National Health and Family Planning Commission, P.R.C 2014-01-09

No. 54 document in 2013 promulgated by Department of Health System Restructuring, NHFPC, P.R.C

Health and family planning commissions (health departments) in provinces, autonomous regions, municipalities directly under the central government; the State Administration of Traditional Chinese Medicine; and Xinjiang Production and Construction Corps:

Speeding up non-public investment in health development is integral to deepening medical and health system reform and promoting health services development. It is an important measure to shift the health development pattern and optimize health resources allocation. It is an important way to increase health resources supply and meet the people’s demand for diversified and multi-level medical and health services. To further implement the spirit of the Third Plenary Session of the 18th CPC Central Committee and the State Council’s Opinions on Promoting Health Services Development (No. 40, 2013), and solve prominent problems and difficulties in speeding up the non-public investment in health development, we put forward the following opinions.

1. Overall requirements

Health and family planning and traditional Chinese medicine administrative departments at all levels should transform their functions, fulfill their responsibilities, strengthen guidance and incorporate non-public investment in health development into the overall regional health plan. Priority should be given to non-public investment in health sectorprivate investment to form a non-public medical system where non-profit medical institutions play a leading role, and for-profit medical institutions play a supporting role. The departments should continue to improve non-public medical management and quality, guide non-public medical institutions towards large-scale and multi-level development, and realize mutually supportive and common development of public and non-public medical institutions.

2. Strengthen planning and guidance

a. Formulate and implement health plan

The national level government shall improve the health resources planning guidance document, compile the National Health Service System Plan (2015-2020), clarify health service system functions, classification configuration requirements and resources allocation guidelines, strengthen function integration and collaboration among regional institutes; and improve supporting measures and the supervision and evaluation mechanism for plan implementation. The provincial governments should formulate the health resource allocation standard based on the national plan and local conditions. Provincial and municipal governments shall formulate and implement the regional health and medical institutions configuration plans, and continue to improve comprehensive medical and health service abilities and resource efficiency.

b. Incorporate non-public investment in health development into overall planning Departments should set aside room for non-public medical institutions in regional health and medical institution plans, and give priority to the needs of non-profit medical institutions. Any financing channels for new health resources should be submitted for approval based on planned requirements and standards.

c. Optimize health resources allocation

Departments should strictly control public hospital development scale based on total quantity control, structural adjustment and appropriate scale, and set aside enough space for non-public investment in health development. When meeting basic public medical needs, they should support and choose reputable private investment with strong management and service abilities in areas abounding in public hospital resources. They should participate in reform and regrouping of some public hospitals (including hospitals run by State-owned enterprises) through various forms. Departments should clarify and standardize reform methods, procedures and conditions, fully listen to employees’ opinions to ensure their legitimate rights and interests, and avoid state-owned assets loss.

3. Step up support for non-public investment in health development

a. Departments should establish an open, transparent, equal and standardized non-public medical access system. They should relax the scope of sole proprietorship hospitals set up by foreign capital in the Chinese mainland, and extend sole proprietorship hospitals set up by Hong Kong, Macao and Taiwan service providers in the mainland to cities at the prefecture level and above, following the principle of gradual liberalization and risk control. Other qualified foreign capital can set up sole proprietorship hospitals at the China (Shanghai) Pilot Free-Trade Zone and other special zones. They should properly set up foreign capital ratio requirements in sino-foreign equity joint venture and cooperative medical institutions, and devolve review and approval authority on the provincial level.

b. Broaden service requirements

Any field that is not specifically banned by laws and regulations should open to private investment non-public capital. Private investment should be encouraged to go directly into scarce resources and meet multi-element service requirements, establish rehabilitation and geriatrics hospitals, nursing homes, hospice care hospitals, large-scale medical institutions or hospital conglomerates. Departments should encourage private sector to develop traditional Chinese medicine institutions or specialized hospitals, encourage pharmaceutical trading enterprises to hold on-site traditional Chinese medicine clinics, and encourage qualified professional traditional Chinese medicine personnel, especially old famous traditional Chinese medicine doctors, to open clinics.

c. Bulk out large medical equipment configuration

All regions should make a scientific plan of large medical equipment configuration, strictly control public medical institutions configuration, give full consideration to the needs of non-public medical institutions development, and follow the principal of equipment configuration of no less than 20 percent in non-public medical institutions. The regions should focus on qualification and technical strength and take into account the number of beds and patients when dealing with a non-public medical institutions’s application for equipment, based on the principle of meeting their reasonable demand and safeguarding medical quality and safety. The newly-established non-public medical institutions can go through configuration review on planned departments and personnel. If they meet standards, they can purchase equipment first and then officially make configuration plans after expert review and all professional personnel are in place. They should actively guide and support medical institutions, and build a large medical equipment inspection center in accordance with the relevant provisions of the State. They should form joint development, use, and management and sharing mechanisms to boost reasonable resources utilization. They should also push for medical institution inspection above the second class to open to all medical institutions.

d. Improve support policy

In accordance with relevant laws, regulations and policies and under the unified leadership of the local government, health and family planning and traditional Chinese medicine administrative departments at all levels should strengthen coordination and communication with related departments to allow medical insurance cover the non-public medical institutions, improve planning and land use, optimize investment and financing guidance policy, improve finance and tax price policy, and adopt market-adjusted price for non-public medical institutions services. They should also let non-public medical institutions play a role in basic public health and medical services and establish and improve the government purchasing social services mechanism.

e. Speed up approval process

All regions should speed up the implementation of equal policies for both public and non-public medical institutions in examination and approval, operation and development. No discriminatory restrictions outside the laws and regulations are allowed. They should speed up and streamline the approval process for qualified non-public medical institutions to raise efficiency.

4. Help non-public medical institutions raise service abilities

a. Support major specialty construction Health and family planning and traditional Chinese medicine administrative departments at all levels shall strengthen specialized clinical abilities of non-public medical institutions, and take non-public medical institutions into overall planning of major specialized clinical strength building. Non-public medical institutions should receive equal treatment in fund allocation when undertaking major national and provincial specialized projects.

b. Support talent introduction and training

Departments should incorporate the need of non-public medical institutions for professional talents into the local talent introduction overall plan, and give non-public medical institutions equally favorable policies in talent introduction. They should treat non-public medical institutions on an equal footing in high-level talent introduction, continued medical education, general practitioner, resident doctor standardization and new technology skills trainings. They should encourage non-public medical institutions to extract education training funds.

c. Allow doctors to have multi-sited license

Departments should formulate standard guidance on multi-sited practice and clarify conditions, registration, practice and responsibilities of multi-sited practice for doctors. Health and family planning administrative departments should promptly take care of qualified doctor’s needs and allow them to work among medical institutions in an orderly fashion. They should explore the linking mechanism between public and non-public medical institutions in seniority calculation, public institution insurance and personnel employment. They should create favorable conditions for famous old traditional Chinese medicine doctors to conduct multi-sited practice.

d. Help raise academic status

Departments should coordinate and support non-profit hospitals that have good management ability and professional and technical skills to be teaching facilities for medical colleges and universities. They should encourage large public medical institutions to support non-public medical institutions. Medical associations, academic organizations and medical institution review committees at various levels should take in non-public medical institutions personnel on equal terms and expand their proportion. They should safeguard opportunities for non-public medical institutions to play a role in industry associations that match their academic and professional strength.

e. Support informatization construction Departments should support non-public medical institutions in speeding up connectivity with medical security and public medical institutions information systems. Health and family planning and traditional Chinese medicine administrative departments should release various health resource allocation plans as well as industrial policy and market demand information. They should smooth the way for non-public medical institutions to acquire relevant policy information, and ensure public and non-public medical institutions have equal rights and interests in accessing policy and information.

5. Strengthen non-public medical institutions supervision

a. Ensure medical service quality

Non-public medical institutions should be brought into the unified medical quality control and evaluation system and receive equal treatment in medical technology and clinical application admittance management. Health and family planning and traditional Chinese medicine administrative departments should earnestly fulfill their responsibilities in supervising and standardizing non-public medical institution’s services to raise service quality. They should conduct innovations to step up supervision of non-public medical institutions. At the same time, industrial associations and social organizations should play a role in supervising non-public medical institution service quality and fees, as well as operations. They should build a unified three-dimensional regulatory system to ensure medical quality and safety. They should crack down on all kinds of violations and set up a “blacklist” system.

b. Effectively protect medical law and order

Departments should bring non-public medical institutions into the medical dispute prevention and treatment management system. When a major medical dispute happens in a non-public medical institutions, local health and family planning and traditional Chinese medicine administrative departments should work with the public security department to actively guide and support disposal work to safeguard the legitimate rights and interests of both doctors and patients and maintain diagnosis and treatment order. They should encourage non-public medical institutions to participate in medical liability and accident insurance.

c. Promote industrial self-regulation and medical ethics construction

Departments should support and encourage relevant associations and societies to offer industrial guidance to non-public medical institutions, strengthen self-discipline, and maintain the legitimate rights and interests of non-public medical institutions. They should support non-public medical institutions in establishing the independent industrial association. They should guide non-public medical institutions to enhance their awareness of social responsibilities. They should urge them to put patients first, strengthen medical ethics construction, carry forward the spirit to heal the wounded and save the dying, and strive to build a harmonious doctor-patient relationship.

National Health and Family Planning Commission

State Administration of Traditional Chinese Medicine

Dec 30, 2013