Nine months after the listing, the "three-definite plan" of the National Bureau of Disease Control and Prevention was finally released.
Just last night, When Chinese institutions compiled online, two "Notices" that had unexpectedly flowed out at the beginning of the week were officially hung on the Internet.
The two documents, the three important departments of the National Health Commission, the functions and powers are adjusted simultaneously.
In the two documents released, there are not only boots that have finally landed - on May 13 last year, after the establishment of the National Bureau of Disease Control and Prevention, the "three plans" (fixed institutions, fixed functions, and fixed establishments) have not been seen for a long time, and after 9 months of eager expectations, the "Regulations on the Functional Allocation, Internal Institutions and Staffing of the National Bureau of Disease Control and Prevention" (hereinafter referred to as the "Three Plans") was finally introduced;
There is also unexpected news: according to the "Notice of the General Office of the CPC Central Committee and the General Office of the State Council on Adjusting the Functional Allocation, Internal Institutions and Staffing of the National Health Commission" (hereinafter referred to as the "Adjustment Notice"), the Largest and Most Powerful Department and Bureau of the National Health Commission, the Medical Administration and Medical Administration Bureau, has been "dismantled".
The "three-certain plan" of hoping for the stars and waiting for the moon is accompanied by the separation of the Medical Administration and the Medical Administration almost without warning, and the two come together. This adds another touch of meaning to this institutional reform.
The "three-definite plan" can roughly see the outline of the CDC's "overhaul or minor supplement"; while the Medical Administration was "split" at the same time, is there some important authority flowing into the CDC?
For a time, speculation and confusion arose.
What work will the CDC undertake for the COVID-19 reform? After the reform of the public health system that has been pressed by the "acceleration button" of the new crown epidemic, can it catch the next epidemic prevention and control? What is the connection between the CDC's "Three Determinations Plan" and the split of the Medical Administration and the Haad Authority?
Image from Visual China
Eight Points of Health talked to a number of people close to the health department, and it was generally believed that this was a "moderate" reform that sought change in stability.
The core of the "three determinations": prevention and control of infectious diseases and emergency treatment
Recently, Shen Hongbing, the newly appointed deputy director of the National Bureau of Disease Control and Prevention, published the latest paper in the Chinese Journal of Epidemiology. One step ahead of the "three-certain plan", the core functions of the National Bureau of Disease Control and Prevention were announced: the prevention and control of infectious diseases and emergency treatment.
According to the "Three Determinations Plan", the main responsibilities of the CdC are 10, including the organization and formulation of draft relevant laws and regulations and the construction of the disease control work system, leading the business work of local disease control institutions, formulating and implementing immunization plans, coordinating and supervising the disease control work of medical institutions, the construction of the epidemic monitoring and early warning system, emergency response work, infectious diseases and other health work supervision.
From the perspective of responsibility setting, the "three certain plans" respond to the voice of society to a certain extent.
Wang Chenguang, a professor at the Vanke School of Public Health and Health and the School of Law of Tsinghua University, told Eight Points that the "three determinations" have strengthened the authority of disease control, and clearly put forward that the Disease Control Bureau is responsible for guiding the prevention and control of infectious diseases, health supervision, immunization planning and other work, so that it can be concentrated in one unit for overall management, and to a certain extent, the phenomenon of weakening the prevention and control ability due to too much fragmentation of authority has been avoided.
In addition, it is clear that the National Bureau of Disease Control and Prevention will have 9 agencies: the Department of Integration, the Department of Planning, Finance and Regulations, the Department of Monitoring and Early Warning, the Department of Emergency Response, the Department of Infectious Disease Prevention and Control, the Department of Health and Immunization Planning, the Department of Comprehensive Supervision I, the Department of Comprehensive Supervision II, and the Department of Science, Technology, Education and International Cooperation. At the same time, the Disease Control Bureau and the Comprehensive Supervision Bureau of the National Health Commission were abolished.
At the same time, there are 170 administrative establishments, including 1 director, 4 deputy directors, and 32 directors and deputy directors.
It can be seen from the subordinate organs that this will be a deputy ministerial-level state bureau with the power to appoint and dismiss personnel, financial power, and an independent and complete structure. "The only difference is that the number one is also a member of the party group of the committee and serves as some other division of labor." A person close to the health system said.
When the National Bureau of Disease Control and Prevention was announced, the candidates for "one main and three deputies" were already determined, and a deputy director was added after that. Director Wang Hesheng is the deputy director of the National Health Commission; Deputy Director Chang Jile, former director of the Disease Control Bureau of the National Health Commission; Shen Hongbing, deputy director of the Chinese Academy of Engineering, an academician and epidemiologist; Sun Yang, deputy director of the National Health Commission; Lu Jiang, deputy director of the National CDC Party Committee. The five bureau leaders, all with medical backgrounds.
The public health supervision function, which has been hampered for a long time, has been disastrous for many years since it was stripped from the national CDC. In this reform, the problem was solved: the relevant supervision and management functions were transferred from the National Health Commission, and the National Bureau of Disease Control and Prevention took over. The Division I and the Department of Integrated Supervision II are responsible for infectious diseases and other public health oversight matters, respectively.
For the "three plans" mentioned, the National Disease Control Bureau should strengthen the business leadership and work coordination of various disease control institutions. Does this mean that in the future, the NATIONAL CDC will be able to manage vertically?
Several experts told Eight Point Kenwen that this was not the case. Business leaders don't care about people, they don't care about money, they just manage business. This is the same as the management standards of the various divisions.
Some people have expected that "can the National Disease Control Bureau break the block management and become a vertical strip management?" But in this reform, this omen is not yet visible.
In the "three-certain plan", there are also some results that deviate from speculation. For example, the management of chronic diseases is not included in the National Bureau of Disease Control and Prevention.
Under the expectation of helping to build a "healthy China" in the past, the core function of the National Bureau of Disease Control and Prevention has been designated as "prevention and control of infectious diseases and emergency treatment". The "Three Determinations Plan" covers environmental sanitation, school sanitation, public place sanitation and other work, but it does not mention anything about the management of chronic diseases.
A comparison of the two documents found that the function of "formulating policies and norms for the prevention and control of chronic diseases and supervising their implementation" did not fall into the pockets of the National Bureau of Disease Control and Prevention, but was classified as the function of the Medical Emergency Department of the National Health Commission.
In this regard, some insiders expressed their understanding to Eight Points. "Infectious diseases are the highlight. For example, in the past two years of prevention and control of the new crown, in order to control the epidemic, others have given way first. A staff member of the Chinese Center for Disease Control and Prevention said.
Zhong Chongming, a medical policy researcher, analyzed that chronic disease management is closer to the clinic, and the requirements for medical professional capabilities are very high, "At present, the ability of the disease control team is relatively narrow, and the chronic disease management work is all given to disease control, and may not be able to do well." ”
Some people disagree. Another staff member of the Chinese Center for Disease Control and Prevention told Eight Point Health That under the Chinese Center for Disease Control and Prevention, the affiliated chronic non-communicable centers for disease control and prevention, although small in scale, have received great attention in development. If its functions are transferred to the Medical Emergency Department of the Health Commission as a whole, the business may shrink in the next two or three years.
Disease control reform, why split the largest department of the Health Commission?
This institutional reform, the split of the National Health Commission's "leading department" medical administration bureau, is another focus of attention.
Judging from the "Adjustment Notice", the Medical Administration Bureau was renamed the Medical Administration Department, and the Emergency Response Office was renamed the Medical Emergency Department.
However, from the detailed study of the work undertaken, it can be simply understood that the responsibilities of the Medical Administration and Medical Administration Bureau have been "split" into two newly established departments and bureaus, and the work responsibilities of the former Emergency Response Office have been absorbed.
A number of people close to the National Health Commission revealed to Eight Points That the Medical Administration bureau has been split, the essence of its work has not changed, and some business intersections in the past have been less. After the split, the Department of Medical Affairs still has the key tasks of public hospital management and performance appraisal.
It is worth noting that the Medical Emergency Department not only undertakes some of the more mature responsibilities of the former Medical Administration, but also undertakes the responsibilities of the former Health Emergency Office (Emergency Command Center for Public Health Emergencies).
This means that the Office of Emergency Response (Emergency Command Center for Public Health Emergencies) was not included in the newly established National Bureau of Disease Control and Prevention, as previously predicted, but the responsibilities were transferred to the newly established Medical Emergency Division.
This makes many people feel unexpected.
Why is the Emergency Response Office not assigned to the National Bureau of Disease Control and Prevention?
This inevitably reminds people that after the outbreak of the epidemic in Wuhan in early 2020, the respiratory disease of "new crown pneumonia" as a special infectious disease, the high case fatality rate and transmission rate make the epidemic prevention work very difficult. At that time, it was impossible to manage the diagnosis and treatment behavior in the hospital by relying on the emergency response alone. At that time, the Medical Administration and Health Authority came to the forefront.
At that time, the Medical Administration bureau, because of its ability to manage and deploy hospitals, not only dispatched doctors and experts from all over the world, but also presided over the introduction of multiple versions of the "Diagnosis and Treatment Plan for Novel Coronavirus Pneumonia".
In the face of the epidemic, the Medical Administration has demonstrated the ability to allocate hospitals and the ability to rescue patients.
It is speculated that some functions of the Emergency Response Office and the Medical Administration Bureau have combined to form a new Medical Emergency Division, which may be a trade-off between the "transition period" at this stage.
There are also professionals who express their helplessness, such a merger, medical and prevention are far away, and there may be many unclear rights and responsibilities in the implementation. But now, if the medical emergency work is rushed to the National Disease Control Bureau, the team team may not be able to catch it.
The "split" and the "three determinations" were carried out simultaneously, and the former Medical Administration bureau also "split" some of its responsibilities to the National Disease Control And Prevention Bureau: the supervision and management of infectious diseases and several major health affairs, as well as the management of infectious disease hospitals and other public hospitals.
The National Bureau of Disease Control and Prevention also clarifies the above functions and powers in its Article 4 duties. Shen Hongbing also mentioned in his latest published paper that public health departments should be set up in public medical institutions.
In the past, for medical institutions such as infectious disease hospitals, disease control agencies did not have direct management authority.
"The cd-off agency should manage a specific mouth in the hospital to avoid the situation that public hospitals are 'multi-line management' by different departments." Wang Chenguang suggested.
Can the expectation of "great disease control" be realized?
At the end of 2020, the news that the "Great Disease Control Bureau" will be established has not stopped in the industry; until May 13, 2021, the National Disease Control Bureau was established - the argument about the "Great Disease Control Bureau" has not stopped.
The so-called "big" corresponds to the "small" CDC set up by the National Health Commission and the more prestigious Chinese Center for Disease Control and Prevention (CDC). The latter was controversial in the early days of the outbreak of the new crown epidemic, and its empty administrative power, the right to release the epidemic, and the unclear positioning of responsibilities have spawned a consensus that the reform of the disease control system is imperative.
Will it be like the National Health Insurance Bureau, or will it be like the Chinese Medicine Administration? Is it directly under the State Council, or is it at the vice-ministerial level?
In May 2021, the National Bureau of Disease Control and Prevention was established, which is a vice-ministerial unit managed by the National Health Commission. People close to the National Health Commission even directly pointed out that the bureau is a deputy ministerial unit, with the same level as the National Medical Insurance Bureau.
This news made the disease control team very angry. Even if the "three-certain plan" has not been decided for a long time, the "Great Disease Control Bureau" has been placed high hopes one after another: Can it change the embarrassing situation in the past when the national CDC could not lead the provincial, municipal and county CDCs? Can the monitoring and early warning system of the disease control agency be improved, and can the right to release the epidemic be implemented? Supervision and emergency response have been stripped away for a long time, can we return to disease control this time?
However, after the introduction of the "three-certain plan", it was generally accused of "moderate" or "seeking change in stability". Functionally, it seems that this reform has not jumped out of the framework of the health system.
A scholar who works in a national think tank confessed to Eight Points Kenwen. "This reform is more like making adjustments to the stock of the health care system." In terms of functions, no increments were seen. ”
The above-mentioned scholars believe that the reform is not enough. "Whether it is enough depends on whether the reforms made in the epidemic can solve the epidemic."
For example, in the next stage of the new crown epidemic, according to the development law, it will be transferred from "Class B A tube" infectious disease to "Class B B tube". After the level of infectious diseases is lowered, the prevention and control work of local party committees and governments will take a step back, relying on the current structure built by the National Bureau of Disease Control and Prevention, will the public prevention of the community be launched at that time? The scholar expressed concern.
Addressing major public health events requires greater centralization and authority. Under its current authority, it is not easy for the CDC to achieve this responsibility.
There are still some observations and concerns, and there is no doubt that this round of reform has clearly strengthened public health, but in the process of strengthening public health, has medicine and prevention become more separated? Comprehensive supervision, is there more comprehensive? There are two types of health emergencies, is it conducive to emergency disposal?
In addition, back to the initial point of reform: after the establishment of the National Bureau of Disease Control and Prevention, where will the national CDC go?
Eight points of health and health learned from within the health system that the "three fixed plans" have just come out, and many detailed rules such as the collection and division of subordinate units have not yet been introduced. The National CDC may become a subordinate institution of the National Bureau of Disease Control and Prevention in the future. "Look at this slowly."
Wang Peiyu, a professor at the School of Public Health of Peking University, also expressed his expectations, in his view, after the establishment of the National Disease Control Bureau, it will be a higher level and stronger coordination of the previous CDC, "In the future, the CDC of the CDC and other relevant departments can combine management capabilities and academic research under its leadership to better prevent and control infectious diseases and chronic diseases and respond to public health emergencies." ”
Wei Xiaoning and Li Linshu wrote
Li Lin 丨 responsible editor
This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)
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![Eight months after its establishment, the National Bureau of Disease Control and Prevention finally wants to issue the "three-definite plan"?[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)