Material for the press conference of the State Council Information Office

 

Introduction of Implementing the Health and Medical Assistance Program for Poverty Alleviation

National Health and Family Planning Commission of the PRC

(2016.6.21)

 

 

Recently authorized by the State Council, 15 government agencies, including the National Health and Family Planning Commission, the National Development and Reform Commission, theMinistry of Education, the Ministry of Science and Technology, the Ministry of Civil Affairs, the Ministry of Finance, the Ministry of Human Resources and Social Security, the Ministry of Environmental Protection, the Ministry of Housing and Urban Construction, Ministry of Water Resources, the State Administration of Traditional Chinese Medicine, the Central Military Commission of the Political Work, the Central Military Commission of the Logistics Support, the China Disabled Persons’Federation, the Poverty Alleviation Office of the State Council jointly introduced"the Guiding Opinions on implementing the Health and Medical Assistance Program for Poverty Alleviation"(National Health Finance [2016] No.26, abbreviated as "Guiding Opinions"hereinafter), which defined the overall requests, objectives, tasks and supporting measures to implement the Health and Medical Assistance Program for Poverty Alleviation. The Guiding Opinions also included requirements for its implementation.

I. Improve the medical insurance level and alleviate the medical burdens of the rural poor population.

The new rural cooperative medical and critical disease insurance system will cover all poverty-stricken population and provide policy inclination. With this insurance system,every individual will have his/her premiums subsidized by government finances,funds will be set up in poverty-stricken areasto reimburse outpatient costs and a higher percentage of hospitalization expenses. The new rural cooperative medical insurance will also increase financing for the major disease coverage, so as to lower its claim threshold and raise the reimbursement percentage. More precise payment policies will be implemented to make the system more beneficial for the impoverished population.Enhance medical aids and temporary aids. All rural poor populations will be included in the critical disease medical insurance to alleviate the burdens of people living in poverty. For those patients who have major disease emergencies but cannot get timely family support and thus live in adversities, more temporary aid will be provided and social charities will be mobilized to help. An information platform that connects government aid resources, civil society aid programs and the poor rural population will be built up to guide and support charitable organizations, public and private entities, and individuals.

II. Provide a triage system to rural poor patients with critical or chronic illnesses.

Set up a dynamically managed electric health file and create a health card for each individual. Urge primary health care organizations to provide contracting service on basic medical care, public health, and health management. With county as the unit and grass-root family planning service network as the basis, further verify the number of families and information of patients whose poverty is caused (again) by disease, and build a database to provide basic data and decision-making reference for differentiated aid. Provide a triage system to patients with critical or chronic illnesses. For those who can be cured once and for all, mobilize experts to focus on the treatment. From 2016 on, focus on the selectedcritical diseases that bring larger burdens, make bigger social impact and find effective treatment by making treatment plans, identifying clinical pathways, and controllingtreatment costs to alleviate the burden of those impoverished patients. For those who need to be hospitalized, find an adjacent medical organization capable of conductingeffective treatment. And for those who need long-term treatment and rehabilitation, assign the primary health care agency to conduct treatment and rehabilitation under the guidance of the superior medical organizations.

III. Adopt the mechanism of providing diagnosis and treatment before payment for the poor rural population in counties.

The poor inpatients receive diagnosis and treatment before payment in counties. The pinpointed medical agencies will set up one-stop service windows for information exchange and real-time settlement of basic medical insurance, major disease insurance, emergency disease aid, and medical aid. Study the settlement mechanism of diagnosis and treatment before payment for the poor rural population in cities and provinces where conditions permit.

IV. Improve medical and health services in poverty-stricken areas.

Firstly, implement thestandardization of county-level hospitals, township health centers, village clinics, enabling each county in contiguous poor areas with particular difficulties and key county included in the national plan for poverty alleviation through development to meet the target of “three one”, that is, one public county-level hospital for each county, one standardized township health centers for each town and one clinic for each administrative village. Reinforce capacity building of telemedicine in poor areas, so as to realize interconnecting between county-level hospitals and various medical health service institutions at different levels within the county. Prioritize The 13th Five-Year Action Plan in promoting traditional Chinese medicine service capacity at grass-root level in poor areas, establish comprehensive traditional Chinese medicine service district like traditional Chinese medicine clinics and hospitals in township health centers and community health centers, strengthening the supply of traditional Chinese medicine equipment and personnel.

Secondly, organize Tertiary urban hospitals to offer one to one support to county-level hospitals in poor areas. Select Tertiary hospitals nationwide (military hospitals and armed police corps hospitals included) to sign responsibility agreements with county-level hospitals of counties in contiguous poor areas with particular difficulties and key counties included in the national plan for poverty alleviation through development. Tasks and aims should be identified in the support agreements. a director or deputy director at a tertiary hospital as well as related medical personnel would be assigned to work in the correspondent hospital, helping them focusing on the clinic and paramedical units development related with the diseases of which the switching out rate out of the county ranked top 5-10 in recent three years, disseminating medical technology suitable for county-level hospitals. Adopt various methods such as technical support, personnel training and management guidance to improve the service capacity of the correspondent hospitals, enabling them to achieve the service level of Grade-II medical institutions by 2020 (correspondent hospitals in counties with a population of 300,000 and above should achieve the level of Class B Grade-II ) .

Thirdly, enforce thecomprehensive training of medicine professionals. Facilitate the development of higher medical education in poor areas and guide them to draw up reasonable enrollment plans of local medical schools and medical specialization based on the demand of the region. Enforce the building-up of health professionals in poor areas comprehensively by taking measures such as standardized training of resident doctors, training of assistant general practitioner, order-type and directional free training, special post plan for general practitioner and specialist. Explore integrated management of health personnel in medical institutions at county and township level. Health professionals working at basic level medical institutions in poor areas, old revolutionary base areas, ethnic areas, border area would be accepted by military medical college and medical institutions, in manner of joint training. Appropriate traditional Chinese medicine technology should be disseminated with clear target, by the year of 2020, there should be at least 2 doctors for each township health centers, 1 village doctors mastering at least 5 appropriate traditional Chinese medicine technology for each village clinic in poor areas, providing convenient, effective traditional Chinese medicine service with low price for patients suffering from common disease or frequently-occurring disease. Local authorities should formulate policies to encourage excellent health professionals to work in poor areas; incentive mechanism for basic level health professionals should be explored, favoring health professionals who have worked in basic level medical institutions in poor areas for a long time in terms of professional title promotion, education and training as well as salary and payment. Talent recruiting and introducing plans that are consistent with the reality of the area have been drawn up, putting in place the right autonomy of medical and health institutions in poor areas in recruiting talents. The team building of village doctors should be enforced and village doctors in poor areas should receive training in rotation one group after another at a different time, the training target will be hit in 2017. Local authorities should further improve aged care service for village doctors on the basis of reality, by way of various forms such as supporting and guiding village doctors to participate in basic pension insurance for the working group or urban and rural pension insurance, and subsidies as well.

V.Enhance the health levels of the population in poor areas by way of comprehensive measures.

Firstly, disease prevention and control such as chronic disease, infectious disease and endemic disease in poor areas should be strengthened. Enhancing follow up register and monitoring the cause of death of patients suffering neoplastic disease, expanding screening for cancer and the coverage of early diagnosis and treatment. Screening and register of patients with serious phychlogical problems in poor areas should be intensified, enhancing the work of medical treatment and aid as well as service management. Water improving project of defluoridation and reducing arsenic in areas where fluorin and arsenic content have been found beyond the normal range should be completed, basically control the hazard of endemic fluorosis and arsenic poisoning. Various measures such as public subsidies for transportation and sales or direct subsidies for consumers have been taken to make poor rural population have access to and are able to afford qualified iodized salt, keeping the situation of elimination iodine deficiency disorders. Comprehensive measures have been taken to prevent and cure endemic disease like Kashin-Beck disease and Kersandisease. Greater efforts should be made to prevent and cure zoonose, basically control the spread of echinococcosis in farming and pastoral area in western regions, effectively preventing Brucellosis from spreading. Greater efforts should also be made to provide professional guidance and technological support to poor areas where epidemic situation of tuberculosis is serious, encouraging crucial population of tuberculosis to accept screening imitatively, standardizing diagnosis and treatment service as well as whole process control, further reducing the incidence of tuberculosis in poor areas. Communication centers in poor areas where there is major epidemic of AIDS should be established, strengthening prevention and control of the disease.

Secondly, the practice of women and children health in poverty-stricken areas should be promoted. Various measures will be implemented across poverty-stricken areas to promote integrated prevention and management of birth defect, including free pre-pregnancy check-up for eugenics, neural tube defects prevention by folic acid supplement of rural women, "Two Cancers" (breast cancer and cervical cancer) screening, nutrition improvement of children, and neonatal screening. Assistance system for disabled children’s rehabilitation is established, in which 0-6 year old children with vision, hearing, speech, intellectual and physical disabilities are gradually provided with free surgery, assistive devices and rehabilitation training. Capacities for treatment of maternal and newborn severe acute diseases in poverty-stricken areas are enhanced to provide maternal health care and to ensure the mother-infant safety. The support for family planning work in poverty-stricken areas is strengthened, and the accountability system for management by objectives in family planning area is adhered to and improved. Assistance for families with difficulties in family planning is increased.

Thirdly,the patriotic public health campaign will be further implemented in poor rural areas. Activities of building hygienic city are enhanced and actions to make our environment clean and tidy are carried out. The sanitation in the poverty-stricken areas is dealt with, and poverty alleviation operations to improve human settlement of rural residents in poverty-stricken areas are carried out, thus effectively promoting the quality of human settlement in the poverty-stricken areas. Improvement of toilets in rural areas is integrated with the rural dangerous building renovation project to speed up the process of constructing sanitary toilets in rural areas. Sanitary monitoring, investigation and assessment on the drinking water and environment in rural areas are strengthened. The consolidation and promotion project for rural drinking water safety is implemented to promote the garbage disposal and sewage treatment in rural areas. Integrated and comprehensive measures are taken to deal with air pollution, surface water pollution and noise pollution. Health promotion and health education are enhanced. The basic knowledge and skills for health literacy are widely publicized, and health awareness of the rural poor is fostered, who will then form good hygiene habits and maintain a healthy lifestyle.

To ensure the effective implementation of the Health Assist Poverty Project, the guiding opinions define requirements for tis implement.

Firstly, organization and implementation should be strengthened. The Guidelines define the leading role of the National Health and Family Planning Commission, and the Leading Group Office of Poverty Alleviation and Development, and specify the distribution of responsibilities among them and other related government agencies. A coordination mechanism across all governmental levels is adopted, in which the central government plan and guide the working, the provincial governments take the overall responsibilities, and the local governments do the front-line implementations. The working plan for implementation, taking into account the actual conditions in poverty-stricken areas, should be set up in different regions, specifying the pathway and timing, and strengthening accountability arrangements. It is emphasized that the county-level government, viewing this Project as a key move to win in the battle of removing poverty, play the main role in the implementation. The finance allocation, policy link-up, and manpower redeployment should be well organized and carried out.

Secondly, investment policies should be in place. The Guidelines specify the central and provincial governments' responsibilities in providing financial support to the poor. The central government continues to increase the transfer payment of the special fund for health and family planning in poverty-stricken areas, promoting the successful implementation of the Project. The central government will not ask county governments and cities in contiguous impoverished areas to support the funding of public programs on health and family planning. The special funds for health and family planning provided by both the provincial and municipal governments will be further skewed towards the poverty-stricken areas. The financial funds are used in a coordinated and integrated way, increasing the investment in health assist poverty. Under the cooperation framework for supporting the poor in Eastern and Western of China, the support for the health care in poverty-stricken areas will be strengthened in the provinces of the East.

Thirdly, the involvement of the private sectors is encouraged. The Guidelines proposes various measures to encourage enterprises, social organizations and individuals to involve in the Health Assist Poverty Project. More social capitals are incentivized to invest in the poverty-stricken areas by such preferential policies as granting the project naming right, tax reduced for donations to support the poor, and tax deduction and exemption. Social organizations such as associations and societies will be brought into full play so as to integrate social resources, including social capitals and technical personnel, providing great support for the poverty-stricken areas.

Fourthly, a strong evaluation system should be ensured. The Guidelines require that the implementation of the Project should be taken as an important component and included in the accountability system for the mission of removing poverty, and in the goal assessment management for the governments in the poverty-stricken areas. The distribution of responsibilities is elaborated and the task requirements are specified. The implementation of the Project is examined and monitored regularly. Annual examination and evaluation are organized by the National Health and Family Planning Commission, and Leading Group Office of Poverty Alleviation and Development to monitor the implementation.

Fifthly, the innovation of forms and approaches for health assist poverty in the local context is encouraged. The Guidelines require that great emphasis should be put on removing the disease-caused poverty and poverty-returning caused by diseases. The funds and programs are allocated and utilized effectively and efficiently, thus promoting the implementation of the Project. By deepening the reform, the driving force for the Project is highly motivated. Integrating health assist poverty with “characteristic industry assist poverty” or with “labor export assist poverty”, a joint force comes into being, enhancing the outcomes of poverty-relief program.