CCTV:

Deepening the reform of public hospitals with a focus on public welfare is a top priority among the various tasks of health care reform. How should we interpret the concept of public welfare in this context? How can we ensure public welfare while also motivating medical staff? Thank you.

Lei Haichao:

Thank you for your question. I'll address this. Public medical institutions form the backbone of China's health care system. They handle over 80% of the country's annual outpatient and emergency visits. Their role is even more prominent in inpatient services. As a result, the public trusts and prefers these institutions for medical treatment. Therefore, ensuring and enhancing the public welfare aspect of these institutions is a matter of concern for the whole society and a key task of medical reform. The third plenary session of the 20th CPC Central Committee has provided clear directives on safeguarding and improving the public welfare role of these institutions. We can understand and implement these directives from four perspectives.

First, the third plenary session of the 20th CPC Central Committee emphasized adhering to a public welfare orientation. As the primary providers of health care services, public medical institutions must always prioritize public welfare. This focus on public welfare should be prominent in hospital management, development strategies, macro-level planning, and government investment.

Second, the third plenary session of the 20th CPC Central Committee explicitly called for establishing a dynamic adjustment mechanism for public hospital staffing. This involves adjusting the size of public medical institutions and ensuring adequate staffing based on changes in local population demographics, public health care needs, and available financial resources. We will formulate corresponding dynamic adjustment standards. Local governments should implement these standards to adjust public hospital staffing accordingly. This approach aims to ensure that qualified, capable, and ethically sound medical professionals receive job security, allowing them to focus on providing health care services to the public with peace of mind.

Third, the third plenary session of the 20th CPC Central Committee clearly proposed establishing a fee mechanism led by medical services. Reforming medical service pricing is a crucial part of public hospital reform. Currently, the main tasks of price reform include incorporating clinically proven and professionally recognized services and technologies into the scope of price management and medical insurance coverage. This should be done in a timely manner and in accordance with changes in medical insurance fund contributions, cost savings from centralized procurement of drugs and medical consumables, and new trends in medical technology. Additionally, necessary adjustments should be made to medical service prices that have long been undervalued, within the limits of what medical insurance funds and the public can afford. At the same time, the reform aims to establish and improve a diversified payment system within medical insurance that supports technological development while controlling unreasonable cost increases.

The fourth aspect involves improving the remuneration system in public hospitals, which is also a reform task designated at the third plenary session of the 20th CPC Central Committee. A reform to the remuneration system can be briefly summarized in two sentences. The first sentence is to implement the "two allowances" policy. The second is to adequately adjust "three structures." "Two allowances" refers to the policy that relevant departments, when verifying the performance-based wages of personnel in public medical institutions, should approve the total amount and make dynamic adjustments to synchronize the performance-based wages of medical staff with economic and social development as well as changes in price levels, reflecting the labor value of doctors and encouraging high rewards for excellent work as well as more pay for more work. To adequately adjust "three structures" refers to the following: first, public medical institutions should regard serving the public interest as their ultimate objective, gradually narrowing the gap in performance-based wages between public medical institutions of different levels. Second, adhering to the requirement of serving the public interest, they should gradually narrow the gap in pay packages among different specialties and departments within medical institutions, so as to improve the income of medical professionals in relatively weak specialties such as pediatrics, pathology, mental health, anesthesia, general practice and obstetrics. Last, in accordance with the requirement of serving the public interest, the proportion of fixed income in the performance-based wages of medical staff should be gradually increased, while the proportion of flexible income bonuses should be appropriately regulated, so as to better align with the positioning of serving the public interest as well as to encourage medical and health professionals to improve skills and provide better services, rather than simply linking personal income with revenue-generating capabilities.

Finally, I would like to emphasize that to ensure that public hospitals better serve the public interest it is also necessary to strengthen comprehensive supervision and strictly control the unreasonable growth of medical expenses, so as to ensure that the people have payment capabilities and that medical insurance funds are more stable, secure and sustainable. The NHC has established systems such as hospital inspections, prescription evaluations, and syndrome differentiation and treatment with traditional Chinese medicine. In addition, we must strengthen the application of information technology to monitor and analyze whether the diagnosis and treatment services comply with relevant standards and norms, guiding medical services to be more quality-oriented, efficient and resource- and cost-saving.

The above measures are the working ideas and initial considerations formed in accordance with the decisions and deployments of the third plenary session of the 20th CPC Central Committee. We will further explore, improve and promote these measures with our future work, so as to ensure that public hospitals better serve the public interest, motivate and maintain the dedication of personnel as well as advance a virtuous cycle and interaction with economic and social development. Thank you.