3. HEALTH POLICY3.1 The Direction of Healthcare

In the first national meeting of healthcare in 1950 9th, the three main principles, face to worker, farmer and soldier, emphasis on prevention, combination of traditional Chinese medicine and western medicine, were instituted. In 1953, in the second national meeting of healthcare, the lessons of patriotic hygienic campaign was concluded and premier Zhou pointed out that in the future the principle of combining hygiene task with the public movement should be applied in the hygienic task. Since then, the four principles mentioned above were formally regarded as the four major policies of hygienic task. Under these policies, Shaanxi province made much great achievement on the work of hygiene. In comparison with the status before the foundation of new china, the life expectancy has increased to 70 from 35. The hygienic movements spread widely. Many hygienic institutions have been established and there is a qualified team of hygienic workers. The hygienic work of ShaanXi has made a lot contribution to development of modernization.With the economic development of China, the cause of building the China’s characteristic hygiene has become one of the most important things among China’s modernization building. So, according to Chinese reality, after concluding the experiences of the past forty years, Chinese government clearly announced the policy that it is to put emphasis on countryside, practice prevention as the main way, balance the traditional medicine and western medicine, depend on science and education, advocate the whole public to participate, and serve for people and China’s modernization building. This great policy is the guide for future development of hygiene and of important realistic and historic significance.

3.1.1.Put emphasis on countryside. This is determined by the reality of China. Most Chinese distribute in countryside and peasants are the primary objects of hygienic service. But in fact, the hygienic force is relatively weak in countryside. This fact not only causes many diseases to occur, but also leads to poverty in some places. Agriculture, countryside and peasants are connected with the whole strategy of China’s modernization. The central government always takes it very seriously. Thus, promoting the hygienic work in countryside is one of the greatest important things in development of China.

3.1.2.Practice prevention as the main way. This way is the conclusion of the past experiences. Depending on effective precautionary measures, China eliminated smallpox in 1960s and mellitus in 1990s. History has proved that this way is of low cost and with good results. It can also show the care of government for people better. We must keep increasing the consciousness of precaution, practice the precautionary measures effectively and especially reinforce the precautionary control and treatment of chronic non-infective diseases.

3.1.3.Balance traditional medicine and western medicine. Chinese traditional medicine is the important part of Chinese hygiene cause. The government always takes it seriously. Chinese traditional medicine has long been the primary means to deal with the various diseases and is drawing more and more countries’ attention. We must reinforce the solidarity, learning from each other, completing mutually, and combination of workers in both fields.

64

3.1.4. Depend on science and education. We must depend on the development of science and technology to control and eliminate some seriously hazardous diseases and to prompt the advance of the Chinese precaution services. All of these can’t be done without education.

Advocate the participation of whole public. The hygienic job covers every one of us. All governmental departments should concern about the problem of hygiene and health, support and push the hygienic work. The patriotic hygienic campaign is an invention and a good model for people to participate in this work. It has great affect on disease control and elimination, and is of big significance in promoting the managerial level of cities. We must spread hygienic knowledge, teach our people to form a good hygienic habit and have a right life style. To achieve this, whole society has its responsibility, and the degree of its participation reflects the level of the spiritual civilization in these areas.

Serve for the people. This is the core of the hygiene policy, the basic point of the hygienic job. It shows the purpose of serving for the people whole- heartedly. It is the requisition of the party and the government for the hygienic cause. It directs the right way and reflects the nature of socialist hygienic cause.

3.2. The Strategy of the Health Promotion

To meet people’s increasing needs for health, we should conform to the rules of having flexibility, promoting quality, adjusting structure, developing proportionately and practice the three firsts of rural hygiene, public hygiene and Chinese traditional medicine.

In city, we put emphasis on the optimization of the distribution of hygienic resources and its contents and build hygienic system that fits with city workers’ medical security institution and casts appropriate roles between community hospitals and middle, or even big hospitals. In countryside, we adjust our direction to put junior hygiene in the first place and set up corresponding medical care system and medical security institution. We expect to establish a medical care system, a hygienic service system, a medical care system of peasants and a technical innovation system that can fit with the reality of Shaanxi.

Territorial hygienic management means that to determine the goals, model, speed and scale by local nature environment, social economy, people’s healthy level, hygienic demands and primary hygienic problem and manage and allocate hygienic resources reasonably to improve local power of hygienic service and provide all residents a developing model of hygienic management which can give fair and effective hygienic service and protect and improve peoples’ healthy level.

China’s current hygienic service system is developed from the planned economy. With the change of the economic and the medical models, especially the reform of medical care system and the development of the socialist market economy, the adjustment of the current distribution of hygienic institutions, service structure and service model are badly required.

3.2.1. The Necessity of speeding up the health planning of ShaanxiAfter the foundation of new China, especially after the opening and reform, Shaanxi province

has made great achievements on hygienic work and improved people’s healthy level remarkably. Shaanxi has formed a fairly good base of hygienic resources by accumulating and an elementary

65

network expected to cover whole province. But with the establishment of socialist market economy and the further reform of the medical institution, the original problems under the planned economy, such as separation of hygienic resources, unreasonable structure and distribution, inflexibility of mechanism and low efficiency, are becoming more serious. These problems are represented by the following realities:

The efficiency of health resources utilization is dropping. So far, in Shaanxi, there are 2.75 beds per one thousand people, 3.79 workers of medical affairs per one thousand and the using rate of sickbeds is only 50.3 percent in hospitals above the class of county, each doctor only treats 837 patients yearly. The utilization of hygienic service relatively concentrates in some top grade and high cost hospitals. Big hospitals in city deal with many diseases that could have been done by some junior hospitals with lower costs. That is responsible for the idleness of hygienic resources in grass roots and inefficient use of that.

The distribution and the structure of health resources are not reasonable. Hygienic resources concentrate overly in city while countryside has few. The contradiction between the lack of resources and waste of that is more and more obvious. In some places, especially some middle and big cities, the overlap of institutions and redundant functions has been the obstacles for forming the combined forces of regional resources.

This status of resource allocation doesn’t suit the ShanXi’s demands for the hygienic services, overloads the finances of the country, enterprises and individuals and limits the development of hygienic cause. To adapt to the new environment, it is cried for speeding up the reform of management system and running mechanism, planning out and enforcing regional hygiene layout soon and reasonably allocating and effectively using the hygienic resources.

3.2.2 Planning goals and organization principlesRegional health plan is the important means for government to practice macro-control over

the development of hygienic cause. The planning work must conform to the No. 16 document by the congress and other instructions of the government departments, considering the whole process of opening and reform, meeting the people’s needs for medical care, by the order of socialist market economy, allocating social hygienic resource reasonably, and by doing that to improve the synthetical hygienic service and the utilization efficiency of resource, to construct a useful, economical and fair hygienic service system and management mechanism that suit the SahnXi’s development of economy and society.

The basic principles for practicing regional health regulation:

3.2.2.1 The regulation must consider the future. The quality and quantity of hygienic resource should fit with the economic development and people’s needs for medical care. The adjustment of hygienic resources should control the increment, use the storage well, encourage reconstruction, lay out properly and improve utilization efficiency of resource.

3.2.2.2 The allocation of hygienic resources should show the public interest. Give priority to the developing and the guarantee of the basic medical care, push urban community hygienic service and rural hygienic cause strongly, put attention on the function of Chinese medicine in the whole health care system.

66

3.2.2.3 The plan should consider cost and profit, can share the resources and improve the service quality and efficiency. Through reform, carefully solve the contradictions between lack and waste, stop the blind behaviors of chasing and using high technology, which is often companied with repeated and inefficient investment.

3.2.2.4 The management should cover all health resources. Put every source of hygienic resources into the scale of plan. Private doctors and other forms of possession must obey the general demands of plan.

3.2.2.5 Base on local reality and give guide respectively. Considering the differences between the regions of ShanXi, give different region appropriate guide, through calculating, to determine the local requirements and the allocation standard. Territorial hygienic plan regards towns as the basic units. Xian is as a special unit. The time for planning is commonly five years.

3.2.3 The main contents of plan and the rules for planningRegional hygienic plan includes analyzing social economy, residents’ healthy level and status

of hygienic resources, determining the primary hygienic problems, instituting planning goals and resource allocation standards, providing measures and giving supervisory evaluation.

Regional hygienic plan should make uniform plan according to the demands of the province. The plan should construct development model from three aspects. The first is to improve the macro-control and supervision; the second is to expand and reinforce various hygienic services; the third is to support the development of education, science and supervision. The detailed demands are listed as below:

3.2.3.1 The factor of medical servicePut to the first place the development of multi-layer basic medical care, especially the rural

and urban community hygienic service. Continue paying attention to the development of big multi-regional medical institutions and to the improving of the diagnostic level, encourage constructing aggregative hospitals in proper ways. Conduct the flowing of hygienic resources. Develop cooperative medical treatment in country. Establish and improve community hygienic service system in city. First class medical institutions should adjust themselves timely, take synthetically medical treatment, precaution and serving as their main tasks. Second class medical institutions should take the diagnosis and treatment of some diseases that occur frequently of difficult to deal with and the training of town’s medical workers as their primary tasks. The third class medical institutions should become a integrated technological guide centers and take the treatment and study of the some rare serious diseases. In each planned region, establish one or two medical technology centers that can facilitate the diagnosis and treatment of diseases. According to local reality, set some characteristic hospitals.

Continue paying same attention to Chinese medicine and western medicine, using and deploying Chinese medical resources properly. According to needs, in the scale of county, build medical institutions of Chinese medicine that take the tasks of medical service, training and study of Chinese medicine. Institutions of Chinese medicine in cities should take the function of medical treatment, precaution, care, recovering, teaching and study. Some regions with characters can establish specific hospitals of Chinese medicine. Towns usually don’t set institutions of Chinese

67

medicine, but can set departments of Chinese medicine. In county, rural doctors with Chinese and western medical knowledge can be set.

3.2.3.2 On the precaution and control of disease. According to the rules of “cover the region” and “see doctor nearly”, concentrate medical institutions, and set some precautionary centers in cities and counties. All government departments should pay enough attention to the public health.

3.2.3.3 Healthcare for women and children. Hygiene of women and children is one of the weak parts of current jobs. Reinforce the building of such institutions of counties. Institutions of women and children in city should take the task of caring women and children, training, guiding, supervising and evaluating. Institutions of women and children in counties should take the tasks of local community care of women and children, training and offering guide for junior workers.

Each city and county should explore the way of deploying and utilizing the local hygienic resources o f institutions of planned birth and of women and children care. Gradually practice the new institution of combination of planned birth, medical care and medical precaution.

3.2.3.4 Medical supervision. The government should establish effective medical supervisory institutions. These institutions’ function is to supervise all medical department’s behaviors. The workers in these institutions must be medical workers

3.2.3.5 Medical education and scientific research. The present middle medical school should adjust their subjects and put attention to standardizing the rural medical team. Evaluate the medical school established by social force. Encourage the investing on science and research.

3.2.3.6 Complete the network of medical service. Establish a network of hygienic service with Xian as the center that covers whole province, including disease supervision, medical care, education of health, information of medical statistics.

3.2.4 Demands and policy measures

3.2.4.1 Speed up the regional health plan. Government should introduce regional hygienic plan as the macro-means for controlling the allocation of hygienic resources and balancing the demand and supply.

3.2.4.2. Practice whole trade management. According to general demands of regional healthcare plan, through means of law, instructions and economy, to enforce whole trade management. Improving relative regulations. Forbid any illegal medical service.The institutions of enterprises and military medical institutions that pen to the public should be included in the planned system of hygiene and be conducted by local government.

3.2.4.3 Establish new classified management system. Divide medical institutions into the non-profitable and the profitable ones. The first one occupies the main part of the system of medical care, and has privileges given by government. The profitable ones don’t be given privileges, but their price will be open.

68

Reform the operating mechanism and widen decision-making power of hygienic institutions. Introduce competition, adjust old structure and enforce new promotion system.

3.2.4.4 Reinforce the works in country and service of urban community. Conduct hygienic resources following to medical precaution, community and country. Gradually establish and perfect community medical service that is convenient, close to people and with comprehensive ability. Country must reform its management system and operating mechanism. Push rural cooperative medical treatment actively and reduce peasants’ medical burden and risk. Put emphasis on the building of fundamental hygienic establishments, improving drinking waters and preventing local diseases and infections.

3.2.4.5 Adjust the educational structure to suit the new environment and new demands.

3.2.4.6 With the development of economy, Governments should increase its investment on hygienic cause. The increased percent should be bigger than that of total financial payout.

3.2.5 Organize Management and EvaluationIt’s government’s duty to organize and execute regional health plan. The big problems

occurred in the process must be presented to government to study and solve. Regional plan is a dynamic process. We must reinforce the supervision, learn the status timely and give proper evaluations. The work of plan should be effective and can obtain good social benefit.

3.3 Reform in Health Promotion

3.3.1 Background

The earliest reform began in 1979. Because of the damages by culture revolution, the development of hygienic work of ShanXi didn’t fit with the progress of economic building. There was still obvious deficiency in management system. In 1985, the document some suggests about the reform of hygiene opened the provincial hygiene reform. ShaanXi encouraged doing medical work in various ways. It used present resources efficiently and expanded services. It reformed old functionless mechanisms and medical education. Basing on realities, it practiced open and reform. Because some measures didn’t be considered wholly, there occurred wrongness. On one hand we tried to solve these problems, and on the other hand we did our best to complete current policies. The 1997 document decisions on reform and development of healthcare was the landmark in the history of hygienic development of ShaanXi. It directed for us a right way.

3.2.2 The goals of health reformThe goal of hygiene reform is to activate hygienic cause, motivate hygienic staff to work

harder, improve the quality and efficiency of hygienic service, serve for people better and serve for socialist modernization. At present, we must manage the following problems:

3.3.2.1 Healthcare can’t get along without the environment of socialist market economy. It must adapt to socialist market economy and consider the whole society’s interests.

69

3.3.2.2 healthcare must obey to the developing law of itself, accomplish its task of protecting and improving people’s health and showing social justice, pushing society forward.

3.3.2.3 Study the control mechanism of the development of healthcare, energize it, activate whole staff, conduct hygienic competition correctly.

All policies and measures must be able to facilitate the continuable, harmonious and healthy development of hygienic cause, the accomplishment of its goal of serving for people and activating all medical staff. These are the standard for judging the policies of hygiene reform.

3.3.3 The Basic rules for healthcare reform and developmentInsist on serving for people as its tenet and put social interest at the first place.

Take the improving of people’s healthy level as the center and expand its serving range on the base of basic hygienic needs of people met.

Give prominence to key points and classified guides.Take the official medical institutions as the main body and other forms of procession as

supplements.Widen open and communication with other countries.Reinforce the building of spiritual and material civilization.

3.3.4 Shaanxi’s health reform has got into new stage.The reform has been in the stage of execute. It primarily introduces the following measures:

3.3.4.1 Establish mew classified managing system of medical institutions. Class all medical institutions into the profitable and the non-profitable. The country give respective policies of privileges to these two classes.

3.3.4.2 Reinforce the managing power of medical trade and realize the optimization of allocation of resources and adjustment of structure.

3.3.4.3 Deepen the reform and increase the energy of hygienic cause. Reform hygienic management system and optimize the deployment of health resource of manpower. Reinforce the institution of corresponding laws and execute them well.

3.3.4.4 To strengthen health legal system, and superintend health regulations

3.4 Policy of Raising Money for Health Service

3.4.1 To retrospect the condition of raising money for health operationThe sanitarian capital of Shaannxi was mainly financed by country 、 collective economy

organization and peasant , when our economical system depended on national scheme before the 1980s.

The national part of capital: The national investment was main source of sanitarian capital and almost covered all parts of sanitarian work including construction of all level of sanitarian

70

institution and establishment.、the training of sanitarian expert、 prevention and cure of disease 、 wage of public-owned people and collective-owned sanitarian supported by public.

Collective economy investment part: Country’s two class collective economies are economic foundation of organization of grass roots, And take main part in the aspect of collecting the funds. Main aspect of investment is: Besides nation subsidy, hygiene room ‘s general maintain and construct expenses is free allocated in the form of funds 、the real object and rent service by the countryside. The countryside highly unifies the funds、physical labor and operate the construction of public hygiene facilities and the work of social disease prevention and cure. Village independently raised capital as independence of production 、allocation and had the priority to used for the hygiene room developments、wage of countryside doctor and offered free or reduced fee for poor farmer and person received five care.

Farmer individual input: Farmer is the collective economy organization member and the object of the hygiene service; its hygiene investment is mainly at two aspect now both side.One way is the rent service investment, such as duty worker of the village hygiene room、public hygiene activity for changing the water and the WC and manage and reform of environmental sanitation combinated with the farmland irrigation capital construction. The other way is pay the cooperative medical treatment fund and take part in the medical health treatment care of itself and member of the collective. In a word , before the 1980s , the ways of raising hygiene money in Shaannxi province’s is smooth and clear, under the certain history condition at that time, the policy preferably solved the problem of radical medical care and preventive healthy care . But something disobeying the farmer will, some unreal request of utilization of funds had brought forward and establishment construction、technic equipment once bring upping some impractically over high request, facilities developments, technique equipment had one knife slicing. There exist many problems, such as the bad management、cauldron rice and no checking, waste of resources is another problem.

The real sense sanitarian system has established after 1980s. It developed to adapt to the new situation brought by reform and opening. Specially, CP commission and government of Shaannxi established many investment ways for carrying out the decision of sanitarian reform and development publicized by CP central commission. Six concrete opinions of the perfect health economic policy were perfected. It is the outline that leading the hygiene raising funds from now on a period of time indicated the direction for the whole province’s hygiene money raising work. It is no doubt to take an active role in fasting the development and reform of healthcare of Shaannxi and will produce profound society influence.

3.4.2 Establish multi-way investment mechanism, perfect health economic policies

3.4.2.1 The investment in healthcare mainly depends on the country、collective and partly on the society. It forms into multi investor mechanism and speed up the development of hygiene work. The whole expense of healthcare in Shaannxi will account for about 5% of G.D.P of Shaannxi.

3.4.2.2 Healthcare investment of all class of government’s will increase with the step of the

increase of economic and still keep and increase the special investment. Each class of finance department must give 10% of the whole capital to use in the countryside health agency, health

71

protection, herb, medical education and bring into the finance budget and economical development plan. The government arranged the basic construction of all class sanitarian department held by government and purchase of large equipment. No less 10% finance from investment on the no profit deal arranged by the province plan commission use in the sanitarian basic construction and incline to the poverty area.

All scale of government ought to make allowance according to different situation. The sanitarian institution of county and hyper-county receive no less 60% of total investment; Central and county sanitarian room in North of Shaannxi、South of Shaannxi and central of Shaannxi each receive 100%、80%、60% of the whole investment. The poverty area can be properly enhanced the proportion of allowance. The government ensured the pension of retired people and insurance of sanitarian people. The finance budget will arrange the outlay of prevention department. The earning get from the repaying service will bring into the management of budget and isn’t instead of appropriate funds. It is ensured by government and carry out two system for income and expense.

3.4.2.3 Collect the sanitarian construction fee and found the sanitarian development fund. The sanitarian construction fee is collect on account of 3% of expense tax.. The private hospital and beauty parlor pay 5% of expense tax for sanitarian construction fee and. The tax mainly be used in countryside sanitarian construction. The concrete plan set down by the province finance department、country tax department、local tax department、sanitarian department and execute after approving by the Shaannxi people government.

3.4.2.4 The 10-15% of country plan fee and 3-5% of the pure income of enterprise of county and countryside is collected for countryside sanitarian fee by the country government. The fee is served as special used sanitarian fee to develop the countryside sanitarian work. The cooperative medical fee paid by former 、scheming immune fee for child and health fee for mother and baby belong to the farmer’s personal expense and don’t take for the country collection and countryside reservation.

The fee can be collected from the society and people, approved by the province 、region and country government. It is used for the special fee of sanitarian of countryside 、 prevention and healthy and endemic prevention. The government encourage the enterprise 、society and people to donate money for help the development of sanitarian work and severe patient without payment ability, meanwhile, introduced into the foreign investment and cooperative plan. Welcome friendly group and people to hold the development of sanitarian work of Shaannxi.

3.4.2.5 Since the public healthcare institution is none profitable and commonweal department, the government can’t treat it as enterprise. All class government ought to execute the favorable tax policy for medicine 、healthy 、emergency cure 、 epidemic prevention 、special prevention 、 women and children care 、 drug checkout 、 sanitarian checkout and sanitarian propagandizer. The government can collect the tax early and withdraw the tax late for the enterprise held by the sanitarian department for helping the medical work.

All class of government ought to reduce or get rid of local money collection 、 fee corresponding to city elemental construction、urban construction fee、additional education fee and fee of road maintenance、transportation and annually check for ambulance、blood collection car

72

and epidemic prevention car.Any of department can’t collect money and add burden to health department also can’t fixed

assets of sanitarian department and practically solve the heavy burden of sanitarian department.

3.4.2.6 The government strengthen and perfect the management of the price level of sanitarian service. The government ought to distinguish the standard of sanitarian fee according to the different character of sanitarian institution. The elemental medical service price is according to the cost price subtracted the financial usually subsidy. The price of none elemental medical service ought to be account for a little high over the cost price. The special demand medical price can be open. The standard price of high tech should be enhanced and pay of examination by large scale medical equipment should be reduce. The right for management right can be properly open. All class of government should plan to manage the medical service fee and set up the system of adjusting the price of medical service fee according to the change of the market and efficient management and monitor system. The government will strive to solve the unreasonable medical service problem in 2-3 years.

3.4.2.7 Keep and add the special use money for sanitarian. As the economical micro control means of country, the special use money for sanitarian take a main role in the development of Shannxi. The province set up special use money for sanitarian to resolving the problem in the countryside sanitarian、prevention healthy、herb etc. The one is special use money for countryside sanitarian. It is mainly used in strengthen “the three construction” in the domain of countryside sanitarian in the period of 8.5. The whole province have already reach the aim of “one no and three match”(no house in danger、house、equipment and person match). The second is prevention health special use money, mainly use in the prevention of disease、construction and renew the cold planed immunity、infectious disease、endemic and women and children care. The third is the herb special use money. The money is used construction of herb department and improvement on the tech equipment and reform the tech. The fourth is the special money used for supervising the sanitarian execute the law. The money be used in supervise the spot test and improve the sanitarian monitor condition, enlarge the cover area. The work of monitoring the sanitarian executes the law relevant to the life of people.

3.4.3 Raising fund in different waysCollecting money in different ways to develop the sanitarian work is an important experience since the reform and open.

At present, while the country has limit financial power, to perfect the economical sanitarian policy, on the one hand , the government should increase the investment on the sanitarian work and regulate the style of the government’s investment, on the other hand , the way of investment on the sanitarian work should be opened wildly and set up a multi-way investment system ,at the same time, encourage the department、enterprise、people、bank、society and fund to invest money to the sanitarian work. According to the situation of China and using for experiment of some countries, for the further, the ways to wildly open the sanitarian work is:

3.4.3.1 Collecting the emphasized construction fee of the course of sanitation Along with economy of the development, people live the quick exaltation of level, and

consume the level of structure is gradually diverse. The consumption behavior of the high level of

73

structure to have relation with health to those collecting the emphases construction fee of the course of sanitation, it is often necessary to lead with the idea of right consumption and the right behavior of people. For example, health care food, health care drugs and health care consumption belong to the high level of structure and unnecessary living consumption, at present nation is not yet collecting the consumption tax of them, it is viable to collect the emphases construction fee of the course of sanitation. The healthy problems aroused by alcohol-abuse have received the extensive concern of the society. The foodstuff number, which consumed by vintage annually mount to 100 ton, and make by fermentation the process inside to waste astonishing. Seen from the international, the great majority nation and the region adopt the policy of the high tax law to wet goods. Generally, violent alcohol tax rate that collected is at the range of 50%-60%, but China to food distilled spirit tax rate is 25%, potato distilled spirit tax rate is 15%, the beer tax rate is 220 Yuan of each ton, other wine of tax rate is 10%. Thus we can also consider the exaltation tax rate, and used for the incensement of the input of sanitation. Harm of smoking is known to us all. The consumption tax rate of the Chinese tobacco finished product is 30%-40%, calculated according to the admixed average price, and plus the value-added tax, Chinese tobacco scoot is about 51% for its retail price, this compared with the other countries in the world is lower. For instance, Denmark is 85%, Brazil is 74%, India is 75%, and Thailand and Philippines are all 55%. Now, the United States, Canada, Australia, New Zealand, Holland etc. all collected the tobacco healthy surtaxes, and according to the rule, tax used exclusively for the education of the smoke-control, hygiene service, medical scientific research and changes of the public hygiene environments, etc.

Furthermore, the lost of economy and the health problem caused by smoking are also rather much. So it is completely necessary to establish the measure of collecting tax law (fee) of health harmed by tobacco to restrain the tobacco bane. Consumption like the service of business hairdressing, sauna etc., high class of the cosmetics and the articles of skin-protected or hair-protected (particularly import the product) belong to the high consumption and not living essential consumption. We can consider taking out part from its revenue using for the hygiene business.

Gasoline, diesel oil is the natural resources, which can't rebirth or replace, so it is acceptable to add some proportional taxes used for health-protected.

3.4.3.2 Establish the develop- regulate funds of the health business. In the development of Chinese hygiene business, there exist not only the problem of lack of hygiene input, also exists the problem of irrationality of resources installment and inefficiency of using.

Therefore, raising health funds from the society can do by many ways. We can also adjust the structure of the internal resources of the hygiene business, concentrate the essential funds, increase the macroscopic regulated power of all levels of hygiene supervisor, support important work or weak link in the hygiene business. For instance, some region stipulate to take out certain proportion from the income of the medical organization business and collected by the bureau of public health. It become the fund for scientific research and man-educated, and support the work of scientific research, educate the point talented person.

Some regions also set fund to support village hygiene and prevention health care work, etc. Now the joint venture hospital, private hospital and individual medical practitioners also enjoy some special policy of the hygiene business given by the nation, it is reasonable to collect develop- regulate funds of the hygiene business.

74

3.4.3.3 Establishing the fund of the healthcare to support the poor or promote healthThe Chinese current system of medical treatment insurance is limited. Quite a lot of

population in the risk of disease is without insurance, also along with conversation of medical mode and science and technology advancement etc., medicine expenses soar more quickly, some sufferer can't undertake the expensive medicine expenses in the society, they need help from the society. Establish the foundation to unify to organize, make a further extend for beneficiary, change the way to cure the serious disease by financing in person in the past, and regulate the management, this is the need of our socialism spiritual civilization construction. The funds source can be various, and to collect the fund primarily by passing round the hat, charity-examined, charity-sold, charity-shown and publish the hygiene welfare the lottery ticket the etc. By doing this, we can extend the amount and the scope of collecting fund.

3.4.3.4 Encourages donate to health serviceHealth service is certainly welfare of social and public practices supported by the

government. Together with the addition of input in the government hygiene, we should encourages all circles to donate to the hygiene business, and welcome foreign amity nation, group, organization to support the development of the Chinese health service. The Chinese Regulation of Business Enterprise Income Taxing clearly stipulate: enterprise, which donates less than 3% of incoming tax to public welfare, will be deducted. Every area, all levels hygiene organization must positive absorb the donation of all circles, promote the development of the hygiene business, and better meet the demand of the crowd health.

3.4.4. Funds Raising for rural cooperative medical service and the usage of funds.The policy of rural cooperative medical service in Shaanxi is individual investment and

collective support, the most important aspect is government’s care.The regulation of cooperative medical service is the basic healthy guarantee rule with must follow voluntary, moderate degree and benefit. The level of raising funds not only considers social economic condition and the capacity of the peasantry but also considers the guarantee level of cooperative medical service. According to average income, the government worked out standard of raising funds. If the peasants live a rich life, the sum of funds can occupy 5% to 10% of peasants’ expenditure. But, if the peasants’ life not so good, the sum of funds only can occupy 3% to 5% of peasants’ expenditure. In the poor villages, the amount is 1% to 3%, at the same time, the government must invest in these districts.

The way of raising funds According to the practice, we found we must carry out three steps: 1)pay 2)sign treaties 3)submit an expense account. We should promote the idea of peasants’ self-protect and helping each other. At the same time, we must encourage peasants to take part in the cooperative medical service. The government should support, organize and lead the cooperative medical service. Local finance set up the specific medical fund according to the financial condition. The fund mainly adjusted the medical policy and expresses the motional care about rural medicine.

The usage of cooperative medical service. First, decrease the cost. Second, stress the capital usage efficiently. We should stress the democratic supervision and scientific administration of the fund. In the medical committee, peasants must be absorbed.

With the social development, the regulation of cooperative service is gradually improved. In

75

the most of villages, the different kinds of regulations have been set up and we gradually promoted their social degree. Some places in good conditions can transfer into medical insurance. 3.5 the Policy of Health Service Manpower Resource

Healthcare manpower resource can be divided into three kinds: the really owned, the training and the potential. There are two kinds of manpower in Shaanxi, in fact. One is the professional health manpower, other is the manpower which are not leave their working position.

3.5.1. Developing the resource of health service manpower greatly. The development of the health service manpower resource must combine with economic development and healthy development. In a long period, we should note the number of hygdian manpower and adjust the structure of healthcare manpower.

3.5.1.1 The increase of healthcare manpower: The amount of healthcare manpower increased from 9439 in1949 to 163950 in 2000. The hospital beds increased from 1328 to 96857.

3.5.1.2. The structure of health manpower: The health manpower should have a proper structure of age, knowledge, profession and ability.

Age structureIt should put emphasis on the training of the youths and middle-ages and build a reasonable

rank of manpower.Knowledge structureReasonable knowledge structure should be made up of junior class, middle class and senior

class in proper proportion with the development of the hygiene cause..Professional structureAccording to the characteristics of hygienic jobs, the whole hygienic system can be

categorized into several academic fields, such as medical treatment, public hygiene, women and children hygiene, medical teaching and so on.. These fields must be adjusted to a proper proportion.

Ability structureAccording to the working requirements, we should be good at grouping together different people with different skills and abilities to help and encourage one another.

3.5.1.3 The quality of hygienic manpower The quality of hygienic manpower can be evaluated by the amount of middle professional

members.

3.5.2. Manpower project1245 Project: By 2000, training for each village a middle level rural doctor, for each town a

Chinese traditional doctor and a western doctor, for each central hospital a physician, a surgeon, a gynecologist, and a pediatrician, for each county a vice-director doctor for internal medicine, surgery, gynecology, penology and Chinese medicine respectively.

76

215 project: Try to foster 20 experts with national advanced level, 100 experts with provincial level and 500 with regional level.

3.5.3 Medical education policy

3.5.3.1 Guidelines and goalTraining the overall development person in the field of medical education around close the educational lines of country and the educational development goal of country, adding the fact that hygiene task needs person with hygienic ability. Transform the teaching thought, training model, teaching contents and training methods. Improve students roundly, including their profession moral and business ability. They must equip with deeply theory level and solid practice basis. Improving the condition of the university (including live condition of the teachers and the students’ live and study conditions), developing teaching equipment, strengthen construction of the teaching base. We must reinforce precautionary measures and adjust the scale, distribution, arrangement frame and profession frame of medical education. Widen the profession field and reinforce the profession applicability.

3.5.3.2 Build the reasonable structure of medical educationArrangement frame and promotion of medical education must combine the hygienic development of Shaanxi province. According to the different arrangement, Shaanxi province has already build three teaching arrangement (junior, middle, senior).

Senior medical educationShaanxi province only has two medical universities that have 400 students 1949.From 1949

to 1965, students increased to 2200.During the cultural revolution, medical university ceased enrolling students about 6 years. They begin enrolled 3 years students in 1972. Nation recovered uniform enroll in 1977. Shaanxi province has three medical universities till 1983. They have 13 departments and 3187 staffs. The number of 1983 was 27.47 times as many as that of 1949. The students’ amount was 4281.It was 10.2 times as many as that of 1949. The amount of enrollment was 929 that were 7.61 times as many as 1949. The amount of graduation was 840 that were 9 times as many as 1949.

The development of Shaanxi province medical university is slow. The person with medical knowledge is shortage, especially the person work at countryside. During innovation, Shaanxi province emphasis on training medical students. Xian medical university firstly set up medical class for Ankang and Hanzhong, then, the fourth military medical university and other medical universities do, either. They set up 8 palaces for teaching. The number of enrollment 6422 and the amount of graduation was 3976. From 1988 some universities set up medical self-study class, or combined with social community, to 1996, the amount of graduation was 1447. From 1991 they opened clinical medicine class and medical test class at Shaanxi province broadcast television university. With permission of National Education Committee, former hygiene school rebuild to the first senior medical school in Shaanxi in 1994. Now, the different kinds of medical schools enroll 2000 and graduate 1500 annual.

Middle medical educationMiddle medical education should train applicable person, reinforce basic skill. It must

applicable to the need of primary level.

77

In 1949, Shaanxi province have 3 hygiene schools which set up 3 departments. In 1960, the schools increased to 17 and the departments increased to 7.In 1965 the schools decreased to 11. There were 566 staffs and 3446 students in the school in 1965. And the amount of graduation was 856 that were 42.8 times as many as 1949. During the cultural revolution, the medical schools didn’t enroll. After 1972, schools start enrolling two years students, they begin to enroll 3 years students in 1977.11 medical schools set up 10 departments and there were 8375 students in 1980. At the same time, they enrolled students 2707.

The education terms changed into 4 years in 1985. Now, there are 10 medical schools in Shaanxi, two hygienic adult school with more than fourteen thousand students there. It also opens many other medical majors. The schools totally occupy the acreage of fifty-five hundred thousand square meters, having about 1076 professional teachers, 92.4 percent of them with college education, eighty-four hundred thousand volumes of books, and four hospitals. 28443 students graduated from them from 1986 to 1988.

Resent years, middle medical schools emphasized on connotative development. They deepened teaching reformation, added precautionary medicine, social medicine, medical ethnics, elementary hygiene, family planning and vocational morality, etc. They carried out the new teaching outline that was issued by healthy office. They adjusted majors according to the instruction of healthy office. They set up medical shadow diagnose, patient archives administer, medical cosmetology，medicine marketing sell and so on. All of measures promoted development of schools.

With the care of leader of healthy office, middle medical schools obtained sustentations from HuaXia Foundation. With the support of government and medical universities, the middle medical schools develop fast. Now, there are 5 schools were evaluated key school in Shaanxi.

Rural doctor teachingAfter liberation, elementary hygiene training mainly set up at county. This kind of training

was very superficial. In 1987, there were 88.7% counties set up hygeian schools which were always in county hospital and trained rural primary doctor.

In 1988, teaching committee of Shaanxi province and healthy office of Shaanxi province deployed to set up hygeian vocational schools gradually on the basis of schools that conditions was better than others. These new schools opened 3 majors. They’re the bases for training standard rural doctor. There are 30 hygeian vocational schools in Shaanxi in 1993. Now, There are more than ten thousand of students, 1252 staffs (including 72 senior staffs and 309 middle staffs) in schools.

The school houses occupied about 313.2 thousand square meters. The teaching equipment cost about 8770thousand yuan. The fix capital of schools is about 13250 thousand yuan. The health vocational schools carried out unified plan, unified outline, unified teaching material, unified standard of lab construction, unified method of recruiting students and unified administration of student status.

For instructing the rural doctors’ working efficiently, the healthy office of Shaanxi set up the center of rural doctors’ training. The hygeian vocational schools must pass the unified graduating provincial exam that started in 1993. carrying out the unified provincial exam has lots of benefit, such as promoting the schools’ administration and hardware construction, improving the teaching quality, stressing the practice. 73095 students already participated in exam from 1993 to 2000. the qualified students were about 60057. The average qualified rate was about 82.16%.

78

The hygeian vocational schools of YuLin was recommended as example of that. The schools of XianYang, BaoJi, NanZheng, ChengGu, LuoChuan and WuGong were recommended as key schools.

According to the rural doctors training plan of Shaanxi, at the end of this century, there should be a rural doctor who must have middle level of medicine. The 80% rural doctors must reach the middle medical schools’ level. Now, there are 24627 rural doctors passed the exam that was about the middle medical schools’ level.

Adult education.The adult education gained the great achievement in Shaanxi, especially in the field of

official teaching. From 1951, in Shaanxi, the different kinds of training classes have been opened. In the 1950s, the amateur medical universities were wet up. These schools opened the medical treatment departments, pharmacological departments, Chinese traditional medical departments and so on. Some hospitals set up “7.21” medical colleges during the 1970’s. But none lasted. It became province, city and county three bands training network in1981. Now, there are 3 national bases and 23 provincial bases in Shaanxi. People want to participate in training is about 10 thousand every year. Form 1984 to 1989, 30730 people in position took part in the training. The number decreased during the 1990s. Shaanxi set up the continued medical education committee in 1992. It formulated “medical education project” and mentioned to train and improve the county medical unit. It also trained medical workers who work at remote places in third class hospitals and conducted many educational activities for improving medical diagnose and treatment.

3.5.4 the practice opinion of deepening hygiene facilities unit personnel system reformation in Shaanxi province (Shaanxi personnel dispersing [2001] No.46)

3.5.4.1 Guidance idea, the target and principle of reformation Guidance idea: Regarding Deng Xiaoping’s theories as guide, carry out《The practice opinion

of deepening hygiene facilities unit personnel system reformation》(central personnel dispersing [2000]No.31, below abbreviated for central three Ministries 《 practice opinion 》 ) issued by Ministry of Organization, Ministry of Personnel and Ministry of Health in Central Committee of the Chinese Communist Party and relevant documents with extensive thought and honesty. In light of the economic developments and satisfying the health require of the people in our province, attach significance to the optimization of hygiene talented person resources installment and improving the hygiene service quantity and efficiency, reform the current hygiene facilities unit personal management system, introduce competition mechanism, changing employing system, accelerate the construction of hygiene professionals and the hygiene facilities unit management professionals with high quality to promote the hygiene reform and development of hygiene facilities in Shaanxi province, and provide the powerful organization guarantee and talented person support.

Target of reformation: Paying regard to promote the appointing system and the duty management system , carry through the various missions in central three Ministries 《 practice opinion 》 . In 3-5 years, gradually establish the personal management system in line with the hygiene working characteristics in Shaanxi province, set up the scientific classification system forming a vigorous employing system which will benefit the development of talented person and a distribution system which gives weight to achievement and contribution.

79

Principle of reformation: Insist the administration of Party over cadres; insist the “four trends” policy in cadres and employing principle with morality and talents; insist the respect for knowledge and talented person; insist open, equality, competition and selection; insist the distribution system depending on labor with production factors. Mobilize the enthusiasm and creativity in various personnel and increase the hygiene profession service quantity and level by system innovation and related reformation.

3.5.4.2 the contents of reformationCompletely promote the employment system and duty management systemCarry out employment system in the whole members. According to the principle of inviting

application openly, selective employment, equal and voluntary consultation, unit should sign the employment contract with person employed with clear and definite duty, right and benefit. Guarantee both parties’ legal rights. Break the life-long system of job and shift management from identification to duty.

Divide sections and place duties reasonably. Placing duties with the principle of “controlling of total amount and structure adjustment”. Considering all kinds of factors such as work requirement, unit development, talented person's construction and education, Place duties when they are needed. On the basis of district hygiene program, all levels of hygiene administrations should break the hygiene organization belonging relation and systemic boundary, and enhance the macroscopic regulation, and optimize installing of hygiene talented person's resources gradually.

Reform the Leader management system in hygiene facilities unit. On the premise of persistence in the administration of Party over cadres and cadres management right, introduce competition mechanism into the appointment of leaders, pay attention to the democracy recommendation and enhance the democracy assess. Reform the single appointment system, distinguish the different circumstance, and practice various ways respectively such as public selection, competitive employment, appointment, selective term and so forth gradually abolish the administration Class in hygiene facilities units. Practice the director responsible system and tenure duty system. The director's tenure is 4 years, and can exchange term or serve another term, but the same lead can't be reappointed for two terms in a unit. Completely exert the political core and organization of all levels party. Depending on employee representative meeting, establish the valid supervision mechanism. Strictly carry out the tenure and leave audit system.

Practice the appointment system in the hygiene management personnel. Practice the tenure system In middle class leaders, which may be direct appointment, bid appointment, elective appointment and so on. The tenure is synchronous with the leader in same units. The general management personnel will be appointed levels by levels.

Practice the technical duty appointment system in profession technical personnel. The assessment and employment are separated with competitive employment.

Practice the contract system in working personnel. From now on, each unit must control the management of working personnel and make preparation for transformation to enterprise, which will help to detach rear service.

Enhance the management after hire, and establish the duty check system.Establish the dismissing and resignation system. The unit can hire the officers and workers

according the rated program, and officers and workers can also resign according to the employment contract practice the duty-shift, admonishment for those who don’t meet the

80

dismissing qualification temporarily.Practice the public invitation system in novice. The personnel who accept appointment of

hygiene technique duty must have the qualified profession educational background and matched qualifications. Those disqualified cannot take the hygiene technique work and those already in the hygiene technique work must turn to another duties. Adopt the new way for novice, which practice the personnel agency.

Enlarge the reformation degree in distribution system. Perfect the actuating mechanism in hygiene facilities unit

According to the characteristics, reformation of distribution system in hygiene facilities unit must insist on the principle that working and production factors must be combined together. The different types of units can practice different wages allotment, indicating the independent and flexible allotment mechanism.

The whole sum budget unit can practice the total wages amount management on the basis carrying out the facilities unit wages system and wages policy; The amount-Difference facilities unit can independently decide the internal allotment method of various personnel according to the national assessed total wages amount; the independent units can also decide the wages allotment method by themselves, but they should persist in the principle that the total wages amount increase slower than economic performance.

Explore the allotment methods and mechanism involved production factors. Practice the new system that a duty has a wage and wage changes with duty. The annual pay system can be allowed for Leaders gradually.

Establish the reasonable personnel fluxion mechanismArrange the personnel unemployed and their basic living expenses, pension and medical

insurance properly.Make use of the market mechanism to adjust the hygiene talented person's construction,

promote the reasonable fluxion of talented person, and gradually practice the personnel agency system.

3.6 Medical Insurance System

The reformation of medical insurance system is an objective request that adapt to socialism market economic development, and also an important condition to insure the enterprise reformation and construction adjustment. In recent years, the public medical care and protection-protection care system reformation have been launched in Shaanxi and have obtained good results. In order to push forward the medical insurance system reformation of town personnel in whole province, Shaanxi continuously perfect the related policies on the summary of previous work and deepen the medical insurance system reformation.

3.6.1 The necessity of medical insurance system reformation Establishing the social guarantee system accorded with the situation of our country is an

important task brought up in fifteenth CCP conference and the first conference of Ninth National Peoples Congresses. Medical insurance system reformation is an importance part of social guarantee system. Promoting the medical insurance system reformation of town personnel and perfecting social guarantee system are related to the general situation of reformation, development

81

and stableness as well as the realization of our target for the socialism modernization developments across the century.

Firstly, medical insurance system reformation of personnel is the general inevitable trend and imperative. The current public medical care and labor-protection care system was set up in early 1950s. They both played important roles in ensuring personnel’s health, promoting economic development, maintain social stableness. However, with the development of economy and reformation, the defects of the system are increasingly outstanding. ： The first, the national finance and units undertake the whole thing, and the personnel medical cost increase sharply. According to the statistics data, the personnel medical cost of whole country is 77.37 billion in 1997, which increased 28 times than that of 1978, average increasing 19% each year. But the finance income in the same period only increased 6.6 times, average increasing 110%. The medical cost increasing quickly is associated with the current public medical care and labor-protection care system, which makes all levels public finance unbearable and aggravate the enterprise and facilities unit’s financial situation. The second, the lack of valid system that restricts medical establishment and personnel themselves results in high medical cost and low efficiency. According to some investigations in the cities, the medical affair is an. outstanding problem which personnel dissatisfied with. Many people complain that the medical cost increased surprisingly. Under the current system, some medical establishment issued the unnecessary descriptions to increase their income. It’s widespread that one person sees a doctor for medicine but the whole family uses the medicine. According to the department concerned, the Irrational expenses account for 20—30% of personnel medical cost. The third, the coverage of current public medical care and labor-protection care system is narrow, and the socialization level of management and service is too low. There are significant differences in medical treatment between personnel in different regions, different ownership system, different professions and different units. Certain personnel even haven’t basic medical treatment. Along with the changes in ownership system structure, the number of personnel not in public ownership units increased from 150 thousand in 1977 to 37.54 million in 1997, which accounts for one third of all personnel in state-owned enterprise, but they can not get the basic medical treatment to guarantee their health.. Labor dispute concerning medical treatment continuously increase. In these years, more and more personnel have been inquiring the units and government, some even in the court, because they haven’t enough money to see a doctor or, can’t submit their expense account. In a word, the current public medical care and labor-protection care system must be reformed.

Secondly, the medical insurance system reformation is needed for realizing the target of state-owned enterprise reformation and development. The Central Committee and State Council suggest helping most large and moderate state-owned loss enterprise get rid of difficulties by reformation and reorganization in about 3 years, and set up the modern enterprise system in most moderate state-owned key enterprises by the end of this century. The basic measure to realize this target is to encourage merge, standardize bankruptcy, come off duty, increase efficiency and apply reemployment project. Because of historical reasons in many ways, there are too many personnel in state-owned enterprises. Coming off duty and increase efficiency is an objective demand for economic development and an important content of state-owned enterprise reformation. To fulfill this task, an important measure is to provide those who come off duties with basic living guarantee including basic medical service. At present, the personnel in state-owned enterprise are unwilling to work in a unit not in public ownership. Besides the old occupation concept，another important

82

reason is that social guarantee has not covered the units not in public ownership which will cause disturbance in personnel. Establishing the medical insurance system covering all units and personnel and ensuring the basic personnel medical service will be propitious to change the old occupation concept and widen occupation channel, thus will accelerate the steps of state-owned enterprise reformation.

Thirdly, the medical insurance system reformation is needed for establishing the socialism market economy. The fundamental target of our economic system reformation is to establish the socialism market economy, which is competitive economy. Under the condition of socialism market economy, the government must advocate and protect competition on the basis of macroscopic adjustment and form the economic functioning mechanism with vigor and efficiency to liberate productivity and make economic progress. Meanwhile，the government must disperse the risk brought by the market competition and maintain the social impartiality and stabilization by establishing providing for the aged, medicine and unemployment insurance system.. Establish the social guarantee system with the function of “safety net”and“regulator” to ensure that all personnel could enjoy the insurance system, which is an elementary function of the government and the basic right of personnel entitled by Constitution and Labor Act in our country.

After years of discovery, we preliminary found the endowment insurance of enterprise employee in last year; the fundamental living insurance and reemployment of the unemployment of state enterprises was carried out; the unemployment insurance have been preliminary found, range from state enterprises to non-state enterprises; the insurance of lowest living standard of citizens have been found in more than 400 cities of China. However, the reform of medical insurance of employee is lagged relatively. This reform must be accelerated to found the system of social insurance, which could speed the process of market economy system of socialism.

Fourthly, the reform of medical insurance of employee also is an important measure to improve the health standard of employee. One of the aims of reform and development of economy is the improving of living standard of people. We must improve the living standard of people to higher level based on the development of economy. Not only the need of material and civilization, but also the need of standard of medical treatment should be satisfied. The reform of medical insurance of employee must be deepening, and the medical insurance must be developed, which is beneficial for the improving of medical condition of the units of all levels, ensuring the employee of the service of fundamental medical care, improving the health of employee. And it is an important symbol of the improving of people’s living standard and advancement of the social.

3.6.2 The aim, guideline ideology and principle of the reformThe main aim of the reform of medical insurance is the following: preliminary founding

medical insurance system of employee, that is, founding the reform of social medical insurance system to meet the medical need of employee, to suit the market economy system of socialism, based on the enduring capacity of finance, enterprise and individual.

The guideline ideology of the reform of medical insurance is the following: taking the spirit of the 15th committee of the liberty party as guideline, according to the demand of “the decision of founding the elemental medical insurance system of town employee by the State Department”, basing on the primary situation of the province of socialism, persisting the guideline of classified instructing, performing by steps and carrying forward as a whole, putting the emphasis on the institutional innovating and system transferring, preliminary founding medical insurance system

83

of employee in a year in our province.The principle of the reform of medical insurance is the following: the level of the elemental medical insurance must adapt to the development level of social economy of our province; all the units and the its employee of the town must participate in the elemental medical insurance system; performing the method of management by local area; the expenses of elemental medical insurance was bear by both the unit and the employee; the fund of the elemental medical insurance system carries out by the combining of social fund and individual fund.

3.6.3 The principle policy in reform of medical insurance systemCoverage range and recruitment of fundsAll employ units in cities or towns all over the province, which includes enterprises (such as

state enterprises, collective enterprises, foreign invested enterprises, or private enterprises), institutions, institutional organizations, social organizations none-enterprise organizations run by the local people and its' clerk, and owners of individual-owned economy and its' clerk should be included in basic medical insurance. Township and village enterprises addressed in city or town must be under control of medical insurance either.

The medical insurance system will be based on city level administration area as management unit. All employ units and its' clerk should attend medical insurance in the local area, and unified policy and standard must be carried out. Those over areas and ambulatory enterprises and its' clerk in railroad and power-industry can be concentrated to join medical insurance in area where they are working, the specific methods will be formulated by labor government agency of Shannxi province according to related regulations of our country and the conference of the administration areas and industries related. Provincial party or executive institutions and institutional organizations stationed in Xi'an will join the system according to the local policy and standards, the medical insurance funds will be administrated respectively according to contemporary financial system.

Elementary medical insurance funds will be paid by employ units and its' clerk together, and all units over the province should pay 6 percent of its' clerk's salary as elementary medical insurance funds, and the employee will pay 2 percent of their wages. And the payment of units and employee will be changed according to the development of economy.

If the employee average salary of the unit is 300 percent higher than average level of local employee last year, they will pay the funds according to the 300 percent of the average employee salary as basis; If the employee average salary of the unit is 60 percent lower than local level, they will pay according to 60 percent of average salary of last year as basis. Owners of individual-owned enterprise and its' employee will pay the funds at the level of local last year average salary, let alone as unit or as individual.

To those who lose their job in national enterprises, the reemployment service center will pay elementary medical insurance premium for them at the level of 60 percent of local average salary the year before, let alone for unit or for individual.

At the time of the enterprise be repealed, combined, transferred, rented, or contracted out, those who take over or operate it instead will assume the responsibility of the clerk's medical insurance, and pay the elementary medical insurance premium at time. At the time of liquidation, the enterprises which have gone bankrupt must pay the insufficient wages of its' employee at first according to the law for enterprise bankrupt, at the same time, the owed elementary medical

84

insurance premium must be paid. Also they must pay medical insurance premium one year for the clerk and 10 year for those retired.

Foundation of elementary medical insurance administration funds and individual accountsThe elementary medical administration funds is composed of administration funds and

individual accounts. The elementary medical insurance premium, which paid by employee individually, will be taken as their individual accounts. Those premium paid by employ units will be divided into two parts, one taken as administration funds and the other as individual accounts. The proportion of the premium to be taken as individual accounts will usually be 30 percent of the whole paid by the unit. And the local area according to the paid range of individual account and the ages of the employee will determine the specific proportion.

The administration funds and the individual accounts will pay for themselves and account individually, and they shouldn't take up each other. The individual accounts pay for clinic service chiefly, and administration funds will be chiefly used to pay to hospital. To pay for those chronic diseases and specific therapeutic service which will cost highly at clinics will be the duty of administration funds, and the specific methods will be determined by local area according to the local facts.

The lowest and highest standard payment of the administration funds must be determined. For individuals to be treated in hospital, every time will make sure the standard to be paid, for the first time the standard usually is 10 percent of local average salary the year before. For those who are in hospital several times per year, the stand can be lowered accordingly. The part above the standard will chiefly be paid by the administration funds, and individuals also must pay part of it. The highest level of the payment of the funds commonly is 4 times than the local average salary. The costs exceeds the highest level can be paid by institutions of social insurance by the way of establishing mutual fund for those suffer from serious illness, also it can be paid through commercial medical insurance. The proportion of the costs between the lowest and highest level which be paid by individuals will be determined by local area according to the balance between income and expenditure.

The individual accounts is they will pay for overspend, and the principle and interest belong to themselves, also it can be transferred or inherited. When the employee moved over area, their accounts will move accordingly.

To adapt the medical insurance system for employee to the social market economy, government of Shaanxi province has classified the way to pay according to light or serious illness, which is applicable for provincial party and government institution, civil organization, and institutional organization wholly supported by government finance (other organization will join local medical insurance). The individual accounts pay for light illness, if individual accounts is insufficient, the rest will be paid by the employee themselves; for serious diseases, the costs of be in hospital or emergency or unusual diseases will be co-paid by individual accounts and finance.

The constitution of employee' individual accounts will be added monthly by financial institution at the basis of the first four items of their wages, and it will be altered according to their working years.

Working years 1-10, add 6%;Working years 11-20, add 8%;Working years 21-30, add 11%;Working years 31-40, add 15%;

85

Working years above 41, add 20%;To those retired, 20% of their pension will be added.The individual accounts of employee is their own deposit book, it must be administrated by

themselves, the part of overspend can't be complemented, the rest will be saved, and it can be transferred or inherited but can't be drawn out or embezzled.

The range of payment of the individual accounts includes the costs of employee at appointed clinical organization (not for serious illness), the costs of buying medicine at appointed drugstore, and the part paid by their own when be in hospital for serious illness or for clinical emergency.

The costs of employee' being in hospital for serious illness or clinical emergency will never be taken up by the nation wholly but by individual accounts and national finance partly. The specific way is to establish individual standard to pay and the upper limit of financial payment. The individual standard is the costs of being in hospital for serious illness, which should be paid by individual at first. The individual standard of payment is 10 percent of average salary the year before in provincial institutions. The standard in 2000 is: for the first time to be in hospital, it will be 600 YUAN for tertiary hospitals, 500 YUAN for secondary hospitals, and 400 YUAN for primary hospitals. For those be in hospital several times per year, the standard can be reduced 200 YUAN. And above the standard, the financial payment can pay four times than average salary of employee in provincial institutions the year before, in 2000, it be determined as 30,000 YUAN.

If the fee-for-service is between the individual standard and the upper limit, according to the stage of the hospital and the fee, some small part of the fee will be paid by individual accounts and governmental finance by the way of accounting periodically and adding up to pay. In this part of the fee, the proportion paid by employee is listed out below in table 3-1.

Table 3-1 The Proportion of Health Costs Paid by Employeesthe cost level of

treatmentthe propotion of payment of employee (%) the propotion of payment of retired (%)

primary hospital

secondary hospital

tertiary hospital

primary hospital

secondary hospital

tertiary hospital

under low-limit of payment

14 16 18 11 13 15

~500 Yuan~1000 Yuan 12 14 16 9 11 13~2000 Yuan 10 12 14 7 9 11~3000 Yuan 8 10 12 5 7 9

The part of the fee, which surpasses the upper limit of financial payment, will be paid by individual accounts and governmental finance. That's to say, for those working years under 20, individual take up 20 percent of the fee, and government finance takes up 80; working years from 21-30,individual takes up 15 percent and finance 85 percent; more than 31 years, individual 10 percent and finance 90 percent; to those retired, individual 10, and finance 90 percent.

At this time of the reform of medical insurance system, the fee of employee to receive treatment in appointed hospital is restricted, so that hospital must take the risk. The specific way is that if the employee' fee-for-service in hospital is between the individual standard and the upper limit, the part surpassing the lower limit will be paid by province social security bureau to the

86

appointed hospital by the way of ration account. And the account ration of hospitals at different level will be executed according to the standard of average discharge fee of city employee who is under the elementary medical insurance in Xi'an in 2000. To specify, it is 3640 YUAN in senior tertiary hospital, 2750 YUAN in junior tertiary hospital, 2400 YUAN in senior secondary hospital, 2260 YUAN in junior secondary hospital, and 1900 YUAN in senior primary hospital and 1800 YUAN in junior primary hospital. If the reasonable fee-for-service is less than 90 percent of the ration, it will be checked out actually. If the fee is between 90~100 percent of the ration, it will be checked out according to the ration. If the fee surpass the ration lower than 10 percent, the appointed hospital will take up 30 percent of the part of overspend, and the financial 70 percent. If the fee surpasses 10 percent but is lower than 20 percent of the ration, the part of overspends will be paid 70 percent by hospital and 30 percent by finance. If the fee surpasses 20 percent, the part of overspends will be paid by hospital alone.

Sequence chart of going in hospital for employee under insurece of provincial institutions or institutional units in Shaanxi province

Fig.3-1 Sequence Chart of Institution of Staff Admission in Shaanxi

Make the administration and surveillance of elementary medical insurance right.Elementary medical insurance funds must be administrated and used by the finance specially;

it can never be embezzled or invaded. The recruitment and administration and spending of the funds will be carried out by local institution of social security, which must establish sound system for budget and final accounting, sound system for finance accounting and inside audit. And the outlay shouldn't be attracted from the funds but be solved by coequal financial budget. The institution of labor security and financial department of every stage must reinforce the surveillance and administration of the elementary medical insurance funds. The institutions of audit must check the arrangement and administration of the funds run by institutions of social security. Also the local administration area must establish an organization to supervise medical insurance funds, which will be composed of representatives of related department of government and employ units

87

patients under insurance

register Departments of clinic service common affairs Inform of hospitalization

urgency

Identification spot of hospitalization charge

If first time, acquiring identification at the medical insurance officewards

spot of discharge account

examined and checked by medical insurance office

discharge or changing hospital

identification of diagnosis and therapy

detailed card of cost for treating

and medical institutions and labor union, also some experts related must be included.Intensify the administration of medical service.The labor agency and the social security agency together with related department of hygiene

and finance of Shaanxi province will establish the carry out standards and methods according to the practice of our province. And they will be based on the range and standard of elementary medical service, the system of checking out fee-for-service or fee for drugs, and the catalog of fundamental drugs, items of medical service and the standard of equipment or establishment for medical service and related administration.

The hospitals (includes its' junior community service spots) and drugstores for elementary medical insurance service will be appended, The social security organizations at every stage have appointed the local hospitals and drugstores for medical service in the insurance system and contracted with them, at the same time, determined their duty, rights and obligation, according to the approved methods for appointed hospital and drugstore, which are constituted by related national institutions of labor and social security. At the same time, competitive mechanism has been drawn in so that the employee can have choice among appointed hospitals and drugstores, or buy medicine among appointed drugstores with description. To accelerate the system reform of medical service actively, and to accelerate the hygiene enterprise to develop right, fee for medical service and for medicine will be checked out respectively to form the competitive mechanism between medical service and circulation of drugs so that the fee for service and medicine can be reduced to a reasonable level. The administration inside medical service and drugstore must be strengthened, which includes unifying service behavior, reducing clerk to improve efficiency, reducing the cost of medicine. At the same time, price for medical service should be determined. And on the basis of checking out and administrating medicine and medical service respectively, which results in reduced ratio of medicine income to total income of medical service, the labor price of medical service must be improved. By the way of improving medical skills and vocational moral quality of the clerk, the quality of service can be improved. The other steps include modifying the distribution of medical institutions, to optimize the arrangement of medical and hygiene resource, to develop community medical service, and to bring the elementary service items in community service into the range of medical insurance. The provincial agency of health has established the plan to carry out in our province together with related department according to the national regulation idea about strengthening the reform in medical service system. And the reform is cooperated by the province committee of economy and trade, who will run the reform of drug circulation well.

3 .7 Basic Policy of Health Service

3.7.1 The review of primary health service in Shanxi province At the 30th world hygiene meeting in1 1977, a global plan was introduced, it was “everyone

can get health care in 2000”. In 1978 WHO and the children fund committee of UN cooperated the international fundamental health–care meeting, the famous “the claim of Alma-Ata”, it was suggested that it is the basic and important pathway to accelerate the basic hygiene-care to get to the aim said in last sentence.

The basic health -care is the most fundamental, health care service which everyone can get, which the government and the people can afford, which can show the equality of the sociality .The

88

Chinese government promised many times to achieve the object.From 1980s, the ministry of health cooperate with WHO, 5 basic health -care centers and 6

health–care countries in rural area as example have been built, and Pucheng of Shanxi province is one of he country .In order to accelerate the health in the whole province, at the basic of these examples, from the reality of the health–care in Shanxi province, used the 12 guidelines made by WHO which was used to measure the effort of basic health care and the document made by the government, the document made by the government of Shanxi province “The plan of make the ‘in 2000,everyoe can get health care’ come true” (the 25th document ), we are asked to do the health care work in the 107 countries in Shanxi .

There are 4 parts of the plan: first, the reason to propose the object in Shaanxi, it was based on the trend got from the investigation of health source and health need from 1991 to 2000; second, withdrew the 15 lowest levels of the object in Shaanxi, it was made based on the reality of Shaanxi, those levels include the support guideline, work guideline, health guideline, by the way, those levels as the date of guideline were separated as the poor the middle class and the wealthy .The support guideline reflects the support effect of the duty of the government, the finial support, the peoples taking part, the building of health care room in a village etc. It includes: (1) put the basic health care into the plan of the government of the country and the town; (2) the money for the care from the country government; (3) the rate of the care in village who can get; (4) the number of health care room in village. Work guideline, reflects the basic hygiene Improvement and the popularity of the basic health care. It includes, (1) popularization of health care education; (2) the popularization of” safe water”; (3) the popularization of clean toilet; (4) the rate of the hygiene is above the level in the workplace owned by the country, the town and the village; (5) the foods is safe; (6) children who got one of the 4 vaccination. The health care guideline reflects the improvement of health after the basic health care proposal was put fore ward. It includes; (1) the decline of the death rate of neonates; (2) the decline of the death rate of the pregnant; (3) the decline of the birth rate of those who are disfigurement; (4) the decline of the epidemics; (5) the decline of endemic. With these object and duty, the plan proposed to realize the total objection with 3 phrases. 1st (1989-1990), make census, make out the proposal, the experiment unit must be done well: The main duty is to educate, to train leaders and techniques besides those who are interested in the plan, to better the department of the health care .All the place in Shanxi should based on the proposal, make out the proposal how to practice the proposal of health care .In the whole province, 3 types of (poor, mediate, wealth) country should be chosen as experiment unit of the health care, in order to provide experience for later use. 2nd (1991-1994), work out the whole plan: The main duty is with the leadership of the government, with the cooperation of every department, peoples taking part in, for 40-50% percent countries in the north of Shanxi, 50% countries in the south of Shanxi, 60% countries in the central Shanxi to get to the lowest level. 3rd (1995-2000), the whole province to get to the level: The main duty is all the countries in Shanxi to get to the lowest level. The countries which to get the level in 1995 should work hard to get to the higher level. An examination should be carry out in 2000 to make sure all the country to get to the level. With the development of the plan, the concept that the government pays attention, the peoples taking part in, the social worry about should be made out. Better the3 phrase network of health care in Shanxi, improve the health care level, and accelerate the economy in Shaanxi.

89

3.7.2 The main policy of primary health care in Shanxi3.7.2.1 the leadership must be better, peoples should know more. The primary health care is

important and is the main part of our country. We should do our best, to educate the peoples, let them know the importance of the plan to be carried out. Each levels of the government should know the importance; put the health care plan in the right place. The leaders should take care the plan often. The organization of primary health care of each level should be work out, everywhere must make out the plan which is about how to come up to he level and how to critic. All the work must be done well to make the duty come into practice.

3.7.2.2 the cooperation is important. The primary health care is a system work, it includes the social economy, the life, the education, the health care, and is a movement which involves plan, economy, finance, propaganda, education, television water, city building, health care movement, the hygiene department etc. the whole social must work together and know there own duty to make sure the plan come true.

3.7.2.3 Education, The improvement of the culture and health care level, the ability to care one own, is the most important part of health care. Compulsory education must be carried out. Women without knowledge should be educated. So the plan to carry out education must be done, the materials of health care must be given to them to better their own health care. The TV, radio and news must be used to educate the people .The health care room must have educative material.

3.7.2.4. Deeper the reform of health care better the health care duty. The health care department is the most important in the health care plan. The health care department put the social benefit in the first place. Carry out they duty, improve their work.

3.7.2.5.Provention is important; Endemics chronics must be under control. At now, and the main point is to prevent the hepatitis, the hemorrhage fever, and the diarrhea. Decrease the whole patients of epidemic. Vaccination must be carried out, regard the object to diminish poliomyelitis and to the 85% vaccination as the core work. All methods must be used to decrease the rate of patients.

The project to benefit the people (1997-1999), 100 million Yuan (31 million by the province government, 26 million by the government, 43 million by the peoples) should be used to the 32 countries where selenium deficiency is serious, those benefited from safe water is 228 thousand, the cooking apparatus improved 23 thousand, 3000 patients who are flurosis be cured, idonium be supplied 113 million in Yulin country.

Health birth and health care .the system care of the neonate, the women who are with young. Examination before marriage is welcome .All these work must be put together, to diminish the patients.

3.7.2.6.The organization of health care in village must be accelerated. The health care net of 3 phrases must be finished; it includes the health care organization in the country, the health care organization in the town as the media, the health care room in the village as the base. The duty of the organization the country must instruct the town and the village beside better itself, technique is also his duty. The town health care organization must do some thing to realize the object, instruct

90

the village health care room besides him work. The village health care room is the basic organization; it must wok hard to solve the problem of doctor deficiency.

Train people for the primary health care. Every country must have their own nurse school, more doctors must be trained for the village, and the city must support the village.

3.7.2.7 The money for the primary health care. The basic method to get the fee is from the country, the organization and the individual. To guarantee the object to come true, more money should be investigated .The committee of the village can take the money from individuals as funds .All the money should b used carefully, we should do our best to get support from the world bank, The children fund of UN.

3.7.3 Duty of every department in this plan In order to make the object come true in 2000, now, the duty of every department is given

here.

3.7.3.1 Health care department: construct the 3 phases net of health care in village, put up the policy of money gathering, serve the villager better.

Take responsibility in women health care, children health care and birth control.Take responsibility in check the epidermis, put up reports and plan in dealing with those

disease.Examinant the effect, supplies technical support.Take responsibility in carry out the laws in healthcare.

3.7.3.2 Plan department: Deal with the health care as the works in the plan of social development and National economy.

3.7.3.3 Finance department: the fees for the development of the health care must improve with the development of economy it must come to the ratio in the plan.

3.7.3.4 Human management department: according to the fact of in Shaanxi and the rules made by the government, solve the problem of how to organize and how many people must be assigned there.

Making policy with the health care department, which can help in keeping the people where they are.

3.7.3.5 Factory management department: they can make the factories to reduce the rubbish, the polluted water and air.

Help the factories in improve they technique to produce products, to diminish the job’s harm.

3.7.3.6 Department of agriculture and beast: Department of agriculture: kill the mice and the mosquito. The no harm toilet in villages must be higher than the basic guideline.

Department of beast: Take responsibility in dealing with the disease people and the beast both can get.

91

3.7.3.7 Water departments: Better the policy of water use, design the plan of water changing, and put the plan into action.

3.7.3.8 Department of construction and environment protection:Department of construction take response in making the plan of how to build house in village

and the town, cooperate with the other department to do the job of water changing. Department of environment protection: prevent the pollution.

3.7.3.9 Food department: carrying out the law about food, making the food healthy. Supply the materials needed in the plan by the health care department.Check the meat, if the meat is not good, it should be forbidden to sale.

3.7.3.10 Peoples department: cooperate with others to help the poor in the village.

3.7.3.11 Tax department: manage the hygiene level in the market; help others in checking the meat.

3.7.3.12 Police: help to carry out the law; manage the village where there is epidermis.

3.7.3.13 Education department: teach the students basic knowledge about health care and etc.Organize the students to take part in the activity of health care, improve the environment near

the school.Educate the adult who did not have knowledge.TV and the news: with every kind they can think about, to tell the people about health care.

3.7.3.15 Health care organization: make all the departments to work together better. Check the water change project, the toilet change project.

3.7.3.16 Birth control department: control the number of people etc.

3.8 Public Health Policy

3.8.1 Governments should have to take all the responsibilities of public sanitary and health care.

All levels of government have to take the responsibilities of public sanitary and health care, which not only in proved as a successful experience by the increasing development of public sanitary and health care in Shaanxi province since the P.R.C. founded, but is the foundation to fulfill the principal of emphasizing prophylactic.

Public sanitary and health care consist of the control of disease, the monitoring of social sanitary, health care of women and children, education of health knowledge and patriotic hygiene movement etc.

Because the essence of Chinese health project is a kind of welfare utility founded by government, we must depend on governments’ organizing, administration, coordination and supporting to develop the project. So all levels of government have to reinforce conduct, support

92

strongly, control positively and take all the responsibilities.Public health policy services the whole society and all people, so we are not allowed to make

a mistake. Health and life is important to individual, but the health of the whole society is more important, so government, the social leader and organizer have the duty-bound responsibility for the social health.

China is in the transition between two health revolution .the first revolution with the chief purpose to controlling the infection and endemic diseases has not been finished yet; however, the second revolution targeting at chronic noninfectious diseases, which are caused by social environment, psychological factor and behaviorist practices, have already been here, so the task is very severe. But the control and elimination of hygiene problems can’t resolve only by hygiene organization, we must depend on all the government organizations and appeal to all the society to solve it.

All levels of governments in china are people’s governments, whose principle is servicing people with heart and soul. The condition of public health and the level of health care in one place not only embody how local government is concerned about citizens, but directly influence on the reputation and status in people’s mind; therefore, all governments should consider the project as a complicated social system and try their best to do better so as to protect the people’s health.

The strong leadership and overall responsibility of government is the important guarantee to go on the project. All levels of committee of the Party, government and relevant organizations should actively take on and accomplish the project according to the following requirement: firstly, chief leaders of government have to be in overall change of local public sanitation. In order to accomplish the tasks, they should step into the basal organization and practice, help them resolve the practical problems and difficulties and point out the importance of prophylactic. Secondly, the they should put the project into the agenda of government think of it as great invent to concern the people’s sufferings, keep an intimate tack with the masses, improve the work style and prompt the development of society and economy. In addition, they must put supervision of the public health control of diseases into the general plan of social development and national economy so as to research, deploy, inspect and sum up it synchronically. Thirdly, in order to appeal to the masses to take up in the project we must coordinate all the ministries and a variety of communists and propagandize them to support and cooperate on it. Furthermore, we should go on building up our health policy and the framework of law. With the severe administration of justice and more strength on carrying out the law, we can launch an oppressive attack on depicts which are menacing public sanitation and do harm to people’s health and interest. Finally, we should guarantee the stable investment. At present, we must secure the staff’s wages, basic construction funds, health supervision funds, the funds on preventing diseases and healthcare. For doing so, we should try our best to accumulate funds by all means. As long as governments take all the responsibility, reinforce leadership and put the project in the prior place; as long as all the organization go all out to practice these measures, we can bring a new ground for health care and benefits.

3.8.2 Health care organization can carry out paying service.Health care organizations take on lots of health tasks. When we talk about the influential

policies that put into effect these years, the paying service should be paid more attention, which is attributed to the incessant attempt of these organizations in the condition of lacking funds. It’s a

93

kind of service in which these organizations charge the costing and some remuneration of labor when they provide society with services. The items of the services include vaccination, health examination, granting health license, supervision, equipment, specialized ambulatory treatment and medicine, technical training and inquiry, health education, censoring the health advertisement etc. it is delayed is to national policy and professional work, and it is professional health care work by itself, so the earning is belongs to servicing earning. Those that involve nonprofessional and other profit-making activities are don’t belong to paying services.

Paying-service is a new innovative measure adopted by government with regard to the health care reality in order to widen health care services and increase the earning in market economy. The proposal of deepening transformation and encourage research health departments to increase social services, which was brought by education and other ministries and permit to transmit by state council in 1989, says: according the national correlated regulation, the units of health epidemic prevention, of health care of women and children and the units of inspecting medicine etc can charge for the services of health inspects, supervision inquires. Deducted the consumption of necessary materials and depreciations of equipments, the earning is used to improve the working condition and the workers’ standard of living.

3.8.3 Reinforcing public health administrationNourishment, food sanitation, environment hygiene, vocational radiation hygiene, school

hygiene is vital parts of public health administration. Doing well in these fields playing a great pole in preventing disease, protecting people’s health improving the level of social sanitation and prompting the social and economy development in Shaanxi province.

As the necessity of human kind, food must be safe and hygiene healthy above all. The condition of food hygiene has been charged a lot, since our country ruled the administration by law in 1983, which require carrying out the inspecting food in two seasons: summer and fall, and during the period of two national festival, announcing the outcome of inspect and punishing these offended units to security the people’s health. However, the behindhand condition of food hygiene still needs altering; food pollution and alimentary toxicities happen from occasionally; among the total infections incidence, the percentage of infection diseases from digestion trait with relation to unsanitary food and water is still high. All levels of government must pay attention to food hygiene at the height of protecting and prompting economical development. In order to do well on food hygiene, we should act on the following. First of all, we must conform to the Food Hygiene Law, other relevant laws or regulations, and must implement all kind of requirement on food supervision and administration we need to reinforce the propaganda on the knowledge of food hygiene and relevant laws; we need to reinforce the training on the food hygiene research and technical staff, strengthening administration of food hygiene. Improving the consumer the awareness of self-protecting; building and perfecting the supervision system on food pollution and food hygiene; being strict on the rule of report dispose on food alimentary toxicities, paying attention to food nourishment.

The task of environment hygiene emphasizes particularly on the sites and facilities in citizens’ daily lives. We had carried out a series of activity: monitoring assessing the effect of pollution on the citizens’ health; supervising and inspecting on sanitation of public places, drinking water and cosmetic products; strengthening the censorship on the products with relation to drinking water.

94

For carrying out labor hygiene and prevention from occupation diseases, we have investigated on the labor health and occupational disease in 32 countries including BaoJi, Tongchuan, Yan’an etc. In order to comply with the labor hygiene laws we have taken the below measures: supervising the civil administration departments, regulating the prevention on pneumoconiosis, changing the employee’s licenses on radioisotope and employee’s licenses on radioactive equipments, carrying out health education on prevention common disease in students; fulfilling the pilot task on prompting sciences. Furthermore, we adopted the act of hierarchy manger on health supervision in the whole province and strengthened the public health administration in accessory units such as hotels, restaurants, and enterprises etc to protect the people’s dietary food hygiene and health. By above supervision methods, the public health condition has been improved a lot; the inspective competent rate of food and cosmetic products has been increased great. At present, the competent rate of food in the whole province is 88.69%; that of cosmetic product is 93%; that of public places is 87.24%; that of labor hygiene is 58.30%; that of radioactive is 86.36%; that of school hygiene is 46.89%.

3.9 Policies on Chinese Traditional Medicine

Chinese Traditional Medicine is an excellent traditional culture in our country, and an experience summarized by Chinese predecessor in the long period of fighting with diseases, which embodies our ethnic witness and has contributed to the prosperity of our country; moreover, it has a positive effect on the world civilization and humankind health. With the specialty and dominances, the development of Chinese Traditional Medicine is the need of reality of our country. Otherwise, the development of health project will be hold back.

With the advantage of simple skills of diagnosis and treatment, abundant sources and the low cost, Chinese Traditional Medicine is able to play a great role in resolving the contradiction between the increasing expanse of medicine and the purchasing ability of national economy. Particularly, Chinese Traditional Medicine has a rich freedom in masses of vast countries, where a suitable technology that services people and people can afford 21 popular, so developing Chinese Traditional Medicine coincide with the situation of our country and meet the need of the framework of our socialist sanitation project with Chinese specialty.

As one of Chinese Traditional Medicine birthplaces, Shaanxi has his specialties and dominances in Chinese traditional medicine. For one thing, the dominance of resource, in ancient time Shaanxi, which was known that there was no grass useless here, is abundant in a variety of Chinese traditional Medicine and is ranked the third according to potential quantity of Chinese Traditional Medicine. There are over 700 species of scarce medicines, as is the special superiority of Shaanxi. For another, the dominance of technology and talents, talents came forth in great number in the history of Shaanxi, for example, Shun Simiao, who was born in Shunyun village in Tang Dynasty, was very famous in Chinese history and was called the most famous three medical experts with Zhang Zhongjing of Han dynasty and Li Shizhen of Ming dynasty. He is so influential in fork that he was called the king of medicine, which showed that the importance and the popularity of Chinese traditional medicine.

In modern times, there are three inventions on the research of Chinese Traditional Medicine in Shaaxi. One, needling anaesthesis, great invention in Shaanxi, has been used in the emergency operation in instead of medicine. Another is electropuncture and scalpneedling. Last, the discovery

95

of those people sensitive to meridian.

3.9.1 Administrative system on Chinese Traditional MedicineChinese Traditional Medicine is a special problem in Chinese health project; the

administration and framework of the Chinese Traditional Medicine is also special problem in Chinese current administration mechanism, so we need special policies.

The Party and governments have strengthened the construction of administrative mechanism on Chinese Traditional Medicine, since the people’s republic of china was founded. Bureau of Chinese Traditional Medicine was established in health ministry in 1954; subsequently, section of Chinese Traditional Medicine was established in Shaanxi; department of Chinese Traditional Medicine was establish in other districts, other provinces or other counties, so the administrative net of Chinese Traditional Medicine was constructed from center to local.

Chinese Traditional Medicine has been developed drastically since the third conference of he 11th committee of Communist Party of China. The National administrative bureau of Chinese Traditional Medicine was officially permitted to be founded by state council in order to adapt to the development of Chinese Traditional Medicine, improve the administration of Chinese Traditional Medicine institution, strengthen the administrative function and fulfill the polices of Chinese Traditional Medicine. The found of National administrative bureau of Chinese Traditional Medicine provides the important safeguard in the framework of institutions. The National Administrative Bureau of Chinese Traditional Medicine was founded in May 1988. The Chinese Traditional Medicine administrative function was transferred from National Medicine Administrative Bureau to Administrative Bureau of Chinese Traditional Medicine. National Chinese Traditional Medicine Bureau was definite as directly under unit of the State Concert to Administrate Chinese Traditional Medicine.

Shaanxi provincial Chinese Traditional Medicine Bureau was founded in 1987, whose administrative functions were strengthened so as to adapt to the development of Chinese Traditional Medicine project, including: taking the responsibility for the administration on the provincial Chinese Traditional Medicine; working out the local policies, laws and regulations; making the developing strategies and plans; strengthening the macroscopically administration and control; compiling the developing plans and yearly plans; arranging and allotting the Chinese Traditional Medicine funds and basic construction investments; reinforcing quality control; organizing scientific research, technology exploit and staffs’ training; carrying out international exchange and foreign affairs; taking the charge of balance among producing, supplying and selling; prompting the inheritance and development.

Other cities successively founded the Administrative Bureau. As the all levels functional institutions, the bureaus perfect the Chinese Traditional Medicine administrative net, provide the reliable organizational guarantee and build the concrete foundation for the development of Chinese Traditional Medicine.

3.9.2 Chinese Traditional Medicine InstitutionAt the beginning of Liberation, Shaanxi had no national Chinese Traditional Medicine

institution. There were only about 1,300 people who took up Chinese Traditional Medicine careers and most of them worked in the private clinic or in the medicine store.

After liberation, guiding by the Chinese Traditional Medicine of Communist Party of China,

96

all levels of governments paid attention to development of the Chinese Traditional Medicine institutions and take the following measures to develop it: holding the Chinese Traditional Medicine training for the retired from Chinese Traditional Medicine to cultivate Chinese Traditional Medicine talents; opening up united clinic; encouraging the Chinese Traditional Medicine talents to work in national hospital. Xi’an founded three Chinese Traditional Medicine clinics in 1955; Xi’an founded three Chinese Traditional Medicine hospitals in 1956, which opened new page in Shaanxi history of Chinese Traditional Medicine.

After the third conference of the 11th committee of Communist Party of China, Center Government transmitted the report on complying with the Chinese Traditional Medicine and resolving the problem of lacking professionals, which was rendered by the Committee of Health Ministry. For comply with the essence of Center Government’s document as well as coinciding with the local reality, Shaanxi committee of CPC sent out the particular document on the task of Chinese Traditional Medicine and considered the advancement of Chinese Traditional Medicine as one of the most important strategies, consequently, the Chinese Traditional Medicine project was resumed and developed. Shaanxi province held the magnificent conference to cheer up the provincial Chinese Traditional Medicine, in which they worked out the Seventh Five-year plan on development of Chinese Traditional Medicine and set the aims of at least one Chinese Traditional Medicine institution in each county at the end of Seventh Five-year plan. So the conference built the concrete foundation for advancement of Chinese Traditional Medicine and accelerated the speed of development on Shaanxi Chinese Traditional Medicine. By December 2000, the number of institution of Shaanxi provincial Chinese Traditional Medicine had increased to 178, owning 10,548 Chinese Traditional Medicine sickbeds and the staff of 22,682 people. The aim of every county’s having one institution was attained.

3.9.3 The Chinese Traditional Medicine's policyTo recover and develop Chinese Traditional Medicine, the political party and government

have paid great attention to the development of Chinese Traditional Medicine and have established a series of guides and polices since established of the nation. The decisions in healthy reform and development, which made by the political party and state department, take Chinese Traditional Medicine as important as western medicine into the development guideline of health in new period. In the national health development conference, president Jiang Zeming pointed out emphatically that the ethical excellent culture must be carried forward and Chinese Traditional Medicine must be revived. All above affirm the important position and role of Chinese Traditional Medicine.

The Chinese Traditional Medicine's policy was made by the political party and government, which based on the people’s need of Chinese Traditional Medicine and on the fact that there existing two different medicine systems: Chinese Traditional Medicine and western medicine. It’s fundamental aim is the following: carrying on the guideline of combining the two different medicine systems, accelerating the development of Chinese Traditional Medicine steadily and in long-term. Chinese Traditional Medicine’s development stratagems, guidelines and policies must be made based on the fundamental aim, whose content include the following: inheriting and carrying forward Chinese Traditional Medicine; combining Chinese Traditional Medicine and western medicine; taking protective and beneficial action of developing Chinese Traditional Medicine to recover and develop Chinese Traditional Medicine.

97

The development of Chinese Traditional Medicine in Shaanxi province has been taken into account since long before. Convention of developing of Chinese Traditional Medicine was hold in 1985, Chinese Traditional Medicine administration bureau was established in 1987 and program appropriation was listed alone, the Shaanxi province’s government printed files about acceleration of Chinese Traditional Medicine’s development in 1995. In 1997, in suggestions about carrying out “PRC Political Party and the State Department’s decisions about health reforming and developing”, the Shaanxi province’s committee and government further took insisting Chinese Traditional Medicine’s importance and reviving Chinese Traditional Medicine as one of the four strategic emphasized works of health works in province, which had accelerated the development of Chinese Traditional Medicine in Shaanxi province.

3.9.3.1 Enforcing the construction of Chinese medical institution, promoting the Chinese Traditional Medicine

Firstly, since the Eighth five-year-project, the governments at all levels have carried out the guideline of health works seriously, persisted in deepening reform of Chinese Traditional Medicine, enhanced the leadership of it, implemented the strategic transformation works from constructing of institution to constructing o intension, of Chinese Traditional Medicine step by step and accelerated the modernization of Chinese Traditional Medicine’s construction. In 1995, The general office of Shaanxi Province confirmed and transmitted “the Decision about Accelerating the development of Chinese Traditional Medicine” issued by Shaanxi province’s office of health, which set forth abstract aim and demand about accelerating Intension construction and modernization of Chinese Traditional Medicine. On the concerning and supporting of all levels leaders, a series of model hospitals of Chinese Traditional Medicine were constructed to begin with. There were six Chinese Traditional Medicine Hospitals, the subordinate hospital of Shaanxi Chinese Traditional Medicine College, Xi’an Chinese Traditional Medicine Hospital, Chinese Traditional Medicine Hospital in Qian country, Chinese Traditional Medicine Hospital in Qi Shan country, Chinese Traditional Medicine Hospital in Han Zhong city and Chinese Traditional Medicine Hospital of in Hu country, which were confirmed as demonstrated hospitals of Chinese Traditional Medical hospitals in China by China Administration Bureau of Chinese Traditional Medicine, censored and accepted as all eligible hospital by China Administration Bureau of Chinese Traditional Medicine, and were permitted listing officially in 1996. Now, they have entered the second period of construction.

Secondly, in order to accelerate the development of medical institution of Chinese Traditional Medicine, seven Chinese Traditional Medicine hospitals were confirmed as province level demonstrated hospitals of Chinese Traditional Medicine in Shaanxi province. After 3 years construction, they will be the models of medical institutes of Chinese Traditional Medicine of all levels within the province.

Thirdly, constructing fund to construct the major hospitals of Chinese Traditional Medicine. Since 1991, the limited fund centralized by the province government and counterpart fund raised by different cities and countries to construct 67 major hospitals of Chinese Traditional Medicine by four batches. 20,670,000 Yuan of major construction fund had been collected, more than 70,000 squares of medical-used room have been newly constructed or reconstructed, medical equipments of most needed were purchased, which remarkable improved the whole standard of the hospitals remarkably.

98

Fourthly, Chinese Traditional Medicine specialized sections and diseases have been intensified. All levels hospitals of Chinese Traditional Medicine in Shaanxi province took the actual situation into account, persisted in the construction principals: ”I have the what others don’t have; I’m proficient when others have”. Facing the more and more competitive medical market, some specialized sections and wards of Chinese Traditional Medicine have been built, which develop the Chinese Traditional Medicine’s advantages of preventing and curing diseases, and strengthen the competitive power of the hospitals. Recently, there are two emphasized Chinese Traditional Medicine specialized sections in the third-grade hospitals of Chinese Traditional Medicine, and one in the second-grade hospitals of Chinese Traditional Medicine in Shaanxi. The development of faculty sections, such as heart, blood vessel of brain disease , nephrites, liver and gall, acupuncture, bone injure, rheumatism, is in the ascendant and ascertained as emphasized subjects and as diagnosis and treat centers.

Fifthly, according to the standards of respective-grade-administration of Chinese Traditional Medical hospital, formulated by China Administration Bureau of Chinese Traditional Medicine, the administration of standards have been executed actively, intension construction ihas been enforced, standardization and normalization of construction has been promoted. Based on the principal of whichever was matured could be evaluated, three hospitals were evaluated as the third-grade-rank-A hospitals of Chinese Traditional Medicine, one hospital was evaluated as the third-grade-rank-B hospital of Chinese Traditional Medicine, 21 hospitals were evaluated as the second-grade-rank-C hospitals of Chinese Traditional Medicine in Shaanxi province by 12,2002.

3.9.3.2 Educational Policy of Chinese Traditional MedicineEducational Policy of Chinese Traditional Medicine in China was drawn on the basis of the

guidelines of education, medical works, policies of Chinese Traditional Medicine and the need of the professional .At the same time, it was combined with the developmental tendency of Chinese Traditional Medicine.

The guiding ideology of developing Chinese Traditional Medicine is the following: carrying forward the spirits of “the decisions of reforming educational system by Center Committee of China Political Party”, carrying on “the three-orientation”, brining up Chinese Traditional Medicine’s professionals of all-developed in virtue, wisdom and body, who will serve for people by soul and heart.

Since the foundation of the PRC, the school education of Chinese Traditional Medicine in Shaanxi is developed rapidly from nothing to presence. Presently, there are 3 educational institutions of Chinese Traditional Medicine, 4046 of technical second school students, training school students, undergraduates and master who are studying at school, total 13,355 professionals of Chinese Traditional Medicine who had been trained for Shaanxi and northwest region. Now, the staffs of Chinese Traditional Medicine per one thousand people of Shaanxi ranks seven in china, the sick berths of Chinese Traditional Medicine per one thousand people of Shaanxi ranks twelve in China.

The school education of Chinese Traditional Medicine is developed rapidly. The Shaanxi Chinese Traditional Medicine College was founded in February, 1952, had only one department of Chinese Traditional Medicine before 1978, its recruit size was small-scale, had 119 staffs, 49 teachers were involved. After the third conference of the 11th expiration of the political party, with the support and concern the government, the staff of the college carried on deepening the reform

99

of the educational system, the educational condition had been improved constantly, the educational scale had been enlarged year by year. Now the college have the area about 120 ace, 2.68 millions Yuan of capital asserts, 537 pieces of educational equipments of big or middle style, about 2.79 millions Yuan in value. There are 617 staffs, include 18 professors, 96 assistant professors, 127 instructors in the college. And department of Chinese Traditional Medicine, department of Chinese Traditional drug, department of Chinese acupuncture, the Adult-education College and pharmaceuticals factory have been set up in the college. Also the college includes one affiliate hospital and 3 clinical education hospitals, 1,397 undergraduates and 76 masts who studying in the college. Since the college founded, 5,662 of training school student and undergraduates, 285 masters have graduated, and it’s the bassinet of the high-grade professionals of Chinese Traditional Medicine in Shaanxi province.

The leave-position Chinese Traditional Medicine class was held for those work with Western medicine to actively bring up combining professionals. In Oct 1958, the Center Committee of Chinese Communist Party confirmed and transmitted “the summary report about the leave-post Chinese Traditional Medicine class for Western Medicines”. In order to response to it , the department of public health of Shaanxi Province summon the medical staff to carry on the guidelines unalterably and the policies of Chinese Traditional Medicine, in the interesting of development of Chinese Traditional Medicine, and to make great efforts to develop education of west medicine studying Chinese Traditional Medicine . Since 11,1958, west medicine study and Chinese Traditional Medicine education were carried out through different channels (specialized school, hospital, night school etc.), different levels (popular class, advance class, research class etc.) and different forms (leave-post, half-time, spare time, apprenticeship etc.). After the third conference of the 11th expiration of the political party, with the deepening of the reform, several classes of studying Chinese Traditional Medicine have been performed on sequence by province to gradually grow in strength the combining professionals, which based on the need of Chinese Traditional Medicine’s development in Shaanxi. By the end of 2000, 6,830 combining professionals were trained in Shaanxi , including 80 from research class of three-year-length, 590 from two-year-length class, 300 from one-year-length class and 5,860 from short period class. After graduated, these students work on clinical, educational and scientific institutions of Chinese Traditional Medicine in Shaanxi province, some of which made great progress.

Continual education of Chinese Traditional Medicine has been developed. Since several years ago, it has been token as an important method to train professionals in Shaanxi, which was important to develop professionals of high level, help staff in post to get well education of new acknowledge and skill, and achieve remarkable result. The Shaanxi Chinese Traditional Medicine College began with correspondence school from 1979, three-year-length professionals of staff in post were trained with intensity, and 2,123 students have graduated. The self-study exam of Chinese Traditional Medicine, began in 1989, recruits staff in post of Chinese Traditional Medicine and rural doctors of country, and 2,057 specialized professionals have been graduated.. Furthermore, the Chinese Traditional Medicine classes in different forms were carried out for 83 times, which based on the special fund allocated by Administration Bureau of Chinese Traditional Medicine in Shaanxi province and took affiliate hospital of Shaanxi Chinese Traditional Medicine College, affiliate hospital of Shaanxi Chinese Traditional Medicine research institution, Chinese Traditional Medicine Hospital of Xi’an city, Chinese Traditional Medicine Hospital of BaoJi city, Chinese Traditional Medicine Academy of Shaanxi province as training bases 3,173 students have

100

been trained. To strengthen the training of professionals of Chinese Traditional Medicine in basic level unit, since 2000, 200 of technical master-hands of Chinese Traditional Medicine have been trained for country level by Administration Bureau of Chinese Traditional Medicine Shaanxi province, which combined the in-province and the out-province study , mainly taking the in-province clinic study.

3.10 Supervision and Management Policy of Medicine

Medicine is a special kind of merchandise. A series of management policies, rules and standards have been set by the government, which manage strictly on every phase of producing, dealing, using of the medicine. Supervision and management of medicine is the responsibility and power of the department of medical administration given by the law, which supervises every phase of producing, dealing, using as a deputy of the government. After the development and adjustment for 5 years, Supervision and management of medicine of Shaanxi province have achieved certain scale, and have contributed to use medicine safely for people in Shaanxi.

3.10.1 Supervision and management institution of medicineBy 2000, the offices of medicine policy have been founded in medical bureaus of 10 cities or

countries in Shaanxi, which is responsible to the management policies of medicine. There are 118 supervision and management institutions of medicine, 147 supervision and management cadres of medicine. There totally are 105 docimastic stations of medicine, more than one thousand staff, contain one province station, 10 city stations, 94 country stations. Inspection station of medicine of Shaanxi province was founded in 1974 and checked the medicine openly and formally to the outside in 1978. It was conformed as the port inspection station of the Northwest region by the Department of Health in 1997.

Supervision and Management Bureau of Medicine of Shaanxi province was founded in Sep, 2000. It’s organization and duties are as the following.

3.10.1.1 Primary dutiesCarrying out the laws and rules of the government in medicinal management, drawing and

revising the endemic rules of medicinal management and supervising by law; making and carrying into execution law about administration of medicinal management of whole province.

Drawing, revising and decreeing the standard of endemic medicine, and supervising the executing; formulating the basic catalogue of the using medicines in Shaanxi province, being in charge of the judgment of the catalogue of government-listed nonprescription medicines in whole province.

Being responsible for the preliminary censorship and reporting of the verified new medicines, imitated medicines, imported medicines, protected Chinese Traditional Medicines; being responsible for re-censorship of the medicines, monitoring undesirable reactions, clinical tests, clinical medical bases and censorship of replacement medicines; Being responsible for management of clinical medical research bases of the government in the whole province, the preliminary censorship and reporting of the new-added bases and specialties.

Drawing, revising and permitted decreeing the standards by law of the products of medical instruments, formulating the catalogue of the classified management of the products; registering

101

medical instruments of import and bases of clinical test; checking and promulgating the registered guarantee of the products of medical instruments and permitted guarantee of production; being responsible for the guaranteeing of quality system of medical instruments and security of the products.

Supervising and managing quality of medical production, business, the execution of standards of pharmaceutical management of medical units; checking and promulgating the guaranteed certificate of pharmaceutics of enterprises of producing, operating and medical units.

Supervising and managing quality of non-clinical researches, the execution of standards of quality management of clinical research of medicine

Supervising and checking the quality of medicines in production, business, medical unit, promulgating reports about the quality of medicines, confiscating artificial medicines in production and business by law, supervising and managing the markets of medicines.

Supervising and managing the works in medical material, equipments of medical production, material of medical packages, intermediate products of medicine and adjuvant.

Censoring the advertisements about medicine and medical instruments, administratively protecting the medicines, instructing the business of the censorship institution of medicines.

Supervising and managing by law the anesthetics, mental medicines, toxic medicines, radioactive medicines, specific medicines and instruments.

Researching and formulating the disciplines about certified enterprises of wholesale and retail, formulating the rules of prescription medicines, non-prescription medicines, medicines of Chinese Traditional Medicine, etc. Responding for the verification of output medicines of Chinese Traditional Medicine produced by enterprises of Shaanxi, and the preliminary censorship and reporting of the output specific medicines of foreign trade corporations.

Being responsible for the registered guarantee of professional pharmacist (including professional pharmacist of Chinese Traditional Medicine), instructing the guaranteed examinations and the registering of professional pharmacist (including professional pharmacist of Chinese Traditional Medicine).

Cooperating with concerned departments to carry out the medicine policies of the government through using supervision and managing methods.

Leading the works of supervision and management of medicines in whole province, being responsible for personnel administration, wage, training and constructing of civilization.

3.10.1.2 InstitutesAccording to the duties mentioned above, Supervision and Management Bureau of Medicine

has six functional departments (offices): Office, educational departments, register departments of medicines, safety supervising and managing departments, market supervising and managing departments, medical instruments departments.

3.10.2 Supervising and managing medicines by the lawBecause of the unsoundness of supervising and managing system of the law, some important

cases caused by false medicine could not be punished in time, moreover, some accidents caused by quality of medicines could not be disposed in time. Hence, utilizing the law, enforcing management of medicines, guaranteeing the quality of medicine, maintaining people’s health are the important measures adopted by the government under the new circumstance.

102

The government through the law promulgated “The decree about management of medicines of P.R.C.” in 1984, which based on the series of guidelines, policies and principals of medicinal management before, marked the new phase of legal management of medicines in China, and changed the situation of no law to abide by in medicinal management.

3.10.2.1 the important meaning of promulgating “The decree about management of medicines of P.R.C.”

It was the first piece of law of medicinal management in Chinese history, and also an important decree in the series of the laws. Its aims are to establish the guidelines and principals of medicinal management through the form of the law, strictly supervising the quality of medicines by the government and the people to guarantee the safety of using medicines. It’ll make great effect on enforcing the supervising of medicines, guaranteeing the quality of medicines, improving the effect of medicines, speeding up the development of medicinal production and medical work, protecting social productivity, and have practical and profound meaning for accelerating the modernized construction of Chinese socialism.

3.10.2.2 The main contents of the law of drug administration. In a word, it is as follows:Firstly, the government carries out drug production and management enterprises and

hospital pharmacies with the policy of license. Pharmaceutical factories and hospital pharmacies producing drugs and similar materials must be examined and verified by local health administration departments and provided with license of drug production and preparing. Enterprises managing drugs must be approved by health administration department of at least county level and provided with licenses of drug management.

Secondly, the national government issued the regulations of the examining and promulgating of drug standard and drug varieties. Drugs produced by pharmaceutical factories must meet with national or provincial standards formulated and issued by national or provincial health administration departments. Drugs produced by pharmaceutical factories must be examined and approved by health administration departments of central or local governments and provided with license numbers.

Thirdly, special drug should be administered special policies. There have been regulated that government exercises special administration and strict control over special drugs such as anesthetic, Psyche, toxicity and radiation drugs.

Fourthly, enforcing the management of Chinese traditional medicine. It is stipulated in the law of medicine management that the Chinese traditional medicine is allowed to be sale in rural and urban markets except that those are not permitted. This business must be supervised strictly; trading new discovered medicinal materials and new breed materials from abroad must be examined and verified by health department of the province. The health administrative departments are authorized to restrict and forbid the export of Chinese traditional medicine that is insufficient in domestic market.

Fifthly, provided the administrative principle of medicine import and export. Drugs imported for the first time must be permitted by the health administrative department and investigated according the law by authorized investigation organizations. The national health ministry must license the import and export of chlorpromazine and narcotic. Sixth, define the counterfeit and shoddy drugs. Provided the responsibility of breaking the law of

103

medicine management, including administrative and criminal punishment.

3.10.2.3 Something about the important tasks of drug administrative and inspective organizations. It is stipulated that drug administrative and inspective organizations affiliates to health administration department of all the governments execute drug supervision on behalf of the country, which is similar to other countries all over the world. These organizations are different from the drug quality administrative departments of drug production, trading and consuming. The latter are only responsible for drug quality of their own units while the other practice supervision, administration and ruling on behalf of the country.

The main tasks of the drug administrative department: supervise and inspect the implement of the law of drug management; examine and provide the license to pharmaceutical factories, drug marketing enterprises and hospital dispensaries; examine and approve drugs, promulgate drug standard, responsible for drug approve, put forward the kinds of drugs should fall into disuse; manage chlorpromazine, narcotic, toxicity and radiation drugs, responsible for the quality supervision of imported drugs, eliminate counterfeit and shoddy drugs; be responsible for medicine ads running and administration, practice administrative punishment to those breaking the law of drug management and offer those should look into criminal reliability to judicial departments.

Drug inspection organizations are specialized in practicing drug quality supervision and investigation on behalf of the country. Their main tasks are as follows: examine and justify drug quality, set up drug standard, investigate and supervise the quality of agent produced by organizations as pharmaceutical factories, drug marketing enterprises and hospital dispensaries, guide technically the work of drug quality investigation units of those organizations mentioned above, sampling and inspecting their drugs.Administrating drugs following the laws is the basic principle of drug management.

3.10.3 The policy of production and supervision of drugsOn 17 May, 1961, the central commission of CCPC announced in the transmission and

publish of report on management of drug production and quality advanced by the health ministry, chemical industrious ministry and commercial ministry that the quality of drugs is concerned with the life and health of thousands millions of people and should be managed powerfully by government everywhere and the departments which are responsible for.

In July 1973, the State Council announced in publishing of regulations of drug administration issued by health ministry that drug is the weapon of prevention and treating diseases. Strengthening drug administration, promoting production of drugs, improving the quality of drugs and ensuring the safety and efficacy of drug utilization are directly related to the life and health of thousands of people. Management should be enhanced and powerful measures should be adopted so as to guarantee the work to be well done.

After1978, the government and Party was attached more importance to drug administration. The State Council made a decision on strengthening the health administration and stressed that medicine and health equipments are special goods used in prevention and treating of diseases, rehabilitation, health protection and family planning. Drug production and circulation is not only part of social economy but also the welfare projects of healthcare. The development of medicine in China has played very important role historically in existence and prosperity of the Chinese

104

nation and is continued to be honorary with responsible for safeguard of people’s health and social productive forces.

In order to enforce the supervision of quality in drug production, we practiced rectification of pharmaceutical factories and strengthening of medicine administration during 1981-1989. This work finished in April 1982. There were 50 pharmaceutical factories, 6 production sites and 6 veterinary drug factories were reserved and 9 pharmaceutical factories were closed, merged and shifted. There were more than 30 kinds of drugs were forbidden from being produced due to their unknown effect and more than 10 kinds of drugs were limited because of disagreement with their clinical result.

The workshop of C-type Mebendazolum of Janssen pharmaceutical Ltd., which is a Sino-Belgian enterprise established and put into production in Hanjiang pharmaceutical factory in 1984. The designed production volume of the workshop is 60 ton per year. This can increase output value of 2.4 million Yuan for Hanjiang pharmaceutical factory per year. In the same year, Hydrochloric-Tetracycline produced by Xi’an pharmaceutical factory got into the U.S market and became the first pharmaceutical factory in Shaanxi province, which export drugs to the U.S. In 1984, Xi’an pharmaceutical factory was placed in the list of top 10 factories arranged by their total productive values of drugs of raw chemical materials.

The law of medicine administrative of P.R China was issued and put into practice in 1 st July, 1985. In the same year, the province government transferred the authority of providing drug production licenses to local district governments according to relative polices. Each district governments put on records of registers to province health department after pharmaceutical factories were verified and licensed. Up to the end of 1985, there were 867 among 2108 drug business enterprises had been registered and 1720 licenses were provided at the end of 1986. There were 72 pharmaceutical factories and 49 Chinese traditional medicine-processing factories were documented on their drug qualities. These actions promoted the improvement of medicine quality and the proportion of drugs that reach the standard was raised from 76% to %.

In order to have the medicine industry of Shaanxi province catch up with the advanced world levels, Yangsen pharmaceutical company that is joint-invested by China and Belgian started to be constructed on 1st March 1987. It was put into production on 4 th May 1989. The factory occupied 112056 square kilometers of areas with 35000 square kilometers of architecture. The designation and construction of the factory building and the installation and adjustment of equipments and their technology craft all live up to the standard of WHO and the regulations on product quality. The whole level of medicine production in Shaanxi was advanced greatly by the establishment of this enterprise.

At the end of 1988, there were 9 drug enterprises of 9 districts established quality supervision units and part of them equipped with chemical check laboratory. The medicine companies of 34 counties set up quality supervision subunits in the same year. There were 756 full-time and part-time employees engaged in drug quality supervision and they accounted for 3.25% of all the employees wording in medicine commercial field of the whole province. Rules and regulations such as the detailed rules of drug quality administration of Shaanxi province, the administrative measures of Chinese traditional medicine quality of Shaanxi province, the detailed practice regulations of quality investigation of commercial enterprises of Chinese traditional medicine and detailed regulations of drug quality check and evaluation.

From the age of 90th, the medicine industry of Shaanxi province has experienced a high-

105

speed development, especially new traditional medicine and healthcare productions. In order to strengthen the management of drug production in Shaanxi province and make the whole industry develop in a health way, the health department refreshed the licenses for those enterprises which met the verified standard of medicine quality so as to strengthen not only supervision but also services in accordance with the instruction, which put forward by Cheng Andong, governor of Shaanxi province that medicine management should be supervised rigorously and meanwhile be encouraged to develop. For those applying for new-construction and reconstruction of factories and workshops, the health department organized experts in time to assess the designed technology route and distribution so as to give service and supervision in advance. The enterprises can meet the requirement of GMP in a short time with possible little waste and avoid detours. The development and manufacture of new drugs is specialty intensified and some factories made many mistakes in their document of applying for new drug production. To solve this problem, the health department set up a specialized office to assess new drugs and there are full-time persons responsible for technical consult and guidance for new drug development, in order to new drugs are adopted by experts as quickly as possible. The health department also instructed the enterprises to adjust their production structures to meet the need of health undertaking. In 1995, 338 kinds of new drugs were examined and verified to be put into production with majority of them being new and special drugs listed in China pharmacopoeia, drug standard of health minister or introduced from outside province. We approved new healthcare drugs promptly as well and made the drugs to be put into production and the enterprises achieve economic results as early as possible. All of these have helped medicine enterprises adjust their production structure and the medicine industry of our province develop at a high speed ultimately.

To date, medicine products such as Jiaogulan, Shanhaidan, Limaixian, Sanbaoshuangxi,Dakeningshuang , Buchangxinnaotong have become famous brand of Shaanxi or the whole state and sell well in domestic and foreign markets. The medicine industry is now a new growing point of Shaanxi and has achieved remarkable economic and social result.

3.10.4 The policies on supervision and administration of drug management

3.10.4.1 Striking the shoddy drug production and sale, the policy has been drawn up and applied in drug circulation field. After founding of the People’s Republic of China, because the drug administration laws is not perfect，some corporations and people produced and sold drug without permission. It was very difficult to prohibit production and sale. of shoddy drug The affairs that customers’ benefit was impaired often emerged. Hence to solve these problems, government and health management department draw up a series of policies dealing with and make much struggle against the illegal affairs which are mentioned above.In 1960’s, the health bureau of Shaanxi province issued the notification about strengthening management of roving doctors and drug vendors and demanded that each level of health management department, police bureau and the civilian administration department must be strict to drug registration, censorship and certification. The drug vendors who got the sale licenses must sale drugs at the price which the government verified in certain places and had no right to advertise their drugs beyond those actual quality and to treat patients. Shaanxi province health bureau also issued drugs management administration standard (draft), dividing drugs in market into three parts, and drugs management administration right into several level.

National medicine and drug administration bureau, the Health Department, the Industrial

106

and Commercial Administration Bureau issued the advice on drugs management administration of collective and individual units on March 1, 1982. It provided administration measures for these drug management units with over-all planning，rational distribution, examination and approval, the requirements of shop employees, to drug management range, to drug resources, and so on. In June the bureaus concerned in Shaanxi province demanded the departments at all levels to strengthen drug management administration, and to facilitate that state-operated hospitals ， the facilities of providing and selling and the hospitals in certain districts united to provide drug resources better. Examination of the collective and individual units in remote border prefectures has priority, in order to make convenient for the people.

In order to conform drug market to the standard, Shaanxi province government provided advice about sternly striking shoddy drugs production and sale. From 1993 to early 1994 the governments concerned handled more than 450 affairs about shoddy drugs production and sale and found almost a hundred of kinds of shoddy Western medicine and traditional Chinese medicine ,and found shoddy drugs about 2,595 times in municipalities(or prefectures), and handled or destroyed 3,300,000 RMB’s worth of shoddy drugs, and banned 7 illegal drug market, and struck more than 300 drug vendors. The departments of drug administration and inspection in counties found and handled a deal of illegal affairs and shoddy drugs. The drug market in Xi ’an Panjiaxun was ever the biggest drug market in Shaanxi, and it also was a place where the fellows who produced and sold shoddy drugs, got in touch with another. Though the apartments had done their best to prevent this illegal behavior, it still was not stopped. But through provincial health bureau, which put emphasis on it, and Xi’an government which draw up specific measures of action and demanded the concerned departments on their duty, deeply surveyed and sternly stricken it ,uniting the provincial office of striking shoddy office ， police bureau, in 1993, in whole Shaanxi province. Now that market has been thoroughly destroyed. This action did the people a favor.

To implement the national issue, the urgent information about further strengthening drug management administration, the government of Shaanxi province provided No.(1995)19 issue. To implement the urgent information, in all municipalities and districts, the leader of the departments constituted drug market consolidation and coordination groups, which were led by the leaders of the governments. There were 43 illegal drug management units and 126 illegal drug pedlars banned just in first 6 months in Baoji. The system of drug purchase and sale centralized was adopted in Shangluo，and 6 municipalities (counties) had already drawn up administration policy, and more than 300 medical facilities and local drug management units had signed on the document agreed upon fixed position purchase and sale. There were more than 60% area of this district did so.

After received the national issue, the information of continual consolidating management of drug production and drug administration, to implement it, the provincial health bureau appointed some people in charge of supervision. According to this instructions, concerning their actual conditions, they consolidated the management of local drug markets in all municipalities and districts. These strongly promoted the development of management of drug markets.

3.10.4.2 The preliminary measure which is used in administrating medical institutions for the concentrated drug purchase and sale

To standardize the behavior of medical facilities of drug purchase and sale, to relieve the

107

unreasonable burden of patients and the society in medical cost field, the government drew up the following preliminary measures.according to the issue provided by nation, the advice about directing the reform of the medical system ， and the issue provided by 5 ministries ncluding national health ministry, this is the information about broadcasting the guideline of administrating medical facilities drug purchase and sale concentrated, and the bidding regulations of the People’s Republic of China, and according to the local actual condition,

1. This measure is suitable for the medical institutions which are public and not seeking profits, and for the medical institutions which are in charge of the workers’ medical insurance who live in Shaanxi. This measure can be the reference for other medical institutions.

2. Medical institutions are the main body in the course of central bid and purchase. If a institution has the capability of drawing up bidding issues and organizing evaluation, it can organize the bids and purchase itself or unite others to do so, or entrust agents with the bidding matters.

3. The drug bidding agent is a legal social medium organization, which has the right to do central drug purchase and sale. The qualification of the drug bidding agent is certified by drug supervision administration bureau and medical bureau of Shaanxi province according to the measures of certification and administration of shaanxi drug bidding agent

4. The central drug bids and purchase were made in public or inviting pattern. A. The medical institutions have a free choice of using the medicine which is in the basic

medical insurance (or free medical service ) catalog and suitable for the workers in town, and there is no restriction on the brand ,but the drug purchase need to adopt public bids pattern, which cost more than 50,000 RMB yuan; B. Drug purchase in huge quantity need to adopt inviting bids pattern, if it is a restrict brand; C. For new drug, the drug which is appear in shaanxi drug market for the first time, the drug which is uncommonly used by medical institutions, or the drug in small quantity or single-source purchase, it had better adopt the unpublic bidding pattern than public bidding, such as inviting bidding drug purchase, or negotiated price purchase, or competitiveness purchase and so on. The specific measure refers to the relative laws and regulations.

D. Purchase of the drug whose management is specially administrated by nation should accord to the relative t laws and regulations.

5. The procedure of central drug bids and purchase.A. With concerning clinical need, the medical institutions purchase drug on the basis of drug

classification, and arrange the catalog of the drugs, which are going to be concertedly purchased, and the plan of purchase quantity next year. After examined and approved by the drug administration institution, the catalog and the plan are provided for the drug bidding and purchase agent which is constituted by the union of the medical facilities.

B. According to nation’s relative laws and regulations, the drug bidding and purchase agent organize drug bidding.

a. Collecting the drug purchase plans of medical institutions.b. Arranging examination and verification by the specialists, to affirm the brands and the

standards and the quantity provided by each medical institution, and feeding back to them.c. Affirming the purchase methods, drawing up and sending the purchase documents, and

releasing the public bidding news in a bulletin.d. Examination and verification legality of the bidders ,and condition of conform to the

108

documents, administration regulations of the drug production corporations(GMP), administration regulations of the drug management corporations(OSP), and scope of drug production and management ,and commerce credit, and support capacity, and qualifications of drug bidders.

e. Examination and verification documents of ratification of drug bidding, and documents of certification of drug quality, and documents of ratification and registration of drug price.

f. Arranging the course of starting and assessing bidding, and selecting the bidders and affirming the brands, form, standard, quantity, price and providing method of drug. But the fourth and the fifth items are the best important.

g. After choosing the bidders, medical institutions signed the purchase and sale contracts with the bidders according to the result of bidding. And the contracts which must conform to nation’s relative regulations and define the right and obligation of both sides clearly.

h. Supervising the bidders (or the agents which are legally entrusted by the bidders and are able to be accepted by both sides of purchase and sale ) and the relative medical institutions to complete the contracts.

C. Bidding of the same drug is not more than twice one year.6. The bidder corporations must have the legal qualifications of drug production and

management.7. When the agents of drug bidding and purchase arrange drug purchase, they can demand the

cost of bid document from the bidders and the cost of service from the bidding corporations. The items and the standards of cost are made by price administration organizations of Shaanxi province according to the issue which is provided by national statistics department and other 5 departments, the measure of cost management of medium service. The agents must simplify the procedure of drug purchase in order to relieve the burden of the relative corporations. The agents can’t ask the corporations for unnecessary samples and documents and technical datum, and can’t test the medicine repetitively.

8. Once the contracts becoming effective, all of the medical institutions must pay up accounts on time according to the purchase and sale contracts.

9. The course of central drug purchase and sale must conform to the following requirements:A. Complying with the principle of fairness, being public, impartiality and honesty.

Implementing the principle of nation’s drug price conscientiously. The bidding units have no right to lay down different bidding standards according to drug price management patterns, and have no right to restrict or reject corporations in other districts.

B. It is important to assure the quality of the drug. We also must determine the drug according the principle of that the ratio of quality and price .We can give priority to the corporations which are authenticated by the GSP and GMP when the case is same.

C. Both sides of purchase and sale must make out bills according to the price they agreed, and submit them to the same level price administration organizations in 15 days, and submit the informations of drug purchase of the medical institutions to the same level health and medicine administration organizations. The price administration organizations must enforce supervision on bidding price, and establish the net of supervision.

D. The units which use electron trade and other modern information net technique to purchase should accept supervision on the information of drug price by relative management department.

E. Accepting supervision from the public legally and resisting the illegal behavior in the

109

procedure of drug purchase. The drug-bidding agent can not join in drug management and should not have any subordinate or benefit relationship with administration organizations and social groups. The drug production corporations joining bidding can’t dump drug at low price in order to capture the markets.

10. All price administration organizations should strengthen direction to drug bidding price, and balance the benefits between the patients and bidding units basing on the drug actual bidding price, according to the range of price administration, adjust and show the interim retail price of the drug which price has been provided by the government to the public in time, and submit the price to province price administration organization. Bidding medical institutions should adjust the retail price of the drug whose price depend on the markets, according to the actual bidding price. If the price administration organizations find the unreasonable drug price, they can provide retail price for reference basing on giving consideration to the benefits of both sides.

11. The drug bidding and purchase agent should seek and practice IT and other modern electron information net technique positively, in order to improve efficiency, and reduce circulation costs of drug.

The medical institutions should support the innovation of the constitution of drug supervision and administration, which accelerate establishment and development of the net of wholesale and delivery of drug.In the procedure of drug purchase and sale, we should lay emphasis on rectification of “sale commission” phenomena, and drawing up and implementing the policy of central drug bidding and purchase.

3.10.5 Innovation of constitution of drug supervision and administrationIn order to improve the constitution of drug supervision and administration, and ensure

safety in taking medicine, and accelerate development of medical undertakings. Shaanxi government provided the information of the draft of innovation of drug supervision and administration according to the draft of innovation of national drug supervision and administration bureau. The main points are listed as follows.

3.10.5.1 GuidelinesTo establish a system of drug supervision and administration progressively, which is legal

and consistent and standard and honest and efficient, by implementing the policy of deepening innovation of administration constitution and strengthening supervision and administration, which is drawn up on the 15th national congress of the communist party of china. To innovate constitution of drug supervision and administration today in shaanxi, according to the principle of efficient and simple administration and action in unison.

3.10.5.2 Establishment and administration of institutionsTo establish the institutions of drug supervision and administration under province level, in order to implement administration functions unified of drug administration and drug inspection and drug production and circulation, to meet objective need of supervision and administration of drug management and requirement of development of medicine trades of Shaanxi, and to improve the institutions of drug supervision and administration,

Setting up the administrative departments

110

1. Drug supervision and administration bureaus should be set up in every municipalities and districts and Yangling demonstrating prefecture, which are directly subordinate to drug supervision and administration bureau of shaanxi province. The main responsibility is organizing drug supervision and administration and leading the subordinate institutions to organize drug supervision and administration.

2. Branches of drug supervision and administration bureau should be established in the countries (or the municipalities and prefectures) whose task of drug supervision and administration is so heavy, and put up a board of drug inspection bureau additionally, They are the agency of drug supervision and administration bureaus of municipality(or prefecture) level. They are in charge of drug supervision and administration in their areas.

3. The structure of the provincial drug supervision and administration bureau and the establishment of whole staff should be adjusted according to actual condition of drug supervision and administration in whole province and the need of vertical administration. It is also important to strengthen the management of drug supervision and administration and the management of administration of relative laws and regulations.

Setting up the technical departmentsAll levels of the technical departments should adopt establishment of government type, and

should comply with the policy of establishment in certain district, recombination, overall planning, rational distribution.

1. the drug inspection bureau in xi’an and the provincial drug inspection bureau unite to be a new provincial drug inspection bureau according to the regulations of prohibiting reestablishment of the facilities of drug inspection in provincial capital.. The drug inspection bureaus in prefectures (including Shangzhou municipality) must be incorporated to the municipal bureaus of drug inspection. The municipal or prefecture bureaus of drug inspection are subordinate to the municipal or prefecture departments of drug inspection.

2. The branches of drug supervision and administration bureau in some counties are named bureaus of drug inspection too, and are in charge of administrative and technical supervision. The stations of drug inspection remain in other counties which have no branches of drug supervision and administration bureaus, and are subordinate to the municipal (or prefecture ) drug supervision and administration bureaus, and are in charge of technical supervision, and are authorized to be in charge of administrative supervision.

3. To strengthen drug technical supervision, a provincial level inspection center of medical apparatus and some special inspection stations of medical apparatus should be established according to national regulations about establishment of technical supervision institutions, , They are in charge of technical supervision on medical apparatus.To set up a provincial level new drug examination and approval center and a provincial level inspection center of harmful response of drug united with the national drug supervision and administration bureau. Both centers are in the provincial drug inspection bureau. A provincial level center of drug administration and service should be established, and is in charge of certification administration, the staff training, information administration and service. This center is subordinate to the provincial inspection center of medical apparatus.

3.10.5.3 Administration of institutionsThe provincial drug supervision and administration bureau provides advices about changes

111

of the drug supervision and administration institutions under provincial ones. The provincial institutions of establishment administration are in charge of examinationa. and verifiction according to relative procedure.

1. Establishment and number of leader position of the provincial drug supervision and administration bureau and its auxiliary technical departments are certificated and administrated by the provincial facilities of establishment administration.

2. Establishment of drug supervision and administration facilities under provincial level is approved by the provincial level governments, and is provided by the provincial facilities of establishment administration, according to total establishment vivificated by the Central Government. According to actual requirement, the provincial drug supervision and administration bureau provides specific advice to establishment and number of leader position of the municipal (prefecture or county) bureaus (branches) of drug supervision and administration and their auxiliary facilities, and the provincial facilities of establishment administration examinants and certificates and approves it secondly.

3. Once establishment having been certificated, all drug supervision and administration facilities will be prohibited changing it by themselves. If needing changes, the municipal(prefecture or county) bureaus (branches) of drug supervision and administration must report to higher levels, and finally reaching the provincial level. According to actual condition, getting agreement from the relevant governments, the provincial drug supervision and administration bureau transmits plan and position (including graduates from colleges or polytechnic schools and army men transferred to civilian work) to lower level.

4. Other municipal (prefecture or county) facilities which are also in charge of drug supervision and administration will be dismantled. Their establishment(including facilities of administration of drug management, technical supervision, drug inspection and drug supervisors,etc.) will be assign to higher levels. In order to assure the quality of new staff, the candidates must pass examination and accept competition. The establishment assigned is the number of staff in technical facilities before Sep.15 2000.

5.after the system of drug supervision and administration under provincial level adopts the pattern of vertical administration, staff planning, being transferred to another post, examining, appointing and dismissing, and training will organized by the provincial drug supervision and administration bureau, according to the cadre administrative policy and the pattern of classified administration.

6.The administrators of all levels supervision and management organization carried out by the inside totally central buildup department concerning adjustment province below drugs direct Management the organization staff manage the system's circular and an Announcement Of Province Committee Organization in 2000.

3.10.5.4 financial budget management 1.The financial budget of Pre all levels drugs direct management is incorporated into the

province finance budget. The standard of incorporation is based on the quantity of staffs. The fund needed by the supervision and management organization is controlled by the Province Finance Department.

2. State-owned property of those original hygiene departments is incorporated into the new departments in every City or county .The state-owned property not being removed, according to the principle: “not ask owning, guarantee the usage", should be transacted into developing the

112

necessary office places and others.3. Reform the current mechanism of drugs testing budget, the budget is supported according

to the plan made by the supervision and management for drugs, allocated by the province finance department.

4. According to the receipt and expenditure undependably principal, the income of administration's undertaking and the business charges with publish in the management and administration organization and its technique organization, passing the special finance department, is turned over to the province finance department.

3.10.5.5 other relevant problems1. The supervision and management organizations for drugs should be leaded by the

corresponding province organizations and the corresponding province departments should lead the management of the organizations and personals

2. All levels management the organization for drugs should establish and develop the system of inspector for drugs.

3.10.5.6 organization and practice1. The system reform of supervision and management for drugs is processed under the

leading of the provincial government Unifying the leading group for inspecting and managing drugs and solving the important items in setting up the work. The group’s office is located in the supervision and management department. Some work such as the organization establish, personnel establishment, staff management, public finance the cardinal number, budget guarantee and its up row the handover and so on, are practiced by the province supervision and management department, the province personnel department, the province finance department etc.

2. The adjustment of the system under province level is practiced step by step from top to bottom. Having finished setting up city level supervision and management department by the end of May 2001, and having completed the corresponding county level organization by the end of July 2001.

3. The way and time of setting up city and county level supervision and management department should be according to the fact situation .In the course of setting, the department should be strict with the entering of staffs and refuse the unqualified staffs in order to set-up a group of high-quality talents.

4. Every government of cities and counties should be aware of the importance of setting up supervision and management system. They should enhanced leadership and construct corresponding organizations, they should take pains to solve all kinds of possible problems and insure the system to reform successfully.

3.11 Policies on Population and Family Planning

Population and family planning is of very importance to which the government pays much attention and is also a basic state policy of China. Since the opening-up to the outside world, especially during the 1990th, great achievements have been made in family planning in Shaanxi. The growth rate of the population in Shaanxi is slower than that of the whole nation in sequent 9 years. The birth rate and the nature growth rate of population are both decreasing dramatically with the birth rate dropping from 23.49‰ in 1990 to 12.51‰ in 1999 and natural growth rate

113

from 16.96‰ to 6.13‰. The historical changes of the model of reproduction have finished from high birth rate, low death rate and high growth rate to low birth rate, low death rate and low growth rate. The program of family planning has entered new era of stabling the low birth rate and improving people’s quality of life. To date, the traditional ideas about reproduction, namely “early marriage and early births”, “more children means greater happiness” have been changed greatly. Family planning programs adhere to "three emphases", namely, publicity & education, contraception and continuous services.

3.11.1 The guidelines and goals of family planning in Shaanxi provinceIn the coming 10 years, the target of family planning program is as follows: the total

population of Shaanxi will not be more than 37.85 millions and the average birth rate will keep less than 14‰. In the year of 2010, the whole population of the province will not be more than 40.00 millions and the quality of people’s lives will improved greatly with all of the women of childbearing ages sharing basic reproductive health services. Shaanxi will be continually in the leading place among the western areas in family planning. To realize this aim, the work of family planning should combine governmental guidance with people's voluntariness and adopt "the integrated approach", i.e. to integrate the rural family planning program with economic development and the assistance to peasants in their endeavors to have happy families with modern ethics and culture and better-off living conditions. Classified guidance for family planning should also be provided.

----Combining the family panning with the exploitation of the western areas. The relationship between the development of economy and curtailing of population should be managed properly.

----Continually taking the controlling of the population as the most important task so as to meet the target of family planning.

----Making great efforts to improve the quality of people’s life and optimize the population structure. Disseminating knowledge of bearing healthy child and lowering the deficiency of newborn babies. Paying more attention to the problem of improper sex ratio of newborn babies.

----Exploring new ways of practicing family planning in current situations of developing socialist marketing economy. Speeding up the reform and transmitting of measures and administrative mechanism

----Adhering to the principle of classified guidance. According to the different situation in different regions, formulate and practice different policies on family planning and ensure balanced development among different regions.

----Doing researches on developing effective ways to deal with false report so as to avoid hypocritical behaviors in population and family planning.

3.11.2 The policies and measures the provincial government adopted in family planning

3.11.2.1 The objective management system for population and family planning exercised in recent years further ensures the government manipulate all resources to support population and family planning activities and spurs coordination and participation of concerned organizations in the population and family planning programs. NGOs play an important role in population and family planning programs.

114

3.11.2.2 Promoting “three-combination” approach and integrating family planning with economic development and poverty alleviation

3.11.2.3 Developing insurance system for the couples with only one child3.11.2.4 Building a family planning and reproductive health service network and improving

its service. Promoting informed choice of contraceptive methods.3.11.2.5. Emphasis has been put on the floating population problem in urban family

planning activities.3.11.2.6 Strengthening the construction of organizations in foot layers such villages. Clarifying the responsibilities, rights and interests of village administrators in family planning program, realizing democratic management and supervision in family planning in villages; Efforts are being made to produce safer, more effective and convenient contraceptive measures and to promote new contraceptive methods and techniques.

115