一、符合国情的健康权保障模式
I. Ensuring People’s Right to Health Based on China’s Conditions文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
中国是一个有着13亿多人口的发展中大国。中国共产党和中国政府始终高度重视发展卫生与健康事业，加快转变健康领域的发展方式，切实尊重和保障公民的健康权，形成了符合国情的健康权保障模式。文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
China is a large developing country with 1.3 billion people. The CPC and the Chinese government have always attached great importance to developing the medical and health services, to transforming the development model of the health sector, and to respecting and protecting citizens’ right to health. A mechanism based on China’s conditions to ensure the people’s right to health has been put in place.文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
1949年新中国成立时，经济社会发展水平相对落后，医疗卫生体系十分薄弱，全国仅有医疗卫生机构3670个，卫生人员54.1万人，卫生机构床位数8.5万张，人均预期寿命仅有35岁。为尽快改变这种状况，国家大力发展医药卫生事业，制定实施“面向工农兵、预防为主、团结中西医、卫生工作与群众运动相结合”的工作方针，广泛开展群众性爱国卫生运动，普及初级卫生保健，人民健康状况得到了很大改善，医疗技术取得重大突破，首次分离了沙眼衣原体，进行了世界第一例断肢再植手术，成功研制出抗疟新药青蒿素等，取得了举世瞩目的伟大成绩。文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
When the People’s Republic of China was founded in 1949, China had a weak medical and health system due to low levels of development in its economy and society. The nation had only 3,670 medical and health institutions, 541,000 health workers and 85,000 beds at health institutions. The average life expectancy was 35 years. To change this situation, the government devoted great efforts to developing the medical and health services, and implemented guidelines which stipulated that the health services were to serve vast majority of the people, that prevention should be stressed, that both Western medicine and Traditional Chinese Medicine (TCM) should be utilized, and that health promotion and people’s involvement should be incorporated. The people were mobilized to carry out health promotion programs, and basic knowledge about healthcare was widely spread. All this greatly enhanced the people’s health, and major breakthroughs were made in medical sciences. Chlamydia trachomatis was identified for the first time by Chinese scientists; Chinese doctors performed the world’s first replantation of a severed limb; and artemisinin, an effective cure for malaria, was extracted in a Chinese laboratory.文章源自英文巴士-https://www.en84.com/3765.html
文章源自英文巴士-https://www.en84.com/3765.html
1978年改革开放以后，国家针对当时存在的医疗卫生资源严重短缺、服务能力不足、服务效率较低等问题，实行多渠道筹资，鼓励多种形式办医，增加资源供给，逐步放开药品生产流通市场，发展医药产业，注重发挥中医药的作用，采取一定的经济激励措施，调动医务人员积极性，增强内部活力。1996年，第一次全国卫生工作会议明确了“以农村为重点，预防为主，中西医并重，依靠科技与教育，动员全社会参与，为人民健康服务，为社会主义现代化建设服务”的新时期卫生工作方针。1998年，国家开始建立保障职工基本医疗需求的社会医疗保险制度。2000年，国家提出建立适应社会主义市场经济要求的城镇医药卫生体制，让群众享有价格合理、质量优良的医疗服务，提高人民健康水平的改革目标。2002年，国家发布《关于进一步加强农村卫生工作的决定》，从农村经济社会发展实际出发，深化农村卫生体制机制改革，将卫生投入重点向农村倾斜，满足农民群众不同层次的医疗卫生需求。
Following the introduction of the reform and opening-up drive in 1978, to address problems such as a severe shortage of medical and health resources and a lack of service capability and low efficiency, the government allowed multi-channel financing for the medical industry, and encouraged medical development in various forms, by increasing resource supply, opening up the pharmaceuticals manufacturing and circulation market, developing the pharmaceutical industry, and promoting TCM. Economic incentives were adopted to encourage medical personnel to enhance their performance. At the First National Health Service Meeting in 1996, a decision was made on implementing the guiding principles for health services in the new era, namely, “focusing on the rural areas, prioritizing prevention, equal emphasis on Western medicine and TCM, relying on science and education, encouraging public participation, promoting public health, and serving socialist modernization.” In 1998, China began to form a social medical insurance system to cover the basic medical needs of workers. In 2000, it set the goal of establishing an urban medical and healthcare system in line with the socialist market economy, so that the people could enjoy reasonably priced, high-quality medical services, and thus become healthier. In 2002, the government released the Decision on Further Enhancing Health Services in Rural Areas. Taking into consideration the levels of economic and social development in rural areas, the government decided to drive health services reform to a deeper level, and put in more funding to rural areas, to provide different levels of medical services to rural residents.
2003年，在党和政府的坚强领导下，全国人民万众一心，取得了抗击“非典”的重大胜利。在总结经验的基础上，国家全面加强了公共卫生服务和重大疾病防控工作，重大疾病防治体系不断完善，突发公共卫生事件应急机制逐步健全，农村和城市社区医疗卫生发展步伐加快，新型农村合作医疗和城镇居民基本医疗保险取得突破性进展。
In 2003, under the firm leadership of the Party and the government, the Chinese people, united as one, won a decisive victory in their combat against the Severe Acute Respiratory Syndrome (SARS) pandemic. Learning a lesson from this experience, the government took comprehensive measures to improve public health services, and the prevention and control of serious diseases. Marked progress was made in the prevention and control system for serious diseases, in the response mechanism for public health emergencies, in the development of community healthcare services in rural and urban areas, and in the new-type rural cooperative medical care and basic medical insurance for urban residents.
2009年，国家启动实施新一轮医药卫生体制改革，颁布了《关于深化医药卫生体制改革的意见》，确立把基本医疗卫生制度作为公共产品向全民提供的核心理念，进一步明确公共医疗卫生的公益性质，提出建立公共卫生、医疗服务、医疗保障、药品供应“四大体系”和医药卫生管理、运行、投入、价格、监管、科技和人才、信息、法制“八项支撑”，加快基本医疗卫生制度建设，推动卫生事业全面协调可持续发展。随后，国家又颁布了《医药卫生体制改革近期重点实施方案（2009－2011年）》和《“十二五”期间深化医药卫生体制改革规划暨实施方案》，提出加快推进基本医疗保障制度建设，健全基层医疗卫生服务体系，促进基本公共卫生服务逐步均等化等改革任务。
In 2009, China launched a new round of reform of the medical and healthcare system. With the release of the Opinions on Deepening Reform of the Medical and Healthcare System, the government delivered a message that the basic medical and healthcare system should be available to all citizens as a public product. The nonprofit nature of public medical and healthcare was made clear. In the document, it was proposed that China would develop the “four systems” of public health, medical services, medical security and drug supply and the “eight supporting mechanisms” of medical and healthcare management, operation, investment, pricing, supervision, technology and personnel, information, and law-based development, in an effort to form a basic medical and healthcare system and promote the all-round, balanced, and sustainable development of the health sector. Soon after that, China issued the Plan for Reforming Key Areas of the Medical and Healthcare System (2009-2011) and Plan for Deepening Reform of the Medical and Healthcare System during the 12th Five-Year Plan Period (2011-2015). In these two documents, the government set the goals of the reform, which were accelerating the basic medical security system, improving community-level medical and healthcare services, and promoting equal access to basic public health services.
2012年以来，中国不断加大医药卫生体制改革力度，加快推进公立医院综合改革，推进药品和医疗服务价格改革，全面实施城乡居民大病保险，积极建设分级诊疗制度，优化完善药品生产流通使用政策。2015年10月29日，健康中国建设正式写入党的十八届五中全会公报。2016年8月，全国卫生与健康大会提出：“要坚持正确的卫生与健康工作方针，以基层为重点，以改革创新为动力，预防为主，中西医并重，将健康融入所有政策，人民共建共享。”2016年10月，国家颁布《“健康中国2030”规划纲要》，为推进健康中国建设，提高人民健康水平做出了战略部署。
Since 2012, China has redoubled its effort to reform the medical and healthcare system; it has accelerated the comprehensive reform of public hospitals and the price reform of drugs and medical service; it has also implemented serious illness insurance policies covering both urban and rural residents, adopted a multi-layer diagnosis and treatment mechanism, and improved the policies regarding the production, distribution and use of drugs. On October 29, 2015, enhancing public health and fitness was formally introduced in the communique of the Fifth Plenary Session of the 18th CPC Central Committee. In August 2016, at the National Health and Fitness Conference, it was stated that the government will “follow the correct guidelines for promoting health and fitness services, focus on lower-level medical institutions, strive to reform and make innovations in the medical sector, prioritize disease prevention, lay equal emphasis on Western medicine and TCM, incorporate health promotion in all policies, and involve all citizens in promoting public health and thereby bring health benefits to all.” In October 2016, the state issued “Healthy China 2030” Planning Outline, a guiding document on promoting public health and fitness, with plans to make the Chinese people healthier.
健康事业的发展给人民群众带来实实在在的健康福祉，中国人均预期寿命从1981年的67.9岁提高到2016年的76.5岁，孕产妇死亡率从1990年的88.9/10万下降到2016年的19.9/10万，婴儿死亡率从1981年的34.7‰下降到2016年的7.5‰，居民的主要健康指标总体上优于中高收入国家平均水平，提前实现联合国千年发展目标。同时，中国已形成了以宪法为总领，以民事法律法规、卫生行政法律法规、地方性法规等为实施基础，以健康领域各种纲要、纲领、计划为行动指南的健康制度体系，有效平衡医患关系，公正化解医疗纠纷，切实实现公民健康权。
The development in the field of health services has brought concrete benefits to the Chinese people. The average life expectancy of the Chinese rose to 76.5 years in 2016 from 67.9 years in 1981; maternal mortality dropped from 88.9 per 100,000 persons in 1990 to 19.9 per 100,000 persons in 2016; and infant mortality declined from 34.7 per 1,000 in 1981 to 7.5 per 1,000 in 2016. The main health indicators of the Chinese are generally better than the average level of middle- and high-income countries, and China has achieved the UN’s Millennium Goals in this regard ahead of schedule. Furthermore, China has established a complete medical and health system that is guided by the Constitution, based on civil laws and regulations, laws and administrative regulations on health, and local regulations, and directed by the outlines, programs, and plans of the health sector. The system has proved effective in maintaining sound doctor-patient relations, addressing medical disputes with impartiality, and ensuring citizens’ right to health.
深化医改效果持续彰显，在较短时间内织起了全世界最大的全民基本医疗保障网，建立大病保险制度、疾病应急救助制度，健全医疗救助制度，为实现病有所医提供了制度保障。重大传染病得到有力控制，艾滋病整体疫情控制在低流行水平，联合国千年发展目标确定的结核病控制指标提前实现，血吸虫病疫情降至历史最低水平，2000年实现无脊髓灰质炎目标。2015年，建成了全球最大的法定传染病疫情和突发公共卫生事件网络直报系统，平均报告时间由直报前的5天缩短为4个小时。
The reform of the medical sector has produced noticeable results. Within a short period of time, China was able to achieve the following: developing the world’s largest basic medical insurance network that covers all citizens, providing insurance for patients of serious diseases, enabling patients to receive emergency medical services, and improving medical assistance. All this has provided institutional guarantee that patients have access to medical services. The state has gained effective control over serious infectious diseases, has kept the spread of AIDS at a low level, has achieved the tuberculosis control target of the UN’s Millennium Goals ahead of schedule, has reduced the number of schistosome infections to the lowest level in history, and became a polio-free country in 2000. China set up the world’s largest online direct reporting system of notifiable epidemics and public health emergencies in 2015, and the average reporting time has been shortened to four hours from five days before the introduction of the system.
医疗卫生服务体系建设取得重大进展，基本建成了覆盖城乡的基层医疗卫生服务网络，各级各类医疗卫生机构超过98万个，卫生人员超过1100万人，卫生机构床位数超过700万张。人才队伍建设加快推进，住院医师规范化培训制度逐步建立，涌现出了诺贝尔生理学或医学奖得主屠呦呦等一批杰出医务工作者。社会办医加速发展，民营医院占医院总数的比重超过57%，多元办医格局初步形成。医疗卫生应急救援能力走在国际前列，经受住了防控埃博拉出血热特大传染病疫情的严峻考验，实现了国内“严防控、零输入”和援非抗疫“打胜仗、零感染”双重胜利。
Significant progress has been made in developing a system of medical and healthcare services. A basic medical services network covering both urban and rural areas has been put in place, with 980,000 medical and health institutions at all levels, 11 million health workers, and seven million beds at medical institutions. The state has increased its efforts to foster more medical professionals. A standardization training system for resident doctors is being established, and outstanding figures such as Nobel Prize laureate in Physiology or Medicine Tu Youyou have made significant contributions to society. As more social resources flow into the medical sector, private hospitals now account for over 57 percent of all hospitals, making medical services more diverse. China’s medical and health emergency rescue capability is among the world’s best. It stood the severe test of the Ebola epidemic, blocking all infectious sources from outside its territory and achieved zero infection while Chinese medical teams went on assistance missions in Africa.
经过长期努力，中国卫生与健康事业发展跨上了崭新台阶，不仅显著提高了人民的健康水平，而且形成了符合本国国情的健康权保障模式，其主要特点是：
After many years of hard work, a new stage has been reached in China’s medical and health services. This has not only made the Chinese people healthier, but has also created a model suited to the country’s prevailing conditions that is able to ensure people’s right to health. This model has the following features:
——健康优先，把健康置于优先发展的战略地位，立足国情，将维护和提升健康的理念融入政策、法律、法规制定实施的全过程，实现健康的生活方式、生产条件和生态环境与经济社会良性协调发展。
– Prioritizing health and fitness. The government places people’s health at the forefront of its development strategies, based on China’s prevailing reality, incorporates the awareness of maintaining and improving people’s health into the decision-making process of policies and the formulation and implementation of laws and regulations, and strives to achieve sound and coordinated development between healthy lifestyles, working conditions, the natural environment, and the economy and society.
——预防为主，把以治病为中心转变为以人民健康为中心，坚持防治结合、身心并重、中西医互补，注重慢性病、地方病、职业病防控，减少疾病发生，把握健康领域的发展规律，强化早诊断、早治疗、早康复。
– Focusing on prevention. The focus on healthcare has been shifted from treating illnesses to enhancing people’s health. Equal emphasis is put on disease prevention and treatment, and the well-being of both mind and body. Western medicine and TCM have been made complementary to each other. More efforts have been focused on the prevention and control of chronic, endemic and occupational diseases. In order to reduce the occurrences of illnesses, China’s medical sector is striving to learn more about the patterns and development of health-related issues, emphasizing early diagnosis, treatment and recovery.
——公益主导，坚持基本医疗卫生事业的公益性，把基本医疗卫生制度作为公共产品向全民提供，将公立医院作为医疗服务体系的主体，逐步实现全民享有公共健康服务。
– Nonprofit services. The basic medical and healthcare services will continue to be basically nonprofit, and made available to all citizens as a public product. Public hospitals are the pillar of the medical service system, and steps will be taken to ensure universal access to public-health services.
——公平普惠，坚持卫生服务和医疗保障覆盖全民，以农村和基层为重点，逐步缩小城乡、地区、不同人群间健康水平的差异，保证健康领域基本公共服务均等化。
– Equality and benefit for all. The state will continue to ensure full coverage of health and medical services. Focusing on rural areas and communities, the gaps in health conditions between urban and rural areas, between different localities and between different groups will be gradually narrowed, so that everyone has equal access to basic health services.
——共建共享，坚持政府主导与调动社会、个人的积极性相结合，推动人人参与、人人尽力、人人享有，正确处理政府与市场的关系，政府在基本医疗卫生服务领域有所作为，市场在非基本医疗卫生服务领域发挥活力。
– Universal participation and sharing of benefits. The government will continue to assume the leading role, while private organizations and individuals are encouraged to participate. The goal is to involve all citizens in the building and development of the medical care system, with the benefits jointly shared by all. The government will appropriately handle its relationship with the market, so that the former can play its due role in the basic medical and healthcare sector and that the market can provide more choices in the non-basic medical care sector.
