Current position:

Do you know the latest division of the basic public health funding financial commitment ratio?

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On August 13, the General Office of the State Council issued the "Notice of the General Office of the State Council on Printing and Distributing the Reform Plan for the Centralization and Disbursement of Financial Responsibilities and Expenditure Responsibilities of the Central and Local Governments in the Medical and Health Field" (hereinafter referred to as the "Notice"). In the "Notice", in terms of public health, the central and local governments have made the latest division of fiscal authority and expenditure responsibilities.



The "Notice" makes it clear that public health mainly includes basic public health services and major public health services, and is divided into two categories: central fiscal authority and central and local common fiscal authority.


Basic public health services




Basic public health services include the original basic public health services such as health education, vaccination, and key population health management, as well as maternity and child health, elderly health services, integrated medical and nursing, and sanitation included in the original major public health services and family planning programs. Emergency, pre-pregnancy inspection, etc.



Among them, the original basic public health service project content, funds, users and other subjects remain relatively independent and stable, organized and implemented in accordance with the corresponding service specifications; new projects classified as basic public health services are independently arranged by the provinces in combination with local actualities, and the funds are not limited to Used by grass-roots medical and health institutions. The content of basic public health services is adjusted in a timely manner according to factors such as economic and social development, public health service needs, and financial affordability.



Basic public health services are clearly the central and local fiscal authority, and the central government and local government jointly bear the responsibility for expenditure. The central government formulates national basic standards for the per capita expenditure of basic public health services, and gradually improves according to economic and social development.



The basic public health service expenditure responsibility shall be implemented in the form of central sharing and sharing as follows:



The first file includes 12 provinces (autonomous regions and municipalities) in Inner Mongolia, Guangxi, Chongqing, Sichuan, Guizhou, Yunnan, Tibet, Shaanxi, Gansu, Qinghai, Ningxia, and Xinjiang, with the central government sharing 80%



The second level includes 10 provinces of Hebei, Shanxi, Jilin, Heilongjiang, Anhui, Jiangxi, Henan, Hubei, Hunan, and Hainan, with the central government sharing 60%;



The third level includes Liaoning, Fujian and Shandong provinces, with the central government sharing 50%;



The fourth level includes Tianjin, Jiangsu, Zhejiang, and Guangdong provinces (municipalities) and Dalian, Ningbo, Xiamen, Qingdao, and Shenzhen, which are planned separately, with the central government sharing 30%;



The fifth level includes two municipalities directly under the Central Government, Beijing and Shanghai, with the central government sharing 10%.



See the table below for details






Major public health services




Major public health services such as national or cross-regional prevention and control of major infectious diseases, including routine immunization included in the national immunization program and the purchase of vaccines and syringes required by the state for group vaccination and emergency vaccination of key populations, AIDS, tuberculosis, Contents such as schistosomiasis and hydatid disease prevention and control, comprehensive management of mental and psychological diseases, prevention and control of major chronic diseases, and exploration of suitable technologies are classified as the central financial authority, and the central finance shall bear the expenditure responsibility.



Inheritance and development of traditional Chinese medicine in the original major public health service are included in capacity building. The original major public health service items other than the above items shall be included in the overall arrangement of basic public health services.





Attached original text:



General Office of the State Council

Notice on the reform plan for the division of fiscal authority and expenditure responsibility

Guobanfa (2018) No. 67



The people's governments of the provinces, autonomous regions and municipalities directly under the Central Government, the ministries and commissions of the State Council and the agencies directly under them:

The reform plan for the division of fiscal authority and expenditure responsibility between the central and local governments in the field of medical and health care has been approved by the Party Central Committee and the State Council, and is now issued to you. Please implement it carefully according to the actual situation.



Office of the State Council

July 19, 2018

(This piece is publicly released)





The central and local financial authority and

Expenditure responsibility division reform plan



In order to fully implement the spirit of the 19th National Congress of the Party and promote the implementation of a healthy China strategy, according to the Party Central Committee and the State Council ’s decision to promote the reform of the division of central and local fiscal authority and expenditure responsibilities The reform of the division of responsibilities establishes the following plan:



1. General requirements

(1) The necessity of reform.

People's health is an important symbol of national prosperity and national prosperity, and medical and health care is an important cause of people's livelihood to protect people's health. According to China's medical and health system, the financial authority in the medical and health field mainly includes public health, medical security, family planning, and capacity building. At present, the system framework for the division of fiscal authority and expenditure responsibility between the central and local governments in the field of health care in China has initially taken shape, but there are still some problems, mainly because the division system is not complete and there is no systematic institutional norm; Lack of basis; unscientific division of financial authority in some matters, overlapping responsibilities; multiple central and local sharing ratios, unreasonable division of expenditure responsibility; partial project decentralization, multi-management, inefficient use of financial funds, etc. Expenditure responsibility division reform to solve.



(2) Guiding ideology.

Fully implement the spirit of the 19th National Congress of the Communist Party of China and the Second and Third Plenary Sessions of the 19th CPC Central Committee, guided by Xi Jinping's new era socialist thinking with Chinese characteristics, adhere to the general tone of progress in stability, adhere to the new development concept, and closely follow the main social contradictions of our society Change, in accordance with the requirements of high-quality development, coordinate the overall layout of the "five in one" and coordinate the promotion of the "four comprehensive" strategic layout, give full play to the institutional advantages of the unified leadership of the central government and the implementation of local organizations, and accelerate the establishment of a modern financial system. The requirements of the central and local fiscal relations with clear powers and responsibilities, coordinated financial resources, and regional balance, adhere to the strategic position of giving priority to the development of people ’s health, strongly support the implementation of a healthy China strategy, deepen the reform of the medical and health system, and promote fertility policies and related economic and social Linking up the supporting policies, striving to provide the people with a full range of full-cycle health services, and promoting the establishment of a long-term mechanism for sustainable investment in the field of medical and health protection and smooth operation. Through reforms, a central government leadership, clear powers and responsibilities, legally regulated, and efficient operation of the central and local financial responsibilities and expenditure responsibility division model in the field of medical and health care will be formed to improve the efficiency and level of the supply of basic medical and health services.



(3) Basic principles.

-Adhere to the government's leadership and promote fair enjoyment for everyone. Scientifically define the responsibility of the government, society and individuals to invest, adhere to the government's leading position in providing basic medical and health services, increase government health investment, strongly support deepening the reform of the medical and health system, promote the improvement of birth policies, and increase Support efforts to promote the realization of basic medical and health services for all. Adhere to the combination of government leadership and the role of market mechanisms, improve the financial investment mechanism, and encourage the government to purchase services and other means to improve the efficiency of medical and health investment.

——Adhere to the rules and moderately strengthen the central authority and responsibility. Follow the general rules for the division of fiscal authority and expenditure responsibility, and scientifically and rationally divide the central and local fiscal authority and expenditure responsibility in the medical and health field. Focus on national or cross-regional public health services, and moderately strengthen central fiscal authority and expenditure responsibilities. Where the central and local governments have the common fiscal authority, the central government shall formulate national basic standards or put forward requirements in principle.

——Adhere to the problem-oriented, make overall consideration and highlight the key points. Focus on the main problems of the current division system, adhere to the full coverage of the medical and health field, improve the integrity of the division system; deeply analyze the nature and characteristics of various basic medical and health services, and improve the scientificity of the division system; reasonably determine the central and local expenditure responsibilities Sharing methods to improve the standardization of the division system; overall planning to promote the optimization and integration of projects to improve the effectiveness of the use of financial funds.

—— Adhere to being active and stable, and pushing forward by category. On the basis of maintaining the overall stability of the existing fiscal authority and expenditure responsibility framework, taking into account the current and long-term, and promote reform by classification. Confirm the current scientific and reasonable and effective matters; reform and adjust the matters that are not reasonable and the reform conditions are mature; for the matters that do not yet have the reform conditions, temporarily continue the current division pattern, and according to the relevant The progress of the reform of institutional mechanisms in the field should be adjusted accordingly.



Second, the main content

According to the “Guiding Opinions of the State Council on Promoting the Reform of the Central and Local Fiscal Authority and Expenditure Responsibility Division” (Guo Fa [2016] No. 49), and in accordance with the overall requirements for implementing the “Healthy China 2030” Planning Outline and deepening the reform of the healthcare system Separately divide the financial authority and expenditure responsibility of the four aspects of public health, medical security, family planning, and capacity building.



(1) Public health.

It mainly includes basic public health services and major public health services, and is divided into two categories: central fiscal authority and central and local common fiscal authority.



1. Basic public health services. Basic public health services include the original basic public health services such as health education, vaccination, and key population health management, as well as maternity and child health, elderly health services, integrated medical and nursing, and sanitation included in the original major public health services and family planning programs. Emergency, pre-pregnancy inspection, etc. Among them, the original basic public health service project content, funds, users and other subjects remain relatively independent and stable, organized and implemented in accordance with the corresponding service specifications; new projects classified as basic public health services are independently arranged by the provinces in combination with local actualities, and the funds are not limited to Used by grass-roots medical and health institutions. The content of basic public health services is adjusted in a timely manner according to factors such as economic and social development, public health service needs, and financial affordability.



Basic public health services are clearly the central and local fiscal authority, and the central government and local government jointly bear the responsibility for expenditure. The central government formulates national basic standards for the per capita expenditure of basic public health services, and gradually improves according to economic and social development. The basic public health service expenditure responsibility is implemented by the central sharing method: the first file includes Inner Mongolia, Guangxi, Chongqing, Sichuan, Guizhou, Yunnan, Tibet, Shaanxi, Gansu, Qinghai, Ningxia, Xinjiang 12 provinces (autonomous regions, municipalities), central Share 80%; the second file includes Hebei, Shanxi, Jilin, Heilongjiang, Anhui, Jiangxi, Henan, Hubei, Hunan, and Hainan, the central government shares 60%; the third file includes Liaoning, Fujian, and Shandong provinces, the central government 50% share; the fourth level includes Tianjin, Jiangsu, Zhejiang, Guangdong, 4 provinces (municipalities) and Dalian, Ningbo, Xiamen, Qingdao, Shenzhen, the five planned cities, the central share 30%; the fifth level includes Beijing, Shanghai 2 In municipalities directly under the Central Government, the central government shares 10%.



2. Major public health services. Major public health services such as national or cross-regional prevention and control of major infectious diseases, including routine immunization included in the national immunization program and the purchase of vaccines and syringes required by the state for group vaccination and emergency vaccination of key populations, AIDS, tuberculosis, Contents such as schistosomiasis and hydatid disease prevention and control, comprehensive management of mental and psychological diseases, prevention and control of major chronic diseases, and exploration of suitable technologies are classified as the central financial authority, and the central finance shall bear the expenditure responsibility. Inheritance and development of traditional Chinese medicine in the original major public health service are included in capacity building. The original major public health service items other than the above items shall be included in the overall arrangement of basic public health services.



(2) Medical security.

It mainly includes basic medical insurance subsidies and medical assistance for urban and rural residents. It is clearly the central and local financial authority, and the central and local finances jointly bear the responsibility for expenditures.

1. Basic medical insurance subsidies for urban and rural residents. The central and local finances provide subsidies for basic medical insurance for urban and rural residents in accordance with regulations. The central government arranges subsidy funds according to certain subsidy standards and with reference to the above-mentioned central public health service expenditure sharing method.

2. Medical assistance. Medical assistance mainly includes urban and rural medical assistance and disease emergency assistance. The central government allocates funds for local transfer payments based on factors such as rescue needs, work progress, and local financial resources.



(3) Family planning.

It mainly includes three rural family planning family incentives, special assistance for family planning families, family planning "less births and faster prosperity" subsidies, three family planning assistance guarantee projects, which are clearly the central and local financial responsibilities and are jointly undertaken by the central finance and local finance. Expenditure responsibility. In addition to the above three projects, the original family planning project is included in the overall arrangement of basic public health services.

The central government formulates national basic standards for family planning support, guarantee and subsidies, and gradually improves according to economic and social development. The central government arranges subsidy funds in accordance with the above-mentioned central grading and sharing method for basic public health service expenditure responsibilities.



(4) Capacity building.

It mainly includes the reform and development of medical and health institutions, the improvement of health and health capabilities, health management affairs, the construction of medical security capabilities, and the inheritance and development of Chinese medicine.



1. Reform and development of medical and health institutions. The state subsidies for the reform and development of medical and health institutions are clearly defined as the central authority or local authority in accordance with their affiliation, and the same level of finance shall bear the responsibility for expenditure. The reform and development of the centrally-owned medical and health institutions that conform to the regional health plan are clearly defined as the central financial authority, and the central government shall bear the responsibility for expenditures; the centrally-owned medical and health institutions shall be responsible for public health, emergency treatment, foreign aid, agricultural support, and border support entrusted by the local government. For tasks, the local finance shall provide reasonable subsidies. The reform, development and construction of local-affiliated medical and health institutions that conform to the regional health plan are clearly defined as local fiscal authority, and the local finance shall bear the responsibility for expenditures; if the local-affiliated medical and health institutions undertake the tasks of central fiscal authority, the central finance shall grant reasonable subsidies. During the deepening of the reform of the medical and health system, the central government will provide local government subsidies for the comprehensive reform of public hospitals, the implementation of the national essential medicine system, and the improvement of service capabilities in difficult areas. Increase support for social forces to run medical services. The central and local governments will implement subsidy policies for social forces to run medical services in accordance with regulations.



2. Improve health and health capabilities. The improvement of health capacity mainly includes the construction of health personnel and the development of key disciplines. The state's unified planning and implementation of the health and health talent team construction and key discipline development projects in accordance with the strategic plan clearly define the central and local financial authority, and the central government and local government jointly bear the responsibility for expenditures. The central government will work according to the amount of tasks, subsidy standards, and performance Factors such as the assessment situation allocate funds for local transfer payments. Local self-implemented capacity enhancement projects are clearly local financial authority, and local finances are responsible for expenditure.



3. Health management affairs. Health management affairs mainly include strategic planning, comprehensive supervision, publicity and guidance, health promotion, monitoring of essential drugs and shortage of drugs, monitoring of major health hazards and major diseases, and monitoring of maternal and child health. For the central fiscal authority or local fiscal authority, the finances at the same level shall bear the expenditure responsibility.



4. Medical security capacity building. The construction of medical security capacity mainly includes strategic planning, comprehensive supervision, publicity and guidance, the improvement of handling service capabilities, information construction, and talent team construction. The local financial authority shall bear the expenditure responsibility for the finance at the same level. During the deepening of the reform of the medical and health system, the central government provided subsidies for local medical security capacity building in accordance with regulations

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