Jiangbei G Office [2018] No. 16

Subdistrict offices, the People’s Government of Cicheng Town, and all departments and direct subordinate units of the People’s Government of Jiangbei District,

The following suggestions are put forth with the purpose of further promoting the comprehensive, coordinated and sustainable development of the medical service market in Jiangbei District, deepening the reform of the medical and health system and enhance the quality of urban agglomeration effect, encouraging and promoting social capital to enter the medical and health care field so as to develop a multi-level and diversified pattern of medical system for the economic and social development and for meeting the needs of the mass public in accordance with the spirit of the documents of Several Suggestions on Further Encouraging and Guiding Social Capital to Invest in Medical Institutions by Ningbo Municipal People’s Government (Ningbo G [2014] No. 105) and the Announcement of Printing and Releasing the Pilot Project Scheme for Deepening the Reform of the Medical and Health System (Ningbo G [2016] No. 96).

I. General Requirements

To fully implement the spirit of the 19th Session of National Congress of the Communist Party of China, and Health Conferences held in Ningbo, in Zhejiang Province and in China. To optimize the structure layout, vigorously develop medical institutions that are invested with social capital and promote the orderly competition, mutual promotion and common development of public medical institutions and private medical institutions under the guideline of developing a “Healthy Jiangbei” with innovative social management mechanism being the motivation while insisting in the principle of overall planning, improving policies, improving quality, supervising and standardizing in accordance with the law. Till Year 2020, the overall size and the development level of private medical institutions in Jiangbei would be highly improved and the number of beds with private medical institutions would account for more than 50% of the total number of beds with those directly subordinate medial institutions in Jiangbei.

II. To relax the scope of access and expand the supply of medical services

1. To give the priority to social capital in the field of medical services

To fully analyze the demand for and the supply of medical services, to put forth the document of the Planning for Arrangement of Medical Institutions in Jiangbei District, to make sure the positioning of public medical institutions and to reserve at least 1.5 beds for 1,000 local citizens. To further open the medical service market and increase or adjust medical and health care resources when needed and social capital would be given the priority to invest in medical institutions. To encourage social capital to invest in Cicheng Town and rural subdistricts that are lacking in medical resources and relevantly week in providing medical services.

2. To guide social capital to invest in a variety of medical institutions with characteristic medical services

To actively support and strengthen the existing private medical institutions by way of resources integration, group management, and trusteeship development and so on so as to provide guidance for professional private medical institutions of ophthalmology, rehabilitation, obstetrics and gynecology, etc. to develop “more professional, more perfect, more outstanding and stronger” and to develop a group of regional private medical specialty brands with strong technical capabilities, quality services and good social reputation. To introduce more social capital for the investment of medical institutions and give priority to the development of specialized private hospitals with prominent scale, distinctive features and prominent medical technology advantages, and properly control repeated construction of “low, small and scattered” private medical institutions. To develop private medical service institutions, such as independent medical imaging and medical disinfectant medical center, etc., and to encourage various kinds of medical cooperation between public medical institutions and private medical institutions by ways of trusteeship, private operation of public ones and public assistance for private ones.

3. To simplify the procedure of the approval of applications for social investment in setting up medical institutions

To improve administrative assessment and approval system, to develop an open, applicant-convenient, highly effective and standard assessment and approval working mechanism, and to file up a directory for projects of medical institutions with social investments. In case qualified, relevant governmental departments of civil affairs, human resources and social security, health care and market supervision are supposed to approve applications as soon as possible. Non-profit and profit-making private medical institutions with total social investment, or those profit-making private medical institutions that are turned from non-profit private medical institutions are supposed to reapply for reopening after liquidation and cancellation of registration, and relevant application materials be submitted to the former assessment and approval department for reassessment and approval in accordance with relevant laws and regulations. The application for turning an original profit-making medical institution into a non-profit one is also allowed and once approved, the relevant state prices and tax policies shall be implemented.

III. To implement supporting policies and create a favorable environment for development

1. To improve the system for land use and credit guarantee

According to the planning and the annual development plan, the land and resources department shall give the priority to social capital investors to apply their favorable land for setting up private medical institutions. As for providing land to non-profit private medical institutions, they are able to enjoy the land just assigned by the local government department. While as for those profit-making private medical institutions, they are able to get the land through bidding, auction and listing. The land acquired upon payment through bidding, auction and listing would be certified as the land for commercial service purposes. The identity and use of the land shall not be changed, transformed or partially transferred (sublet) without pre-application and approval. Social capital is also encouraged to make full use of the existing land and buildings of abandoned factory shops, schools, commercial facilities and rural collective houses to develop their medical institutions and are able to appropriately increase the plot ratio and building density appropriately upon paying the land transfer cost in accordance with relevant regulations, in case not conflicted with relevant planning. The profit-making private medical institutions can make use of the bought fixed assets, such as land use right and property right, to provide guarantee for their own debts, and apply for mortgage loan, and the departments of land and resources and housing administration shall go through the formalities of mortgage registration. To support private medical institutions to raise funds for construction and development by means of equity financing and project financing. To support qualified private medical institutions to raise fund through getting to be listed and from bond issues. To strengthen credit guarantee and actively encourage and guide guarantee institutions to carry out credit guarantee businesses for qualified private medical institutions.

2. To implement the tax and price policy for private medical institutions

Private medical institutions shall enjoy the same price for use of electricity, water and gas with those public ones. The cost for medical services that are provided by private medical institutions are market adjusted prices. Profit-making private medical institutions are allowed to set up their own detailed prices for their own medical services, while non-profit private medical institutions are able to formulate their own detailed specific prices but for only those services that are the same with those of public medical institutions. Sales of medicine shall apply the relevant existing policies. The tax reduction and exemption policy for private medical institutions shall be implemented in accordance with relevant regulations.

Social capital investment in medical institutions construction projects will be reduced by half of the engineering quota measurement fee and municipal solid waste disposal fee. For non-profit private medical institutions, they are exempted from supporting fee for urban construction and urban afforestation compensation cost. Private medical institutions also have access to telephone calls, cable (digital) TV and broadband Internet access for free. While the maintenance fee of cable (digital) TV shall be no higher than 50% of the cost for the maintenance of terminals of local citizens.

3. To equally enjoy the policies of government purchase services and social security

To bring the eligible private medical institutions into the designated institutions of the public health service project to undertake public health services such as the government's mandatory health examination, kids’ pit and fissure sealing, and services for pregnancy and parturition in rural areas in accordance with requirements of setting up prices for different paid services on social undertakings that are made by the government institutions. Government institutions are able to purchase services by way of buying “service coupons and experience coupons” and service takers are able to choose their own favorable medical service providers. Private medical institutions are able to enjoy subsidies in case undertaking treatments of public health emergencies that are caused by incidents of major infectious diseases, accidents and disasters or social security incidents, as well as medical and health care supports for rural citizens and those in border areas, counterpart medical support and the first aid green treatment.

Departments of civil affairs, human resources and social security, and health care and family planning are supposed to include those qualified private medical institutions into the service scope of the basic medical insurance of the workers, the basic medical insurance of urban and rural residents, the insurance of industrial injury, the birth insurance, the urban and rural medical assistance and so on. Such private medical institutions are allowed to enjoy the same equal access to these insurance systems just like those public medical institutions. When the medical insurance department and those qualified included private medical institutions settle accounts, the same payment policy will be implemented with the public medical institutions. The entire medical personnel of private medical institutions are to be recruited by personnel agencies, and those personnel with or above medium grade professional titles from those private medical institutions with above designated scale as is required by the document of Several Suggestions on the Promotion of Standards of Social Medical Institutions and the Development of Private Medical Institutions by Ningbo Municipal People’s Government (Ningbo G [2005] No. 45) are able to apply for the endowment insurance for employees of public institutions in accordance with relevant regulations upon approval. For detailed information, please refer to the document of Suggestions for the Reform of the Endowment Insurance for the Employees of Government and Public Institutions by Zhejiang Provincial Department of Human Resources and Social Security and Zhejiang Provincial Financial Department (Zhejiang Human Resources & Social Security [2015] No. 153).

IV. To carry out policies of rewards and subsidies and to encourage private medical institutions to develop bigger and stronger

1. Self-built buildings and discipline construction are to be rewarded

As for private comprehensive medical hospitals (including nursing homes for the aged) who have self-built (or self-bought) buildings with more than 200 beds for patients each and those private characteristic medical hospitals with more than 50 beds each (dental hospitals with 30 dental chairs each), the following subsidies can be enjoyed in case the use rate of the beds is higher than 50% annually after its opening upon the acquisition of the Medical Practicing License: as for those newly built hospitals, upon the first application, a one-time subsidy of 40 thousand yuan would be granted for each actually opening bed. As for those old hospitals but having new opening beds, a one-time bonus of 20 thousand yuan would be granted for each actually opening bed. The subsidies would be borne by the municipal and district finance department at a ratio of 30% and 70% respectively. One medical resource, one subsidy only.

Special subsides would be granted by the district finance department to private medical institutions whose medical disciplines are listed as key disciplines and key specialist projects, those who have set up academician workstations, those who boast scientific and technological planning projects that are certified by the science and technology administration department and health care and family planning department, those who have introduced leading innovators and talents and medical staff who have been entitled as outstanding discipline leaders or middle-age and youth health care technicians and so on. Detailed rewarding measures would be put forth by the health care and family planning department, together with relevant departments of science and technology, finance and human resources and social security.

2. Level-upgraded hospitals are to enjoy subsidies

In case a private medical institution passes the provincial or national evaluation and assessment and upgrades into a higher level, one-time subsidies of different amounts would be granted in accordance with different levels that hospitals have been upgraded into. The subsidy standards for private comprehensive hospitals and private TCM hospitals would be the same with those of public hospitals of levels of Grade A of the Secondary Level, Grade B of the Third Level and Grade A of the Third Level and the subsidies amounts would be 5 million yuan, 10 million yuan and 20 million yuan accordingly. As for the private characteristic hospitals, the subsidy standards would refer to those of the public hospitals of Grade A of the Secondary Level, Grade B of the Third Level and Grade A of the Third Level, granting 10 thousand yuan, 20 thousand yuan and 30 thousand yuan for each opening bed for patients respectively. The number of actual opening beds would be counted exactly the number of beds opened to patients at the end of the year right before level assessment and evaluation. Though level upgraded, no more new beds added outnumbering the supposed number of beds of the new level, no new subsidy would be granted. The subsidies would be borne by the municipal and district finance department at a ratio of 30% and 70% respectively.

3. A special reward would be granted for favorable development

To set up a special rewarding fund for subsidizing those private medical institutions with favorable development. A special district subsidy would be granted to those private comprehensive medical hospitals with more than 200 beds for patients each, those private characteristic medical hospitals (including nursing homes for the aged) with more than 50 beds each (dental hospitals with 30 dental chairs each) and those private rehabilitation hospitals with 100 beds or more, all of those with the use rate of their beds for patients over 75% and tremendous increases in outpatient visits and total business income. Detailed measures for the annual special fund would be worked out soon.

V. To improve the working environment for medical staff and to strengthen the development of health care staff and medical technicians

1. To explore the guarantee mechanism for the operation of private medical institutions

To explore developing a unified registration administration system for private non-profit medical institutions as public institutions. To carry out the pilot development of a unified registration administration system among private non-profit medical institutions as public institutions and to encourage qualified private non-profit medical institutions to register as the legal person of a public institution in accordance with the document of the Guidance and Suggestions for Pilot Development of Unified Registration Administration Systems and for the Promotion of the Development of Private Public Welfare Undertakings by the General Office of Zhejiang Provincial People’s Government (Zhejiang G Office [2016] No. 14) so as to develop an integrated, mutual beneficial and fair-competition employment environment for medical institutions, both private non-profit and public.

2. To improve the two-way flow mechanism for health care and technicians of the medical service providing industry between public hospitals and private medical institutions

To encourage doctors with public medical institutions to go and provide health care services in government-supported private medical institutions. In case those staff, registered with public medical institutions, want to work for private medical institutions, their employment contracts with the public medical institutions are supposed to be cancelled before they sign contracts with private ones. Such changes are required to submitted to the local human resources and social security bureau in documents for record and later references. In case these doctors want to go back to the public medical institutions, they are allowed when there are vacancies for their specialty after they are approved by the public medical institutions that they want to return to, and local health care and family planning department as well as the local human resources and social security department. To actively encourage private medical institutions to establish a system of an annuity and other supplementary insurances for their medical staff and to further improve their retirement benefits.

3. To develop a better environment for the medical staff of private medical institutions to have access to further education and scientific researches

The private medical institutions have equal treatment with the public medical institutions in the construction of key clinical subjects, clinical teaching bases in medical colleges and the standardized training bases for residents. The personnel of the private medical institutions enjoys equal treatment in the evaluation of professional titles, participation in academic activities and business competitions, scientific research projects and the appraisal of their achievements and relevant evaluations for outstanding titles, and equally enjoys the rights of leading positions in the industrial associations and academic organizations in accordance with their academic and professional abilities.

VI. To provide guidance for standardized employment for a sustainable and healthy development

1. To improve the management system. The internal management system of private medical institutions should be improved, and the disclosure system of information on medical services, such as medical service items, processes, standards, medical personnel qualification, medical service charge standard, drug price and so on, is supposed to be established for the public. Private medical institutions carry out accounting and financial management in accordance with regulations, and improve risk prevention and control mechanisms. The non-profit private medical institutions should give full play to the role of audit supervision of accounting firms and other intermediary organizations.

2. To practice strictly in accordance with the law. The private medical institutions should carry out the management system according to the corresponding grade hospital standards and carry out the practice activities in accordance with the laws and regulations, and accept the supervision and inspection of the relevant departments. The private medical institutions should provide the patients with the approved medical services in accordance with the necessary clinical principles, control the medical expenses reasonably, and strictly prohibit the induction of medical and excessive medical treatment. Any improper profit making and damage to patients' legitimate rights and interests should be punished by relevant functional departments.

3. To strengthen public responsibilities. The private medical institutions should adhere to the humanitarian spirit of saving death and injury, adhere to the belief taking patients as the center, and strengthen the construction of medical ethics and the humanistic spirit education of the medical staff. To encourage private medical institutions to give back to society by setting up relief funds, promoting free consultation and charitable donations and to encourage the establishment of industrial associations of private medical institutions, to strengthen self-discipline, and to consciously promote the construction of industry integrity and maintain a fair competitive market environment.

VII. Safeguards

1. To strengthen organization and leadership. All departments and all sub-districts and towns in Jiangbei shall fully recognize the importance of accelerating the development private medical institutions, put it on their agenda as an important thing to do, strengthen organizational leadership, make clear responsibilities and detailed assignments, make joint efforts for a stronger force to promote the sustainable, rapid and healthy development of private medical institutions.

2. To strengthen supporting policies. Relevant functional departments of public sector reform, development and reform, civil affairs, finance, human resources and social security, health care and family planning, market supervision and land resources are supposed to work out and modify regulations and policies for the healthy development of private medical institutions in accordance with their own duties and responsibilities, so as to provide powerful support for the healthy development of private medical institutions.

3. To strengthen supervision and management. The health care and family planning department shall perform the regulatory functions over overall planning, access supervision, project setting, and practice behaviors and implement non differential management of the whole industry for a standardized and healthy development of private medical institutions. Other relevant departments shall manage and provide services according to their respective functions. In case any illegal medical treatment or unallowed services, private medical institutions would be punished and disqualified from the special financial subsidy.

This policy takes effect since March 30, 2018.

General Office, the People’s Government of Jiangbei District, Ningbo

February 28, 2018