构建公平高效的卫生体制wangld

构建公平高效的卫生体制： 中国的策略 To develop an equitable and efficient health system: China’s strategy 中国卫生部副部长 王陇德 Wang Longde Vice Minister of Health of China 2006年10月26日 Oct. 26, 2006 2006年10月8-11日，中共中央召开十六届六中全会 Oct. 8-11, 2006, the Sixth Plenary Session of the 16th Central Committee of the Communist Party 会议作出了《中共中央关于构建社会 主义和谐社会若干重大问 题 快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题 的决定》， 把全民族的健康素质明显提高作为构 建社会主义和谐社会的重要目标和任 务，提出了加强医疗卫生服务，完善 社会保障 制度 关于办公室下班关闭电源制度矿山事故隐患举报和奖励制度制度下载人事管理制度doc盘点制度下载 等一系列重要论述和政 策措施。 The Resolution on Major Issues Regarding the Building of a Harmonious Socialist Society was adopted, listing the obvious improvement of the whole nation’s health quality as one of the major goals and tasks to build a harmonious socialist society. The resolution also elaborates on a series of significant policies and measures such as to strengthen medical and health services, and to improve the social security system. 健康、发展与公平 Health, Development and Equity  提高民众健康水平是经济社会发展的基本目标 To improve the people’s health is a basic goal for economic and social development.  提高民众健康水平是促进经济社会发展的重要基础 To improve the people’s health is an important basis to promote economic and social development.  提高民众健康水平是社会公平正义的重要保障 To improve the people’s health is an improvement guarantee for social equity and justice. 中国卫生发展的成就 Achievements of the health system in China  基本建立了遍及城乡的医疗卫生服务体系 A medical and health service system covering the rural and urban areas has been basically established.  初步建立了城镇职工医疗保险制度，开展了新型农村合作 医疗制度试点，初步建立了城乡医疗救助制度 A medical insurance system covering urban employees has been primarily established; pilot projects on new rural cooperative medical system have been implemented; a system of financial aid for medical treatment has been primarily established.  居民健康水平不断提高，达到了发展中国家的较高水平； 重大传染病防治取得了明显进展 The health of the citizens keeps improving to a high level among developing countries; marked progress has been made in the prevention and treatment of major communicable diseases. 1980-2005年我国卫生资源与服务能力 Health resources and service capacity in China 1980-2005 指 标 indicators 1980 1990 2000 2005 卫生机构（万） Health institutions (10thousand) 18.1 20.9 32.5 30.07 其中：医院 Including hospitals 9902 14377 16318 18703 卫生技术人员(万) Health professionals (10thousand) 279.8 389.8 449.1 446.0 床位(百万) Beds(million) 218.4 292.5 317.7 336.8 床位(千人口) Beds(thousand population) 2.02 2.32 2.38 2.45 医生(千人口) doctors(thousand population) 1.17 1.56 1.68 1.51 诊疗人次(亿) Consultations (100million) 10.53 25.6 21.2 23.1 入院人次(百万) Hospital admissions(million) 22.47 51.4 52.97 71.84 初步建立了多形式的医疗保障体系 Various schemes of medical security have been primarily established  城镇职工医疗保险：截止2006年6月底，参保人员1.45亿 Medical insurance for urban employees: by the end of June, 2006, covering 145 million people  新型农村合作医疗：截止2006年6月底，全国1399个（48.9%）县开展；参加人口 3.96亿（44.7%），参合率80.1% New rural cooperative medical system: by the end of June, 2006, covering 1399 counties(48.9%) with the participation of 396 million people（44.7%），participation rate: 80.1%  农村医疗救助试点：覆盖农村贫困家庭，到2005年，累计救助贫困农民1112万人次， 发放救助金10.8亿元 Pilot sites on financial aid for medical treatment in rural areas: covering poverty-stricken rural families. By 2005, having issued 11.12million financial aids, with the total of 1080 million RMB yuan.  城市医疗救助试点：覆盖最低生活保障对象， 到2005年累计救助163万人次，发放 资金5.2亿元 Pilot sites on financial aid for medical treatment in urban areas: covering people with minimum subsistence security. By 2005, having issued 1.63million financial aids, with the total of 520 RMB yuan. 中国人口主要健康指标的变化 Changes in major health indicators among the Chinese population 健康指标 Health indicators 建国前 before 1949 1981 2005 平均期望寿命(岁) Average life expectancy (years) 35 67.9 72.0 婴儿死亡率(‰) Infant mortality rate (‰) 200 34.7 19.0 5岁以下儿童死亡率(‰) Under-5 children’s mortality rate(‰) 250-300 61.0** 22.5 孕产妇死亡率(1/10万) Maternal mortality rate (per 100,000) 1500 80.0** 47.7 甲乙类法定报告传染病 发病率(1/10万) Incidence rate of notifiable diseases in Categories A and B (per 100,000) 2139.7* 1884.4 263.3 死亡率(1/10万) Death rate (per 100,000) 18.43* 3.51 0.76 *为1955年数据(data in 1955)；**为1991年数据(data in 1991) 2002年卫生资源及健康指标的国际比较 International comparison on health resources and indicators in 2002 指标 indicators 中国 China 低中收入国家 low-and- middle-income countries 中等收入国家 middle- income countries 高收入 国家 high-income countries 世界平均 World average 人均GDP(按汇率,美元) Average national income(USD) 970 1180 1350 26570 5130 卫生总费用占GDP的% Percentage of GDP in health expenditure (%) 5.8 5.9 6 11.1 10 人均卫生总费用(美元) Per capita health expenditure(USD) 63 74.6 84 3039 524 公共支出占卫生总费用%) Percentage of public expenditure in Total health expenditure(%) 33.7 46.2 45.4 63.3 60 千人口床位数(张) Beds per thousand population 2.5 2.8 3.8 7.4 3.9 千人口医生数(张) Doctors per thousand population 1.6 1.2 1.9 3.8 1.7 平均期望寿命(岁) Average life expectancy(years) 71 65 69 78 67 婴儿死亡率 (‰) Infant mortality rate(‰) 32 69 36 5 45 5岁以下儿童死亡率(‰) Under-5 children’s mortality rate(‰) 40 103 44 7 61 孕产妇死亡率(1/10万) Maternal mortality rate(per 100,000) 56 444 121 13 407 中国卫生发展存在主要问题 Major problems in health development in China  健康状况改善速度放慢,与经济快速增长不相匹配 Speed of improvement in health slows down, not matching rapid economic development  医疗费用快速上涨，超过同期经济增长水平和国民收入增长水平， 看病贵、看病难问题突出 Rapid increase in medical expenditure, faster than economic growth and increase in national income for the same period  健康不公平问题日益突出，医疗保健可及性下降 Increasingly serious health inequity, and decreased accessibility to medical care  医疗服务效率下降，资源缺乏与浪费并存 Lower efficiency in medical services, lack of resources and waste coexist 医疗费用上涨迅速 Rapid increase in medical expenditure 1980年到2004年： From 1980-2004:  我国卫生总费用由143亿元增加到7590亿元，增长了52倍； Total health expenditure increased 52-fold from 14.3 billion RMB yuan to 759 billion RMB yuan  居民个人负担的卫生费用由30.4亿元增加到4,071亿元，增长了133倍 Citizens’ health expenditure increased 133-fold from 3.04 billion RMB yuan to 407.1 billion RMB yuan  同期，城乡居民可支配收入分别增长18倍和14.3倍 During the same period, urban and rural residents’ dispensable income rose 18-fold and 14.3-fold respectively  城市家庭平均医疗保健支出占消费性支出比重由2.5%上升为7.4%，农 民由2.4%上升到6% Average percentage of consumption expenditure of medical expenditure in urban families rose from 2.5% to 7.4%, in rural families, from 2.4% to 6% 卫生服务的可及性和公平性下降 Decreased accessibility and equity in health services 2003年全国第三次卫生服务调查显示： As was demonstrated in the 3rd national health service survey in 2003:  我国居民患病应就诊而未就诊的比例由1993年的36.4%上升到2003年的48.9%； 应住院而未住院的比例达29.6% The percentage of diseased citizens in China that should have sought medical treatment but hadn’t done so rose from 36.4% in 1993 to 48.9% in 2003  出院者中，病情未愈主动出院的占43.3%（大多数是无力支付医药费用） Among the people discharged from hospitals, 43.3% were patients not recovered but asked to be discharged(mostly unable to afford the medical costs)  农民由于经济原因应住院而未住院的比例由1998年的63.7%上升到2003年的 75.4% The percentage of farmers that should have been hospitalized but not done so for economic reasons rose from 63.7% in1998 to 75.4% in 2003  因病致贫、返贫的农民占贫困农民的比例由21.6%上升到33.4% The percentage of farmers stricken by poverty because of diseases rose from 21.6% to 33.4% 1988-2005年卫生部门综合医院工作效率 Efficiency of general hospitals 1988-2005 6 . 1 5 . 3 4 . 3 4 . 6 4 . 8 5 . 3 2 . 2 1 . 9 1 . 5 1 . 4 1 . 7 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 1 9 8 8 1 9 8 9 1 9 9 0 1 9 9 1 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 诊疗人次/医生/天consulations/doctor/day 住院床日/医生/天hospitalization bed days/doctor/day 1978-2005年全国医院、卫生院床位使用率情况 Utilization rate of hospital beds 1978-2005 8 0 . 4 8 4 . 8 8 4 . 5 7 1 . 1 6 0 . 2 6 4 . 3 6 8 . 4 4 6 4 3 . 4 3 8 . 4 3 3 . 2 3 4 . 7 3 7 . 1 0 10 20 30 40 50 60 70 80 90 19 78 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 县及县以上医院hospitals at and over county levels 卫生院 卫生筹资体制存在问题 Problems in the health financing system  城镇医疗保障制度覆盖面有限；农村合作医疗覆盖面不全，保障力度较低；大部 分城乡居民未被任何形式的医疗保险覆盖 Limited coverage of urban medical insurance, incomplete coverage of rural cooperative medical system, low level of insurance, most rural and urban residents not covered by any medical insurance  约40%的城镇居民、50%的农村居民没有任何医疗保障 About 40% of urban residents and 50% rural residents not covered by any medical insurance  个人支付比例过大，公共筹资比例过低： Excessive percentage of payment from the pocket, and too low percentage of pulic financing  1982年，政府预算卫生支出占卫生总费用的比例为39%，2004年下降到 17% In 1982, the percentage of total heatlh expenditure in government health budget was 39%, but decreased to 17% in 2004  同一时期，居民个人承担的医疗卫生费用占卫生总费用的比重，由22%上升 到54% For the same period, the percentage of total health expenditure in health expenditure paid by citizens increased from 22% to 54%. 1978-2004年中国卫生总费用构成(%) Percentage of components of total health expenditure in China 1978-2004 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 19 78 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 政府government 社会society 个人individuals 卫生服务体制存在问题 Problems in the health service system  宏观：条块分割、城市医院交叉重叠设置严重；资源配置不合理，农村 和社区等基层卫生服务薄弱；缺乏分级医疗体系和守门人制度 Macro level: serious overlaps in urban hospitals; irrational allocation of resources, weak health services in rural areas and at community level  微观：公立医疗机构补偿 机制 综治信访维稳工作机制反恐怖工作机制企业员工晋升机制公司员工晋升机制员工晋升机制图 、运行机制和内部分配制度不合理，出现 了逐利倾向，公益性质淡化 Micro level: irrational mechanism for compensation, operation and internal distribution in public medical institutions, resulting in profit-seeking trend and faded nature of public goods 卫生管理体制存在问题 Problems in health administration system  中央与地方：缺乏明确分工；财权与事权不对称 Central and local authorities: no clear division of labor, authority for finance not matching that for work  政府职能缺位、越位与不到位 Over administration and insufficient government functions  职能分散，缺乏协调 Decentralized functions and lack of coordination 发展健康事业的基本原则 Basic principles to develop health  坚持把实现好、维护好、发展好民众的健康权益作为卫生事业的出发点和落 脚点。坚持为民众健康服务的宗旨和公益性质 ，坚持发展成果由民众共享的 原则，促进健康公平 Making maintaining health interests of the people the starting point and goal of health services. Keeping the mission of serving public health and the nature of public goods. Sticking to the principle of people sharing the development results, and promoting health equity.  遵循卫生事业发展的内在规律，走符合中国国情的卫生发展道路 Following the rule of health development, and develop health in China’s context  坚持部门合作、全社会共同促进健康 Multi-sector cooperation, and participation from the whole society  坚持政府主导和引入市场机制相结合 Led by the government, and introducing market mechanism 致力于构建一个公平高效的卫生体制 Committed to develop an equitable and efficient health system  加强公共卫生体系建设 Strengthen public health system development  完善疾病预防控制体系和应急救治体系 To improve the system of disease control and the system of emergency response and medical treatment  建立突发公共卫生应急管理机制 To establish the mechanism of public health emergency preparedness  完善卫生监督体系 To improve the system of health supervision  开展爱国卫生运动 To conduct patriotic health campaign  发展妇幼卫生事业 To develop maternal and children’s health  加强医学研究和推广应用 To strengthen medical research, scale-up and application 致力于构建一个公平高效的卫生体制 Committed to develop an equitable and efficient health system  健全城乡医疗卫生服务体系 To improve the system of rural and urban health services  建立以社区卫生服务为基础的城市卫生服务体系 To establish an urban health service system based on community health services  实施《农村卫生服务体系建设与发展规划》，巩固和健全农村三级医疗卫 生服务体系和网络 To implement the Program on the Development and Improvement of the Rural Health Service System, to improve the 3-tier rural healthcare system and network  整合城乡医疗卫生资源，建立城市支援农村的机制 To integrate rural and urban medical and health resources, and to establish the mechanism of cities assisting the countryside  积极引导社会资金进入医疗卫生服务领域 To actively guide social capital to enter the area of medical and health services 致力于构建一个公平高效的卫生体制 Committed to develop an equitable and efficient health system  建立健全健康保障体系 To establish and improve the health security system  建设覆盖城乡居民的基本卫生保健制度 To develop a system of basic healthcare covering rural and urban residents  建立不同形式的社会医疗保险制度并逐步覆盖城乡全体居民 To establish various forms of social medical insurance system and to gradually cover all rural and urban residents  完善城镇职工基本医疗保险，覆盖城镇全体从业人员 To improve the basic medical insurance system for urban employees, covering all urban employees  建立以大病统筹为主的城镇居民医疗保险，逐步覆盖城镇非职工居民 To establish an urban medical insurance scheme against catastrophic diseases, gradually covering all non-working urban residents  加快推进新型农村合作医疗，基本覆盖农村居民 To step up new rural medical cooperative medical system, basically covering all rural residents  发展城乡社会医疗救助 To develop financial aid for medical treatment in rural and urban areas 致力于构建一个公平高效的卫生体制 Committed to develop an equitable and efficient health system  改革公立医疗机构管理体制和运行机制 To reform the management system and operational mechanism of public medical institutions  实行属地化和全行业管理 To implement localized and whole-sector management  整合政府医疗卫生管理职能，实施综合管理 To integrate government functions in health administration, and to conduct integrated administration  改革“以药补医”机制 To reform the current mechanism of “compensating medical treatment by selling medicine”  规范公立医疗机构收支管理，规范医务人员收入分配机制 To regulate the management of income and expenditure in public medical institutions, and to standardize the mechanism of medical professionals’ income distribution  加强医德医风建设 To strengthen medical professional ethics 致力于构建一个公平高效的卫生体制 Committed to develop an equitable and efficient health system  加快药品生产流通和监管体制改革 To step up the reform of mechanisms of pharmaceutical manufacturing distribution and supervision  建立国家基本药物制度 To establish a national list of basic medicine  改革药品生产流通体制 To reform the mechanism of drug manufacturing and distribution  加强药品监管 To strengthen supervision and regulation on medicine  改革药品定价机制和管理 To reform the pricing mechanism and management of medicine 致力于构建一个公平高效的卫生体制 Committed to develop an equitable and efficient health system  扶持中医药和民族医药发展 To support the development of traditional Chinese medicine and national medicine  充分发挥中医药在基本卫生保健中的作用 To make the best of traditional Chinese medicine in basic healthcare  强化对中医药的继承与创新 To strengthen the continuation and creation of traditional Chinese medicine  发展现代中药产业，推动中医药走向世界 To develop the modern industry of traditional Chinese medicine, and to promote traditional Chinese medicine in the whole world 强化政府责任，促进健康事业发展 To strengthen government roles, and promote health development  理顺医药卫生行政管理体制 To improve the system of medical and health administration  完善卫生法律法规 To improve health laws and regulations  积极推进卫生 管理制度 档案管理制度下载食品安全管理制度下载三类维修管理制度下载财务管理制度免费下载安全设施管理制度下载 改革创新 To actively promote reform and creation of the health administration system  完善公共财政体制，增加对卫生事业的财政投入 To improve public finance system, and to increase financial budget for health services  鼓励公民有序参与卫生事业管理 To encourage citizens to participate in the management of health services 谢谢！Thank you !