People's governments of all provinces, autonomous regions and municipalities directly under the Central Government, ministries and commissions of the State Council, and institutions directly under the Central Government:

Comprehensive reform of urban public hospitals is an important task in deepening the reform of the medical and health system. since the launch of the reform of public hospitals in pilot cities in the state-connected areas in 2010, the pilot cities have been actively exploring and making significant progress in the reform, and accumulating valuable experience, which lays the foundation for expanding and deepening the reform. The foundation for expanding and deepening the reform has been laid. However, the reform of public hospitals is a long-term arduous and complex systematic project, there are still some prominent contradictions and problems, public hospitals profit-seeking mechanism to be broken, the external governance and internal management level to be improved, in line with the characteristics of the industry's personnel compensation system to be improved, the structure and layout to be optimized, the reasonable order of medical care has not yet been formed, the burden of the people's access to health care is still heavy, etc., there is an urgent need to reform the institutional mechanism to gradually solve the problem. It is urgent to solve these problems by reforming the system and mechanism. According to the spirit of the 18th CPC National Congress, the Second, Third and Fourth Plenary Sessions of the 18th CPC Central Committee and the Opinions of the Central Government and State Council on Deepening the Reform of the Medical and Health System, and the Circular of the State Council on the Issuance of a Plan for Deepening the Reform of the Medical and Health System during the Twelfth Five-Year Plan Period and its Implementation Program (Guofa 〔2012〕 No. 11), the reform of urban public hospitals (prefecture-level municipal hospitals) has been strengthened. The urban public hospitals (prefectural municipal districts and above urban public hospitals) comprehensive reform of the pilot guidance, agreed by the State Council, is hereby put forward the following views.

I. General requirements (a) Guiding ideology. In-depth implementation of the spirit of the 18th CPC National Congress and the 18th Second, Third and Fourth Plenary Sessions, in accordance with the CPC Central Committee, the State Council decision-making and deployment, focusing on solving the problem of access to health care for the masses, deepening the health care reform as an important initiative to safeguard and improve people's livelihood, will be fair and accessible, the masses benefited from the reform as a starting point and foothold to speed up the reform of public hospitals in the city. Public hospitals give full play to the nature of public welfare and the main role, effectively implement the government's responsibility for medical care, and strive to promote the reform of the management system, compensation mechanism, pricing mechanism, personnel establishment, income distribution, medical supervision and other institutional mechanisms. Coordinate the optimization of the layout of medical resources, build a reasonable order of medical care, promote social medical care, strengthen personnel training and other work, for the continued deepening of public hospital reform to form a replicable, scalable practical experience.　　(ii) Basic principles.　　Adhere to the reform linkage. Promote the linkage of medical care, medical insurance and medicine, promote the synchronization of reforms in public medical institutions in the region, strengthen the division of labor between public hospitals and primary health care institutions, and coordinate the development of social medical care, create a favorable environment for public hospital reform, and enhance the systematic, holistic and synergetic nature of the reform.　　Adhere to categorized guidance. Clearly define the functional positioning of urban public hospitals, and give full play to their backbone role in the provision of basic medical services and the diagnosis and treatment of acute, critical and difficult illnesses. From a practical point of view, for different regions, different levels, different types of public hospitals, the implementation of differentiated reform policies in the payment of medical insurance, price adjustment, performance evaluation and other aspects.　　Adhere to exploration and innovation. Under the reform direction and principles determined by the central government, localities are encouraged to carry forward the spirit of creativity, boldly explore and innovate, break through policy barriers and interest barriers, and establish institutional mechanisms in line with reality.　　(iii) Basic objectives. To break the profit-seeking mechanism of public hospitals, implement the government's responsibility for leadership, protection, management and supervision, give full play to the role of the market mechanism, and establish a new mechanism for maintaining public welfare, mobilizing enthusiasm and guaranteeing sustainable operation; to build up a rationally arranged and coordinated healthcare system and a hierarchical diagnosis and treatment pattern, and to effectively alleviate the problem of the public's difficulty in accessing medical treatment and the high cost of medical treatment. 2015 will further expand the pilot comprehensive reform of urban public hospitals. Pilot comprehensive reform of urban public hospitals. By 2017, the pilot comprehensive reform of urban public hospitals will be fully implemented, a modern hospital management system will be initially established, the capacity of the medical service system will be significantly improved, the order of medical treatment will be improved, and the proportion of general outpatient visits in urban tertiary hospitals in the total number of visits to medical and health care institutions will be significantly reduced; the irrational growth of medical costs will be effectively controlled, and the increase in total health costs will be coordinated with the increase in the gross domestic product (GDP); public satisfaction will be significantly improved, and the proportion of visits to medical and health care institutions will be significantly reduced. ; the satisfaction of the public has been significantly improved, the burden of medical expenses has been significantly reduced, and overall the proportion of personal health expenditure to total health expenses has been reduced to less than 30%.　　(iv) Basic Path. Establishing a modern hospital management system, accelerating the transformation of government functions, promoting the separation of management and operation, improving the corporate governance structure and governance mechanism, and rationally defining the responsibilities and rights of the government, public hospitals, society, and patients. Establishing a scientific compensation mechanism for public hospitals, with the elimination of the mechanism of compensating doctors with medicines as the key link, and setting aside space for the simultaneous rationalization of the prices of medical services in public hospitals and the establishment of a remuneration system in line with the characteristics of the medical industry by reducing the costs of medicines and consumables, eliminating the increase in the price of medicines, deepening the reform of the payment method of medical insurance, and standardizing the use of medicines and medical behaviors, among other measures. To build a service system for synergistic development, based on capacity building of grassroots services and supported by a division of labor and collaboration mechanism, and to make comprehensive use of legal, social security, administrative and market means to optimize the allocation of resources and to guide reasonable access to medical care.　　Reform of the management system, operation mechanism, service price adjustment, medical insurance payment, personnel management, income distribution and other reforms as a key task, the relevant departments at the national and provincial levels to strengthen guidance, policy support, and will be the relevant authority delegated to the pilot cities.　　Second, the reform of public hospital management system (e) the establishment of efficient government-run medical system. The implementation of the separation of government affairs, a reasonable definition of the government as a funder of the organization and supervision responsibilities and public hospitals as a business unit of the independent operation and management authority. Actively explore various effective forms of realizing the separation of management and operation of public hospitals, clarify the management powers and duties of the government and relevant departments, and build a power operation mechanism with mutual division of labor and checks and balances among decision-making, implementation and supervision. To establish a coordinated, unified and efficient medical system, each pilot city may form a management committee led by a responsible government comrade, and composed of relevant government departments, some NPC deputies and CPPCC members, as well as other stakeholders, to fulfill the government's function of running the medical system, and to be responsible for the public hospital's development planning, charter formulation, implementation of major projects, financial investment, operation supervision and performance evaluation, etc., as well as to specify the office to undertake the management committee's daily work. Administrative departments at all levels should innovate management methods, shift from direct management of public hospitals to industry management, and strengthen the formulation of policies and regulations, industry planning, standards and norms, as well as supervisory and guiding responsibilities. Health planning, education and other departments should actively study and explore the reform of the management system of hospitals affiliated with universities.　　(F) the implementation of the autonomy of public hospitals. Improve the corporate governance structure and governance mechanism of public hospitals, and implement the autonomy of public hospitals in personnel management, internal distribution, operation and management. Take effective forms to establish public hospitals internal decision-making and constraints mechanism, the implementation of major decisions, important cadres, the implementation of major projects, the use of large sums of money to discuss collectively and in accordance with the provisions of the procedure, the implementation of the hospital affairs of the openness of the function of the staff congress, and strengthen the democratic management. Improve the system of selecting and appointing deans, encourage the implementation of the appointment system for deans, highlight the specialized management capacity, and promote the construction of professionalism. Implementing target responsibility assessment and accountability for the tenure of deans. Gradually abolish the administrative hierarchy of public hospitals, and no one in charge of the administrative departments of health planning and sanitation at any level should be permitted to hold concurrent leadership positions in public hospitals. For public hospitals with diversified assets and trusteeship, as well as medical consortia, councils may be set up at the hospital level.　　(vii) Establishment of a public welfare-oriented assessment and evaluation mechanism. Health planning administrative departments or specialized public hospital management agencies to develop performance evaluation index system, highlighting the functional positioning, responsibility fulfillment, cost control, operational performance, financial management, cost control and social satisfaction and other assessment indicators, and regularly organize performance assessment of public hospitals, as well as the dean of the annual and term of the target responsibility assessment, the results of the assessment to the community, and with the hospital's financial subsidies, health insurance payments, payroll, and dean's remuneration, appointment, awards and incentives. The results of the appraisal shall be publicized to the public and linked to the financial subsidies, medical insurance payments, total wages of the hospital, and the remuneration, appointment, removal, rewards and punishments of the dean of the hospital, so as to establish a mechanism of incentive and constraint.　　(viii) Strengthening the refined management of public hospitals. Strengthen the financial and accounting management of hospitals, intensify cost accounting and control, and implement the chief accountant system for three-tier public hospitals. Promote the socialization of logistics services in public hospitals. Strengthening medical quality management and control, standardizing clinical examination, diagnosis, treatment, use of drugs and implant (mediator) class medical equipment behavior. Comprehensively carry out convenient and beneficial services for the public, strengthen the management of appointments and triage, continuously optimize the flow of medical services, and improve the environment and experience of patients in medical treatment. In-depth development of quality nursing services. Optimize the practice environment, respect the labor of medical personnel, and safeguard the legitimate rights and interests of medical personnel. Improve the mediation mechanism, encourage medical institutions and individual physicians to purchase medical liability insurance and other medical practice insurance, and build a harmonious doctor-patient relationship.　　(ix) Improve the multi-party regulatory mechanism. Strengthen the administrative departments of health and family planning (including Chinese medicine management) medical services regulatory functions, unified planning, unified access, unified supervision, the establishment of localized, industry-wide management system. Strengthen the accounting supervision of the economic operation and financial activities of hospitals, and enhance audit supervision. It has strengthened the disclosure of hospital information, established a system of regular public announcements, utilized information systems to collect data, and focused on disclosing information on financial status, performance evaluation, quality and safety, prices and medical costs. Information related to public hospitals above the second level is released to the public annually. Give full play to the role of medical industry associations, societies and other social organizations, strengthen industry self-discipline, supervision and professional ethics, and guide medical institutions to operate in accordance with the law and exercise strict self-discipline. Give full play to the supervisory roles of the National People's Congress, supervisory and auditing authorities, as well as at the social level. Explore the evaluation of public hospitals by third-party professional organizations to strengthen social supervision.　　Third, the establishment of new mechanisms for the operation of public hospitals (10) to eliminate the mechanism of medicine for medicine. All public hospitals in the pilot cities to promote the separation of medicine, and actively explore a variety of effective ways to reform the mechanism of medicines to compensate for medical care, abolish the drug markup (except for traditional Chinese medicine tablets). A scientific and reasonable compensation mechanism has been established by adjusting the price of medical services, increasing government investment, reforming payment methods, and reducing hospital operating costs. The costs of storage, safekeeping and wear and tear of medicines in hospitals are included in the running costs of hospitals to be compensated. Comprehensive measures have been taken to cut off the chain of interests between hospitals and medical personnel and medicines, to improve the system for controlling medicine costs, and to strictly control unreasonable increases in medicine costs. In accordance with the approach of total control and structural adjustment, the income structure of public hospitals will be changed, the proportion of technical labor income in business income will be increased, and the proportion of income from medicines and sanitary materials will be lowered, so as to ensure the benign operation and development of public hospitals. Strive to reduce the proportion of drugs (excluding traditional Chinese medicine tablets) in public hospitals in pilot cities to about 30% overall by 2017; and reduce the sanitary materials consumed in 100 yuan of medical income (excluding drug income) to less than 20 yuan.　　(xi) Reducing the costs of medicines and medical consumables. Reform the way drug prices are regulated, and standardize the price behavior of high-value medical consumables. Reduce the circulation of medicines and medical consumables, and regulate the circulation of business and the autonomous pricing behavior of enterprises. Fully implement the Guiding Opinions of the General Office of the State Council on Improving the Centralized Purchasing of Medicines for Public Hospitals (Guo Ban Fa [2015] No. 7), and allow pilot cities to conduct their own purchases on provincial centralized purchasing platforms for medicines on a city-by-city basis, in accordance with the principles of facilitating the mechanism of eliminating medicines as a substitute for medical treatment, lowering the exorbitant prices of medicines, preventing and curbing corruptive practices, and promoting the integration and reorganization of enterprises engaged in the production and distribution of medicines. The transaction price in the pilot cities shall not be higher than the winning price at the provincial level. If the transaction price in the pilot city is significantly lower than the provincial winning price, the provincial winning price shall be adjusted according to the transaction price in the pilot city. Inter-provincial cross-regional, specialized hospitals and other joint procurement can be practically encouraged. High-value medical consumables must be purchased through the provincial centralized purchasing platform for sunshine, online public transactions. Encourage the procurement of domestic high-value medical consumables under the premise of quality assurance. Strengthening the supervision of drug quality and safety, strict market access and drug registration and approval, and guaranteeing the supply and distribution of drugs and quality and safety. Various forms have been adopted to promote the separation of medicines, with patients being able to independently choose to purchase medicines at hospital outpatient pharmacies or at retail pharmacies with a prescription. Strengthening the rational use of drugs and prescription supervision, taking the form of prescription negative list management, prescription review and other forms of control of the irrational use of antibacterial drugs, and strengthening the clinical use of hormone drugs, antitumor drugs, and auxiliary drugs to intervene.　　(XII) rationalizing the price of medical services. Under the premise of ensuring the benign operation of public hospitals, the affordability of health insurance funds, and the overall burden on the masses will not increase, the pilot cities should formulate and introduce a reform program for the price of medical services in public hospitals in 2015. After scientific calculations, in reducing the cost of drugs, medical consumables and the abolition of drug markups at the same time, reduce the price of large-scale medical equipment inspection and treatment, and reasonably adjust and raise the price of medical services reflecting the value of medical personnel's technical labor, especially the price of diagnosis and treatment, surgery, nursing care, beds, traditional Chinese medicine and other service items. Reform the price formation mechanism, gradually reduce the number of medical service items priced by item, and actively explore pricing by type of disease and by service unit. The price relationship between medical institutions at different levels and medical service items will be gradually rationalized, and a dynamic price adjustment mechanism based on changes in cost and revenue structure will be established. Large-scale equipment purchased by public hospitals with government investment shall be priced according to the cost of examination after deduction of depreciation; for large-scale equipment purchased with loans or pooled funds in line with planning and relevant policies, the government shall buy back the equipment at the price of the equipment after deduction of depreciation, and reduce the price of the examination in the event that there are difficulties with the buyback for a limited period of time. Policies on medical service prices, health insurance payments, and hierarchical diagnosis and treatment should be interconnected. Strengthen the supervision of medical prices, establish price monitoring and early warning mechanisms, and promptly prevent price variations. Increase the investigation and handling of price monopolization and fraud and other illegal acts.　　(M) the implementation of government investment responsibility. Governments at all levels should implement the public hospitals in line with regional health planning, capital construction and equipment purchases, the development of key disciplines, personnel training, in line with the national provisions of the cost of retirees and policy loss subsidies and other inputs, public hospitals to undertake public **** health tasks to give special subsidies to ensure that the government-designated emergency treatment, disaster relief, foreign aid, support for agriculture, support for the border and urban and rural hospitals to support each other, and other public **** service Funding. Implement policies that favor investment in specialized hospitals such as Chinese medicine hospitals (ethnic hospitals), infectious disease hospitals, psychiatric hospitals, occupational disease prevention and treatment hospitals, maternity hospitals, children's hospitals, and rehabilitation hospitals. Reform the method of financial subsidies, and strengthen the linkage between financial subsidies and the results of performance appraisals of public hospitals. Improve the mechanism of government-purchased services.　　(d) Strengthening the role of medical insurance payment and monitoring (xiv) Deepening the reform of medical insurance payment methods. Give full play to the fundamental role of basic medical insurance, strengthen the budget of income and expenditure of the medical insurance fund, and establish a composite payment method mainly based on payment by disease, payment by headcount, payment by service unit, etc., and gradually reduce the payment by item. The implementation of payment by disease diagnosis-related groups (DRGs) is encouraged, and the reform of health insurance payment methods should cover all public hospitals in the region in 2015, and gradually cover all medical services. Clinical paths will be formulated by comprehensively considering factors such as the quality and safety of medical services and basic medical needs, and the management of clinical paths will be accelerated. By the end of 2015, the number of cases in pilot cities implementing clinical pathway management should reach 30% of the number of cases discharged from public hospitals, and the number of diseases for which payment is made on a case-by-case basis should be expanded simultaneously, as well as the coverage of hospitalized patients paying on a case-by-case basis, with no fewer than 100 diseases for which payment is made on a case-by-case basis. Accelerating the establishment of open and equal negotiation and consultation mechanisms and risk-sharing mechanisms between various types of medical insurance operators and designated medical institutions. Give full play to the role of various types of medical insurance in regulating, guiding and supervising the behavior and costs of medical services, effectively controlling medical costs, and gradually extending the supervision of medical insurance on the services of medical institutions to the supervision of the behavior of medical services of medical personnel. Utilizing the expertise of commercial health insurance companies and playing their role as third-party purchasers to help alleviate the problems of asymmetry of information between doctors and patients and conflicts between doctors and patients.　　(xv) Gradually improving protection performance. Gradually raise the level of medical insurance coverage and gradually narrow the gap between the proportion of hospitalization expenses paid within the policy scope and the proportion of actual hospitalization expenses paid. On the basis of standardizing daytime surgery and Chinese medicine non-pharmaceutical diagnostic and treatment techniques, gradually expanding the scope of daytime surgery and Chinese medicine non-pharmaceutical diagnostic and treatment techniques, such as Chinese medicinal preparations, acupuncture and moxibustion, and therapeutic tui-na and other Chinese medicine techniques that are included in the payment of medical insurance, and encouraging the provision and use of appropriate Chinese medicine services. Establishing a system of emergency relief for illnesses. Fully implement major disease insurance for urban and rural residents. Promoting the development of commercial health insurance. Strengthening the connection between basic medical insurance, major disease insurance for urban and rural residents, employee supplemental medical insurance, medical assistance, commercial health insurance and other protection systems, so as to further reduce the burden of medical expenses on the public.　　V. Establishing a personnel and salary system in line with the characteristics of the medical industry (16) Deepening the reform of the establishment and personnel system. Within the existing local total establishment, the total number of reasonably approved public hospitals, innovative public hospitals organization and establishment management, and gradually implement the establishment of the filing system, the establishment of a dynamic adjustment mechanism. In terms of job setting, income distribution, title evaluation, management and utilization, the treatment of personnel inside and outside the establishment will be considered in an integrated manner, and the reform of the pension insurance system will be promoted in accordance with national regulations. The implementation of the employment system and job management system, personnel from the identity management to job management change, the fixed number of fixed posts is not fixed personnel, the formation of the ability to enter and exit, can be up and down the flexible employment mechanism. The implementation of the autonomy of public hospitals, hospitals in short supply, high-level talent, according to the provisions of the hospital to be recruited by way of inspection, the results are public.　　(xvii) Reasonably determine the level of remuneration for medical personnel. According to the characteristics of the medical industry, such as long training cycle, high occupational risk, technical difficulty, heavy responsibility, etc., the relevant state departments shall accelerate the study and formulation of the salary reform program in line with the characteristics of the medical and health care industry. Before the introduction of the program, pilot cities can first explore the development of public hospitals total performance pay approved methods, focusing on reflecting the value of the technical labor of medical personnel, and reasonably determine the level of income of medical personnel, and establish a dynamic adjustment mechanism. Improve the performance pay system, public hospitals through the scientific performance appraisal of independent income distribution, to do more work more pay, merit pay, focusing on the clinical front line, business backbone, key positions, as well as to support the grassroots and outstanding contributions to the personnel tilted, and reasonably open the income gap.　　(xviii) Strengthening the performance appraisal of medical personnel. Public hospitals are responsible for internal assessment, rewards and punishments, highlighting job workload, service quality, code of conduct, technical ability, medical ethics and patient satisfaction, and linking the assessment results to the employment of medical personnel, promotion of titles and individual remuneration. Improve the management of medication in public hospitals, and strictly control the unreasonable use of high-value medical consumables. It is strictly prohibited to set income-generating targets for medical personnel, and the personal remuneration of medical personnel shall not be linked to the business income of hospitals from drugs, consumables and large-scale medical examinations.　　Sixth, the construction of various types of medical institutions synergistic development of the service system (19) optimize the planning and layout of urban public hospitals. In accordance with the "General Office of the State Council on the issuance of the National Medical and Health Care Service System Planning Outline (2015-2020) Notice" (State Office of the State Council [2015] No. 14) requirements as well as the province (autonomous regions and municipalities), health resource allocation standards, and combined with the service population and service radius, the level of urbanization and development and changes in the medical needs of the masses, the development of regional health planning, Talent team planning and medical institution setup planning. National and provincial health planning departments and relevant departments shall strengthen guidance and coordination, and incorporate all aspects and levels of medical and health resources in the region into the planning for overall consideration. The implementation of planning should be taken as the basis for hospital construction, financial input, performance assessment, medical insurance payment, staffing, bed setting, etc., to enhance the binding force of planning, and regularly publicize the implementation of planning to the community. Strictly control the size of public hospital beds, construction standards and large-scale medical equipment, public hospitals exceeding the size of the standard, to take comprehensive measures to gradually compress the beds. Public hospitals to prioritize the allocation of domestic medical equipment. Public hospitals are strictly prohibited from incurring debt for construction and over-standard renovation. Control the scale of special needs services in public hospitals, the proportion of providing special needs services does not exceed 10% of all medical services.　　(xx) Promoting the participation of social forces in the reform of public hospitals. In accordance with regional health planning and medical institution setup planning, the number, layout and structure of public hospitals will be rationally controlled, and social forces such as enterprises, charitable organizations, foundations and commercial insurance institutions will be encouraged to run medical institutions, so as to expand the total amount of health resources. Encourage the relocation, integration, transformation and other ways to transform some of the city's second-tier hospitals into community health service organizations, specialized hospitals, elderly care and rehabilitation institutions. Social forces are encouraged to invest in medical care in various forms, such as funding new construction and participating in restructuring, and priority is given to supporting the organization of non-profit medical institutions. Public hospitals in resource-rich cities, can choose some public hospitals to introduce social capital for restructuring pilot, strengthen the assessment of tangible and intangible assets, to prevent the loss of state-owned assets, to adhere to the standardized and orderly, strong supervision, to ensure openness and fairness, and safeguard the legitimate rights and interests of employees.　　(xxi) Strengthening the mechanism of division of labor and collaboration. Guiding public hospitals at all levels to establish a division of labor and collaboration mechanism with clear objectives, powers and responsibilities with primary healthcare institutions, and strengthening communication and collaboration between public hospitals and specialized public **** health institutions. Guided by the need to enhance the capacity of primary medical and health care services, and using business, technology, management and assets as ties, various modes of division of labor and collaboration, including medical consortia, are being explored, management and operation mechanisms are being improved, and orderly competition is being guided. Mutual recognition of medical examination and test results among medical institutions at the same level should be implemented under the premise of unified quality control standards. Integration and use of existing resources can be explored to set up specialized medical imaging, pathology diagnostic and medical testing medical institutions, and to promote the use of large-scale medical equipment between medical institutions **** enjoy.　　(xxii) Strengthening the training of human resources and enhancing service capacity. Promote the synergistic development of medical education and research. 2015, the pilot cities shall implement standardized training of resident physicians, and in principle, all urban public hospitals shall receive standardized training of resident physicians for new clinical physicians with bachelor's degree or above in medical positions. Actively expanding the scale of training in general medicine and pediatrics, psychiatry and other urgently needed and scarce specialties. Promote the establishment of general medicine departments in tertiary general hospitals. Promote the establishment of a system of standardized training for specialists, and strengthen the training of backbone doctors and the construction of key clinical specialties in public hospitals. Strengthening the relevance and effectiveness of continuing education, innovating education modes and management methods, and enhancing comprehensive professional quality education and business technology training. Strengthen the vocational training of public hospital directors. Explore the establishment of a talent evaluation system that is demand-oriented and focuses on medical ethics, competence and performance.　　VII. Promoting the establishment of a hierarchical diagnosis and treatment system (23) Building a hierarchical diagnosis and treatment service model. Promote the center of gravity of medical and health care work to move down, medical and health care resources sinking. In accordance with the national policy requirements for the establishment of a graded diagnosis and treatment system, a graded diagnosis and treatment model of primary-level first diagnosis and treatment, two-way referral, emergency and slow treatment, and up-and-down linkage has been constructed in pilot cities. Primary-level first diagnosis will be implemented, with primary-level medical and health-care institutions providing basic medical care and referral services, focusing on the role of general practitioners, and promoting contracted services for general practitioners. Gradually increasing the number of appointments and referral services provided by urban public hospitals through primary medical and healthcare institutions and general practitioners, with higher-level hospitals giving priority to patients who have made appointments or referrals through primary medical institutions and general practitioners in terms of receiving consultations, examinations and hospitalization. By the end of 2015, the proportion of appointments and referrals in outpatient visits to public hospitals should be increased to more than 20%, reducing the number of general outpatient visits to tertiary hospitals. To improve two-way referral procedures, localities should formulate entry and exit standards for common diseases and two-way referral standards, and realize orderly referral between medical institutions of different levels and categories, with an emphasis on smoothing channels for downward referral of patients, and encouraging higher-level hospitals to issue treatment plans for treatment to be carried out in lower-level hospitals or grassroots medical and health institutions. The formation of a pattern of separate treatment for acute and chronic diseases will be promoted, a scientific and reasonable mechanism for the division of labor and collaboration between hospitals, primary healthcare institutions and long-term care facilities for chronic diseases will be established, and the interface between primary healthcare institutions and public hospitals in the procurement and use of medicines will be strengthened. Medical teams can be formed by tertiary hospital specialists and primary care general practitioners and nursing staff to manage and guide downwardly transferred patients with chronic diseases and in recovery. Promoting and regulating the multi-disciplinary practice of physicians, and facilitating the sinking of high-quality medical resources to the grassroots.　　(xxiv) Improving medical insurance policies that are compatible with hierarchical diagnosis and treatment. by the end of 2015, pilot cities should take into account the advancement of hierarchical diagnosis and treatment, and clarify medical insurance payment policies that promote hierarchical diagnosis and treatment. For those who do not follow the referral procedure, the proportion of medical insurance payment will be reduced or not paid according to the regulations. Improve the differentiated payment policies for different levels of medical institutions. Appropriately widen the gap between the starting line and payment ratio of different levels of medical institutions, and continuously calculate the starting line for patients referred for hospitalization in accordance with the regulations.　　(viii) Accelerating the construction of medical and healthcare informatization (xxv) Strengthening the construction of regional medical and healthcare information platforms. It will build a comprehensive regional population health information platform, establish dynamically updated standardized electronic health records and electronic medical records databases, improve technical standards and security protection systems, gradually realize operational synergies between residents' basic health information and the application systems for public *** health, medical services, medical insurance, drug management, and comprehensive management, and promote the docking of systems for medical and health care, medical insurance, and drug management, as well as the sharing of information***, and promote the establishment of comprehensive supervision, scientific decision-making, and the establishment of a comprehensive medical and health care information platform. and promote the establishment of a new model of comprehensive supervision, scientific decision-making and fine services. by the end of 2015, all public hospitals above the second level and more than 80% of primary medical and healthcare institutions in the administrative area will be docked with the regional platform.　　(xxvi) Promoting the construction and application of medical information systems. Strengthening the construction of information technology in medical and healthcare institutions, and enhancing the application of information technology standards and data security management. Comprehensively implementing the action plan for benefiting the public with healthcare information, facilitating residents' booking of medical appointments, time-slot medical consultations,**** enjoyment of test and examination results, payment between consultations and instant settlement of medical insurance fees, and facilitating drug retailers' verification of patient-provided physician's prescriptions through online information systems. Relying on the support of big data, performance evaluation and quality supervision of medical and health services will be strengthened. Strengthening the construction of telemedicine systems, reinforcing remote consultation, education and other service functions, and promoting the enjoyment of high-quality medical resources*** By the end of 2015, docking with the national drug electronic supervision system will be realized, and the electronic supervision code for drugs will be actively carried out for verification and cancellation; all pilot cities will basically complete the construction of informatization standards for all hospitals above the second level, and 60% of primary healthcare institutions will establish telemedicine with higher-level hospitals. IX.　　Nine, strengthen the organization and implementation (27) clear schedule. The governments of the pilot regions should take into account the actual situation and introduce specific implementation programs for the reform in a timely manner. Clearly define the roadmap and timetable for the reform, grasp the key tasks, priorities and ways of promoting the reform, and achieve scientific measurement, categorization, pragmatic operation and breakthroughs. The establishment of the pilot area of the national, provincial and municipal public hospital reform linkage mechanism to ensure that all public hospitals in the pilot area are included in the scope of the reform to promote the overall. The counties and county-level cities under their jurisdiction should promote the reform in accordance with the national policy requirements on comprehensive reform of county-level public hospitals. Comprehensive healthcare reform pilot provinces should take the reform of urban public hospitals as the top priority of the reform, strengthen organizational leadership, policy guidance and supervision and promotion, make new breakthroughs in institutional mechanism innovation, and promote comprehensive reforms of healthcare security, healthcare services, drug supply, public **** health, and regulatory system, to take the lead in achieving the overall goal of healthcare reform.　　(xxviii) Strengthening organizational safeguards. Each region should take the public hospital reform as an important element of the local comprehensive deepening of reform, the main leader of the pilot city is responsible for the overall responsibility, the leaders in charge of specific responsibility, around the public hospital reform policy, decomposition of the work task, clear responsibilities of various departments, responsibility to ensure the implementation. National and provincial levels should also clarify the division of tasks, health planning, finance, development and reform, price, preparation, human resources and social security, traditional Chinese medicine, education and other relevant departments in their respective areas of responsibility, to further emancipate the mindset, strengthen the support and guidance of local pilot, improve supporting reform measures, close coordination, integrated promotion.　　(XXIX) strengthen supervision and evaluation. Provinces (autonomous regions and municipalities) should establish supervision, assessment, evaluation and accountability mechanisms to urge the pilot cities to promote the reform tasks as a whole, and incorporate public hospital reform into the performance assessment of the pilot city governments. Relevant departments should strengthen their guidance on the pilot reform of urban public hospitals, and formulate an index system for evaluating the effectiveness of the reform. Explore third-party evaluation of the reform effect in pilot cities. The establishment of pilot city reform to promote the situation of regular notification and exit mechanism, the reform of lagging areas to the provincial people's government notification and accountability, recovery of the relevant subsidies.　　(xxx) Summarize and publicize in a timely manner. All relevant departments should closely track the progress of work, summarize experience in a timely manner, and study and solve problems arising from the reform. For relatively mature reform experience, it is necessary to speed up the promotion and application. Vigorously publicize and interpret the policies and measures of the reform, increase positive publicity, reasonably guide public opinion and the expectations of the masses, cohesion *** knowledge, enhance confidence, and create a favorable atmosphere for reform. It has done a good job of publicity and mobilization of medical personnel, explored and publicized advanced models, and mobilized the enthusiasm and initiative of the majority of medical personnel to participate in the reform. Carry out policy training for local governments at all levels, leading cadres of relevant departments and managers of public hospitals to improve the level of policy and implementation to ensure the smooth progress of the reform.