I. Planning Background
(1) Current Situation
1. Continually Increasing Healthcare Resources
The number of healthcare institutions in the city increased from 4,490 in 2015 to 5,526 in 2020.In 2020, the city had a total of 322 hospitals (105 public hospitals and 217 private hospitals); 5,110 primary healthcare institutions [including 391 community health service centers (stations), 95 township health centers, 3,124 clinics (health stations, medical offices), 1,263 village health stations, and 237 other primary healthcare institutions];57 specialized public health institutions [including 17 disease prevention and control centers, 17 maternal and child health care hospitals (institutes, stations), 2 emergency centers (stations), 16 health supervision bureaus (centers), and 5 other specialized public health institutions].
The number of hospital beds per 1,000 people in the city increased from 8.27 in 2015 to 9.22 in 2019 (due to population adjustments following the Seventh National Population Census, the final figure for 2020 was 7.76);The number of licensed (assistant) physicians and registered nurses per 1,000 people increased from 3.61 and 4.21 in 2015 to 3.96 and 5.38 in 2020, respectively, while the number of general practitioners per 10,000 people rose from 1.74 in 2015 to 1.93 in 2020.
2. Continuous Improvement in Healthcare Service Capacity
In 2020, the total number of outpatient visits at medical and health institutions in Kunming reached 48.779 million, an increase of 8.95% from 44.770 million in 2015. Of these, hospitals accounted for 29.174 million visits (59.81%), while primary-level medical and health institutions accounted for 17.759 million visits (36.41%).New breakthroughs were achieved in attracting high-quality medical resources, with healthcare partnerships established with nine top-tier domestic medical institutions. During the 13th Five-Year Plan period, Kunming continued to implement the Quality Improvement and Standardization Project for 14 county-level hospitals, with 12 of them passing provincial-level inspections. Strengthening the quality and safety management of blood collection and supply, Kunming was honored as a National Advanced City for Voluntary Blood Donation for the 2018–2019 period, and the Yunnan Kunming Blood Center received the 9th Kunming Mayor’s Quality Award.
3. Significant Improvement in Residents’ Overall Health
In 2020, the city’s average life expectancy reached 79.36 years, surpassing the 2020 target of 78 years set in the “Kunming City 13th Five-Year Plan for Health and Healthcare.” The health literacy rate among residents steadily increased from 11.40% in 2015 to 26.75% in 2020.In 2020, the maternal mortality rate decreased from 21.05 per 100,000 in 2015 to 6.55 per 100,000; the infant mortality rate fell from 5.95‰ in 2015 to 3.03‰; and the under-five mortality rate dropped from 7.63‰ in 2015 to 4.18‰.During the 13th Five-Year Plan period, no Class A infectious diseases were reported in Kunming, and no outbreaks of Class B infectious diseases occurred due to inadequate prevention and control measures; in 2020, the incidence rate of Class B infectious diseases was 166.20 per 100,000, far below the national and provincial averages. All comprehensive health indicators for residents have met the targets set in the 13th Five-Year Plan, and the overall health level of residents has significantly improved.
(II) Major Existing Issues
During the 13th Five-Year Plan period, the city’s healthcare service system achieved significant progress, but numerous issues remain, primarily manifested in the following:
1. Insufficient Total Health Workforce and Suboptimal Structure
First, the primary-level healthcare workforce is insufficient in number and lacks adequate capacity. By the end of 2020, Kunming had a total of 92,800 healthcare professionals, including 33,487 licensed (assistant) physicians.Primary healthcare institutions, such as community health service centers (stations) and township (subdistrict) health centers, employed a total of 23,920 primary-level healthcare professionals, accounting for 25.78% of the city’s total healthcare workforce. Among them, 10,863 were licensed (assistant) physicians, representing 32.44% of the city’s total licensed (assistant) physicians.Second, there is a shortage of high-level talent, most notably a shortage of general practitioners, an insufficient number of pharmacists with slow growth, and shortages of physicians in psychiatry, pediatrics, and rehabilitation medicine. Due to factors such as location and career development opportunities, municipal-level medical institutions lack sufficient appeal for individuals with doctoral degrees or higher.The city faces a shortage of high-level talent in health science and technology, with significant challenges in both attracting and retaining personnel in the health sector. The city is unable to attract outstanding high-level talent, nor can it retain the excellent talent it has cultivated and developed, thereby failing to effectively drive talent development and disciplinary advancement across the city’s healthcare institutions.
2. The public health institution system is underdeveloped, and disease control and prevention capabilities need to be enhanced
The level of modernization and smart technology in the infrastructure and equipment of specialized public health institutions—such as disease control and prevention centers, blood banks, and emergency medical centers—remains low. General hospitals lack a strong awareness of public health services, have insufficient motivation, and demonstrate weak capabilities in transitioning between routine and emergency care. Core disease control and prevention capabilities, such as monitoring and early warning for public health emergencies and epidemiological investigations, are not robust. Emergency response mechanisms for major epidemics and sudden public health incidents remain inadequate.Overall command, dispatch, and coordination among public health institutions are insufficient; the system is incomplete, and service capacity needs to be strengthened. Compared with developed regions, the operational capabilities of county (city) and district disease control centers are relatively weak, with inadequate facilities, equipment, and office space, failing to fully meet the requirements of disease prevention and control work. The responsibilities of the two municipal-level maternal and child health care institutions are unclear and their functions overlap, while county-level maternal and child health care institutions are too small in scale and lack sufficient service capacity.
3. Regional distribution of healthcare resources is uneven, their structure is unreasonable, and overall efficiency is low
Healthcare resources are unevenly distributed across counties (cities), districts, the Central Yunnan New Area, development (resort) zones, and free trade pilot (economic cooperation) zones (hereinafter referred to as “counties and districts”). High-quality healthcare resources are primarily concentrated in the five central urban districts, where medical resources (beds, healthcare professionals, equipment, etc.) and patients are highly concentrated. This results in a coexistence of overburdened tertiary hospitals and underutilized service resources in a large number of primary-level healthcare institutions.The uneven distribution of high-quality medical resources makes it difficult for many suburban counties and districts to access high-level medical services nearby. There is a coexistence of misallocation and insufficient allocation of specialized service resources in obstetrics and gynecology, pediatrics, psychiatry, dentistry, rehabilitation medicine, and geriatrics.The distinctive strengths of traditional Chinese medicine have not been fully leveraged, and a collaborative framework integrating traditional and Western medicine has yet to take shape. Privately-run medical institutions remain fragmented, small-scale, and underdeveloped. Bed occupancy rates in public hospitals and tertiary hospitals have continued to rise, with these facilities operating at sustained overcapacity, while rates in private hospitals, secondary hospitals, primary hospitals, and primary-level healthcare institutions have continued to decline.
4. There remains a certain gap between the service capacity of healthcare institutions and the needs of the public
As of the end of 2020, Kunming had only 36 tertiary hospitals. The city has few nationally leading specialties and renowned experts, and there is a significant gap in high-quality medical resources compared to major cities such as Beijing, Shanghai, Guangzhou, and Wuhan.The strength of medical disciplines is relatively lagging, with insufficient development depth and a lack of national-level key specialties. Additionally, the leading causes of death among the city’s residents are chronic non-communicable diseases such as cardiovascular and cerebrovascular diseases, respiratory diseases, and cancer; the quality of medical services and technical capabilities for addressing such chronic non-communicable diseases in Kunming still need improvement. With the rapid population growth in the central urban area, the existing facilities and personnel of primary healthcare institutions can no longer meet the public’s demand for basic medical and public health services.The capacity of county-level healthcare services, particularly that of primary-level institutions, remains relatively weak. Affected by the COVID-19 pandemic and associated prevention and control measures, the bed occupancy rate at primary-level healthcare institutions across the city has shown a downward trend. In 2020, the bed occupancy rate at these institutions was only 33.60%, indicating a significant gap from the goal of establishing a sound tiered diagnosis and treatment system.
(3) Opportunities and Challenges
During the 14th Five-Year Plan period, the development of Kunming’s healthcare service system presents both opportunities and challenges.
The Municipal Party Committee and Municipal Government attach great importance to the development of the health sector and actively promote the “Healthy Kunming” initiative, pooling collective efforts to accelerate the shift of the healthcare service system from a disease-centered approach to a people’s health-centered approach. The implementation of major strategies such as the Rural Revitalization Strategy, the New Era Western Development Strategy, and the Central Yunnan Urban Cluster Development Plan has created an unprecedented platform for promoting the sharing and balanced development of health service resources across the city.
With the construction and development of the Mohan-Mouding Cooperation Zone, Kunming’s international exchanges are increasing. Given the varying levels of disease prevention and control capabilities among South and Southeast Asian countries, higher demands are placed on Kunming’s capacity for cross-border and emerging infectious disease surveillance, early warning, and emergency response. The optimization and adjustment of medical insurance policies have created more pressing requirements for healthcare institutions across the city to accelerate the transformation of their development models and improve the utilization efficiency of existing hospital beds.
The public’s aspirations for a better life continue to rise, accelerating the demand for greater accessibility, convenience, comfort, and quality in health service provision. The accelerating pace of population aging poses challenges to Kunming’s elderly health service system, service capacity, and service models. Changes in fertility demands and further adjustments to fertility policies have introduced new requirements and tasks for the development of Kunming’s maternal and child health service system and the establishment of a high-quality, inclusive infant care system for children aged 0–3.
II. General Requirements
(1) Guiding Principles
Guided by Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era, we will thoroughly implement the spirit of the 20th National Congress of the Communist Party of China, carry out General Secretary Xi Jinping’s important expositions on health and medical work and the spirit of his important speeches during his inspection of Yunnan, earnestly implement the decisions and arrangements of the Municipal Party Committee and Municipal Government, adhere to the general principle of seeking progress while maintaining stability,fully, accurately, and comprehensively implement the new development philosophy; thoroughly implement the health and healthcare work guidelines for the new era; accelerate the construction of a robust public health system; advance the development of an integrated medical and health service system covering the entire life cycle and the full process of health; promote a shift in the development model from a disease-centered approach to a people’s health-centered approach, in the service system from scale- and quantity-driven growth to quality- and efficiency-driven improvement, and in resource allocation from an emphasis on material factors to a greater emphasis on talent and technological factors; and strive to ensure that the people enjoy a higher level of health and healthcare services.
(2) Basic Principles
Coordinated Planning and Systematic Integration. We will coordinate the allocation of resources across regions and between urban and rural areas, and integrate prevention, treatment, rehabilitation, and health promotion. We will adhere to the principle of giving equal emphasis to both traditional Chinese medicine and Western medicine to enhance overall effectiveness. We will formulate categorized standards for the allocation of health resources based on factors such as population structure, distribution, and disease patterns.
Demand-Driven, Quality and Capacity Enhancement. Focusing on major health issues, we will expand resource supply, optimize structural layout, and improve allocation efficiency. We will accelerate the expansion and balanced regional distribution of high-quality healthcare resources, narrow gaps in resource allocation and service levels across regions, urban and rural areas, and among different population groups, and strengthen the foundation of primary-level healthcare.
Coordination between medical care and prevention; integration of routine and emergency services. Prioritize prevention and integrate prevention with treatment to establish a long-term mechanism for medical-prevention coordination. Based on routine needs and the requirements for major epidemic prevention and control, improve the capacity for integrating routine and emergency services and for rapid transition to maintain public health security.
Government Leadership, Multi-stakeholder Participation. Uphold the public welfare nature of basic healthcare services, strengthen the government’s responsibilities for investment guarantees, management, and supervision, and intensify efforts to build public healthcare institutions. Leverage market mechanisms to encourage and guide social forces to establish healthcare institutions in accordance with the law, thereby meeting the people’s multi-level and diverse health needs.
Reform and Innovation, Strengthening Support. We will continue to deepen reforms of the medical and health system, focusing on the systematic integration of healthcare resource allocation with policies on finance, medical insurance, and human resources, and leveraging the leading and supporting roles of talent, science and technology, and informatization. We will seize the important opportunity presented by the construction of regional medical centers to enhance their core engine functions and expand their regional influence and disciplinary leadership.
(3) Development Goals
By 2025, we will have basically established an integrated healthcare service system that is commensurate with Kunming’s level of economic and social development and aligned with residents’ health needs—a system characterized by a complete structure, rational layout, clear division of labor, complementary functions, close collaboration, and high quality and efficiency. We will deepen the “Healthy Kunming” initiative and preliminarily establish Kunming as an “International Health City” and a “Regional International Medical Center” that is rooted in Southwest China,面向 the whole country, and radiates to South and Southeast Asia.The capacity for efficient and responsive public health services will be significantly enhanced; the high-quality and balanced medical service system will be further refined; the distinctive traditional Chinese medicine service system will be more robust; the comprehensive, full-cycle health service system will be gradually improved; medical science and technology levels and innovation capabilities will continue to rise; the internationalization and modernization of health services will be comprehensively elevated; and the physical and mental health of residents will be markedly improved.
