《中國的醫療衛生事業》白皮書WhitePaper:MedicalandHealthServicesinChina中華人民共和國國務院新聞辦公室26日發表《中國的醫療衛生事業》白皮書。全文如下：TheStateCouncilInformationOfficeofthePeople'sRepublicofChinaonWednesdaypublishedawhitepaperonthemedicalandhealthservicesinChina.Followingisthefulltextofthewhitepaper:中國的醫療衛生事業（2012年12月）中華人民共和國國務院新聞辦公室MedicalandHealthServicesinChina

(December2012)InformationOfficeoftheStateCouncilThePeople'sRepublicofChina目錄Contents前言\o""Foreword一、衛生基本狀況\o""I.BasicConditions二、醫藥衛生體制改革\o""II.ReformofMedicalandHealthcareSystems三、傳染病防治與衛生應急\o""III.InfectiousDiseasePreventionandTreatment,andHealthEmergencyManagement四、慢性非傳染性疾病防治\o""IV.PreventionandTreatmentofChronicNon-communicableDisorders五、婦女兒童健康權益保護\o""V.ProtectingWomenandChildren'sRighttoHealth六、中醫藥發展\o""VI.DevelopmentofTraditionalChineseMedicine七、衛生國際合作\o""VII.InternationalMedicalandHealthcareCooperation結束語\o""Conclusion前言Foreword健康是促進人的全面發展的必然要求。提高人民健康水平，實現病有所醫的理想，是人類社會的共同追求。在中國這個有著13億多人口的發展中大國，醫療衛生關系億萬人民健康，是一個重大民生問題。Goodhealthisaprerequisiteforpromotingall-rounddevelopmentoftheperson.Anditisacommonpursuitofhumansocietiestoimprovepeople'shealthandensuretheirrighttomedicalcare.ForChina,alargedevelopingcountry,medicalandhealthcareisofvitalimportancetoitspopulationofover1.3billion,andisamajorissueconcerningitspeople'swellbeing.中國高度重視保護和增進人民健康。憲法規定，國家發展醫療衛生事業，發展現代醫藥和傳統醫藥，保護人民健康。圍繞憲法，中國逐步形成了相對完善的衛生法律法規體系。Chinapaysgreatattentiontoprotectingandimprovingitspeople'shealth.AstheConstitutionstipulates,"Thestatedevelopsmedicalandhealthservices,promotesmodernmedicineandtraditionalChinesemedicine...,allfortheprotectionofthepeople'shealth."Basedonthisconstitutionalstipulation,Chinahasputinplaceacompletesystemoflawsandregulationsconcerningmedicalandhealthservices.多年來，中國堅持“以農村為重點，預防為主，中西醫并重，依靠科技與教育，動員全社會參與，為人民健康服務，為社會主義現代化建設服務”的衛生工作方針，努力發展具有中國特色的醫療衛生事業。經過不懈努力，覆蓋城鄉的醫療衛生服務體系基本形成，疾病防治能力不斷增強，醫療保障覆蓋人口逐步擴大，衛生科技水平日益提高，居民健康水平明顯改善。Overtheyears,ChinahasworkedhardtodevelopitsmedicalandhealthserviceswithChinesecharacteristicsinaccordancewiththepolicyof"makingruralareasthefocusofourwork,puttingdiseasepreventionfirst,supportingbothtraditionalChinesemedicineandWesternmedicine,relyingonscience,technologyandeducation,andmobilizingthewholeofsocietytojointheefforts,improvingthepeople'shealthandservingsocialistmodernization."Thankstounremittingeffortsthathavebeenmade,medicalandhealthcaresystemscoveringbothurbanandruralresidentshavetakenshape,thecapabilitiesofdiseasepreventionandcontrolhavebeenenhanced,thecoverageofmedicalinsurancehasexpanded,continuousprogresshasbeenmadeinmedicalscienceandtechnology,andthepeople'shealthhasbeenremarkablyimproved.

為建立起覆蓋城鄉居民的基本醫療衛生制度，保障每個居民都能享有安全、有效、方便、價廉的基本醫療衛生服務，中國深入推進醫藥衛生體制改革，取得了重要階段性成效。Toputintoplacebasicmedicalandhealthcaresystemscoveringbothurbanandruralresidents,andensurethateveryresidenthasaccesstosafe,effective,convenientandaffordablebasicmedicalandhealthservices,Chinahaskeptadvancingthereformofitsmedicalandhealthcaresystem,andmadeimportantachievementsinthecurrentstage.一、衛生基本狀況I.BasicConditions居民健康狀況不斷改善。從反映國民健康狀況的重要指標看，中國居民的健康水平已處于發展中國家前列。2010年人均期望壽命達到74.8歲，其中男性72.4歲，女性77.4歲。孕產婦死亡率從2002年的51.3/10萬下降到2011年的26.1/10萬。嬰兒死亡率及5歲以下兒童死亡率持續下降，嬰兒死亡率從2002年的29.2‰下降到2011年的12.1‰，5歲以下兒童死亡率從2002年的34.9‰下降到2011年的15.6‰，提前實現聯合國千年發展目標。Thepeople'shealthhasbeenimproved.Judgingfromimportantindicatorsthatgiveexpressiontonationalhealth,thehealthoftheChinesepeopleisnowamongthetopindevelopingcountries.In2010,thelifeexpectancywas74.8years-72.4yearsformalesand77.4yearsforfemales;thematernalmortalityratewentdownfrom51.3per100,000in2002to26.1per100,000in2011;theinfantmortalityrateandthemortalityrateofchildrenundertheageoffivehavekeptdropping,withtheformergoingdownfrom29.2perthousandin2002to12.1perthousandin2011,andthelatter,from34.9perthousandto15.6perthousand,attainingaheadofscheduletheUNMillenniumDevelopmentGoalinthisregard.

建立起覆蓋城鄉的醫療衛生體系。一是公共衛生服務體系。包括疾病預防控制、健康教育、婦幼保健、精神衛生、衛生應急、采供血、衛生監督和計劃生育等專業公共衛生服務網絡，以及以基層醫療衛生服務網絡為基礎、承擔公共衛生服務功能的醫療衛生服務體系。二是醫療服務體系。在農村建立起以縣級醫院為龍頭、鄉鎮衛生院和村衛生室為基礎的農村三級醫療衛生服務網絡，在城市建立起各級各類醫院與社區衛生服務機構分工協作的新型城市醫療衛生服務體系。三是醫療保障體系。這個體系以基本醫療保障為主體、其他多種形式補充醫療保險和商業健康保險為補充。基本醫療保障體系包括城鎮職工基本醫療保險、城鎮居民基本醫療保險、新型農村合作醫療和城鄉醫療救助，分別覆蓋城鎮就業人口、城鎮非就業人口、農村人口和城鄉困難人群。四是藥品供應保障體系。包括藥品的生產、流通、價格管理、采購、配送、使用。近期重點是建立國家基本藥物制度。Medicalandhealthcaresystemscoveringbothurbanandruralresidentshavebeenputinplace.Ofthesesystems,thefirstisthepublichealthservicesystem,whichcoversdiseasepreventionandcontrol,healtheducation,maternityandchildcare,mentalhealth,healthemergencyresponse,bloodcollectionandsupply,healthsupervision,familyplanningandsomeotherspecializedpublichealthservices,andamedicalandhealthcaresystembasedoncommunity-levelhealthcarenetworksthatprovidespublichealthservices.Thesecondisthemedicalcaresystem.Intheruralareas,itreferstoathree-levelmedicalservicenetworkthatcomprisesthecountyhospital,thetownshiphospitalsandvillageclinics,withthecountyhospitalperformingtheleadingrole,andtownshiphospitalsandvillageclinicsserviceatthebase.Andinthecitiesandtowns,itreferstoanewtypeofurbanmedicalhealthservicesystemthatfeaturesdivisionofresponsibilitiesaswellascooperationamongvarioustypesofhospitalsatalllevelsandcommunityhealthcarecenters.Thethirdisthemedicalsecuritysystem.Thissystemcomprisesmainlythebasicmedicalsecurity,supportedbymanyformsofsupplementarymedicalinsuranceandcommercialhealthinsurance.Thebasicmedicalsecuritysystemcoversbasicmedicalinsuranceforworkingurbanresidents,basicmedicalinsurancefornon-workingurbanresidents,anewtypeofruralcooperativemedicalcareandurban-ruralmedicalaid,whichcover,respectively,theemployedurbanpopulation,unemployedurbanpopulation,ruralpopulationandpeoplesufferingfromeconomicdifficulties.Andthefourthisthepharmaceuticalsupplysystem,whichcoverstheproduction,circulation,pricecontrol,procurement,dispatchinganduseofpharmaceuticals.Therecentworkisfocusedonestablishinganationalsystemforbasicdrugs.衛生籌資結構不斷優化。衛生籌資來源包括政府一般稅收、社會醫療保險、商業健康保險和居民自費等多種渠道。2011年，中國衛生總費用達24345.91億元人民幣，同期人均衛生總費用為1806.95元人民幣，衛生總費用占國內生產總值的比重為5.1%。按可比價格計算，1978—2011年，中國衛生總費用年平均增長速度為11.32%。個人現金衛生支出由2002年的57.7%下降到2011年的34.8%，衛生籌資系統的風險保護水平和再分配作用不斷提高。2011年，醫院、門診機構費用為18089.4億元人民幣，公共衛生機構費用為2040.67億元人民幣，分別占衛生總費用的71.74%和8.09%。醫院費用中，城市醫院、縣醫院、社區衛生服務中心、鄉鎮衛生院費用分別占64.13%、21.28%、5.17%、9.3%。Thehealthfinancingstructurehasbeenconstantlyimproved.China'shealthexpenditurecomesfromthegovernment'sgeneraltaxrevenue,socialmedicalinsurance,commercialhealthinsurance,residents'out-of-pocketspending,etc.In2011,thetotalhealthexpenditureinChinareached2,434.591billionyuan,1,806.95yuanpercapita.Thetotalexpenditureaccountedfor5.1%ofthecountry'sGDP.Incomparableprices,thehealthexpendituregrewbyanaverageannualrateof11.32%from1978to2011.Individual"out-of-pocket"spendingdeclinedfrom57.7%in2002to34.8%in2011,showingthathealthfinancingisworkingbetterintheareasofriskprotectionandre-distribution.In2011,thespendingonhospitalsandoutpatientestablishmentswas1,808.94billionyuan,andthatonpublichealthagencies,204.067billionyuan,comprising71.74%and8.09%,respectively,ofthetotalhealthexpenditure.Ofthetotalspendingonhospitals,thoseonurbanhospitals,countyhospitals,communityhealthservicecentersandtownshiphealthservicecentersstoodat64.13%,21.28%,5.17%and9.3%,respectively.衛生資源持續發展。截至2011年底，全國醫療衛生機構達95.4萬個(所)，與2003年比較，醫療衛生機構增加14.8萬個(所)。執業(助理)醫師246.6萬人，每千人口執業(助理)醫師數由2002年的1.5人增加到1.8人。注冊護士224.4萬人，每千人口注冊護士數由2002年的1人增加到1.7人。醫療衛生機構床位數516萬張，每千人口醫療衛生機構床位數由2002年的2.5張提高到3.8張。Healthresourceshavebeendevelopinginasustainedway.Bytheendof2011,medicalandhealthcareinstitutionsaroundthecountrytotaled954,000,anincreaseof148,000over2003.Licenseddoctors(assistants)reached2,466,000,or1.8perthousandpeople,ascomparedwith1.5perthousandpeoplein2002.Registerednursestotaled2,244,000,or1.7perthousandpeople,ascomparedwithoneperthousandpeoplein2002.Thenumberofhospitalbedsreached5160,000,or3.8perthousandpeople,ascomparedwith2.5perthou-sandpeoplein2002.醫療衛生服務利用狀況顯著改善。2011年，全國醫療機構診療人次由2002年的21.5億人次增加到62.7億人次，住院人數由2002年的5991萬人增加到1.5億人。中國居民到醫療衛生機構年均就診4.6次，每百居民住院11.3人，醫院病床使用率為88.5%，醫院出院者平均住院日為10.3天。居民看病就醫更加方便，可及性顯著提高。15分鐘內可到達醫療機構住戶比例，由2003年的80.7%提高到2011年的83.3%，其中農村地區為80.8%。醫療質量管理和控制體系不斷完善。建立無償獻血制度，血液安全得到保障。Markedimprovementhasbeenseenintheutilizationofmedicalandhealthservices.In2011,medicalinstitutionsthroughoutthecountryhosted6.27billionoutpatients,ascomparedwith2.15billionin2002;andadmitted150millioninpatients,ascomparedwith59.91millionin2002.Thatyear,Chineseresidentswenttothemedicalinstitutionsformedicaltreatment4.6timesonaverage;11.3ofevery100peoplewerehospitalized;theutilizationrateofhospitalbedsreached88.5%;andthehospitalstayoftheinpatientsaveraged10.3days.Thesefiguresshowthatithasbecomeincreasinglyconvenienttoseeadoctorandmoreeasilyaccessibletogetmedicalservices.In2011,83.3%ofallhouseholds(80.8%inruralareas)couldreachmedicalinstitutionswithin15minutes,ascomparedwith80.7%in2002.Medicalservicequalitymanagementandcontrolsystemshavebeenconstantlyimproved.Asystemofblooddonationwithoutcompensationhasbeenestablished,soastoensurebloodsupplyandsafety.二、醫藥衛生體制改革II.ReformofMedicalandHealthcareSystems經過多年努力，中國衛生事業取得顯著發展成就，但與公眾健康需求和經濟社會協調發展不適應的矛盾還比較突出。特別是隨著中國從計劃經濟體制向市場經濟體制的轉型，原有醫療保障體系發生很大變化，如何使廣大公眾享有更好、更健全的醫療衛生服務，成為中國政府面臨的一個重大問題。從20世紀80年代開始，中國啟動醫藥衛生體制改革，并在2003年抗擊傳染性非典型肺炎取得重大勝利后加快推進。2009年3月，中國公布《關于深化醫藥衛生體制改革的意見》，全面啟動新一輪醫改。改革的基本理念，是把基本醫療衛生制度作為公共產品向全民提供，實現人人享有基本醫療衛生服務，從制度上保證每個居民不分地域、民族、年齡、性別、職業、收入水平，都能公平獲得基本醫療衛生服務。改革的基本原則是?；尽娀鶎?、建機制。Withyearsofeffort,Chinahasmaderemarkableachievementsinthedevelopmentofitshealthcareundertakings,which,however,stillfallfarshortofthepublic'sdemandsforhealthcareaswellastherequirementsofeconomicandsocialdevelopment.EspeciallywhenChinaturnedfromaplannedeconomytoamarketeconomy,theoldmedicalcaresystemhasundergonegreatchanges.SoitbecameanissueofmajorimportancefortheChinesegovernmenttoprovidebetterandmoreaccessiblemedicalandhealthservicestothepublic.Inthe1980s,theChinesegovernmentinitiatedreformofthemedicalandhealthcaresystems,andspeededupthereformin2003afterasuccesswaswoninthefightagainsttheSARS.InMarch2009,theChinesegovernmentpromulgatedthe"OpinionsonDeepeningReformoftheMedicalandHealthCareSystems,"settingoffanewroundofreforminthisregard.Thebasicgoalofthisreformwastoprovidethewholenationwithbasicmedicalandhealthservicesasapublicproduct,andensurethateveryone,regardlessoflocation,nationality,age,gender,occupationandincome,enjoysequalaccesstobasicmedicalandhealthservices.Andthebasicprinciplestobefollowedinthereformweretoensurebasicservices,improvingsuchservicesatthegrass-rootslevelandestablishingtheeffectivemechanisms.醫改是一項涉及面廣、難度大的社會系統工程，在中國這樣一個人口多、人均收入水平低、城鄉區域差距大的發展中國家，深化醫改是一項十分艱巨復雜的任務。三年多來，中國政府大力推進醫藥衛生服務與經濟社會協調發展，積極破解醫改這一世界性難題。通過艱苦努力，中國的新一輪醫改取得積極進展。Medicalreformisasocialprogramthatcoversawiderangeandinvolvesdifficulttasks.AnditisahardandcomplicatedtasktodeepenthisreforminChina,adevelopingcountrywithalargepopulation,lowper-capitaincomeandawidegapbetweenurbanandruralareas.Foroverthreeyears,theChinesegovernmenthasworkedhardtostrikeabalancebetweenimprovingmedicalandhealthservicesononehandandeconomicandsocialdevelopmentontheother,tryingtofindasolutiontothisworldwideproblem.Thankstothepersistenteffortsmade,Chinahasmadepositiveprogressinthisnewroundofmedicalreform.——基本醫療保障制度覆蓋城鄉居民。截至2011年，城鎮職工基本醫療保險、城鎮居民基本醫療保險、新型農村合作醫療參保人數超過13億，覆蓋面從2008年的87%提高到2011年的95%以上，中國已構建起世界上規模最大的基本醫療保障網?；I資水平和報銷比例不斷提高，新型農村合作醫療政府補助標準從最初的人均20元人民幣，提高到2011年的200元人民幣，受益人次數從2008年的5.85億人次提高到2011年的13.15億人次，政策范圍內住院費用報銷比例提高到70%左右，保障范圍由住院延伸到門診。推行醫藥費用即時結算報銷，居民就醫結算更為便捷。開展按人頭付費、按病種付費和總額預付等支付方式改革，醫保對醫療機構的約束、控費和促進作用逐步顯現。實行新型農村合作醫療大病保障，截至2011年，23萬患有先天性心臟病、終末期腎病、乳腺癌、宮頸癌、耐多藥肺結核、兒童白血病等疾病的患者享受到重大疾病補償，實際補償水平約65%。2012年，肺癌、食道癌、胃癌等12種大病也被納入農村重大疾病保障試點范圍，費用報銷比例最高可達90%。實施城鄉居民大病保險，從城鎮居民醫保基金、新型農村合作醫療基金中劃出大病保險資金，采取向商業保險機構購買大病保險的方式，以力爭避免城鄉居民發生家庭災難性醫療支出為目標，實施大病保險補償政策，對基本醫療保障補償后需個人負擔的合規醫療費用給予保障，實際支付比例不低于50%，有效減輕個人醫療費用負擔。建立健全城鄉醫療救助制度，救助對象覆蓋城鄉低保對象、五保對象，并逐步擴大到低收入重病患者、重度殘疾人、低收入家庭老年人等特殊困難群體，2011年全國城鄉醫療救助8090萬人次。Thebasicmedicalcaresystemscoverbothurbanandruralresidents.By2011,morethan1.3billionpeoplehadjoinedthethreebasicmedicalinsuranceschemesthatcoverbothurbanandruralresidents,i.e.,thebasicmedicalinsuranceforworkingurbanresidents,thebasicmedicalinsurancefornon-workingurbanresidents,andthenewtypeofruralcooperativemedicalcare,withtheirtotalcoveragebeingextendedfrom87%in2008to95%in2011.ThissignaledthatChinahasbuilttheworld'slargestnetworkofbasicmedicalsecurity.Medicalcarefinancingandthereimbursableratioofmedicalcostshavebeenraised,andthegovernmentsubsidystandardsforthenewruralcooperativemedicalcaresystemwereincreasedfrom20yuanatthebeginningto200yuanperpersonperyearin2011,benefiting1.315person/timesin2011asagainst585person/timesin2008.Thereimbursementrateforhospitalizationexpensescoveredbyrelevantpolicieshasbeenraisedtoaround70%,andtherangeofreimbursableexpenseshasbeenexpandedtoincludeoutpatientexpenses.Real-timereimbursementhasbeenadoptedformedicalexpenses,makingitmoreconvenientforpeopletohavetheirmedicalcostssettled.Reformhasbeencarriedoutinrespectoftheformsofpaymenttoincludepaymentbyperson,paymentbydiseaseandtotalamountpre-payment,enablingmedicalinsurancetoplayabetterrestrictiveroleovermedicalinstitutionsaswellastocontrolexpensesandcompelthemedicalinstitutionstoimprovetheirefficiency.Criticalillnessinsurancehasbeenincludedinthenewtypeofruralcooperativemedicalcaresystem.By2011,some230,000patientsofcongenitalheartdisease,advancedrentaldiseases,breastcancer,cervicalcancer,multidrug-resistanttuberculosisandchildhoodleukemiahadbeengrantedsubsidiesformajorandseriousdiseases,withtheactualsubsidiesaccountingfor65%oftheirtotalexpenses.In2012,lungcancer,esophaguscancer,gastriccancerandeightothermajordiseaseswereincludedintheruralpilotprogramofinsuranceforthetreatmentofmajordiseases,andthereimbursementratereachedashighas90%.Criticalillnessinsurancehasbeenintroducedforbothurbanandruralresidents,inwhichcertainamountsofmoneyareearmarkedinthemedicalinsurancefundfornon-workingurbanresidentsandthatofthenewtypeofruralcooperativemedicalcaretobuycriticalillnessinsurancepoliciesfromcommercialinsurancecompanies,aimingtorelieveurbanandruralfamiliesoftheheavyburdenofcatastrophicmedicalspending.Thepolicyofsubsidyforcriticalillnessinsurance,whichcoversnolessthan50%oftheactualmedicalcosts,providesaguaranteeforthecompliancecoststobeshoulderedbytheindividualafterreimbursementfromthebasicmedicalinsurance.Thishaseffectivelyreducedthefinancialburdenofindividuals.Anurban-ruralmedicalassistancesystemhasbeenestablishedandimproved,whichatfirstcoveredurbanandruralsubsistenceallowancerecipientsandchildlessandinfirmruralresidentswhoreceivetheso-called"fiveguarantees,"andisnowextendedtocoverthosewhoareseverelyillandhavelowcomes,theseverelydisabled,seniorcitizensfromlow-incomefamilies,andsomeothergroupswithspecialdifficulties.In2011,theurban-ruralmedicalassistancewasgrantedto80.90millioncasesacrossthecountry.——基本藥物制度從無到有。初步形成了基本藥物遴選、生產供應、使用和醫療保險報銷的體系。2011年，基本藥物制度實現基層全覆蓋，所有政府辦基層醫療衛生機構全部配備使用基本藥物，并實行零差率銷售，取消了以藥補醫機制。制定國家基本藥物臨床應用指南和處方集，規范基層用藥行為，促進合理用藥。建立基本藥物采購新機制，基本藥物實行以省為單位集中采購，基層醫療衛生機構基本藥物銷售價格比改革前平均下降了30%?；舅幬锶考{入基本醫療保障藥品報銷目錄。有序推進基本藥物制度向村衛生室和非政府辦基層醫療衛生機構延伸。藥品生產流通領域改革步伐加快，藥品供應保障水平進一步提高。Abasicsystemofdrugshasbeendevelopedfromscratch.Asystemfortheselection,production,supplyanduseofbasicdrugs,andcoveroftheminmedicalinsurancehasbeenputintoplace.In2011,thecoverageofthissystemwasextendedtoallgrass-rootsmedicalandhealth-careinstitutionsrunbythegovernment,wherethesedrugsweresoldatzeroprofit,practicallyeliminatingthepracticeofhospitalssubsidizingtheirmedicalserviceswithdrugsales.Anationalguidelinefortheclinicalapplicationofbasicdrugsandaformularyhavebeendrawnuptoensurethatbasicdrugsareusedaccordingtodueproceduresatgrass-rootsmedicalinstitutions.Anewmechanismhasbeenestablishedfortheprocurementofbasicdrugs,underwhichthebasicdrugsaretobepurchasedbyprovinces.Asaresult,thepricesofbasicdrugsatgrass-rootsmedicalandhealthcareinstitutionshavedroppedby30%onaverage,ascomparedwiththosebeforethereform.Thebasicdrugshaveallbeenincludedinthelistofreimbursabledrugscoveredbybasicmedicalinsurance.Also,effortshavebeenmadetosupplybasicdrugsinanorderlywaytovillageclinicsandnon-governmentalmedicalinstitutionsatthegrass-rootslevel.Thestepsofreformhavebeenquickenedindrugproductionandcirculation,andthesupplyofdrugshasbeenbetterensured.——城鄉基層醫療衛生服務體系進一步健全。加大政府投入，完善基層醫療衛生機構經費保障機制，2009—2011年，中央財政投資471.5億元人民幣支持基層醫療機構建設發展。采取多種形式加強基層衛生人才隊伍建設，制定優惠政策，為農村和社區培養、培訓、引進衛生人才。建立全科醫生制度，開展全科醫生規范化培養，安排基層醫療衛生機構人員參加全科醫生轉崗培訓，組織實施中西部地區農村訂單定向醫學生免費培養等。實施萬名醫師支援農村衛生工程，2009—2011年，1100余家城市三級醫院支援了955個縣級醫院，中西部地區城市二級以上醫療衛生機構每年支援3600多所鄉鎮衛生院，提高了縣級醫院和鄉鎮衛生院醫療技術水平和管理能力。轉變基層醫療服務模式，在鄉鎮衛生院開展巡回醫療服務，在市轄區推行社區全科醫生團隊、家庭簽約醫生制度，實行防治結合，保障居民看病就醫的基本需求，使常見病、多發病等絕大多數疾病的診療在基層可以得到解決。經過努力，基層醫療衛生服務體系不斷強化，農村和偏遠地區醫療服務設施落后、服務能力薄弱的狀況明顯改變，基層衛生人才隊伍的數量、學歷、知識結構出現向好趨勢。2011年，全國基層醫療衛生機構達到91.8萬個，包括社區衛生服務機構2.6萬個、鄉鎮衛生院3.8萬所、村衛生室66.3萬個，床位123.4萬張。Urbanandruralgrass-rootslevelmedicalandhealthserviceshavebeenfurtherimproved.Thegovernmenthasinvestedmoretoensurethefundingforgrass-rootsmedicalandhealthcareinstitutions.From2009to2011,thecentralgovernmentinvested47.15billionyuantosupportthebuildinganddevelopmentofgrass-rootslevelmedicalinstitutions.Diverseformshavebeenadoptedtostrengthentheranksofhealthcareworkersatthegrass-rootslevel,andpreferentialpolicieshavebeenmadetotrainandintroducecompetentpersonnelforruralandcommunityhealthcare.Asystemofgeneralpractitioners(medicalworkerswithsufficientknowledgeinallbranchesofmedicine)hasbeenestablished,underwhichgeneralpractitionersaretrainedintheregularway;grass-rootsmedicalandhealthcareworkersareenrolledintrainingcoursesforupgradingthemtogeneralpractitioners;andmedicalstudentsarespeciallytrainedfortheneedsofcentralandwesternurbanareas,forwhichtheydonothavetopaytheirtuitionfees.Aproject,knownas"tenthousanddoctorsextendingsupporttoruralmedicalcare,"hasbeenlaunched.From2009to2011,over1,100Grade-IIIurbanhospitalsextendedsupportto955ruralcounty-levelhospitalseveryyear,andurbanmedicalinstitutionsaboveGradeIIincentralandwesternChinagrantedaidtoover3,600townshiphospitalseveryyear,thushelpingimprovetheoveralltechnologicallevelandmanagementofthecountyandtownshiphospitals.Meanwhile,themodeofmedicalserviceshasbeenchanged.Touringmedicalserviceshavebeenprovidedintownshiphospitals;andintheurbandistrictsranksofgeneralpractitionershavebeenformedandasystemoffamilydoctorshasbeensetup.Preventionhasbeencombinedwiththetreatment,measureshavebeentakentoensurebasicneedsoftheresidentstoseedoctorsandmakeitpossiblethatthediagnosisandtreatmentofmostcommonlyseenandfrequentlyoccurringdiseasesareperformedatthecommunitylevel.Afteryearsofeffort,community-levelmedicalandhealthcaresystemhasbeenstrengthened;markedchangeshavetakenplacetothesituationofbackwardfacilitiesandpoorservicesinruralandremoteareas;community-levelmedicalworkershaveincreasedinnumber,andtheireducationalbackgroundandknowledgehaveimproved.In2011,thenumberofgrass-rootsmedicalandhealthcareinstitutionsacrossthecountryreached918,000,including26,000urbancommunityservicecenters,38,000townshiphospitalsand663,000villageclinics,andthenumberofhospitalbedsreached1,234,000.——基本公共衛生服務均等化水平明顯提高。國家免費向全體居民提供國家基本公共衛生服務包，包括建立居民健康檔案、健康教育、預防接種、0—6歲兒童健康管理、孕產婦健康管理、老年人健康管理、高血壓和II型糖尿病患者健康管理、重性精神疾病患者管理、傳染病及突發公共衛生事件報告和處理、衛生監督協管等10類41項服務。針對特殊疾病、重點人群和特殊地區，國家實施重大公共衛生服務項目，對農村孕產婦住院分娩補助、15歲以下人群補種乙肝疫苗、消除燃煤型氟中毒危害、農村婦女孕前和孕早期補服葉酸、無害化衛生廁所建設、貧困白內障患者復明、農村適齡婦女宮頸癌和乳腺癌檢查、預防艾滋病母嬰傳播等，由政府組織進行直接干預。2011年，國家免疫規劃疫苗接種率總體達到90%以上，全國住院分娩率達到98.7%，其中農村住院分娩率達到98.1%，農村孕產婦死亡率呈逐步下降趨勢。農村自來水普及率和衛生廁所普及率分別達到72.1%和69.2%。2009年啟動“百萬貧困白內障患者復明工程”，截至2011年，由政府提供補助為109萬多名貧困白內障患者實施了復明手術。Accesstobasicpublichealthserviceshasbecomemoreequitable.Thestateprovidesallresidentswithafreepackageof41basicpublichealthservicesintencategories,includinghealthrecord,healtheducation,preventiveinoculation,healthcareforchildrenundersix,healthcareforpregnantandlying-inwomen,healthcareforelderlypeople,treatmentforhypertensionandtypeIIdiabetespatients,healthcareforseverepsychosispatients,reportingandhandlingofinfectiousdiseasesandpublichealthemergencies,andhealthcaresupervisionandcoordination.Targetingspecialdiseases,keygroupsandspecialareas,thestatehaslaunchedkeypublichealthserviceprograms,includingsubsidizingruralpregnantwomenforhospitalizedchildbirth,re-vaccinatingpeopleunder15againsthepatitisB,eliminatingfluorosiscausedbycoalburning,supplementarytakingoffolicacidbyruralwomenbeforepregnancyandintheearlystageofpregnancy,buildingsanitarytoilets,cataractremovalforpoorpatients,cervicalandbreastcancertestsforruralwomenwithineligibleage,andpreventingmother-to-childtransmissionofAIDS.In2011,theinoculationrateoftheNationalImmunizationProgram(NIP)exceeded90%;therateofhospitalizedchildbirthnationwidereached98.7%(98.1%inruralareas);andthematernitymortalityrateinruralareaskeptgoingdown.Intheruralareas,72.1%ofthepopulationhadaccesstotapwaterand69.2%hadaccesstosanitarytoilets.In2009,thegovernmentlaunchedaprogramtoprovidecataractoperationsforamillionpoorpatients,andby2011morethan1.09millionsuchpeoplehadhadsuchoperationswithgovernmentsubsidies.

——公立醫院改革有序推進。從2010年起，在17個國家聯系試點城市和37個省級試點地區開展公立醫院改革試點，在完善服務體系、創新體制機制、加強內部管理、加快形成多元化辦醫格局等方面取得積極進展。2012年，全面啟動縣級公立醫院綜合改革試點工作，以縣級醫院為龍頭，帶動農村醫療衛生服務體系能力提升，力爭使縣域內就診率提高到90%左右，目前已有18個省(自治區、直轄市)的600多個縣參與試點。完善醫療服務體系，優化資源配置，加強薄弱區域和薄弱領域能力建設。區域醫學中心臨床重點專科和縣級醫院服務能力提升，公立醫院與基層醫療衛生機構之間的分工協作機制正在探索形成。多元化辦醫格局加快推進，鼓勵和引導社會資本舉辦營利性和非營利醫療機構。截至2011年，全國社會資本共舉辦醫療機構16.5萬個，其中民營醫院8437個，占全國醫院總數的38%。在全國普遍推行預約診療、分時段就診、優質護理等便民惠民措施。醫藥費用過快上漲的勢頭得到控制，按可比價格計算，在過去三年間，公立醫院門診次均醫藥費用和住院人均醫藥費用增長率逐年下降，2011年比2009年均下降了8個百分點，公立醫院費用控制初見成效。Thereformofpublichospitalshasbeencarriedoninanorderlyway.In2010,theChinesegovernmentstartedpilotreformsofpublichospitalsin17state-designatedcitiesand37province-leveldistricts;andpositiveprogresshasbeenwitnessedinimprovingservices,innovatinginstitutionsandmechanisms,strengtheninginternalmanagementandspeedingupthecreationofasituationinwhichhospitalsareestablishedandrunindiversifiedforms.In2012,thegovernmentlaunchedapilotcomprehensivereformofcounty-levelpublichospitals,aimingtoimproveruralsystemofmedicalserviceswiththecountyhospitalsplayingtheleadingrole,andenabling90%ofthepopulationinacountytoseedoctors.Sofar,over600countiesin18provinces,autonomousregionsandmunicipalitiesdirectlyunderthecentralgovernmenthavebeenincludedinthisreform.Thegovernmenthasworkedhardtoimprovemedicalservices,optimizetheallocationofmedicalresources,andenhancethemedicalcapabilitiesofweakareasandweakfields.Thecapabilitiesofkeyclinicalspecialtiesinregionalmedicalcentersandcounty-levelhospitalstodelivermedicalserviceshavebeenenhanced,andthemechanismofdivisionofresponsibilitiesandcooperationbetweenpublichospitalsandcommunity-levelmedicalinstitutionsisbeingstudiedandformed.Thegovernmenthasintensifiedeffortsinthecreationofasituationofestablishingandrunninghospitalsindiversifiedforms,encouragingandguidingnon-governmentalfundstoestablishbothfor-profitandnon-profitmedicalinstitutions.By2011,therewere165,000medicalinstitutionsestablishedwithnon-governmentalinvestment,including8,437privatehospitals,accountingfor38%ofthenationaltotal.Doctor-appointmentservice,time-phasedoutpatientserviceandhigh-qualitynursingservicethatbringbenefitsandconveniencetothepeoplehavebeenintroducednationwide.Thefastpricegrowthofmedicinehasbeencontained.Incomparableprices,thegrowthratesofaverageoutpatientandinpatientcostsinpublichospitalshasdecreasedyearbyyearinthepastthreeyears,andthatof2011wentdownbyeightpercentagepointsfromthatof2009,reapingini