中国的医疗卫生事业白皮书汉英对照版

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1、.中国的医疗卫生事业白皮书White Paper: Medical and Health Services in China中华人民共和国国务院新闻办公室26日发表中国的医疗卫生事业白皮书。全文如下：The State Council Information Office of the Peoples Republic of China on Wednesday published a white paper on the medical and health services in China.Following is the full te*t of the white paper:中国的

2、医疗卫生事业2012年12月中华人民共和国国务院新闻办公室Medical and Health Services in China(December 2012)Information Office of the State CouncilThe Peoples Republic of China目录Contents前言Foreword一、卫生根本状况I. Basic Conditions二、医药卫生体制改革II. Reform of Medical and Healthcare Systems三、传染病防治与卫生应急III. Infectious Disease Prevention and

3、Treatment, and Health Emergency Management四、慢性非传染性疾病防治IV. Prevention and Treatment of Chronic Non-communicable Disorders五、妇女儿童安康权益保护V. Protecting Women and Childrens Right to Health六、中医药开展VI.Development of Traditional Chinese Medicine七、卫生国际合作VII. International Medical and Healthcare Cooperation完毕语Co

4、nclusion前言Foreword安康是促进人的全面开展的必然要求。提高人民安康水平，实现病有所医的理想，是人类社会的共同追求。在中国这个有着13亿多人口的开展中大国，医疗卫生关系亿万人民安康，是一个重大民生问题。Good health is a prerequisite for promoting all-round development of the person. And it is a common pursuit of human societies to improve peoples health and ensure their right to medical care.

5、 For China, a large developing country, medical and healthcare is of vital importance to its population of over 1.3 billion, and is a major issue concerning its peoples well being.中国高度重视保护和增进人民安康。宪法规定，国家开展医疗卫生事业，开展现代医药和传统医药，保护人民安康。围绕宪法，中国逐步形成了相对完善的卫生法律法规体系。China pays great attention to protecting an

6、d improving its peoples health. As the Constitution stipulates, The state develops medical and health services, promotes modern medicine and traditional Chinese medicine., all for the protection of the peoples health. Based on this constitutional stipulation, China has put in place a complete system

7、 of laws and regulations concerning medical and health services.多年来，中国坚持以农村为重点，预防为主，中西医并重，依靠科技与教育，发动全社会参与，为人民安康效劳，为社会主义现代化建立效劳的卫生工作方针，努力开展具有中国特色的医疗卫生事业。经过不懈努力，覆盖城乡的医疗卫生效劳体系根本形成，疾病防治能力不断增强，医疗保障覆盖人口逐步扩大，卫生科技水平日益提高，居民安康水平明显改善。Over the years, China has worked hard to develop its medical and health servi

8、ces with Chinese characteristics in accordance with the policy of making rural areas the focus of our work, putting disease prevention first, supporting both traditional Chinese medicine and Western medicine, relying on science, technology and education, and mobilizing the whole of society to join t

9、he efforts, improving the peoples health and serving socialist modernization. Thanks to unremitting efforts that have been made, medical and healthcare systems covering both urban and rural residents have taken shape, the capabilities of disease prevention and control have been enhanced, the coverag

10、e of medical insurance has e*panded, continuous progress has been made in medical science and technology, and the peoples health has been remarkably improved.为建立起覆盖城乡居民的根本医疗卫生制度，保障每个居民都能享有平安、有效、方便、价廉的根本医疗卫生效劳，中国深入推进医药卫生体制改革，取得了重要阶段性成效。To put into place basic medical and healthcare systems covering b

11、oth urban and rural residents, and ensure that every resident has access to safe, effective, convenient and affordable basic medical and health services, China has kept advancing the reform of its medical and healthcare system, and made important achievements in the current stage.一、卫生根本状况I. Basic Co

12、nditions居民安康状况不断改善。从反映国民安康状况的重要指标看，中国居民的安康水平已处于开展中国家前列。2010年人均期望寿命到达74.8岁，其中男性72.4岁，女性77.4岁。孕产妇死亡率从2002年的51.3/10万下降到2011年的26.1/10万。婴儿死亡率及5岁以下儿童死亡率持续下降，婴儿死亡率从2002年的29.2下降到2011年的12.1，5岁以下儿童死亡率从2002年的34.9下降到2011年的15.6，提前实现联合国千年开展目标。The peoples health has been improved. Judging from important indicators

13、 that give e*pression to national health, the health of the Chinese people is now among the top in developing countries. In 2010, the life e*pectancy was 74.8 years - 72.4 years for males and 77.4 years for females; the maternal mortality rate went down from 51.3 per 100,000 in 2002 to 26.1 per 100,

14、000 in 2011; the infant mortality rate and the mortality rate of children under the age of five have kept dropping, with the former going down from 29.2 per thousand in 2002 to 12.1 per thousand in 2011, and the latter, from 34.9 per thousand to 15.6 per thousand, attaining ahead of schedule the UN

15、Millennium Development Goal in this regard.建立起覆盖城乡的医疗卫生体系。一是公共卫生效劳体系。包括疾病预防控制、安康教育、妇幼保健、精神卫生、卫生应急、采供血、卫生监视和方案生育等专业公共卫生效劳网络，以及以基层医疗卫生效劳网络为根底、承担公共卫生效劳功能的医疗卫生效劳体系。二是医疗效劳体系。在农村建立起以县级医院为龙头、乡镇卫生院和村卫生室为根底的农村三级医疗卫生效劳网络，在城市建立起各级各类医院与社区卫生效劳机构分工协作的新型城市医疗卫生效劳体系。三是医疗保障体系。这个体系以根本医疗保障为主体、其他多种形式补充医疗保险和商业安康保险为补充。根本医

16、疗保障体系包括城镇职工根本医疗保险、城镇居民根本医疗保险、新型农村合作医疗和城乡医疗救助，分别覆盖城镇就业人口、城镇非就业人口、农村人口和城乡困难人群。四是药品供应保障体系。包括药品的生产、流通、价格管理、采购、配送、使用。近期重点是建立国家根本药物制度。Medical and healthcare systems covering both urban and rural residents have been put in place. Of these systems, the first is the public health service system, which covers

17、 disease prevention and control, health education, maternity and child care, mental health, health emergency response, blood collection and supply, health supervision, family planning and some other specialized public health services, and a medical and healthcare system based on community-level heal

18、thcare networks that provides public health services. The second is the medical care system. In the rural areas, it refers to a three-level medical service network that comprises the county hospital, the township hospitals and village clinics, with the county hospital performing the leading role, an

19、d township hospitals and village clinics service at the base. And in the cities and towns, it refers to a new type of urban medical health service system that features division of responsibilities as well as cooperation among various types of hospitals at all levels and community healthcare centers.

20、 The third is the medical security system. This system comprises mainly the basic medical security, supported by many forms of supplementary medical insurance and commercial health insurance. The basic medical security system covers basic medical insurance for working urban residents, basic medical

21、insurance for non-working urban residents, a new type of rural cooperative medical care and urban-rural medical aid, which cover, respectively, the employed urban population, unemployed urban population, rural population and people suffering from economic difficulties. And the fourth is the pharmace

22、utical supply system, which covers the production, circulation, price control, procurement, dispatching and use of pharmaceuticals. The recent work is focused on establishing a national system for basic drugs.卫生筹资构造不断优化。卫生筹资来源包括政府一般税收、社会医疗保险、商业安康保险和居民自费等多种渠道。2011年，中国卫生总费用达24345.91亿元人民币，同期人均卫生总费用为180

23、6.95元人民币，卫生总费用占国内生产总值的比重为5.1%。按可比价格计算，19782011年，中国卫生总费用年平均增长速度为11.32%。个人现金卫生支出由2002年的57.7%下降到2011年的34.8%，卫生筹资系统的风险保护水平和再分配作用不断提高。2011年，医院、门诊机构费用为18089.4亿元人民币，公共卫生机构费用为2040.67亿元人民币，分别占卫生总费用的71.74%和8.09%。医院费用中，城市医院、县医院、社区卫生效劳中心、乡镇卫生院费用分别占64.13%、21.28%、5.17%、9.3%。The health financing structure has been

24、 constantly improved. Chinas health e*penditure comes from the governments general ta* revenue, social medical insurance, commercial health insurance, residents out-of-pocket spending, etc. In 2011, the total health e*penditure in China reached 2,434.591 billion yuan, 1,806.95 yuan per capita. The t

25、otal e*penditure accounted for 5.1% of the countrys GDP. In comparable prices, the health e*penditure grew by an average annual rate of 11.32% from 1978 to 2011. Individual out-of-pocket spending declined from 57.7% in 2002 to 34.8% in 2011, showing that health financing is working better in the are

26、as of risk protection and re-distribution. In 2011, the spending on hospitals and outpatient establishments was 1,808.94 billion yuan, and that on public health agencies, 204.067 billion yuan, comprising 71.74% and 8.09%, respectively, of the total health e*penditure. Of the total spending on hospit

27、als, those on urban hospitals, county hospitals, community health service centers and township health service centers stood at 64.13%, 21.28%, 5.17% and 9.3%, respectively.卫生资源持续开展。截至2011年底，全国医疗卫生机构达95.4万个(所)，与2003年比较，医疗卫生机构增加14.8万个(所)。执业(助理)医师246.6万人，每千人口执业(助理)医师数由2002年的1.5人增加到1.8人。注册护士224.4万人，每千人口

28、注册护士数由2002年的1人增加到1.7人。医疗卫生机构床位数516万张，每千人口医疗卫生机构床位数由2002年的2.5张提高到3.8张。Health resources have been developing in a sustained way. By the end of 2011, medical and healthcare institutions around the country totaled 954,000, an increase of 148,000 over 2003. Licensed doctors (assistants) reached 2,466,000

29、, or 1.8 per thousand people, as compared with 1.5 per thousand people in 2002. Registered nurses totaled 2,244,000, or 1.7 per thousand people, as compared with one per thousand people in 2002. The number of hospital beds reached 5160,000, or 3.8 per thousand people, as compared with 2.5 per thou-s

30、and people in 2002.医疗卫生效劳利用状况显著改善。2011年，全国医疗机构诊疗人次由2002年的21.5亿人次增加到62.7亿人次，住院人数由2002年的5991万人增加到1.5亿人。中国居民到医疗卫生机构年均就诊4.6次，每百居民住院11.3人，医院病床使用率为88.5%，医院出院者平均住院日为10.3天。居民看病就医更加方便，可及性显著提高。15分钟内可到达医疗机构住户比例，由2003年的80.7%提高到2011年的83.3%，其中农村地区为80.8%。医疗质量管理和控制体系不断完善。建立无偿献血制度，血液平安得到保障。Marked improvement has bee

31、n seen in the utilization of medical and health services. In 2011, medical institutions throughout the country hosted 6.27 billion outpatients, as compared with 2.15 billion in 2002; and admitted 150 million inpatients, as compared with 59.91 million in 2002. That year, Chinese residents went to the

32、 medical institutions for medical treatment 4.6 times on average; 11.3 of every 100 people were hospitalized; the utilization rate of hospital beds reached 88.5%; and the hospital stay of the inpatients averaged 10.3 days. These figures show that it has become increasingly convenient to see a doctor

33、 and more easily accessible to get medical services. In 2011, 83.3% of all households (80.8% in rural areas) could reach medical institutions within 15 minutes, as compared with 80.7% in 2002. Medical service quality management and control systems have been constantly improved. A system of blood don

34、ation without compensation has been established, so as to ensure blood supply and safety.二、医药卫生体制改革II. Reform of Medical and Healthcare Systems经过多年努力，中国卫生事业取得显著开展成就，但与公众安康需求和经济社会协调开展不适应的矛盾还比较突出。特别是随着中国从方案经济体制向市场经济体制的转型，原有医疗保障体系发生很大变化，如何使广阔公众享有更好、更健全的医疗卫生效劳，成为中国政府面临的一个重大问题。从20世纪80年代开场，中国启动医药卫生体制改革，并在

35、2003年抗击传染性非典型肺炎取得重大胜利后加快推进。2009年3月，中国公布关于深化医药卫生体制改革的意见，全面启动新一轮医改。改革的根本理念，是把根本医疗卫生制度作为公共产品向全民提供，实现人人享有根本医疗卫生效劳，从制度上保证每个居民不分地域、民族、年龄、性别、职业、收入水平，都能公平获得根本医疗卫生效劳。改革的根本原则是保根本、强基层、建机制。With years of effort, China has made remarkable achievements in the development of its healthcare undertakings, which, howe

36、ver, still fall far short of the publics demands for healthcare as well as the requirements of economic and social development. Especially when China turned from a planned economy to a market economy, the old medical care system has undergone great changes. So it became an issue of major importance

37、for the Chinese government to provide better and more accessible medical and health services to the public. In the 1980s, the Chinese government initiated reform of the medical and healthcare systems, and speeded up the reform in 2003 after a success was won in the fight against the SARS. In March 2

38、009, the Chinese government promulgated the Opinions on Deepening Reform of the Medical and Health Care Systems, setting off a new round of reform in this regard. The basic goal of this reform was to provide the whole nation with basic medical and health services as a public product, and ensure that

39、 everyone, regardless of location, nationality, age, gender, occupation and income, enjoys equal access to basic medical and health services. And the basic principles to be followed in the reform were to ensure basic services, improving such services at the grass-roots level and establishing the eff

40、ective mechanisms.医改是一项涉及面广、难度大的社会系统工程，在中国这样一个人口多、人均收入水平低、城乡区域差距大的开展中国家，深化医改是一项十分艰巨复杂的任务。三年多来，中国政府大力推进医药卫生效劳与经济社会协调开展，积极破解医改这一世界性难题。通过艰辛努力，中国的新一轮医改取得积极进展。Medical reform is a social program that covers a wide range and involves difficult tasks. And it is a hard and complicated task to deepen this ref

41、orm in China, a developing country with a large population, low per-capita income and a wide gap between urban and rural areas. For over three years, the Chinese government has worked hard to strike a balance between improving medical and health services on one hand and economic and social developme

42、nt on the other, trying to find a solution to this worldwide problem. Thanks to the persistent efforts made, China has made positive progress in this new round of medical reform.根本医疗保障制度覆盖城乡居民。截至2011年，城镇职工根本医疗保险、城镇居民根本医疗保险、新型农村合作医疗参保人数超过13亿，覆盖面从2008年的87%提高到2011年的95%以上，中国已构建起世界上规模最大的根本医疗保障网。筹资水平和报销比例

43、不断提高，新型农村合作医疗政府补助标准从最初的人均20元人民币，提高到2011年的200元人民币，受益人次数从2008年的5.85亿人次提高到2011年的13.15亿人次，政策范围内住院费用报销比例提高到70%左右，保障范围由住院延伸到门诊。推行医药费用即时结算报销，居民就医结算更为便捷。开展按人头付费、按病种付费和总额预付等支付方式改革，医保对医疗机构的约束、控费和促进作用逐步显现。实行新型农村合作医疗大病保障，截至2011年，23万患有先天性心脏病、终末期肾病、乳腺癌、宫颈癌、耐多药肺结核、儿童白血病等疾病的患者享受到重大疾病补偿，实际补偿水平约65%。2012年，肺癌、食道癌、胃癌等12

44、种大病也被纳入农村重大疾病保障试点范围，费用报销比例最高可达90%。实施城乡居民大病保险，从城镇居民医保基金、新型农村合作医疗基金中划出大病保险资金，采取向商业保险机构购置大病保险的方式，以力争防止城乡居民发生家庭灾难性医疗支出为目标，实施大病保险补偿政策，对根本医疗保障补偿后需个人负担的合规医疗费用给予保障，实际支付比例不低于50%，有效减轻个人医疗费用负担。建立健全城乡医疗救助制度，救助对象覆盖城乡低保对象、五保对象，并逐步扩大到低收入重病患者、重度残疾人、低收入家庭老年人等特殊困难群体，2011年全国城乡医疗救助8090万人次。The basic medical care systems

45、 cover both urban and rural residents. By 2011, more than 1.3 billion people had joined the three basic medical insurance schemes that cover both urban and rural residents, i.e., the basic medical insurance for working urban residents, the basic medical insurance for non-working urban residents, and

46、 the new type of rural cooperative medical care, with their total coverage being e*tended from 87% in 2008 to 95% in 2011. This signaled that China has built the worlds largest network of basic medical security. Medical care financing and the reimbursable ratio of medical costs have been raised, and

47、 the government subsidy standards for the new rural cooperative medical care system were increased from 20 yuan at the beginning to 200 yuan per person per year in 2011, benefiting 1.315 person/times in 2011 as against 585 person/times in 2008. The reimbursement rate for hospitalization e*penses cov

48、ered by relevant policies has been raised to around 70%, and the range of reimbursable e*penses has been e*panded to include outpatient e*penses. Real-time reimbursement has been adopted for medical e*penses, making it more convenient for people to have their medical costs settled. Reform has been c

49、arried out in respect of the forms of payment to include payment by person, payment by disease and total amount pre-payment, enabling medical insurance to play a better restrictive role over medical institutions as well as to control e*penses and compel the medical institutions to improve their effi

50、ciency. Critical illness insurance has been included in the new type of rural cooperative medical care system. By 2011, some 230,000 patients of congenital heart disease, advanced rental diseases, breast cancer, cervical cancer, multidrug-resistant tuberculosis and childhood leukemia had been grante

51、d subsidies for major and serious diseases, with the actual subsidies accounting for 65% of their total e*penses. In 2012, lung cancer, esophagus cancer, gastric cancer and eight other major diseases were included in the rural pilot program of insurance for the treatment of major diseases, and the r

52、eimbursement rate reached as high as 90%. Critical illness insurance has been introduced for both urban and rural residents, in which certain amounts of money are earmarked in the medical insurance fund for non-working urban residents and that of the new type of rural cooperative medical care to buy

53、 critical illness insurance policies from commercial insurance companies, aiming to relieve urban and rural families of the heavy burden of catastrophic medical spending. The policy of subsidy for critical illness insurance, which covers no less than 50% of the actual medical costs, provides a guara

54、ntee for the compliance costs to be shouldered by the individual after reimbursement from the basic medical insurance. This has effectively reduced the financial burden of individuals. An urban-rural medical assistance system has been established and improved, which at first covered urban and rural

55、subsistence allowance recipients and childless and infirm rural residents who receive the so-called five guarantees, and is now e*tended to cover those who are severely ill and have low comes, the severely disabled, senior citizens from low-income families, and some other groups with special difficu

56、lties. In 2011, the urban-rural medical assistance was granted to 80.90 million cases across the country.根本药物制度从无到有。初步形成了根本药物遴选、生产供应、使用和医疗保险报销的体系。2011年，根本药物制度实现基层全覆盖，所有政府办基层医疗卫生机构全部配备使用根本药物，并实行零差率销售，取消了以药补医机制。制定国家根本药物临床应用指南和处方集，标准基层用药行为，促进合理用药。建立根本药物采购新机制，根本药物实行以省为单位集中采购，基层医疗卫生机构根本药物销售价格比改革前平均下降了30%

57、。根本药物全部纳入根本医疗保障药品报销目录。有序推进根本药物制度向村卫生室和非政府办基层医疗卫生机构延伸。药品生产流通领域改革步伐加快，药品供应保障水平进一步提高。A basic system of drugs has been developed from scratch. A system for the selection, production, supply and use of basic drugs, and cover of them in medical insurance has been put into place. In 2011, the coverage of t

58、his system was e*tended to all grass-roots medical and health-care institutions run by the government, where these drugs were sold at zero profit, practically eliminating the practice of hospitals subsidizing their medical services with drug sales. A national guideline for the clinical application o

59、f basic drugs and a formulary have been drawn up to ensure that basic drugs are used according to due procedures at grass-roots medical institutions. A new mechanism has been established for the procurement of basic drugs, under which the basic drugs are to be purchased by provinces. As a result, th

60、e prices of basic drugs at grass-roots medical and healthcare institutions have dropped by 30% on average, as compared with those before the reform. The basic drugs have all been included in the list of reimbursable drugs covered by basic medical insurance. Also, efforts have been made to supply bas

61、ic drugs in an orderly way to village clinics and non-governmental medical institutions at the grass-roots level. The steps of reform have been quickened in drug production and circulation, and the supply of drugs has been better ensured.城乡基层医疗卫生效劳体系进一步健全。加大政府投入，完善基层医疗卫生机构经费保障机制，20092011年，中央财政投资471.

62、5亿元人民币支持基层医疗机构建立开展。采取多种形式加强基层卫生人才队伍建立，制定优惠政策，为农村和社区培养、培训、引进卫生人才。建立全科医生制度，开展全科医生标准化培养，安排基层医疗卫生机构人员参加全科医生转岗培训，组织实施中西部地区农村订单定向医学生免费培养等。实施万名医师支援农村卫生工程，20092011年，1100余家城市三级医院支援了955个县级医院，中西部地区城市二级以上医疗卫生机构每年支援3600多所乡镇卫生院，提高了县级医院和乡镇卫生院医疗技术水平和管理能力。转变基层医疗效劳模式，在乡镇卫生院开展巡回医疗效劳，在市辖区推行社区全科医生团队、家庭签约医生制度，实行防治结合，保障居民

63、看病就医的根本需求，使常见病、多发病等绝大多数疾病的诊疗在基层可以得到解决。经过努力，基层医疗卫生效劳体系不断强化，农村和偏远地区医疗效劳设施落后、效劳能力薄弱的状况明显改变，基层卫生人才队伍的数量、学历、知识构造出现向好趋势。2011年，全国基层医疗卫生机构到达91.8万个，包括社区卫生效劳机构2.6万个、乡镇卫生院3.8万所、村卫生室66.3万个，床位123.4万张。Urban and rural grass-roots level medical and health services have been further improved. The government has inve

64、sted more to ensure the funding for grass-roots medical and healthcare institutions. From 2009 to 2011, the central government invested 47.15 billion yuan to support the building and development of grass-roots level medical institutions. Diverse forms have been adopted to strengthen the ranks of hea

65、lthcare workers at the grass-roots level, and preferential policies have been made to train and introduce competent personnel for rural and community healthcare. A system of general practitioners (medical workers with sufficient knowledge in all branches of medicine) has been established, under whic

66、h general practitioners are trained in the regular way; grass-roots medical and healthcare workers are enrolled in training courses for upgrading them to general practitioners; and medical students are specially trained for the needs of central and western urban areas, for which they do not have to pay their tuit