The people's governments of the districts, cities and counties, the administrative committees of the pilot zones, the relevant departments of the municipal government and the relevant units:
With the consent of the municipal government, the implementation plan for the reform of the division of financial powers and expenditure responsibilities in the medical and health field between the city and the district, city and county ( pilot area ) is hereby printed and distributed to you.                       
Dalian Municipal People's Government Office
December 26, 2018
City, District, City and County in Medical and Health Field ( Pilot Area )
Implementation Plan of Reform on Division of Financial Responsibility and Expenditure Responsibility
In order to implement the spirit of the Circular of the General Office of the State Council on Printing and Distributing the Reform Plan of Central and Local Fiscal Responsibility and Expenditure Responsibilities in the Field of Health Care ( Guo Ban Fa [ 2018 ] No. 67 ), and in accordance with the Implementation Opinions of Dalian Municipal People's Government on Promoting the Reform of Fiscal Responsibility and Expenditure Responsibilities of Cities, Districts, Cities and Counties ( Pilot Districts ) ( No. 26 of Da Zheng Fa [ 2018 ] ), and in the light of the actual situation in our city, the following implementation plan is hereby formulated for the reform of fiscal responsibility and expenditure responsibilities of cities, districts and counties ( pilot districts ) ( hereinafter referred to as counties and districts ) in the field of health care:
I general requirements
( 1 ) Guiding ideology.
We will 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 Central Committee, under the guidance of Xi Jinping's socialism with Chinese characteristics in the new era, adhere to the general tone of seeking progress in stability, adhere to the new development concept, promote the overall layout of ' Five in One' as a whole and promote the strategic layout of ' Four in All' in a coordinated manner, closely combine the reality of the city with the reality of the city, and scientifically and rationally divide the financial responsibilities and expenditure responsibilities in the medical and health fields of cities and counties. Adhere to the strategic position of giving priority to the development of people's health, vigorously support the implementation of the healthy Dalian strategy, deepen the reform of the medical and health system, promote the matching of the birth policy and relevant economic and social policies, strive to provide all-round and full-cycle health services to the people, and promote the establishment of a long-term mechanism for sustainable investment in medical and health care and its smooth operation.
( 2 ) Basic principles.
- Insisting on government-led and fair access. Scientifically define the responsibilities of the government, society and individuals, adhere to the leading role of the government in providing basic medical and health services, increase the government's health investment, strongly support deepening the reform of the medical and health system, promote the improvement of the fertility policy, increase the support for difficult areas and the poor, and promote the realization of universal access to basic medical and health services. Adhere to the combination of government leadership and market mechanism, improve the financial investment mechanism, and encourage the government to purchase services to improve the efficiency of medical and health investment.
- Persisting in problem orientation and taking into account overall considerations. Focus on the main problems existing in the current division system, adhere to the full coverage of medical and health fields, and improve the integrity of the division system. In - depth analysis of the nature and characteristics of various basic medical and health services to improve the scientific nature of the division system; Reasonably determine the mode of burden sharing between city and county, and improve the standardization of the division system; Overall planning to promote the optimization and integration of projects and improve the efficiency of the use of financial funds.
- Insist on steady progress and implement classified policies. On the basis of maintaining the overall stability of the existing fiscal responsibility and expenditure responsibility framework, the reform will be carried out in a classified manner, taking into account the current and long-term situation. The current division of scientific and reasonable and effective matters shall be confirmed; To carry out reform and adjustment on matters that are not properly classified and ripe for reform; On matters that do not yet meet the conditions for reform, the current division pattern will be temporarily continued and adjusted in a timely manner according to the progress of institutional reform in related fields.
II. Main Contents
According to the ' Dalian Municipal People's Government's Implementation Opinions on Promoting the Reform of Division of Financial Powers and Expenditure Responsibilities between Cities and Counties ( Pilot Areas )' and ' Notice of the General Office of Dalian Municipal People's Government on Printing and Distributing the Reform Plan of Division of Financial Powers and Expenditure Responsibilities between Cities and Counties ( Pilot Areas ) in the Field of Basic Public Services' ( No. 168 [ 2018 ] of the General Office of the General Office of the General Administration of the People's Government of Dalian ). According to the overall requirements of implementing the ' Healthy Dalian 2030' Action Plan and deepening the reform of the medical and health system, the financial responsibilities and expenditure responsibilities of public health, medical security, family planning and capacity building are divided respectively.
( 1 ) Public health.
Mainly including basic public health services, major public health services and local public health services.
1. Basic public health services. Basic public health services include the original basic public health services such as health education, vaccination and health management for key groups, as well as maternal and child health, elderly health services, medical and nursing combination, health emergency and pre-pregnancy check-up included in the original major public health services and family planning projects. Among them, the contents, funds and users of the original basic public health service projects remain relatively independent and stable and are organized and implemented in accordance with the corresponding service standards. The new projects included in the basic public health services are independently arranged by the counties and districts in combination with local conditions, and the funds are not limited to the use of primary medical and health institutions. The content of basic public health services is adjusted in due course according to such factors as economic and social development, public health service needs and financial affordability.
The basic public health service is clearly the common financial responsibility of the city and the county, and the municipal finance and the county finance jointly assume the responsibility of expenditure. Municipal governments have formulated basic standards for the per capita funding of basic public health services and have gradually raised them according to the economic and social development. The responsibility for expenditure on basic public health services shall be divided into municipal levels: the first level includes six counties and districts in Wafangdian city, Pulandian District, Zhuanghe city, Changhai County, Changxing Island Economic Zone and Huayuankou Economic Zone, with the municipal level sharing of 70 %. The second file includes one county and one district in Lushunkou District, with the municipal level sharing 50 %. The third stage includes 8 counties and districts of Ganjingzi District, Zhongshan District, Xigang District, Shahekou District, Jinpu New District, Hi - tech Zone, Bonded Zone and Puwan Economic Zone, with 40 % share at the municipal level.
2. Major public health services. Major public health services such as national or cross-regional prevention and control of major infectious diseases mainly include routine immunization included in the national immunization program and the purchase of vaccines and syringes required for group vaccination and emergency vaccination for key population groups, prevention and control of AIDS, tuberculosis, schistosomiasis and echinococcosis, comprehensive management of mental and psychological diseases, management mode of major chronic diseases prevention and control and exploration of appropriate technologies, which are clearly the responsibility of the central government, with the central government bearing the responsibility for expenditure. The inheritance and development of traditional Chinese medicine in the original major public health services will be included in capacity building. Major public health service projects will be gradually incorporated into the overall arrangement of basic public health services in accordance with the requirements of the central and provincial reforms.
3. Local public health services. Local public health services such as prevention and control of infectious diseases in the whole city or across counties mainly include standardization of vaccination work and information capacity building, anti-virus treatment of AIDS, prevention and control of school and drug-resistant tuberculosis, subsidies for tuberculosis patients, comprehensive intervention in oral diseases, screening of newborn babies for two diseases, food safety work, preventive health examination, and major public health service items and basic public health service items not included in the central government's responsibility for spending. In addition, the comprehensive management of infectious diseases, endemic diseases, mental and psychological diseases, the prevention and control of major chronic diseases, environmental health monitoring, occupational health monitoring, and other key local public health services determined by the city do not have the conditions to formulate municipal standards for the time being. It is clear that the municipal finance and the county finance share the responsibility of spending, and the municipal finance allocates funds to the county according to the amount of work, performance evaluation, local financial status and other factors. The prevention and control of infectious diseases independently implemented by the counties and the emergency treatment of sudden epidemic situations within the counties or with a low degree of harm are clearly the financial powers of the counties and districts, and the county and district finance shall bear the responsibility for expenditure.
( 2 ) Medical security.
It mainly includes the basic medical insurance subsidies and medical assistance for urban and rural residents. It is clearly the common financial responsibility of the city and the county, and the municipal finance and the county finance share the responsibility of spending.
1 basic medical insurance subsidies for urban and rural residents. The municipal finance and county finance shall pay subsidies for the basic medical insurance for urban and rural residents in accordance with the regulations. Municipal governments have formulated basic standards for basic medical insurance subsidies for urban and rural residents and have gradually raised them according to the economic and social development. The municipal finance will arrange subsidy funds according to the above-mentioned municipal allocation method of basic public health service expenditure responsibility.
2. Medical assistance. Medical assistance mainly includes urban and rural medical assistance and emergency medical assistance for diseases, and there are no conditions for the formulation of municipal standards for the time being. Among them, the municipal finance of urban and rural medical assistance shall arrange subsidy funds in accordance with certain subsidy standards and with reference to the above-mentioned municipal allocation method of responsibility for basic public health service expenditures. Emergency relief for diseases shall be jointly undertaken by the municipal finance and county finance in accordance with the affiliation and territorial principle of medical institutions. 

( 3 ) family planning.
It mainly includes three items: encouragement and assistance to some family planning families in rural areas, special assistance to family planning families, and assistance to local family planning families.
1. Reward and support for some family planning families in rural areas. Clear for the city and county financial powers, by the city finance and county finance jointly bear the responsibility of spending. Municipal government has formulated basic subsidy standards and gradually raised them according to the economic and social development. The municipal finance will arrange subsidy funds according to the above-mentioned municipal allocation method of basic public health service expenditure responsibility.
2. Special support for family planning. Clear for the city and county financial powers, by the city finance and county finance jointly bear the responsibility of spending. Municipal government has formulated basic subsidy standards and gradually raised them according to the economic and social development. The municipal finance will arrange subsidy funds according to the above-mentioned municipal allocation method of basic public health service expenditure responsibility.
3. Local family planning support. It mainly includes the incentive fees for rural one-child parents, hospitalization care insurance for special family planning, subsidies for family heads in rural family planning centers, birth care, and other key local family planning assistance determined by the city. It is clearly the common financial authority of the city and the county, and the municipal finance and the county finance share the responsibility of spending. Municipal government has formulated basic subsidy standards and gradually raised them according to the economic and social development. The municipal finance will arrange subsidy funds according to the above-mentioned municipal allocation method of basic public health service expenditure responsibility. To comply with the provisions of the town has never been employed and unemployed ( after going through retirement procedures ), according to the unit personnel standards to pay subsidies, and the county autonomous implementation of local family planning assistance projects, clearly for the county financial powers, by the county finance bear the responsibility of spending.
( 4 ) Capacity - building.
It mainly includes the reform and development of medical and health institutions, the improvement of health capacity, health management affairs, the construction of medical security capacity, and the inheritance and development of traditional 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 financial powers of the central, provincial, municipal or county governments in accordance with their subordinate relations, and the finance at the same level shall bear the responsibility for expenditure. According to the regional health plan, the reform and development of municipal medical and health institutions are clearly the municipal financial responsibility, and the municipal finance shall bear the responsibility for expenditure. If the central, provincial and municipal medical and health institutions undertake the tasks of public health, emergency treatment, foreign aid, agriculture support and border support entrusted by the county government, the county government will give reasonable subsidies. In line with the regional health planning, the reform and development of medical and health institutions in counties and districts are clearly the financial powers of the counties and districts, and the county and district governments bear the responsibility for expenditure. The medical and health institutions in the counties and districts that undertake the tasks of municipal financial powers shall be given reasonable subsidies by the municipal finance. During the period of deepening the reform of the medical and health system, the municipal finance provided subsidies to counties and districts to promote the comprehensive reform of public hospitals and implement the national basic drug system. Increase support for social forces to run medical services, and implement the subsidy policy for social forces to run medical services in accordance with the regulations by the municipal finance and county finance.
2. Improvement of health ability. The improvement of health ability mainly includes the construction of health personnel and the development of key disciplines. According to the strategic plan, the municipal health and family planning Commission has organized and implemented projects such as the construction of health personnel and the development of key disciplines in a unified way, which are clearly the common financial responsibilities of the city and county, with the municipal finance and county finance jointly assuming the responsibility for expenditures, and the municipal finance allocating funds to the counties and districts according to the workload, subsidy standards, performance appraisal and other factors. The ability improvement project independently implemented by counties and districts is clearly defined as the county's financial powers, with the county's finance assuming the responsibility of expenditure.
3. Health management. Health management affairs mainly include strategic planning, comprehensive supervision, publicity and guidance, health promotion, monitoring of essential drugs and drugs in short supply, monitoring of major health hazards and major diseases, and monitoring of maternal and child health. According to the affiliation of the relevant functional departments responsible, they are clearly defined as municipal financial powers or county financial powers, and the finance at the same level shall bear the responsibility of expenditure.
4. Capacity - building for medical security. The construction of medical security capacity mainly includes strategic planning, comprehensive supervision, publicity and guidance, improvement of handling service capacity, informatization construction, and talent team construction, etc. According to the affiliation of the relevant functional departments and their subordinate agencies, they are clearly defined as municipal financial powers or county financial powers, and the finance at the same level shall bear the expenditure responsibility. During the period of deepening the reform of the medical and health system, the municipal finance gave subsidies to local medical security capacity building according to regulations.
5. Inheritance and development of Chinese medicine. The inheritance and development of the cause of traditional Chinese medicine mainly includes the cultivation of clinical advantages of traditional Chinese medicine, inheritance and innovation of traditional Chinese medicine, protection and excavation of traditional knowledge of traditional Chinese medicine, technical specification and promotion of the ' prevention of disease' of traditional Chinese medicine, etc. It is clearly defined as the common financial responsibility of the city and county, with the municipal finance and county finance jointly assuming the responsibility of spending, and the municipal finance allocating funds to the county according to factors such as workload, performance appraisal and local financial status.
The above-mentioned medical and health matters will be adjusted by the relevant functional departments in due course according to the requirements of the central and provincial reforms. Other matters not listed in the medical and health field shall be specifically determined in terms of financial powers and expenditure responsibilities in accordance with the overall requirements and characteristics of the reform. Municipal capital construction expenditure shall be implemented in accordance with the relevant provisions of the state. Medical and health institutions organized by the army, state-owned and collective enterprises and institutions shall carry out the responsibility of funding guarantee in accordance with the requirements of the current system and related field reform.
Clear for the city's financial powers and matters that need to be entrusted to the counties and districts, the entrusted place shall exercise its functions and powers in the name of the entrusted unit, assume corresponding legal responsibilities, and accept the supervision of the entrusted unit. The county government can reasonably increase the security content or raise the security standards on the basis of the municipal basic standards on the premise of ensuring that the basic standards are fully implemented. For medical assistance, health personnel team building, key discipline development and other issues that are not easy or temporarily qualified to uniformly formulate municipal basic standards, the municipal government puts forward principles and requirements and sets performance targets, and the counties and districts independently formulate local standards accordingly, and the municipal finance gives appropriate subsidies. County and district governments should fully consider the fairness of regional basic medical and health services, the level of local economic and social development and financial affordability to ensure financial sustainability when formulating regional standards. If the county standard is higher than the municipal basic standard, it shall be reported to the higher authorities for filing in advance. If the county government has introduced major policy adjustments and other matters, they should be reported to the municipal competent departments for filing in advance.
In accordance with the principle of maintaining the overall stability of the financial situation of the existing cities and counties, the transfer of the expenditure base of the cities and counties involved in the above reform shall be handled in accordance with the relevant provisions of budget management.
III. Supporting Measures
(1) to strengthen organizational leadership. The division of financial powers and expenditure responsibilities in the field of medical and health care is an important part of the reform of the division of financial powers and expenditure responsibilities between cities and counties. All regions and departments should attach great importance to strengthening organizational leadership, close coordination and cooperation, combining with the actual situation to refine policies and measures, carefully organize implementation and ensure the smooth progress of the reform.
(2) to promote the relevant reforms. The reform of the division of financial responsibilities and expenditure responsibilities between cities and counties and the deepening of the reform of the medical and health system will be closely combined and promoted as a whole, with emphasis on improving the stable and sustainable mechanism for adjusting the financing and reimbursement ratio of the basic medical insurance for urban and rural residents, reasonably determining the share ratio between the government and individuals, promoting the reform of the system and mechanism of public hospitals, and strengthening the binding force of regional health planning, thus creating a situation of benign interaction and coordinated promotion between the two reforms.
(3) to strengthen the implementation of expenditure responsibility. The municipal finance and county finance should reasonably arrange the budget according to the determined expenditure responsibility, fully implement budget performance management according to the principle of ' who uses and who is responsible' and ensure the effective provision of basic medical and health services. For the county and district governments to reasonably set security standards and implement the gap between revenue and expenditure existing in the expenditure responsibility, capital expenditures such as the basic construction of medical and health institutions in line with regional health planning can be arranged by issuing local government bonds according to law. The municipal finance will grant general transfer payments to difficult areas in accordance with regulations to promote equalization of basic public services.
(4) Revise and improve the rules and regulations. Municipal Health and Family Planning Commission, Municipal People's Social Bureau and other departments should, in accordance with the division of responsibilities, according to this implementation plan, on the basis of a comprehensive and systematic review, combine with the requirements of central and provincial reforms, refine relevant medical and health matters, and promptly revise and improve specific project management measures and other rules and regulations. The Municipal Finance Bureau revised and improved the relevant fund management measures in due course. All regions and departments should strengthen the construction of the rule of law and standardization, and actively promote the regulations on the division of financial powers and responsibilities in the medical and health field in the form of local laws and government regulations, so as to ensure that the administrative power operates within the legal and institutional framework.
This implementation plan will be implemented from January 1, 2019. If the previous relevant regulations are inconsistent with this implementation plan, this implementation plan shall prevail.