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1、中国内地中国内地社区卫生服务进展社区卫生服务进展Development of CHS in Mainland卫生部妇幼保健与社区卫生司卫生部妇幼保健与社区卫生司Department of MCH and CHS, Ministry of Health许宗余许宗余 Zongyu Xu20062006年年1111月月1212日日 November 12th,2006加快城市社区卫生服务发展的背景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人口老龄化与城市化疾病的双重负担与疾病谱的改疾病的双重负担与
2、疾病谱的改变变社区建设的推进与医疗保险制社区建设的推进与医疗保险制度的深化度的深化医药费用过快增长，看病难、医药费用过快增长，看病难、看病贵问题突出看病贵问题突出社区卫生服务的初步成效社区卫生服务的初步成效城市卫生服务体制改革城市卫生服务体制改革D Demographic transition to an older society and urbanizationD Dual threat from the non-communicable diseases and infective diseases with the transition of the disease spectrumD
3、evelopment in the construction of the community and institution of the medical insuranceRapid increase in the total expenditure on health with expensive and inaccessible medical care problem CHS have take effect step by stepThe reform of urban health system 2社区卫生服务网络逐步发展社区卫生服务网络逐步发展CHS network is ta
4、king 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By the end of 200571.6% cites in mainland (472 cities) had established CHS network3460 CHS centers and 11816 CHS stations had been established nation-wideAbout 100,000 doctors
5、, 73,000 nurses and 15,000 public health practitioner work in CHS facilities Set up 108 demonstrated districts which succeed in CHS3国务院印发国务院印发指导意见指导意见 2006年2月，国务院印发国务院印发关于发展城市社区卫生服务的指导意见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明确了发展城市社区卫生服务的指导思想指导思想基本原则基本原则工作目标工作目标提出十二方面政策措施提出十二方面政策措施In Feb of 2006, The State
6、 Council distributed The Guiding Suggestions further clarify: The guiding philosophy The basic principle The goals of urban CHS development In addition, concrete policy measures were stipulated in 12 aspects.4政策措施政策措施 policy measures1、完善社区卫生服务功、完善社区卫生服务功能能2、建立健全社区卫生服、建立健全社区卫生服务网络务网络3、构建两级城市卫生服、构建两级城
7、市卫生服务体系务体系4、加强人才队伍建设、加强人才队伍建设5、完善运行机制、完善运行机制6、加强监督管理、加强监督管理1.Improving the function of CHS2.Building up wide-covered CHS network3.Establish two-tier urban health service system4.Enhance capacity building of CHS workers 5.Rationalizing operation mechanism6.Strengthening supervision and management 5政策
8、措施政策措施 policy measures7、发挥中医药优势与作用、发挥中医药优势与作用8、纳入城市经济社会发展、纳入城市经济社会发展规划规划9、加大财政投入、加大财政投入10、发挥社区卫生服务在、发挥社区卫生服务在医疗保障中的作用医疗保障中的作用11、落实部门职责、落实部门职责12、加强政府领导、加强政府领导7.Make good use of the potentials of traditional Chinese medicine 8.Integrating CHS into urban social economic development plan 9.Foster financ
9、ial subsidy policy on CHS 10.Encourage beneficiaries of medical insurance to make full use of CHS 11.Clarifying roles and responsibilities of the concerned departments and take into effect12.Enhance the leadership of the government6全国城市社区卫生工作会议全国城市社区卫生工作会议National Conference on Urban CHS 20062006年年2
10、 2月月24242525日在北京日在北京召开召开胡锦涛总书记、温家宝总理胡锦涛总书记、温家宝总理做重要批示做重要批示吴仪同志作了重要讲话吴仪同志作了重要讲话卫生部、发展改革委、财政卫生部、发展改革委、财政部、劳动保障部、民政部、部、劳动保障部、民政部、食品药品监管局提出工作思食品药品监管局提出工作思路和措施路和措施3 3个省级政府、个省级政府、3 3个省会城市个省会城市政府、政府、2 2个市辖区政府和个市辖区政府和2 2个个社区卫生服务中心做了经验社区卫生服务中心做了经验介绍介绍 On Feb 24th and 25th, the State Council held national con
11、ference 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, attended the conference and made an important speech. Ministry of Health, National Development and Reform Committee, Ministry of Finance, Ministry of
12、 Labor and Social Security, Ministry of Civil Affairs, State Food and Drug Administration offered some more concrete policy measures on the development of CHS. In addition, representatives from 3 provincial governments, 3 governments of provincial capital, 2 municipal governments and 2 CHS centers i
13、ntroduced their successful experiences on the promotion of CHS. 7胡锦涛总书记批示胡锦涛总书记批示: President Hu Jintao : 发展社区卫生服务，发展社区卫生服务，对于缓解群众看病难、看对于缓解群众看病难、看病贵问题，为群众提供廉病贵问题，为群众提供廉价、便捷的医疗保健服务，价、便捷的医疗保健服务，提高全社会疾病预防控制提高全社会疾病预防控制水平，具有重要意义。各水平，具有重要意义。各级党委和政府要坚持以人级党委和政府要坚持以人为本，加强领导，明确责为本，加强领导，明确责任，狠抓落实，积极发展任，狠抓落实，积极发
14、展这项这项利国利民的事业利国利民的事业，以，以造福人民群众。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 ability of prevention. In or
15、der 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. 8温家宝总理批示温家宝总理批示Premier Wen Jiabao : 社区卫生服务是城市公共卫生社区卫生服务是城市公共卫生和基本医疗服务的和基本医疗服务的基础基础。各级政府。各级政府和有关部门要认真贯彻和有关部门要认真贯彻国务院关国务院关于发展城市社区卫生服务
16、的指导意于发展城市社区卫生服务的指导意见见，把发展社区卫生服务作为深把发展社区卫生服务作为深化城市医疗卫生体制改革的重要环化城市医疗卫生体制改革的重要环节，节，加强领导，加大投入，改革机加强领导，加大投入，改革机制，完善管理，不断改善社区卫生制，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，保障群众健病难、看病贵的问题，保障群众健康，促进经济社会协调发展。康，促进经济社会协调发展。 Being an important component of urban health system, CHS is the fundamental t
17、o guarantee universal access to primary health care and public health. In order to relieve expensive and inaccessible medical care problems, maintain public health and promote society harmony, Governments and CPC at all levels should effectively implement relevant national guidelines and policies, e
18、nhance the guidance to CHS, offer more financial input, reform operation mechanism, strengthen supervision and management, and improve the service and condition of CHS facilities. 9国务院城市社区卫生工作领导小组国务院城市社区卫生工作领导小组National Leadership Group of CHS 2006年年2月，成立国务院月，成立国务院城市社区卫生工作领导小城市社区卫生工作领导小组组吴仪同志任领导小组组长
19、，吴仪同志任领导小组组长，国务院办公厅、卫生部、国务院办公厅、卫生部、财政部等财政部等12个相关部门为个相关部门为成员成员领导小组办公室设在卫生领导小组办公室设在卫生部部 In Feb of 2006, National Leadership Group of CHS was established, in which Vice-premier Wu Yi leads General Office of State Council, Ministry of Health, Ministry of Finance and 9 other ministries concerned working
20、together for the development of CHS. There is a general office of the leadership group working in Ministry of Health.10研究制订配套文件工作研究制订配套文件工作Supportive Policy 2006年年2月以来，月以来，卫生部、中央编办、国卫生部、中央编办、国家发展改革委、人事部、家发展改革委、人事部、财政部、劳动保障部、财政部、劳动保障部、国家中医药管理局等部国家中医药管理局等部门牵头制订了门牵头制订了9个社区个社区卫生服务配套文件。卫生服务配套文件。 Since Fe
21、b 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 Civil Affairs, Minis
22、try of Labor and Social Security and State Administration of Traditional Chinese Medicine have jointly promulgated 9 supportive policy documents. 11一、完善社区卫生服务机构管理规则一、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城市社区卫生服务机构管理办法、编制标准及中心（站）基法、编制标准及中心（站）基本标准。本标准。确定了社区卫生服务机构承担确定了社区卫生服务机构承
23、担的各项公共卫生和基本医疗服的各项公共卫生和基本医疗服务职责与任务务职责与任务促进服务模式转变、强化质量促进服务模式转变、强化质量管理管理社区卫生服务中心人员编制社区卫生服务中心人员编制v按每万名居民配备按每万名居民配备23名全科名全科医师，医师，1名公共卫生名公共卫生医师。医师。v在医师总编制内配备一定比例在医师总编制内配备一定比例的中医类别执业医师。的中医类别执业医师。v全科医师与护士的比例暂按全科医师与护士的比例暂按1：1标准配备标准配备Formulate , and .Clarify the position of CHS facilities in public health and
24、 medical service field.Promote the transition in serving pattern and enhance the management in quality. Staffing Standard of CHC 2-3 GPs and 1 public health practitioner for 10,000 residents Include a certain proportion of Traditional Chinese Medicine practitioners The ratio between GPs and nurses s
25、hould be set at 1:1 12二、二、完善社区卫生服务财政补助政策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、明确财政投入内容：基本建设、房屋修缮、基本设备配置、人员房屋修缮、基本设备配置、人员培训以及公共卫生服务。培训以及公共卫生服务。完善财政投入方式：完善财政投入方式：v购买服务购买服务v暂不具备条件的，按照人员工资暂不具备条件的，按照人员工资和公共卫生所需经费核定；和公共卫生所需经费核定；确定财政投入主体：确定财政投入主体：v市辖区和设区的市级政府承担主市辖区和设区的市级政府承担主要投入责任要投入责
26、任v省级财政对困难城市给予转移支省级财政对困难城市给予转移支付支持付支持中央财政：从中央财政：从2007年起安排专项年起安排专项转移支付资金，对中西部地区社转移支付资金，对中西部地区社区基本公共卫生服务分别按社区区基本公共卫生服务分别按社区服务人口人均服务人口人均3元和元和4元给予补助。元给予补助。 uDefine the items of finance subsidy Government should provide finance subsidy on capital construction, housing maintenance, procurement of basic equ
27、ipment, staff training and public health services.uImprove 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. u Clarify the responsibilities of governments Distric
28、t and city government shall be major 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,
29、 RMB 3 and 4 per capita among the CHS covered population. 13三、加强社区卫生服务人才队伍建设三、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加强高等医学院校的全科医学和社区护理学科科医学和社区护理学科建设建设完善全科医师、护士等完善全科医师、护士等卫生技术人员的任职资卫生技术人员的任职资格制度和聘用制度格制度和聘用制度加大培训力度加大培训力度实行富有活力的用人机实行富有活力的用人机制制u Strengthen the education and su
30、bject construction of general medicine and community nursing.u Complete Licensing and recruitment system for GPs, nurses and other CHS workers.u Supply more on-job trainingu Implement more attractive and active personnel management14四四、加强价格管理，促进与医疗保险的结合加强价格管理，促进与医疗保险的结合Combination with medical insur
31、ance 对社区卫生服务机构实行政府指对社区卫生服务机构实行政府指导价导价在实行按服务项目收费同时，探在实行按服务项目收费同时，探索按合约式收费、按病种收费等索按合约式收费、按病种收费等收付费方式收付费方式符合条件的社区卫生服务机构纳符合条件的社区卫生服务机构纳入医疗保险定点机构。入医疗保险定点机构。将符合规定的社区卫生服务项目，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目纳入医疗保险支付范围适当拉开医疗保险基金对社区卫适当拉开医疗保险基金对社区卫生服务机构和大中型医院的支付生服务机构和大中型医院的支付比例档次。比例档次。Imp
32、lement 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 paymentTake qualified CHS facilities into the Medical Insurance NetworkTake accredited services such as family-bed wh
33、ich is particular into benefit packageBroaden the gap of co-payment in medical insurance scheme for CHS institutions and medium and large hospitals 15进一步明确发展方向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谐社会若干重大问题的决定： 建设覆盖城乡居民的建设覆盖城乡居民的基本基本卫生保健制度卫生保健制度。健全医疗卫生。健全医疗卫生服务体
34、系，重点加强农村三级服务体系，重点加强农村三级卫生服务网络和卫生服务网络和以社区卫生服以社区卫生服务为基础的新型城市卫生服务务为基础的新型城市卫生服务体系体系建设建设。 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 reside
35、nts and urban residents. We shall further complete the health system, especially the trilevel rural services network and the two-tier urban health system based on CHS.16下一步工作下一步工作 Next to do 了解各地落实了解各地落实指导意见指导意见工作进展，总结经验，工作进展，总结经验，加强交流。加强交流。积极推进有关试点工作积极推进有关试点工作v社区卫生服务机构收支社区卫生服务机构收支两条线管理两条线管理v社区首诊制及双
36、向转诊社区首诊制及双向转诊制度制度v药品政府采购、统一配药品政府采购、统一配送、零差率销售送、零差率销售加强对各地落实加强对各地落实指导意指导意见见及配套政策有关情况及配套政策有关情况进行检查、督导。进行检查、督导。 Pay more attentions on the development of CHS, enhance the communication among various regions, disseminate good practices and experiences constantly. Make more experiments on related reforms
37、 such as:uImplement separating management of revenue from expenditureuEstablish dual-referral system and have CHS as the gate keeperuExplore concentrated procurement, universal delivery, zero markupReinforce the supervision and guidance on implementation of the and the supportive policies 17 谢谢！Thank You !
