李克强副总理：不断深化医改 推动建立符合国情惠及全民的医药卫生体制（中英对照）

不断深化医改

Deepening the Reform of Health Care<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

李克强

by Li Keqiang

医改是一个世界性难题。近年来许多国家都在推进医改，但在改革中都遇到重重困难，有的甚至举步维艰。我国深化医药卫生体制改革，是深入贯彻落实科学发展观的重大实践行动，是维护十几亿人民健康福祉的重大民生工程，也是协调推进经济社会建设、扩大内需的重大发展工程。医改实施两年多来，探索了路子，积累了经验，取得了明显进展和初步成效，为下一步改革打下了好的基础。同时，在实践中还存在一些亟待解决的问题，实现2020年医改的总体目标还需要一个过程。我们要进一步把思想和行动统一到中央的决策部署上来，把改革不断推向深入，着力建设覆盖城乡居民的基本医疗卫生制度，继续探索医改这一世界性难题的中国式解决办法。

Health care reform is a challenging global issue. A number of countries around the world have carried out health care reform over recent years. All of these countries have encountered a range of difficulties during the course of reform, and some have even struggled. The deepening of health care reform represents a key aspect of our efforts to apply the Scientific Outlook on Development. It is a major welfare initiative aimed at safeguarding the health and happiness of more than one billion people, and a crucial development campaign that will underpin the promotion of economic and social development and the growth of domestic demand. During more than two years of efforts, we have worked out effective approaches, gained new experiences, and made clear progress, and we are now starting to see the positive effects of our reforms. Our progress so far has helped us to put solid foundations in place for our future reform efforts. However, we must be aware that there are still pressing issues to be resolved, and that achieving our overall objectives in health care reform by the year 2020 will involve a gradual process. We must think and act in line with the decisions and arrangements made by the central leadership in an effort to further deepen health care reform in China. Focusing on our goal of providing basic medical and health services to all urban and rural residents in China, we must continue to work out our own distinctive way of tackling the issue of health care reform.

一、统一思想，深刻认识医改的重要性和紧迫性

I. The importance and urgency of health care reform

党中央、国务院高度重视医改工作。2009年上半年，中共中央、国务院颁发了《关于深化医药卫生体制改革的意见》，明确了医改的指导思想、总体目标、基本框架和政策措施。国务院出台了《医药卫生体制改革近期重点实施方案（2009—2011年）》，确定了医改的五项重点任务。这两个文件的制定出台都经过了深入调研、认真讨论、反复协调，具有很强的指导性和针对性。各地区、各有关部门和单位认真贯彻医改部署，加大工作力度，加强协同配合，克服起步阶段的种种困难，使医改各项任务不断推进，得到了广大人民群众的拥护和支持。

The CPC Central Committee and the State Council have attached great importance to health care reform. In the first half of 2009, the CPC Central Committee and the State Council promulgated the Opinions on Deepening the Reform of the Health Care System, which outlined the guiding thoughts, overall objectives, basic framework, and policy measures for China’s health care reform. The State Council subsequently issued the Implementation Plan for Short-Term Priorities in Health Care Reform (2009-2011), identifying five key tasks in reform. As important guidelines geared towards specific issues, these two documents were formulated through a process of in-depth investigation, careful discussion, and repeated coordination. Since then, all localities, departments, and institutions concerned have engaged in a conscientious effort to implement the scheme for health care reform. They have stepped up their efforts, increased their collaboration, and managed to overcome the various challenges that were encountered during the early stages of reform. This has allowed us to make sound progress in the various aspects of our health care reform and secure widespread public support for these initiatives.

医改的初步成效主要表现在：一是基本医疗保障面大幅扩大。新型农村合作医疗、城镇居民医疗保险、城镇职工医疗保险三项制度不断健全，近600万关闭破产国有企业退休人员医保问题妥善解决，城乡居民参保人数合计已达12.8亿人，全民基本医保惠及全国95%左右的人口。二是基层医疗卫生服务能力明显增强。2000多个县级医院和3万多个基层医疗卫生机构得到改造建设，以全科医生为重点的基层医疗卫生队伍培养规划启动实施，为中西部地区基层机构免费培养了约1万名医科学生，为乡镇卫生院招聘了2万多名执业医师，培训在岗医务人员达数百万人次。三是基本公共卫生服务均等化取得新进展。10类国家基本公共卫生服务项目、7项重大公共卫生服务行动在全国范围内开展，人均经费标准逐步提高，公共卫生服务受惠面明显扩大。四是基本药物制度建立和公立医院改革试点有序推进。基本药物制度已在所有政府办基层医疗卫生机构实施，基层机构药品价格平均下降30%左右，门诊药费、住院费用相应降低。公立医院改革试点以及县级医院综合改革试点有序开展。五是卫生事业投入力度不断加大。中央财政2009—2011年共新增医改资金3318亿元，各地相应加大了医改资金投入，财政医疗卫生支出大幅度增长，个人卫生支出在卫生总费用中所占比重连续下降，群众就医负担初步减轻。

We have produced the following results in the initial stage of our reforms: First, the coverage of basic medical insurance has been expanded by a large margin. We have made constant improvements to the new cooperative medical care system in rural areas and to medical insurance for working and non-working residents in urban areas. This has allowed us to bring 6 million retired workers from closed or bankrupt state-owned enterprises under the coverage of medical insurance. At present, 1.28 billion rural and urban residents are covered by basic medical insurance, accounting for about 95% of the total population. Second, medical and health care services at the grassroots level have been improved. More than 2,000 county-level hospitals and over 30,000 grassroots medical and health institutions have been constructed or reconstructed. A campaign to train grassroots medical workers, especially general practitioners, has been launched. Through this campaign, around 10,000 medical students have been trained for grassroots medical and health institutions in central and western regions free of charge; over 20,000 medical practitioners have been recruited for town and township medical centers; and millions of practicing medical workers have been provided with training. Third, new progress has been made in our effort to provide equitable access to basic public health services for all people. As a part of our initiatives, we have launched a portfolio of basic public health service programs spanning 10 different categories and initiated 7 major public health service campaigns across the country. With the gradual increase of expenditure per capita, more and more people are now benefiting from public health services. Fourth, steady progress has been made in the establishment of a national system for basic drugs and in the trial reform of public hospitals. With the implementation of a system for basic drugs in all government-run medical and health institutions at the grassroots level, drug prices have decreased by an average of 30%, while outpatient drug fees and hospitalization fees have also decreased. Trial reforms in public hospitals and trials for the comprehensive reform of county-level hospitals have been carried out. Fifth, investment in health programs has progressively increased. From 2009 to 2011, an additional 331.8 billion yuan in central government funds was allocated to health care reform. At the same time, all localities have also increased their expenditure in health care reform. With the significant increase of government expenditure, the proportion of health care fees borne by individuals has dropped on a constant basis. This has allowed us to ease the financial burden of the public in medical care.

总的看，我国医改起步扎实，发展势头良好，推动了民生保障和改善，加强了社会事业建设，也为扩大内需、促进经济发展创造了好的条件。改革的实践表明，医改的理念、方向和路径是正确的，符合广大人民群众的愿望和要求，符合我国基本国情和卫生事业发展的规律，也借鉴了国际成功经验。但应当清醒地认识到，医改还面临诸多困难和挑战，主要表现在：长期存在的基本医疗保障短缺、医疗资源总量不足且配置不合理、城乡和区域卫生事业发展不平衡、人才队伍建设薄弱和“以药补医”等矛盾依然存在，看病难、看病贵问题还相当突出。同时，各地改革进展仍不平衡，一些地方医改政策和资金落实不到位，机制和制度建设相对滞后。对此，我们必须高度重视，采取有效措施认真解决。

Speaking in overall terms, our health care reform has gained good momentum after making a solid start, which has promoted our efforts to ensure and improve the public well-being, enhanced our social programs, and created favorable conditions for the growth of domestic demand and the stimulation of economic development. Our experiences in reform so far have proven that the concepts, the orientation, and the approaches of our medical reforms are correct. Making sound use of international experiences, our reforms not only conform to the hopes and demands of the general public, but also to the conditions of our country and the laws governing the development of health programs. Despite this, however, we need to be aware of the fact that we are still facing a number of difficulties and challenges in reform, such as the long-term lack of basic medical security, the shortage and irrational allocation of medical resources, the unbalanced development of health programs in urban and rural areas and among different regions, insufficient development of medical workers, and the practice of compensating doctors with proceeds from the over-prescription of high-priced drugs. In addition, the problem of high medical fees and difficulty in securing access to medical services is still serious. Meanwhile, the progression of reforms has varied in different regions. Some localities are yet to fully implement policies and guarantee funding for reforms, and are lagging behind in the development of mechanisms and systems. We must attach a high level of priority to the effective resolution of these problems.