DECISION OF THE CENTRAL COMMITTEE OF THE COMMUNIST PARTY OF CHINA AND THE STATE COUNCIL CONCERNING PUBLIC HEALTH REFORM AND DEVELOPMENT

(January 15, 1997)

    That everyone enjoys health care and the continuous improvement in the
quality of health of the whole nation constitute an important objective of socialist modernization, an important hallmark of the improvement
in the
quality of people’s life, an important content of socialist spiritual
civilization and an important guarantee of sustainable socio-economic
development. The whole party and the whole society should pay great attention
to the cause of public health, protect and promote people’s health.

    Since the founding of the People’s Republic of China, and especially since
the implementation of the policy of reform and opening up, great advancements
have been made in the cause of public health in our country and achievements
scored which have attracted worldwide attention. Public health ranks on a
considerable scale has been formed, public health service system has basically
taken shape and scientific and technical standards of public health have
witnessed rapid improvement. There has been marked improvement in the
production and supply of medicine and the cause of traditional Chinese
medicine and pharmacology has been inherited and expanded. Public health
reform has achieved results and has been gradually deepening and legislation
continuously stepped up. With the in-depth unfolding of the patriotic public
health movement, some diseases which seriously endanger people’s health are
under control or have been basically eradicated. The standards of people’s
health have been markedly raised with average life expectancy raised to 70
years from 35 years before the founding of the People’s Republic and infant
mortality reduced to 31.4%. from 200%.. In the past four decades or more,
public health work has played an important role in promoting the development
of socialist modernization of our country and the broad masses of public
health workers have made major contributions in the protection and promotion
of people’s health. Meanwhile, it should be noted that the growth of the
cause of public health at present cannot yet keep up with the requirement
of economic construction and social progress, regional imbalances exist in
the development of public health work, there are weak links in rural public
health, prevention and health care, imperfection in medicare system,
inadequacy in public health input, irrational resources allocation, excessive
rise in medical cost, there are still inadequacies in public health service
quality and attitude as desired by the people and public health work fail to
win sufficient attention of the whole society. Party committes and governments
at all levels should further step up their leadership over public health work
and public health reform needs urgent deepening.

    In the next 15 years, public health work is entrusted with heavy tasks.
With the development of the economy, scientific and technological advancement
and improvement in the living standards of the people, they will have more
and higher requirements in respect of improved health services and quality
of life. With acceleration of the process of industrialization, urbanization
and aging of the population, health problems connected with ecological
environment and lifestyles will increasingly aggravate and rate of chronic
non-infectious diseases will increase. A number of infectious diseases and
endemic diseases still endanger people’s health and some new infectious
diseases pose a great threat to people’s health. All this calls for a big
development and improvement of the cause of public health in our country.

    The period from the present to 2010 is an important one during which the
past shall be inherited and the future ushered in, and the cause of the older
generation carried forward and new ground broken in the building of socialism
with Chinese characteristics. To put into practice the spirit of the Fifth and
Sixth Plenary Sessions of the Fourteenth Central Committee of the Communist
Party of China and carry out the public health tasks put forth in the Five-Year Plan of National Socio-economic Development and Programme of Perpective Objectives in 2010 of the People’s Republic of
China> and ensure
the smooth realization of the splendid trans-century objectives, the Central
Committee of the Communist Party of China and the State Council hereby make
the following decision.

    I.THE OBJECTIVES TO BE STRIVEN FOR AND GUIDING THOUGHT IN PUBLIC HEALTH
WORK

    (1)The objectives to be striven for in public health work are as follows:
with Marxism-Leninism, Mao Zedong Thought and Deng Xiaoping’s theory of building socialism with Chinese characteristics as guidance,
adhering to the
Party’s basic line and policy and continuously deepening public health reform,
by the year 2000, a preliminary public health system including health services,
medicare security and public health law enforcement and supervision with
Chinese characteristics shall be established, with basic realization of primary health care enjoyed by everyone and further improvement
in health
standards of its nationals. By 2010, a complete public health system catering
for the requirements of the systen of socialist market economy and people’s
health shall be established throughout the country, with main national health
targets in economically developed regions reaching or being close to average
standards of medium developed countries in the world and the less developed
regions reaching the advanced standards of developing countries.

    (2)The policy of public health work in the new period is as follows:put
the stress on the rural areas, put prevention first, pay equal attention to
Western medicine and traditional Chinese medicine, rely on science and
technology and education, mobilize the whole society to participate, render
service for people’s health and socialist modernization.

    (3)Public health work in our country is a non-profit social undertaking
while the government pursues a certain welfare policy. The development of public health work must be in coordination with national
socio-economic
development, and the welfare level of security of people’s health must
correspond with the level of economic development. The government bears
important responsibilities in the development of public health work.
Governments at all levels should make efforts to increase public health input
and mobilize various circles of the society in an extensive way to raise
funds for the development of the cause of public health. Citizens themselves
should also, step by step, increase their own input for medicare. By the end
of the century, efforts will be made that total public health expenditure of
the whole society shall be approximately 5% of gross domestic product.

    (4)Public health reform and development shall abide by the following basic
principles:

    Adhere to the aims and purposes of serving the people, correctly handle
the relations between social benefit and economic performance and put social
benefit first. The tendency of seeking lopsided economic benefit to the
neglect of social benefit should be prevented.

    Center round the improvement in the standards of people’s health, give
priority to the development and guarantee of basic health service, embody
social fairness and satisfy step by step the diversified requirements of the
masses of people.

    Proceed from the state of the nation in the development of the cause of public health, allocate resources
rationally and put the stress on the
improvement in quality and efficiency. Put the stress on the strengthening
of public health in the rural areas, prevention and health care and
traditional Chinese medicine and pharmacology. Narrow the gap between regions
by giving guidance to different types of areas suiting local conditions.

    Medical institutions run by the state and collectives shall constitute the
main body while those run by other social institutions and individuals serve
as a supplement.

    Expand opening up to the outside world, promote international exchange and
cooperation in the field of public health and actively make use of and draw on
advanced foreign science and technology and expertise in management.

    Adhere to the principle of grasping the two links of socialist material
civilization and spiritual civilization and both should be tough. Strengthen
the building of professional ethics in health service and raise continuously
the ideological and moral quality and professional and technical levels of public health workers.

    II.ACTIVELY PROMOTE PUBLIC HEALTH REFORM

    (5)The aim of public health reform is to reinvigorate the cause of public
health, fully mobilize the enthusiasm of public health institutions and public
health workers, continuously improve the quality and efficiency of health
service and serve the cause of people’s health and socialist modernization
in a better way. Adapt to the development of socialist market economy, abide
by the inherent rules of the development of public health and establish step
by step the new mechanism of strong macro regulation and control and vigorous
micro operation.

    (6)Reform the medicare system for urban workers and staff members.
Establish the medical insurance system based on the combination of unifiedly
raised social medical funds and individual accounts, expand step by step its
coverage and provide basic medicare for all urban workers. The level of medicare should correspond with the level of development
of social
productivity and the tolerance of the different sectors of society. The
insurance cost shall be rationally borne by the state, the employer unit and
the worker or staff member. Social medical insurance for workers and staff
members shall practise dependency administration. Strengthen in real earnest
administration and supervision of medical insurance fund. Establish the
mechanism of checks on medical institutions and patients, actively explore
scientific and rational mode of payment and effectively control the irrational
growth of medical cost.

    Medical institutions and medical personnel who play an important role in
doing a good job of medicare system reform for workers and staff members
should actively participate in the reform, treat patients according to their
ailments, conduct rational examinations, prescribe medicine rationally so as
to curb waste. Meanwhile, the government should, in real earnest, solve the
problem of compensation for medical institutions.

    During the “Nineth Five-Year Plan” period, social medical insurance system
for urban workers and staff members shall basically be set up on the basis of successful experiments and summing up experiences,
and actively develop
supplementary medical insurance in diverse forms.

    (7)Reform public health management system. Departments of public health
administration at all levels shall transform their functions and stengthen
public health administration by applying laws and regulations, policies, plans
and guidances, information services and economic means.

    Rationally allocate and fully exploit existing public health resources to
raise the rate of exploitation of public health resources. Regional public
health planning is an important means of the government in the macro
regulation and control of the development of the cause of public health. Its
goal is to satisfy the requirements of all residents in a region in basic
health service and it practises unified planning and rational allocation of
such public health resources as the medical institutions, hospital beds,
personnel, equipment and funds.

    Municipal(prefectural) governments shall, in accordance with the guiding
principles and standards for public health resources allocation for regional
public health planning formulated by the Central People’s Government and the
provincial people’s governments, work out regional public health plans of the
localities and organize their implementation. Departments of public health
administration shall, in accordance with the regional public health plans,
conduct policy guidance, organize coordination and carry out supervision and
inspection with regard to the development of public health in their respective
regions; adjustments should be made step by step with regard to existing
public health resources, and new additions to public health resources shall be
subjected to strict examination and approval and management.

    Public health institutions of enterprises which are an important component
part of public health resources, should actively explore and realize step by
step socialization of public health institutions of enterprises in the light
of the actual conditions in the process of deepening enterprise reform.

    (8)Reform urban health service system, actively develop community health
service and form step by step health service networks with rational functions
and convenient for the masses. Grass-roots level public health institutions
should target at the communities and families, carry out prevention of diseases, diagnosis and treatment of commonly encounted diseases
and
frequently encounted diseases, recovery of the injured and disabled, health
education, planned parenthood technical service and health care for women,
children, the elderly and the disabled. Community medical service should be
integrated into medical insurance for workers and staff members and two-way
diagnosis transfer system established. Medical personnel should be diverted
in a planned way and medical personnel in society organized in setting up
health service networks in residential areas which should be integrated into
the community health service system.

    Major urban hospitals shall mainly engage in the diagnosis and treatment
of emergent and serious cases and suspected and difficult cases, carry out
medical education and scientific research in combination with clinical
practice, continuously raise the level of medical science and technology.
They should also develop suitable techniques, provide guidance and training
for grass-roots medical personnel.

    Social groups and individuals shall practise self-operations in running
medical institutions and be responsible for profits and losses. The government
shall actively provide guidance and examine and approve such institutions
according to law and carry out strict supervision and administration.

    (9)Reform the operational mechanism of public health institutions. Public
health institutions should establish an operational mechanism which is
responsible and with incentives, restraints, competition and vitality by
way of reform and strict management.

    Public health institutions shall practise and perfect the responsibility
system of the president of the hospital(director of the institute or station).
The independent operational and managerial powers of public health
institutions shall be further enlarged. Continue to deepen the reform of the
personnel system and distribution system, break egalitarianism by employing
correct policy guidance, ideological education and economic means to mobilize
the enthusiasm of the broad masses of public health workers.

    Accelerate formulation of standards for the establishment of public health
institutions and authorized size of personnel, standardize financial input for
public health institutions, reform and perfect the price system of health
service. Adjust the revenue structure of medical institutions, reduce the
proportion of income accrued from medicine in the revenue of medical
institutions, rationally control the range of growth of medical expenses and
there shall be separate accounting and separate management of medical revenue
and expenditure and medicinal revenue and expenditure.

    Under the prerequisite of guaranteed completion of basic health service,
medical institutions may engage in services related to their domain of profession, institutions of preventive health care may engage
in suitable
compensatory service to meet the social requirements of different tiers, and
in the meantime, supervision and administration should be reinforced.

    III.STRENGTHEN PUBLIC HEALTH WORK IN THE RURAL AREAS FOR THE REALIZATION
OF THE GOALS OF PRIMARY PUBLIC HEALTH AND HEALTH CARE PLAN

    (10)Public health in the rural areas concerns the overall interests of the
health of peasants and invigoration of rural economy to which Party committees
and governments at all levels should pay close attention and take strong
measures to strengthen it in good earnest.

    Primary public health and health care plan has put forth the main tasks
and goals for rural public health work in different regions by the year 2000.
Implementation of the primary public health and health care plan is the key
in doing a good job of rural public health work. Governments at all levels
should integrate this work into the plan for national economic and social
development and practise management by objectives to create necessary
conditions for the building of well-to-do counties, xiangs(?) and villages.

    (11)Actively, steadily and satisfactorily develop and perfect cooperative
medical service. Cooperative medical service plays an important role in
ensuring that peasants enjoy basic medical service, implementation of preventive health care tasks, and prevention of impoverishment
caused by
diseases. Establishment of cooperative medical service should abide by the
principle of being run by local people with some state subsidies and
voluntary participation. Individual input shall be the main source in fund-
raising with collective support and appropriate government support, raise
peasants’ awareness of self-health care and mutual assistance and mutual
support and mobilize peasants to actively participate through propagation
and education. The mode of cooperation, standards for fund-raising and
percentage of reimbursement shall be determined in the light of local
conditions and insurance level raised step by step. Preventive health care
compensatory system should continue as a form of cooperation. Scientific
management and democratic supervision of cooperative medical service shall
be enhanced to ensure that peasants reap actual benefits. Efforts should be
made to establish cooperative medical service in various forms in most rural
areas by the year 2000 and the extent of socialization increased step by step;
where conditions are ripe, transition to social medical insurance can be
effected step by step.

    (12)Step up the building of rural public health organization and perfect
the county-, xiang- and village-level health service networks. The scale and
distribution of public health institutions shall be determined rationally and
their structure and functions adjusted. County-level hospitals should be
managed well in real earnest to upgrade their integrated services capabilities.
Continue to step up the building of county-level epidemic prevention organs,
maternal and infant health care institutions and rural and township health
centers. Strive to realize in the main the goal of “one without and three
matchings”, i.e., without condemned houses and with matching houses, staff
and equipment during the “Nineth Five-Year Plan” period. Rural and township
health centers should do well preventive health care, make efforts to upgrade
medical quality, and put the stress on strengthening the building of emergency
and maternity wards. Village-level public health institutions shall mainly be
run by collectives. Modes of operation and management of xiang and village
public health institutions may be determined in the light of actual local
conditions. Perfect channels of rural medical supplies to ensure safety and
effectiveness of medicine.

    (13)Consolidate and upgrade the ranks of rural basic health workers.
Rationally solve the salary problem of rural health workers, the income of rural doctors in collectively-run village public health
institutions shall
be no lower than the level of income of local village cadres. 80% of rural
doctors shall reach the level of vocational high school by the year 2000
through various forms of training. Non public health technical personnel are
strictly forbidden to take up technical positions in public health.

    Medical and public health colleges and schools should do well direction-
oriented admission of students and on-job training and train for the rural
areas public health technical personnel who are prepared to stay on in the
localities and apply the knowledge acquired. Preferential policies shall
be formulated to encourage intermediate college graduates and above to
work in county and xiang public health institutions.

    (14)Establish the system of urban public health institutions rendering
support to their counterpart units in the rural areas and help rural public
health institutions raise their capabilities in services in the form of personnel training, technical guidance, mobile medical service
and equipment
support. Urban public health technical personnel must work for a period of six months and one year respectively in county or xiang
public health
institutions before their promotion to the positions of visiting physician
and assistant visiting physician.                              

    (15)Great importance should be attached to public health work in poverty-
stricken areas and minority nationalities regions which should be done well.
Governments at all levels should incorporate assistance in public health to
poor areas into local plans of assistance to poor areas, arrange necessary
funds to assist poor areas, and help these areas mainly in building
infrastructure in public health, improving conditions for drinking water
and prevention of endemic diseases and infectious diseases. Support for
the development of public health work in those regions shall be important
contents of financial transfer payment. Developed regions shall be encouraged
to render assistance to their counterpart units in public health work in
poverty-stricken areas and minority nationalities regions.

    IV.DO A GOOD JOB OF PREVENTIVE HEALTH CARE IN REAL EARNEST, CONDUCT
IN-DEPTH PATRIOTIC HEALTH MOVEMENT

    (16)Governments at all levels shall be fully responsible for public health
and preventive health care, step up the building of preventive health care
institutions by providing necessary input and ensuring the required funds
for the prevention and control of major diseases. Preventive health care
institutions should do a good job of preventive health care of social groups.
Medical institutions should also actively engage in preventive health care
in close association with their own professional fields. Carry out publicity
and motivation among masses, take integrated measures and concentrate efforts
to eradicate or control a number of infectious diseases and endemic diseases
which seriously threaten people’s health;step up prevention and control of diseases spread through blood; actively carry out prevention
and treatment
of such chronic non-infectious diseases as cardiovascular and cerebral-vascu-
lar diseases and tumors. Enhance contingency powers in dealing with injuries
and diseases caused by accidents and outbreak of epidemics. Attach importance
to surveillance of occurences and spreading of infectious diseases in and
outside the country.

    (17)Earnestly do a good job of food hygiene, environmental hygiene,
occupational hygiene, radiation hygiene and school hygiene. Improve the
sanitary conditions of places of living, production, work, learning and
entertainment, step up surveillance and monitoring of environmental hygiene
and prevention and treatment of occupational diseases, protect people’s
rights to health. It is not allowed to seek economic growth one-sidedly
at the expense of environmental pollution and endangering people’s health.

    (18)Health education is an important content of citizens’ quality
education. Great importance should be attached to health education to enhance
the consciousness of health and self-healthcare capability of the broad masses
of people, and actively promote “health education action of 900 million
peasants”. Popularize knowledge of medical science. Educate and guide the
masses to break away from superstition and old customs and take part in
national fitness activities, promote rational nutrition, nurture good health
habits and civilized way of life, cultivate health and psychological quality.
Publicize and promote in a big way voluntary blood donation.

    (19)Protect the health of major human groups in accordance with law.
Enhance maternal and infant health care, upgrade population quality
of new births, reduce infant mortality and mortality of women in pregnancy,
and realize the goals set in the Children in 1990s> and the .
Actively carry out health care for the elderly, prevention and treatment of old-age diseases, prevention of injuries and disabilities
and recovery of the disabled.

    (20)Patriotic public health movement is a good form of our country
in mobilizing the masses to take part in health work. Activities to create
hygienic cities should continue to be carried out in cities to upgrade the
level of modernized management, enhance the awareness of citizens in public
health and civility and promote the building of civil cities. In the rural
areas, priority should continue to be given to reconstruction of water supply
and renovation of lavatories to push ahead improvement in environmental
hygiene, prevention and reduction of occurences of diseases to promote the
building of civil villages and towns. Both urban and rural areas should
persevere in carrying out activities of “four eradications”, i.e.,
eradication of mosquitoes, flies, rats and cockroaches.

    V.LAYING EQUAL STRESS ON TRADITIONAL CHINESE MEDICINE AND WESTERN
MEDICINE, DEVELOPING TRADITIONAL CHINESE MEDICINE AND PHARMACOLOGY

    (21)Traditional Chinese medicine and pharmacology which constitute fine
traditional culture of the Chinese nation is an important component part of the cause of public health of our country with unique
characteristics and
advantages. The traditional medicine and pharmacology and modern medicine and
pharmacology of our country which are mutually complementary, jointly shoulder
the task of protecting and promoting people’s health. Party committees and
governments at all levels should earnestly implement the policy of laying
equal stress on traditional Chinese medicine and Western medicine, strengthen
leadership of the work of traditional Chinese medicine and pharmacology,
increase input step by step to create good material conditions for the
development of traditional Chinese medicine and pharmacology. Medical
personnel, Chinese and Western style, should enhance unity, learn from each
other, complement each other, achieve mutual improvement and promote the
integration of traditional Chinese medicine and Western medicine.

    The medicine and pharmacology of all nationalities constitute component
parts of traditional medicine and pharmacology of the Chinese nation and
efforts should be made to discover, compile, summarize and improve upon
them to give them full play in the protection of people’s health of all
nationalities.

    (22)Correctly handle the relationhip between inheritance and innovation.
On the one hand, features and advantages of traditional Chinese medicine and
pharmacology should be earnestly inherited;on the other, there should be
creative spirit in actively employing modern science and technology, promote
the development of the theory and practice of traditional Chinese medicine
and pharmacology to realize the modernization of traditional Chinese medicine
and pharmacology. Persevere in the policy of “Let hundred flowers bloom, let
hundred thoughts contend” and bring about prosperity in academic research of traditional Chinese medicine and pharmacology.

    Medical institutions of traditional Chinese medicine should step up the
building of disciplines with special features, improve technical equipment,
expand areas of service so as to continuously satisfy the requirements of masses for traditional Chinese medicine. Attention should
be paid to give
full play to the advantages and role of traditional Chinese medicine and
pharmacology in rural health work.

    Actively train all types of specialized personnel in traditional Chinese
medicine in an effort to train famed new-generation physicians of traditional
Chinese medicine. Seriously sum up experiences in running seats of higher
learning of traditional Chinese medicine and pharmacology and manage well
existing seats of higher learning of traditional Chinese medicine and pharmaco-
logy by continuously deepening reform. Continue to do a good job of inheriting
the academic tho