(yī)藥優(yōu)勢與作用8、納入城市經(jīng)濟社會開展規(guī)劃9、加大財政投入10、發(fā)揮社區(qū)衛(wèi)生效勞在醫(yī)療保障中的作用11、落實部門職責(zé)12、加強政府領(lǐng)導(dǎo)MakegooduseofthepotentialsoftraditionalChinesemedicineIntegratingCHSintourbansocialeconomicdevelopmentplanFosterfinancialsubsidypolicyonCHS

EncouragebeneficiariesofmedicalinsurancetomakefulluseofCHSClarifyingrolesandresponsibilitiesoftheconcerneddepartmentsandtakeintoeffectEnhancetheleadershipofthegovernment6.全國城市社區(qū)衛(wèi)生工作會議

NationalConferenceonUrbanCHS

2006年2月24－25日在北京召開胡錦濤總書記、溫家寶總理做重要批示吳儀同志作了重要講話衛(wèi)生部、開展改革委、財政部、勞動保障部、民政部、食品藥品監(jiān)管局提出工作思路和措施3個省級政府、3個省會城市政府、2個市轄區(qū)政府和2個社區(qū)衛(wèi)生效勞中心做了經(jīng)驗介紹

OnFeb24thand25th,theStateCouncilheldnationalconferenceonurbanCHSinBeijing.BothPresidentHu

JintaoandPremierWen

JiabaogavetheirinstructionsonCHS.AndWuYi,vice-premierofthestate,attendedtheconferenceandmadeanimportantspeech.MinistryofHealth,NationalDevelopmentandReformCommittee,MinistryofFinance,MinistryofLaborandSocialSecurity,MinistryofCivilAffairs,StateFoodandDrugAdministrationofferedsomemoreconcretepolicymeasuresonthedevelopmentofCHS.Inaddition,representativesfrom3provincialgovernments,3governmentsofprovincialcapital,2municipalgovernmentsand2CHScentersintroducedtheirsuccessfulexperiencesonthepromotionofCHS.

7.胡錦濤總書記批示:

PresidentHuJintao:開展社區(qū)衛(wèi)生效勞，對于緩解群眾看病難、看病貴問題，為群眾提供廉價、便捷的醫(yī)療保健效勞，提高全社會疾病預(yù)防控制水平，具有重要意義。各級黨委和政府要堅持以人為本，加強領(lǐng)導(dǎo)，明確責(zé)任，狠抓落實，積極開展這項利國利民的事業(yè)，以造福人民群眾。

CHSwillplayanirreplaceableroleinrelievingexpensiveandinaccessiblemedicalcareproblems,ensuringtheresidentsaccesstosafe,effective,convenientandcost-effectivepublichealthandbasichealthservices,improvingtheabilityofprevention.Inordertobenefitresidentsfurthest,GovernmentsandCPCatalllevelsshouldstrengthentheguidanceinCHS,andpromotethedevelopmentofCHSactivelyandresponsibly.8.溫家寶總理批示

PremierWenJiabao:社區(qū)衛(wèi)生效勞是城市公共衛(wèi)生和根本醫(yī)療效勞的根底。各級政府和有關(guān)部門要認真貫徹?國務(wù)院關(guān)于開展城市社區(qū)衛(wèi)生效勞的指導(dǎo)意見?，把開展社區(qū)衛(wèi)生效勞作為深化城市醫(yī)療衛(wèi)生體制改革的重要環(huán)節(jié)，加強領(lǐng)導(dǎo)，加大投入，改革機制，完善管理，不斷改善社區(qū)衛(wèi)生效勞條件和水平，努力解決群眾看病難、看病貴的問題，保障群眾健康，促進經(jīng)濟社會協(xié)調(diào)開展。

Beinganimportantcomponentofurbanhealthsystem,CHSisthefundamentaltoguaranteeuniversalaccesstoprimaryhealthcareandpublichealth.Inordertorelieveexpensiveandinaccessiblemedicalcareproblems,maintainpublichealthandpromotesocietyharmony,GovernmentsandCPCatalllevelsshouldeffectivelyimplementrelevantnationalguidelinesandpolicies,enhancetheguidancetoCHS,offermorefinancialinput,reformoperationmechanism,strengthensupervisionandmanagement,andimprovetheserviceandconditionofCHSfacilities.

9.國務(wù)院城市社區(qū)衛(wèi)生工作領(lǐng)導(dǎo)小組

NationalLeadershipGroupofCHS

2006年2月，成立國務(wù)院城市社區(qū)衛(wèi)生工作領(lǐng)導(dǎo)小組吳儀同志任領(lǐng)導(dǎo)小組組長，國務(wù)院辦公廳、衛(wèi)生部、財政部等12個相關(guān)部門為成員領(lǐng)導(dǎo)小組辦公室設(shè)在衛(wèi)生部InFebof2006,NationalLeadershipGroupofCHSwasestablished,inwhichVice-premierWuYileadsGeneralOfficeofStateCouncil,MinistryofHealth,MinistryofFinanceand9otherministriesconcernedworkingtogetherforthedevelopmentofCHS.ThereisageneralofficeoftheleadershipgroupworkinginMinistryofHealth.10.研究制訂配套文件工作

SupportivePolicy2006年2月以來，衛(wèi)生部、中央編辦、國家開展改革委、人事部、財政部、勞動保障部、國家中醫(yī)藥管理局等部門牽頭制訂了9個社區(qū)衛(wèi)生效勞配套文件。SinceFebof2006,inordertofullyimplementtheGuidingSuggestionsandfollownationalconferenceonurbanCHS,MinistryofHealth,theStateCommissionOfficeforPublicSectorReform,NationalDevelopmentandReformCommittee,MinistryofPersonnel,

MinistryofFinance,MinistryofCivilAffairs,MinistryofLaborandSocialSecurityandStateAdministrationofTraditionalChineseMedicinehavejointlypromulgated9supportivepolicydocuments.11.一、完善社區(qū)衛(wèi)生效勞機構(gòu)管理規(guī)那么

ManagementrulesonCHSfacilities城市社區(qū)衛(wèi)生效勞機構(gòu)管理方法、編制標(biāo)準(zhǔn)及中心〔站〕根本標(biāo)準(zhǔn)。確定了社區(qū)衛(wèi)生效勞機構(gòu)承擔(dān)的各項公共衛(wèi)生和根本醫(yī)療效勞職責(zé)與任務(wù)促進效勞模式轉(zhuǎn)變、強化質(zhì)量管理社區(qū)衛(wèi)生效勞中心人員編制按每萬名居民配備2－3名全科醫(yī)師，1名公共衛(wèi)生醫(yī)師。在醫(yī)師總編制內(nèi)配備一定比例的中醫(yī)類別執(zhí)業(yè)醫(yī)師。全科醫(yī)師與護士的比例暫按1：1標(biāo)準(zhǔn)配備Formulate<RegulationonUrbanCommunityHealthServiceInstitutionManagement>,<GuidingSuggestionsontheOrganizationandStaffingofUrbanCommunityHealthServiceInstitutions>and<BasicStandardforUrbanCommunityHealthServiceCenter(station)>.ClarifythepositionofCHSfacilitiesinpublichealthandmedicalservicefield.Promotethetransitioninservingpatternandenhancethemanagementinquality.

StaffingStandardofCHC

2-3GPsand1publichealthpractitionerfor10,000residents

IncludeacertainproportionofTraditionalChineseMedicinepractitioners

The

ratiobetweenGPsandnursesshouldbesetat1:1

12.二、完善社區(qū)衛(wèi)生效勞財政補助政策

FinancialsubsidypolicyonCHS明確財政投入內(nèi)容：根本建設(shè)、房屋修繕、根本設(shè)備配置、人員培訓(xùn)以及公共衛(wèi)生效勞。完善財政投入方式：購置效勞暫不具備條件的，按照人員工資和公共衛(wèi)生所需經(jīng)費核定；確定財政投入主體：市轄區(qū)和設(shè)區(qū)的市級政府承擔(dān)主要投入責(zé)任省級財政對困難城市給予轉(zhuǎn)移支付支持中央財政：從2007年起安排專項轉(zhuǎn)移支付資金，對中西部地區(qū)社區(qū)根本公共衛(wèi)生效勞分別按社區(qū)效勞人口人均3元和4元給予補助。Definetheitemsoffinancesubsidy

Governmentshouldprovidefinancesubsidyoncapitalconstruction,housingmaintenance,procurementofbasicequipment,stafftrainingandpublichealthservices.Improvethewayoffinance:

Ifconditionspermits,governmentshouldpayforPublichealthservices.Ifnot,financialsubsidywillbeestimatedaccordingtosalaryandpublichealthexpenditure.Clarifytheresponsibilitiesofgovernments

Districtandcitygovernmentshallbemajorcontributorsofthefinancialsubsidy,.Provincialgovernment,throughearmarkedtransferpayment,providessupporttopoorlocalities.Startingfrom2007,centralgovernmentwillintroduceaperformance-basedsubsidyonCHStargetingcentralandwesternregions,RMB3and4percapitaamongtheCHScoveredpopulation.

13.三、加強社區(qū)衛(wèi)生效勞人才隊伍建設(shè)

EnhancecapacitybuildingofCHSworkers加強高等醫(yī)學(xué)院校的全科醫(yī)學(xué)和社區(qū)護理學(xué)科建設(shè)完善全科醫(yī)師、護士等衛(wèi)生技術(shù)人員的任職資格制度和聘用制度加大培訓(xùn)力度實行富有活力的用人機制

Strengthentheeducationandsubjectconstructionofgeneralmedicineandcommunitynursing.CompleteLicensingandrecruitmentsystemforGPs,nursesandotherCHSworkers.Supplymoreon-jobtrainingImplementmoreattractiveandactivepersonnelmanagement14.四、加強價格管理，促進與醫(yī)療保險的結(jié)合

Combinationwithmedicalinsurance

對社區(qū)衛(wèi)生效勞機構(gòu)實行政府指導(dǎo)價在實行按效勞工程收費同時，探索按合約式收費、按病種收費等收付費方式符合條件的社區(qū)衛(wèi)生效勞機構(gòu)納入醫(yī)療保險定點機構(gòu)。將符合規(guī)定的社區(qū)衛(wèi)生效勞工程，包括家庭病床等社區(qū)特色效勞工程納入醫(yī)療保險支付范圍適當(dāng)拉開醫(yī)療保險基金對社區(qū)衛(wèi)生效勞機構(gòu)和大中型醫(yī)院的支付比例檔次。Implementgovernment-instructedpriceinCHSfacilities

Applyvariouspaymentmethods,exceptfeeforservice,suchascase-basedpayment,contract-basedpayment,aswellasnegotiationpaymentTakequalifiedCHSfacilitiesintotheMedicalInsuranceNetworkTakeaccreditedservicessuchasfamily-bedwhichisparticularintobenefitpackageBroadenthegapofco-paymentinmedicalinsuranceschemeforCHSinstitutionsandmediumandlargehospitals15.進一步明確開展方向

ThewayofCHSinthefuture?中共中央關(guān)于構(gòu)建社會主義和諧社會假設(shè)干重大問題的決定?：建設(shè)覆蓋城鄉(xiāng)居民的根本衛(wèi)生保健制度。健全醫(yī)療衛(wèi)生效勞體系，重點加強農(nóng)村三級衛(wèi)生效勞網(wǎng)絡(luò)和以社區(qū)衛(wèi)生效勞為根底的新型城市衛(wèi)生效勞體系建設(shè)。

Decisiononseveralproblemsabouttheconstructionofharmo