深化卫生与健康事业改革发展

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健康是人民幸福和社会发展的基础，是全国人民对美好生活的共同追求。党的十八大以来，以习近平同志为核心的党中央，从“五位一体”总体布局、“四个全面”战略布局出发，作出了推进健康中国建设的决策部署。2016年，党中央、国务院召开了新世纪以来第一次全国卫生与健康大会，习近平总书记发表重要讲话。随后，党中央、国务院颁布实施《“健康中国2030”规划纲要》（以下简称《规划纲要》），勾画了打造健康中国的美好蓝图。这是我国卫生与健康事业发展的重要里程碑，对于全面提升中华民族健康素质、实现“两个一百年”奋斗目标具有重大的现实意义和深远的历史意义。各地各有关部门要认真学习贯彻习近平总书记关于卫生与健康事业的新理念新思想新战略，深入落实好全国卫生与健康大会精神，扎实工作，奋发有为，推动党中央、国务院决策部署落地生根，为建成健康中国而努力奋斗。

Health is the foundation of people’s happiness and social development; it is also the common aspiration of all Chinese people in their pursuit of a happy life. Since the Communist Party of China (CPC) convened its 18th National Congress in 2012, the CPC Central Committee with Xi Jinping at the core has made decisions and arrangements pertaining to developing a healthy China on the basis of the “Five-Pronged” overall plan and the “Four Comprehensives” strategy. In 2016, the CPC Central Committee and the State Council convened the National Health Conference – the first national meeting of its kind in the 21st century – at which General Secretary Xi delivered an important speech. Subsequently, the CPC Central Committee and the State Council promulgated the “Outline of the Healthy China 2030 Plan”, which lays out a fine blueprint for developing a healthy China. This is an important milestone in the development of China’s health care, and will have major short- and long-term implications for our efforts to raise the health of the Chinese nation as a whole and realize the “Two Centenary Goals.”

一、准确把握新形势，进一步增强推进健康中国建设的责任感和紧迫感

I. Accurately identifying new circumstances and further enhancing the sense of responsibility and urgency concerning the development of a healthy China

党和政府历来高度重视保障人民健康。新中国成立后，大力发展医药卫生事业，坚持把重点放在农村，创建了城乡三级医疗卫生服务网、农村合作医疗、赤脚医生等具有中国特色的初级卫生保健制度，注重发挥中医药“一根针、一把草”简便验廉独特优势，切实解决群众看病就医问题。同时，以“发展体育运动、增强人民体质”为宗旨，广泛开展群众性体育健身运动，发挥其对健康的促进作用。在党中央、国务院坚强领导下，依靠广大医务人员奋力拼搏，依靠广大人民群众轰轰烈烈开展爱国卫生运动，以“纸船明烛照天烧”的气魄，迅速提高了人民健康水平，一举摘掉了“东亚病夫”的帽子，被世界卫生组织誉为“发展中国家的典范”，中华民族开始以强健的姿态屹立于世界民族之林。

The CPC and government have long attached major importance to ensuring public health. After the founding of the PRC in 1949, they vigorously promoted health care with a heavy emphasis on improving it in rural areas. To address people’s difficulty in securing access to medical services, the CPC and government established China’s unique primary health care system which features a triple-tier network for the provision of medical services for both urban and rural areas, a cooperative medical care program for rural residents, and barefoot doctors. This system emphasizes taking advantage of the traditional Chinese medicine with regards to its quick diagnosis, convenient treatment, and low cost of its natural therapies and medicines. Meanwhile, with a view to “promoting physical culture and building up people’s physique,” extensive sporting and fitness activities for the general public were launched in an effort to promote public health. Under the firm leadership of the CPC Central Committee and the State Council, the Chinese nation is standing tall among the nations of the world as a strong and healthy nation. With great rapidity, China has improved its level of public health via the tireless efforts of its medical workers and the vigorous patriotic health campaigns the people have launched. Thus, it has cast aside its former label as the “sick man of East Asia”, and is now acclaimed as a paradigm for other developing countries by the World Health Organization (WHO).

改革开放以来，我国卫生与健康事业加快发展，取得了举世瞩目的伟大成就。2009年，在总结抗击非典经验基础上，启动实施了新一轮医药卫生体制改革，明确了保基本、强基层、建机制的基本原则和实现人人享有基本医疗卫生服务的目标。特别是党的十八大以来，以习近平同志为核心的党中央，面对深化改革攻坚期的新特点和群众新期待，提出了以人民为中心的发展思想，把维护人民健康作为治国理政的基本要务，统揽全局、系统谋划、突出重点、立柱架梁，实施一系列利当前、惠长远的重大举措，推动医药卫生体制改革由易到难渐次突破，蹄疾步稳不断深化，取得了重大阶段性成效，我国卫生与健康事业发展跨上了崭新台阶。

Since the launch of reform and opening-up, China’s undertakings in health care have developed apace, and the monumental achievements made in this regard have captivated the world. In 2009, on the basis of an encapsulation of the experience of the SARS outbreak, China launched a new round of reform of the health care system, in which it clearly identified the basic principles of guaranteeing basic health care services, developing primary care, and establishing mechanisms, in order to realize the goal of providing basic medical services for everyone. Especially since the 18th CPC National Congress, in light of the new features at this critical point in furthering reform and meeting the new expectations of the people, the CPC Central Committee with Xi Jinping at the core has put forward a people-centered notion of development; thus, safeguarding public health has been adopted as a task fundamental to national governance. By adopting an overall perspective, making systematic plans, highlighting priorities, and establishing frameworks, the CPC Central Committee has implemented a series of major measures capable of yielding both short- and long-term benefits, driven forward with reform of the health care system using a gradual approach by making easy breakthroughs before moving onto the harder ones, and taken fast yet steady steps to continue reform, attaining a milestone achievement. Thus, China’s health care has progressed to new heights.

一是织起了全世界最大的全民基本医保网。我们从保基本起步，完善城镇职工医保制度，扩大新农合和城镇居民医保覆盖面，建立大病保险制度、疾病应急救治制度，健全医疗救助制度，形成了覆盖城乡、相互衔接、多层次的基本医疗保障网。城乡居民参保率稳定在95%以上，保障水平大幅提升，政府补助标准从2009年的每人每年80元增加到2017年的450元，居民住院费用政策范围内报销比例稳步提高，为实现人人病有所医提供了坚实的制度保障。

First, China has woven the world’s largest universal basic health care network. With a view to guaranteeing basic health care services, we have improved the medical insurance scheme for working urban residents, and expanded its coverage for new rural cooperatives and for non-working urban residents, developed a major disease insurance scheme and an emergency disease treatment scheme, and improved the medical assistance scheme, thus forming a closely linked, and multi-layered basic health care network that covers both urban and rural areas. Basic health care coverage has now stabilized at over 95% of the population, and the level of benefits has increased by a large margin. Government subsidies for basic health care have risen from 80 yuan per person per annum in 2009 to 450 yuan in 2017, and the proportion of reimbursement of hospital fees using medical insurance funds as prescribed by the relevant policies has steadily risen. This basic health care network provides strong institutional guarantees for universally affordable and accessible medical care.

二是完善了覆盖城乡的医疗卫生服务体系。我们从强基层抓起，加强农村三级基本医疗卫生服务网络和城市社区卫生服务中心建设，全面实施国家基本药物制度，深化基层医疗卫生机构综合改革，加快全科医生培养，有序推进分级诊疗，使更多的城乡居民拥有了家庭医生。全面启动县级公立医院综合改革，全面推开城市公立医院改革试点，探索建立维护公益性、调动积极性、保障可持续的运行新机制。积极推动社会力量办医，民营医院数量占总数的比例已经超过56%，多元办医格局初步形成，人民群众多元化、多样化健康需求不断得到满足。

Second, China has improved the health care service system that covers both urban and rural areas. With a view to developing primary care, we have stepped up efforts to develop a triple-tier network for the provision of basic medical services in rural areas and community health service centers in urban areas, fully implemented the national essential drugs system, deepened the comprehensive reform of grassroots medical and health institutions, prioritized the training of general practitioners, and made orderly progress with a classification mechanism for determining the kind of medical treatment required, so as to give more urban and rural residents access to family doctor services. We have launched comprehensive reform of county-level public hospitals, implemented pilot reforms for urban public hospitals, and explored the establishment of a new operational mechanism for health care institutions that will help to preserve their public welfare orientation, ensure that they are fully motivated, and guarantee their sustainability. We have actively encouraged non-government investment in health care, and the number of private hospitals now accounts for over 56% of the total. Thus, a health care service system with a diverse range of medical service providers is taking shape that will continue to satisfy the many-faceted and diverse health needs of the people.

三是筑牢了严密的公共卫生安全防控屏障。我们坚持预防为主，加强突发公共卫生事件应急处置能力，建成了全球最大的传染病疫情和突发公共卫生事件监测网，组建了一支平战结合、反应迅速、能打胜仗的应急防控队伍，能够有效应对各种重大突发疫情，特别是经受住了2015年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。我国公共卫生整体实力和疾病防控能力上了一个大台阶，卫生应急救援水平走在了世界前列。

Third, we have erected enduring and tight security and prevention barriers for safeguarding public health. With a firm focus on prevention, we have strengthened our ability to respond to public health emergencies, developed the world’s largest monitoring network for epidemic diseases and public health emergencies, and organized a disease prevention and control emergency response team who is capable in both calm and calamitous times, of a swift response, and of successfully carrying out their work; these efforts have enabled us to effectively respond to major epidemic outbreaks. These efforts proved especially effective in 2015, when we stood the test of the outbreak of Ebola hemorrhagic fever and realized a double victory – domestically by taking strict precautions and thus achieving zero outbreaks, and in Africa by giving a successful response so that none of our aid workers contracted infections. China’s overall strength in public health and capabilities in the prevention and control of diseases have taken a great step forward, and its capacity for public health emergency response is now among the best in the world.

四是提升了人民群众的健康福祉。我们把人民群众得实惠作为卫生与健康事业发展的最终目标，努力让人民有更多的健康获得感。居民看病就医负担明显减轻，个人卫生支出占卫生总费用比重降到30%以下，为近20年来最低水平。基本公共卫生服务项目均等化水平明显提高，免费向城乡居民提供12类国家基本公共卫生服务，财政投入由2009年的人均15元提高到今年的50元，重大公共卫生服务惠及千万家庭。全面实施两孩政策及其配套措施，努力保障每个家庭生得起、生得好。我国人均期望寿命从2009年的74.8岁提高到2015年的76.3岁，孕产妇死亡率从31.9/10万降为20.1/10万，婴儿死亡率从13.8‰降为8.1‰。居民主要健康指标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。这是用8年左右时间，以人均不到500美元的费用支出取得的，充分体现了我国基本医疗卫生制度的优越性。

Fourth, we have improved the health and wellbeing of the people. We strive to give people a greater sense of gain with regard to health; as such, in improving health care our ultimate goal is to bring tangible benefits to the public. We have lightened the burden of people in obtaining medical services and reduced individual payment of the expenditure to below 30% of the total, the lowest level in 20 years. We have made clear improvements in equal access to public health services, provided 12 free national basic public health services to urban and rural residents, and increased per capita government expenditure on health care from 15 yuan in 2009 to 50 yuan in 2017, benefiting tens of millions of households. We have implemented a new two-child policy and its supporting measures to ensure that every family can afford to raise two healthy children. From 2009 to 2015, China’s average life expectancy rose from 74.8 years to 76.3, the maternal mortality rate fell from 0.319‰ to 0.201‰, and the infant mortality rate decreased from 13.8‰ to 8.1‰. Major public health indicators in China are better than those of the average medium- to high-income country, signaling that China has achieved the United Nations Millennium Development Goal ahead of schedule. These achievements were made in only eight years with a per capita cost of less than US$500, demonstrating the superiority of China’s basic health care system.

总之，党的十八大以来的五年，是我国卫生与健康事业投入力度大、发展速度快、人民群众获得实惠多、国内外影响力空前提升的时期，是卫生与健康事业发展的又一个黄金期，特别是党中央、国务院开展了卓有成效的理论创新、制度创新和实践创新，出台了一系列具有里程碑意义的新政策新举措，初步搭建起保障人人享有基本医疗卫生服务的制度框架，基本构建起与经济社会发展水平相适应的卫生与健康事业发展的政策体系，为推进健康中国建设打下了坚实基础。世界银行、世界卫生组织等国际组织认为，中国以史无前例的速度，只用了富裕国家一半的时间，实现了全民健康覆盖，成就令人瞩目。实践证明，我国卫生与健康事业改革发展的基本方向、总体思路和重大举措是正确的，成效是显著的，有力地保障和改善了民生，促进了经济发展和社会公平。在医改这个世界性难题上，逐步探索出中国式解决办法。这些都是我国改革开放和社会主义现代化建设重大成就的重要组成部分。成绩来之不易，应倍加珍惜。

In sum, the five years since the 18th CPC National Congress have witnessed great investment in and rapid growth of China’s health care, which brings many benefits to the people and enjoys domestic and international recognition at unprecedented levels. This period has been another golden age for the development of health care in the country. Particularly, the CPC Central Committee and the State Council have made remarkably effective theoretical, systemic, and practical innovations, formulated a series of new, landmark policies and measures, formed an initial institutional framework that ensures universal basic medical services, and created policy systems for health care that are commensurate with China’s level of social and economic development, thus laying a solid foundation for a healthy China. International organizations such as the World Bank and the WHO believe that, with unprecedented speed, China realized universal coverage of basic health care in just half the time it took some developed countries, captivating the world with its achievements. Experience has proven that the basic direction, general approach, and major measures that China takes in reforming and developing its health care are valid and its achievements are remarkable, and that they guarantee and improve public wellbeing and promote economic development and social equity. China has gradually made inroads towards a Chinese approach to health care reform, which is a difficult issue of global proportions. This rapid investment in and development of health care are an important constituent of the major achievements of China’s reform and opening-up and socialist modernization. These achievements did not easily come by, and as such they are of extra value.

“人生天地间，长路有险夷”。要清醒地看到，在我们这样一个有着13亿多人口的发展中大国，推进健康中国建设任重道远，还存在不少困难和挑战，特别是党中央、国务院对卫生与健康事业改革发展提出了新的更高要求，人民群众对健康服务有了新的更高期盼，医药卫生领域正在发生前所未有的深刻变革，需要从全局高度认识、把握建设健康中国面临的新形势。

As the old saying goes, “There will be both good and bad times on the long journey of life.” We must always keep in mind that, as China is a large developing country with a population of over 1.3 billion, developing a healthy China remains a long and arduous task with many difficulties and challenges yet to be overcome. Particularly, the CPC Central Committee and the State Council have put forward new and more demanding requirements regarding the reform and development of health care; the people have new and higher expectations for public health services; and the health care sector is undergoing profound changes without precedent. To arise to these challenges, we must understand the bigger picture and fully understand the new conditions facing our efforts to develop a healthy China.

推进健康中国建设是实现国家发展战略的重大决策部署。我们正在朝着实现“两个一百年”奋斗目标、建设社会主义现代化国家、实现中华民族伟大复兴的中国梦奋勇阔步向前。健康梦是中国梦的重要组成部分，特别是2020年全面建成小康社会奋斗目标，把建立覆盖全民的基本医疗卫生制度和人均期望寿命在原有基础上再提高1岁作为重要指标。实现这些目标面临着多重因素交织叠加的复杂局面，工业化、城镇化、人口老龄化不断加快，疾病谱、生态环境、生活方式不断变化。我国60岁以上人口已达2.3亿，2030年将达3.7亿，2050年将达4.87亿，人口老龄化不仅带来赡养问题，而且带来医疗、照护、精神生活等方面的健康问题。我国高血压患者超过2.5亿，糖尿病患者超过9700万，心脑血管疾病、癌症等慢性非传染性疾病导致的死亡占总死亡人数的85％左右，成为危及人民健康的第一“杀手”。我们还面临着生态环境污染和破坏的严峻形势，食品药品安全、饮水安全、职业安全隐患犹存，煤矿、交通等领域安全生产事故屡有发生，这些都严重威胁着人民群众的身体健康，需要采取果断有力的措施，更加积极主动加以解决。

Developing a healthy China is a major decision towards realizing our national development strategy. We are marching ahead to realize the “Two Centenary Goals,” achieve socialist modernization and the Chinese dream of national rejuvenation. The dream of a healthy China is an important constituent of the Chinese dream; in particular, developing a basic health care system with universal coverage and raising average life expectancy by one year are two important indicators for the goal of achieving moderate prosperity throughout society by 2020. In realizing these goals, we are faced with complex situations with many intertwined and overlapping factors, including continued acceleration of industrialization, urbanization, and population aging, and constant changes in the spectrum of disease, the environment, and ways of life. The number of citizens aged 60 years and over has now reached 230 million, and is projected to reach 370 million by 2030 and 487 million by 2050. Alongside issues regarding the provision of support for the elderly, population aging also brings with it health issues regarding medical treatment, care, and the emotional wellbeing of the elderly. In China, there are over 250 million patients suffering from high blood pressure, and over 97 million from diabetes. Chronic non-communicable ailments such as cardiovascular and cerebrovascular diseases and cancer account for 85% of the death toll, and have now become the number one killer. In addition, we still face a grim situation regarding damage and pollution to the environment, safety of food and drugs, safety of drinking water, hidden occupational dangers, and the frequent occurrence of industrial accidents in coal mining and transportation, which all pose threats to public health. In order to more actively prevent these potential threats, we need to take strong and decisive measures.

推进健康中国建设是我们党努力满足人民健康新期盼的一项迫切任务。一方面，随着经济社会发展和人民收入水平的不断提高，人民群众健康理念的普及和健康意识的增强，更加重视生命质量和健康安全，不仅要求看得上病、看得好病，更希望不得病、少得病，看病更舒心、服务更体贴，对政府保障人民健康、提供基本卫生与健康服务寄予更高的期望，多层次、多样化的健康需求不断释放。2016年全国医疗机构总诊疗人次接近80亿，比新医改初期2009年的49亿人次增加了63％。另一方面，部分群众对医学的局限性、复杂性、风险性认识不足，存在健康管理意识不强、看病预期过高等问题。由于多种原因，医患纠纷时有发生，影响了我国医疗卫生事业的发展，也影响了社会和谐稳定。健康问题不仅是重大的民生问题，也是重大的社会问题、政治问题。

Developing a healthy China is a pressing task that the CPC undertakes in order to meet the people’s new expectations regarding their health. On one hand, in the wake of increasing economic and social development and growing personal incomes, people lay more emphasis on quality of life as well as health and safety because ideas about health are disseminated and people’s awareness of their health improves; that is to say, rather than simply having adequate and effective medical services, they hope to avoid or reduce the risk of contracting illnesses, and enjoy medical services that are more agreeable and better catered to their particular needs. In this regard, the people are placing higher expectations on the government when it comes to ensuring their health and providing basic health services, and they are making increasingly multi-layered and diversified demands for health services. In 2016, medical institutions provided 8 billion sessions of treatment nationwide, which is an increase of 63% compared to 4.9 billion in 2009. On the other hand, some people do not fully understand the limitations, complexities, and risks of medicine, and have a weak awareness of health management and overly high expectations for medical services. From time to time and for a variety of reasons, medical disputes occur, and these disputes adversely affect health care development, social harmony and stability in China. Issues with health care not only affect people’s livelihood, they also have major social and political implications.

推进健康中国建设是深化医改、促进卫生与健康事业协调发展的内在要求。我国卫生与健康领域面临着老问题与新情况叠加、发展问题与改革任务交织、巩固已有改革成果与拓展深化新领域改革并重的复杂局面。医药卫生事业发展还存在不少短板，供给服务质量偏低、资源总量不足、资源配置不合理、人员结构不平衡、基层服务能力薄弱、老少边穷地区发展滞后。深化医改进入深水区和攻坚期，触及更多的深层次矛盾和问题，面临的都是更难啃的“硬骨头”。公立医院的逐利机制尚未消除，大处方、过度检查等问题仍然存在。城乡居民医保筹资标准偏低，医保在控制费用、发挥对医疗行为的有效激励约束方面亟待完善。药品流通秩序不规范，药价虚高问题突出。我们要坚持以问题为导向，直面挑战，敢于担当，全力以赴破解这些难题。

Developing a healthy China is an inherent requirement for furthering health care reform and coordinated development of health care. China’s health care faces a complex situation whereby old and new problems overlap, development issues and reform tasks intertwine, and emphasis needs to be placed equally on both consolidating extant achievements in reform and expanding and furthering reform into new areas. There are still many shortcomings in developing health care, which include the low quality of services supplied, insufficient resources, unequal distribution of resources, disequilibrium in personnel structures, insufficient capability in providing services at the grassroots, and lagging development in old revolutionary base areas, ethnic minority areas, border areas, and impoverished areas. As we move into the “deep end” of health care reform, a decisive phase in which still more deep-seated issues will arise, the troubles we face will be much harder to resolve. Profit-driven mechanisms still exist in public hospitals, and thus the phenomena of excessive prescriptions and medical examinations remain. Funding standards for medical insurance for urban and rural residents are relatively low, and medical insurance needs urgent improvement regarding its roles in controlling cost and encouraging certain types of practices and discouraging others. Due to poor control of drug circulation, artificially high drug prices are a prominent issue. We need to maintain a problem-oriented approach, confront challenges head-on, not be afraid to assume responsibility, and fully devote ourselves to overcoming these difficulties.

推进健康中国建设是适应全球健康治理变革、更好履行国际责任的必然要求。全球卫生与健康体系正处于发展变革的重要时期。联合国2030年可持续发展议程，把健康放在了更加突出位置。世界各国都在积极推进卫生与健康改革，不少国家都制定健康规划，确保国民健康水平与经济发展同步提高。此外，随着全球化进程加快，传染病疫情、生物恐怖安全、抗生素耐药等跨国播散的公共安全威胁日益严峻。近年来在一些国家爆发的埃博拉出血热、中东呼吸综合征等新发传染病已经成为各国共同应对的重大公共卫生问题。还要看到，全球健康发展的不平衡、不平等问题比较突出。健康是人类共同的事业，是国际社会共同的责任，我们要积极主动地推进全球卫生与健康治理改革，促进建立更加公正合理的国际健康新秩序。

Developing a healthy China is essential for us to adapt to changes in global health governance and better fulfill our international responsibilities. The global health system is at an important stage of development and reform. The UN’s 2030 Agenda for Sustainable Development raised health to an even more prominent position. All countries worldwide are actively promoting health care reform, with many of these formulating health plans to better coordinate the level of public health with economic development. Moreover, as the pace of globalization quickens, transnational threats to public security such as outbreaks of epidemic diseases, bioterrorism, and antibiotic resistance become increasingly serious. The outbreak in some countries of new infectious diseases such as Ebola hemorrhagic fever and Middle East respiratory syndrome has resulted in major public health issues that must be addressed via the joint efforts of all countries. Furthermore, developmental imbalances and inequality in global health are still evident. As health is a common undertaking of humanity and common responsibility of the international community, we need to actively drive reforms of global health governance and spur the founding of a new order in international health that is fairer and more equitable.

总之，卫生与健康事业改革发展到了攻坚克难的关键时期，也面临翻开新篇章的重大机遇。有以习近平同志为核心的党中央的坚强领导，有社会主义制度的优越性，有综合国力的持续提升，有多年来卫生与健康事业改革发展打下的坚实基础，只要我们团结一心，开拓进取，抢抓机遇，破障闯关，就一定能够把健康中国建设的美好蓝图变为现实。

In sum, the reform and development of health care in China has entered a crucial stage in which we must overcome many difficulties; yet it also presents us with a great opportunity for writing a new chapter in this regard. With the strong leadership of the CPC Central Committee with Xi Jinping at the core, the superiority of the socialist system, the continued increase in overall national strength, and the solid foundation already laid down in prior reforms and developments of health care over the years, as long as we unite as one, forge ahead, seize opportunities, and dismantle barriers, we will surely actualize our blueprint for developing a healthy China.