When responsibilities, institutions, and establishments are set, and when the three plans are finalized, that is, when the reform tasks are basically finalized.
"The Three Plans of the National Bureau of Disease Control and Prevention will be announced in the near future, and the process has reached the final stage." Recently, a person close to the national health and disease control system revealed. Multiple independent sources confirmed the news to the "Medical Think Tank".
At this time, it has been 8 months since the National Bureau of Disease Control and Prevention announced its establishment on April 28, 2021, and more than 100,000 disease controllers across the country have also waited for 8 months. "As soon as the National Disease Control Bureau was established, reform was already on the string. When the three-way plan is finalized, that is, when the reform task is basically finalized, it will have a direct and far-reaching impact on the industry. Zhong Chongming, a medical policy researcher and former associate researcher of the National Medical Security Research Institute of Capital Medical University, said.
Also under the blazing clamor for reform, the National Bureau of Disease Control and Prevention is often compared to the National Health Security Administration. From the listing to the "three determinations", the National Medical Insurance Bureau has only spent more than 3 months, and in the "transition period" of more than 3 months, it has already acted in a high-profile manner: anti-cancer drug collection and medical insurance access negotiations, pharmaceutical and medical behavior governance, investigation of high-value medical consumables management, etc., which have frequently caused waves in the industry, as if they cannot wait for the announcement of the three plans to start the reform process.
Since the establishment of the National Bureau of Disease Control and Prevention, in the past 8 months, it has only jointly issued the "Implementation Plan for the Construction of the 14th Five-Year Plan for the Construction of a High-quality and Efficient Medical and Health Service System" and the "Notice on The Advance Release of the Budget for the Prevention and Control of Major Infectious Diseases in 2022", and added a new deputy director, in addition, there are almost no official actions of any institutions.
Why is the National Bureau of Disease Control so "silent" after its establishment? Why is the three-definite plan delayed? There are many opinions on the reform plan, and in the end, which version will be decided?
The listing ceremony of the National Bureau of Disease Control and Prevention. Photo/ CCTV News
Long wait
"When will the CDC's three-decision plan be announced?"
Wu Rui, an employee of a business unit of the Chinese Center for Disease Control and Prevention (CDC), is not the only one familiar with this issue. Since the establishment of the National Bureau of Disease Control and Prevention at the end of April, from top to bottom, many CDC staff have always been asked when they go to local meetings or research, and the staff of the health and disease control departments are particularly concerned. The answer they heard changed from the first half of the year to the middle of the year and the end of the year, and the latest version is to ensure the work of the Winter Olympics and the two sessions, so the plan may not come out until March or April 2022.
At that time, the Establishment of the National Bureau of Disease Control and Prevention will be one year old. "But we don't know if the leaders will be so patient and able to wait so long?" Wu said.
At the beginning of 2020, the direct reporting system for epidemic information failed, and the unreasonable system and functions of the CDC were regarded as the direct causes: institutionally, the four levels from the central to the local level were non-vertical management models, and the local CDCs needed to obey the local governments rather than the higher-level CDCs; in terms of functions, there has always been a heavy emphasis on business and technology, light management and policies, and insufficient information dissemination and administrative power. After the SARS epidemic, China's public health team has shrunk and its status is low, and problems such as the separation of medical and preventive care have also been mentioned again.
The call for reform of the DISEASE control system thus rose to a climax when the National Bureau of Disease Control and Prevention was announced.
When it was listed, the level of the National Bureau of Disease Control and Prevention was also officially announced: the deputy ministerial level, which was under the management of the National Health Commission. Sun Chunlan, member of the Political Bureau of the CPC Central Committee and vice premier of the State Council, pointed out that the newly established National Disease Control Bureau should complete the establishment of national, provincial, municipal and county institutions with high quality and efficiency, strengthen the professional leadership and work coordination of higher-level disease control institutions over lower-level disease control institutions, and form a powerful, authoritative and efficient disease control system from the central to the grass-roots level. It is equivalent to setting the tone for giving administrative power to the disease control system.
According to Xinhua News Agency, the State Administration for Disease Control and Prevention will be responsible for formulating policies for the prevention and control of infectious diseases and public health supervision, guiding the construction of disease prevention and control systems, planning and guiding the construction of epidemic monitoring and early warning systems, guiding the construction of disease control scientific research systems, public health supervision and management, and supervision of the prevention and control of infectious diseases.
With the National Bureau of Disease Control and Prevention, the personnel and operations of the CDC must be integrated and adjusted. Wu said that at that time, many business units of the CdC in China were almost ready to accept personnel changes, and employees of departments with a high probability of transfer often joked that "we are going out soon." Local CDCs are also eager to wait for the plan to be announced, so as to determine the direction of change as soon as possible and try to win as much buffer time as possible.
On August 19, 2021, Fujian Province took the lead in preparing for the establishment of a provincial-level disease control bureau, which will integrate relevant responsibilities and institutions such as disease prevention and control, emergency response, and public health supervision. Photo: Fujian Daily
A Beijing-based disease control practitioner told the "medical think tank" that grass-roots disease control personnel are worried about the future establishment and salary package, and often get together to discuss related topics.
After the listing, the National Disease Control Bureau was almost silent. Yu Zhao, a person close to the CDC, revealed to the "think tank of the medical community" that the continuous local more serious epidemic situation is a major reason, "all kinds of delays, if because of any changes that affect everyone's enthusiasm for fighting the epidemic, it is not worth the loss." ”
At the same time, he said that another major reason for the delay in the three-way plan was that "we had to sort out some relationships", "At that time, everyone imagined it better, and it felt very natural." "Yu Zhao said that it refers to the construction of the National Disease Control Bureau like the State Administration of Traditional Chinese Medicine, although it reports to the National Health Commission, but has relatively independent administrative power." But it turned out that there were still some interests to deal with. ”
Internal collaboration and interests need to be coordinated, and external expectations are deep
Public health not only includes the prevention and treatment of infectious diseases such as new crown pneumonia, but also the nutritional diet, tobacco control, mental health, and prevention and control of key chronic diseases emphasized by the "Healthy China Action" in recent years. Yu Zhao analyzed that from the perspective of population health, CDC has two major businesses in addition to infectious diseases, chronic diseases and injuries. Judging from the background and publication functions of the directors who have been appointed so far, the future work of the National Bureau of Disease Control and Prevention will focus on the prevention and treatment of infectious diseases. Staff in CDC's Noncommunicable Diseases Division are concerned about whether the ownership of CDC will affect future business development.
Screenshot of the "Organizations" page of the official website of the Chinese CDC.
Even if all of CDC's business units are successfully transferred to the National Bureau of Disease Control and Prevention, future collaboration with the relevant departments and bureaus of the National Health Commission will be a problem. At present, CDC, the National Health Commission within the Agency for Disease Control and Prevention, the Department of Aging Health, the Department of Maternal and Child Health, the Department of Primary Health and Health, etc. are all subordinate units of the National Health Commission, and are closely linked in the prevention and control of chronic diseases, and CDC has also provided important personnel and technical support for several other departments and bureaus. Once the CDC is relatively independent and separates from the Health Commission, and several other departments and bureaus want to win this support, or the CDC needs relevant assistance, the process will become cumbersome.
"It may be that the office in the committee is on the right door, and the cadres at the department or bureau level or the department level can communicate directly," Yu Zhao said, "After the separation, it is possible that the office is still only separated by a few meters, but the document needs the approval of the departments, departments, and departments on both sides to apply for support from the other unit." Things that can be solved in one day may take longer to go through the process after that. ”
Yu Zhao said that other interests, there is also the level of the CDC: it is now a public institution directly under the National Health Commission (the level of the ministry), and if the CdC is included after the establishment of the National Bureau of Disease Control and Prevention, then it will change from a unit directly under the level of the ministry to a unit directly under the vice minister, and the overall decline of half a level; as well as the establishment of unincorporated professional and technical institutions under the CDC after belonging to the CDC, the tendency of the National Health Commission to retain the non-infectious disease business under the CDC, etc.
"There is no overwhelming consensus, and several parties have their own opinions." Yu Zhao believes that this is one of the reasons why the CDC's three-decision plan has not been decided.
From the perspective of the external environment, Zhong Chongming believes that the relative victory of China's new crown epidemic prevention and control has provided an opportunity for the disease control system to "overtake in curves" in the world; but at the same time, China's disease control system is not strong and public health services are not large, which is still an indisputable fact, and it is urgently needed to reform and build. China has established the National Bureau of Disease Control and Prevention in the context of the overall downsizing of government agencies, and the primary task is to do a good job in the prevention and control of the new crown epidemic, and to reflect professionalism, systematization and sustainability on the basis of previous work; then there is the development of health businesses such as chronic disease prevention and control, mental and mental health, reflecting the depth, efficiency and responsibility of China's public health development in the future.
"The National Disease Control Bureau's three-certain plan can reflect to a certain extent how the 'Healthy China' strategy will be implemented." Zhong Chongming said that the urgency and importance of the reform task and the deep expectations of the outside world have made the process of determining the three plans very cautious. Under the principle of medical and prevention synergy, business such as chronic disease prevention and treatment will inevitably be played a stronger role by the disease control system, and pressure, resistance and motivation will be the same.
On the other hand, Zhong Chongming believes that the Three Determinations Plan of the National Disease Control And Prevention Bureau also needs to respond to some chronic diseases of the disease control system, such as unstable construction of personnel, poor treatment, and the possible risk of gold sales of public health services in the actual business.
"The main thing is whether the treatment can be improved? Our anti-epidemic task is also very heavy, but the salary is the lowest in the same level of medical system, and the same title enters the system at the same time, and the treatment is only about one-third of other systems. A county-level CDC public health physician at the border of Yunnan told the "medical think tank" that "improving treatment, other identities and statuses do not matter." ”
After the establishment of the CDC and before the "three determinations", some disease controllers could not wait for the reform to officially start and chose to leave. The laboratory physician of a banner CDC in Inner Mongolia told the "medical think tank" that public health is already unpopular in the health system, and the laboratory department is even more "unpopular", but its work is very critical and important to the prevention and control of the epidemic. In the two years of the new crown epidemic, the workload of the laboratory department has soared, but the staff has not increased, the degree of electronic and automated information registration is almost zero, and the epidemic can only sleep 2-3 hours a day. Because of the lack of resolution of staffing problems and low salaries, at the end of the year, two of Corey's most capable colleagues resigned.
On the eve of New Year's Day, Gao Fu, director of the Chinese CDC, paid condolences to the frontline staff of the new crown epidemic prevention and control in Beijing. Photo: CDC, China
Will it be the protagonist of public health or the "high-end version of the epidemic prevention station"?
If the health business under the CDC such as chronic diseases is also attributed to the National Bureau of Disease Control and Prevention, which is easy to bring about problems in terms of collaboration and benefits, is it feasible to build the National Disease Control Bureau into a "high-end version of epidemic prevention station" focusing on the prevention and treatment of infectious diseases?
The available information seems to reveal such signs. As mentioned above, judging from the functions currently stated by Xinhua News Agency, it seems that the future work of the State Disease Control Bureau will focus on the prevention and treatment of infectious diseases. Moreover, only two documents issued after the establishment of the National Bureau of Disease Control and Prevention have something worth discussing.
The first is the "Implementation Plan for the Construction of the 14th Five-Year Plan for the Construction of High-quality and Efficient Medical and Health Service System" jointly issued by the National Bureau of Disease Control and Prevention with the National Health Commission, the National Development and Reform Commission, and the State Administration of Traditional Chinese Medicine in July. The plan proposes to focus on the construction of four major projects, "public health prevention and control and treatment capacity improvement project" as the first, the task includes the construction of a modern disease control system, the construction of a national major infectious disease prevention and control base, and the construction of a national emergency medical rescue base, which is obviously biased towards the prevention and treatment of infectious diseases; while the elderly health involving a variety of non-infectious chronic diseases, as well as occupational health, maternal and child health and other tasks, are classified as the third project "key population health services to make up for shortcomings". It reflects the separation of disease control and health work.
Secondly, the National Bureau of Disease Control and Prevention jointly issued the "Notice on Issuing the Budget for the Prevention and Control of Major Infectious Diseases in 2022 in Advance" jointly issued by the State Administration of Disease Control and Prevention in December, involving 15.57 billion yuan of financial funds; at the same time, the Ministry of Finance and the National Health Commission also issued the "Notice on The Advance Release of the 2022 Basic Public Health Service Subsidy Fund Budget", with a total budget of 58.85 billion yuan, nearly 4 times the budget for the prevention and control of major infectious diseases. The budget document for public health services is not involved in the National Bureau of Disease Control and Prevention.
Yu Zhao revealed that splitting the CDC and only attributing the infectious disease business to the National Bureau of Disease Control and Other Businesses to the relevant departments and bureaus of the Health Commission is one of the reform plans. The latest news is that the National Health Commission may set up another department to take over these businesses and avoid disputes. "If this is the case, in this era of 'great health', our public health system may become a joke, and if the reform plan is not scientific, then it will return to the era of epidemic prevention stations." Yu Zhao said.
The reform plan has not been announced, and the outside world is still placing high hopes on the impact of the National Disease Control Bureau on the cause of public health in China. In Zhong Chongming's imagination, the National Disease Control Bureau can divide the internal institutions in the way of "naming key tasks" like the CDC, such as the establishment of tuberculosis prevention and control departments, chronic disease prevention and control departments, etc., to improve efficiency and avoid unclear responsibilities; you can also learn from the National Medical Insurance Bureau's "cage for birds", start procurement or negotiation of the second type of vaccines with inflated prices as soon as possible, and leave the balance to the salary improvement of disease controllers.
"Public health needs a protagonist, and this protagonist is the National Disease Control Bureau and local disease control teams." Zhong Chongming said, "The National Disease Control Bureau must improve its position, really do solid work, and must also reflect its work ability and business philosophy as soon as possible." ”
"The reform of the national disease control system launched in May 2021 has brought a period of strategic development opportunities to the development of Public Health in China. It has also created opportunities to make up for shortcomings and build mechanisms for the prevention, control and treatment of emerging infectious diseases and the response to public health emergencies. Li Liming, founder and first director of the Chinese CDC and professor at the School of Public Health of Peking University, told the "medical think tank", "However, however, how to adhere to the concept of great health and great health, coordinate the response to the double burden of disease in China, meet the health challenges brought by aging, and calmly deal with environmental health problems and public health problems such as food and drug safety is still a long way to go." ”
The opportunity for reform is rare. This time, the consensus has been determined to reform, but the process and details of reform in reality are difficult to predict. "What I have said is not entirely certain at the moment, and any one possibility will be overturned and reset." Yu Zhao said. And he especially hopes that the National Disease Control Bureau will be built into a "high-end version of the epidemic prevention station" will be the version that will be overturned.
(At the request of the interviewee, Wu Qi and Yu Zhao are pseudonyms in the text)
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Source: Medical Community Think Tank
Editor-in-charge: Zheng Huaju
Proofreader: Zang Hengjia
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