权利、约定和尊严

Rights, Agreements and Dignity

--《基本医疗卫生与健康促进法》的核心价值初探

-A Preliminary Study on the Core Values of the Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care

胡晓翔

Hu Xiaoxiang

摘  要  权利、约定和尊严，是《基本医疗卫生与健康促进法》最核心的价值取向，其首要的立法主旨即在于具化《宪法》有关公民基本权利规定。公民基本权利，首要的是人权。生存权是最重要的人权，生存权不仅仅指生命权本身，还包括维持生命健康的各种必须的条件，因此，生存权必然导出生命健康权，也就必然要求政府确保公民的“基本医疗卫生服务保障权”。在此共识性基点上的社会“约定”，即立法予以明确国家的实现义务。《基本医疗卫生与健康促进法》建基于人权的最重要组成部分健康权，定位其于积极人权属性，据以配置国家和各级政府的实现职责，以及保障机制和措施，辅之以监督与制裁规制。在立法设计上以足够的篇幅充分阐明了政府必须承担起保障责任，我国政府有足够的经济实力在公民的基本医疗保障上有更大的作为。由此推进健康中国战略，奠定小康社会的本底。整部法律定位清晰、理念高蹈，结构谨严、层次分明。

Abstract: Rights, agreements and dignity are the core values of the Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care (“the Law”), and its primary legislative purpose is to embody the provisions of the Constitution on citizens’ basic rights. The basic rights of citizens are, above all, human rights. The right to subsistence is the most important human right. It not only refers to the right to life itself, but also includes various necessary conditions to maintain life and health. Therefore, the right to subsistence inevitably leads to the right to life and health, and inevitably requires the government to ensure citizens’ “basic medical and health service guarantee right”. The social “agreement” on this consensus basis, that is, legislation is used to clarify the state’s realization obligation. The Law is based on the right to health, the most important component of human rights, and defines it as a positive human right attribute. It aims to stipulate the realization responsibilities of the state and all levels of government, as well as safeguard mechanisms and measures, and supervision and sanction regulations. In the legislative design, it fully expounds that the government must assume the responsibility of protection. Our government has sufficient economic strength to make more efforts in the basic medical protection of citizens in a bid to push forward the strategy of a healthy China and lay the foundation for a well-off society. The whole law features a clear orientation, lofty ideas, a cautious structure and clear levels.

关键词 权利  约定 尊严  健康权  国家实现义务

Key words: Rights, agreements, dignity, right to health, state’s realization obligation

1 概述

1 Overview

权利、约定和尊严，是《基本医疗卫生与健康促进法》最核心的价值取向，是理解这部“基本法”的锁钥。

Rights, agreements and dignity are the core values of the Law and the key to understanding the Law.

作为基本医疗卫生与健康促进领域的母法，立法的主旨即在于具化《宪法》有关公民基本权利规定。公民基本权利，首要的是人权。生存权是最重要的人权，生存权不仅仅指生命权本身，还包括维持生命健康的各种必须的条件，因此，生存权必然导出生命健康权，也就必然要求政府确保公民的“基本医疗卫生服务保障权”。在此共识性基点上的社会“约定”，即立法予以明确国家的实现义务，在立法设计上以足够的篇幅充分阐明了政府必须承担起保障责任，我国政府有足够的经济实力在公民的基本医疗保障上有更大的作为。由此推进健康中国战略，奠定小康社会的本底。这个路径，习总书记有明确指示。2019年4月15日下午，习总书记到石柱土家族自治县中益乡华溪村贫困户谭登周家时的讲话指出:“基本医保、大病保险、医疗救助是防止老百姓因病返贫的重要保障。这个兜底作用很关键。”所谓“基本医保、大病保险、医疗救助”，一言以蔽之，就是确保群众的基本医疗卫生服务的可及，和符合与社会发展相适应的水准。可见，基本医疗卫生服务，在习总书记的健康促进思想体系里，成为了解决“两不愁 三保障”突出问题的“兜底”措施，具有主纲的地位，显然不是市场里的买卖的民事行为，其实，是作为积极人权的国家和政府实现义务的胜负手来布局的。因此，习总书记要求，“加快完善低保、医保、医疗救助等相关扶持和保障措施，用制度体系保障贫困群众真脱贫、稳脱贫。”才能使得全民免于病伤就治经济负担的恐惧，从而不因伤病而减损尊严！要而言之，即：凭权利和约定赢得尊严！这也是《基本医疗卫生与健康促进法》核心价值最浓缩的概括。

    As the mother law in the field of basic medical care and health promotion, the main purpose of legislation is to incorporate the provisions of the Constitution on citizens’ basic rights. The basic rights of citizens are, above all, human rights. The right to subsistence is the most important human right. It not only refers to the right to life itself, but also includes various necessary conditions to maintain life and health. Therefore, the right to subsistence inevitably leads to the right to life and health, and inevitably requires the government to ensure citizens’ “basic medical and health service guarantee right”. The social “agreement” on this consensus basis, that is, legislation is used to clarify the state’s realization obligation. In the legislative design, it fully expounds that the government must assume the responsibility of protection. Our government has sufficient economic strength to make more efforts in the basic medical protection of citizens  in a bid to push forward the strategy of a healthy China and lay the foundation for a well-off society. General Secretary Xi has clear instructions on such path. On the afternoon of April 15, 2019, General Secretary Xi pointed out in his speech in Tan Dengzhou’s family, a poor family in Huaxi Village, Zhongyi Township, Shizhu Tujia Autonomous County, “Basic medical insurance, serious illness insurance and medical assistance are important guarantees to prevent people from returning to poverty due to illness. The guarantee role is crucial.” The so-called “basic medical insurance, serious illness insurance and medical assistance”, in a word, is to ensure that the basic medical and health services of the masses are accessible and conform to the standards suitable for social development. It can be seen that in General Secretary Xi’s health promotion ideology, basic medical and health services have become a guarantee measure to solve the outstanding problem of “two assurances and three guarantees”. As the main principles, they are not civil acts of buying and selling in the market. In fact, they are the priorities of countries and governments that are active in human rights to realize their obligations. Therefore, General Secretary Xi requested that “we should speed up the improvement of relevant support and safeguard measures such as subsistence allowances, medical insurance and medical assistance, and use the system to prevent the reoccurrence of poverty to those who had been lifted out.” Only in this way can the whole people be free from the fear of treatment burden as soon as they are ill or injured, so as not to impair their dignity due to sickness or injury! In short, it means winning dignity by rights and agreements! This is also the summary of the core values of the Law.

2 权利与约定

2 Rights and agreements

我国《宪法》明文规定国家尊重和保障人权（第三十三条），国家保护人民健康（第二十一条），我国公民在年老、疾病或者丧失劳动能力的情况下，有从国家和社会等方方面面获得物质帮助的权利。国家及各级政府发展为公民享受这些权利所需要的社会保险、社会救济和医疗卫生事业（第四十五条），学术界和实务界多年来并不擅于直接用人权理论来驾驭和阐述围绕健康权的实现机制的医药卫生体制改革与卫生法学研究，也不注意以此指导和统御卫生立法。而通过司法实现这些社会权是国家不可推卸的责任和保障社会权最有效的方式。中共中央政治局5月29日下午就“切实实施民法典”举行第20次集体学习。习近平总书记在主持学习时强调，民法典对坚持以人民为中心的发展思想、依法维护人民权益、推动我国人权事业发展…具有重大意义。可见，权利（人权）-约定（立法），是我国法律体系的重要功能，更是固根本、稳预期、利长远的基础性法律的主要功能。

China’s Constitution expressly stipulates that the State respects and protects human rights (Article 33), that the State protects people’s health (Article 21), and that our citizens have the right to receive material assistance from the State and society in the event of old age, illness or incapacity to work. The State and governments at all levels shall develop social insurance, social relief and medical and health services necessary for citizens to enjoy these rights (Article 45). For many years, academic and practical circles have not been good at directly using human rights theory to control and elaborate the medical and health system reform and health law research around the realization mechanism of the right to health, nor have they paid attention to guiding and governing health legislation. The realization of these social rights through justice is the unshirkable responsibility of the State and the most effective way to protect social rights. On the afternoon of May 29, the Political Bureau of the CPC Central Committee held its 20th collective study on the “Effective Implementation of the Civil Code”. When presiding over the study, General Secretary Xi Jinping stressed that the Civil Code is of great significance to adhere to the people-centered development idea, safeguard the rights and interests of the people in accordance with the law, and promote the development of China’s human rights cause. It can be seen that rights (human rights)-agreement (legislation) are an important function of China’s legal system, and are also the main functions of basic laws that consolidate foundations, stabilize expectations and bring long-term benefits.

在《基本医疗卫生与健康促进法》颁布之前，2017年12月22日由第十二届全国人大常委会第三十一次会议审议了草案，其“最为精彩的是第三条首次在法律层面上直接提出健康是人的基本权益”。申卫星教授认为“健康权”的概念将是这部法律的灵魂和最大亮点，“‘健康权’入法，就可强化政府对医疗卫生的投入和保障”。第四条第一款规定：“国家和社会尊重、保护公民的健康权。”首次在法律层面上直接提出健康是人的基本权益，以法律的形式激活了宪法里公民基本权利中的健康权。其实，其第一条“为了…保障公民享有基本医疗卫生服务…根据宪法，制定本法”，就是很明确的“健康权作为积极人权”定位的表述。何谓“保障”？就是“确保拥有”！国家、各级政府确保公民拥有基本医疗卫生服务。而这个服务极具专业性，其目标指向和功能承载，非其他，唯“公民健康权”一端，而非其他。因此说，保障公民享有基本医疗卫生服务，就等于说保障公民健康权，因为基本医疗卫生服务仅仅指向于健康权。继之，就当然有了第五条的公民有从国家和社会获得基本医疗卫生服务的权利。国家保护和实现公民获得基本医疗卫生服务的权利。和第六条的各级政府应当把人民健康放在优先发展的战略地位，将健康理念融入各项政策，推进全民健身，将公民主要健康指标改善情况纳入政府目标责任考核。全社会应当共同关心和支持医疗卫生与健康事业的发展。这些内容明显渊源于《宪法》有关条款。同时，最重大的意义在于，在《宪法》意外的法律层面首次明确“公民健康权”的积极人权属性，及国家、各级政府对此的实现职责。这是与民事性法律里的人权保护规则的区别之处。

Before the promulgation of the Law, the draft was deliberated by the 31st Session of the 12th National People’s Congress Standing Committee on December 22, 2017. The “most wonderful thing is that Article 3 directly proposes that health is the basic right of human beings at the legal level for the first time”. Professor Shen Weixing believed that the concept of “right to health” will be the soul and highlight of this law. When the “right to health” becomes a law, it may strengthen the government’s investment and protection in health care”. Paragraph 1 of Article 4 stipulates that “The State and society respect and protect citizens’ right to health.” For the first time, it is directly proposed that health is the basic rights and interests of human beings at the legal level, which activates the right to health in the basic rights of citizens in the Constitution in the form of laws. In fact, Article 1, “in order to... protect citizens’ enjoyment of basic medical and health services... this law is enacted in accordance with the Constitution”, is a clear expression of the orientation of “the right to health as a positive human right”. What is “protection”? It is to “make sure that people enjoy it”! The State and governments at all levels ensure that citizens have basic medical and health services. Such service is highly professional, and its target orientation and function bearing are merely “citizens’ right to health”. Therefore, to protect citizens’ access to basic medical and health services is to protect citizens’ right to health, because basic medical and health services only focus on the right to health. Then, Article 5 is introduced: Citizens have the right to obtain basic medical and health services from the state and society. The State protects and realizes citizens’ right to basic medical and health services. And Article 6 “governments at all levels should place people’s health in the strategic position of giving priority to development, integrate health concepts into various policies, promote nationwide fitness, and incorporate the improvement of citizens’ major health indicators into the government’s target responsibility assessment. The whole society should jointly care about and support the development of medical and health care and health undertakings. These contents obviously originate from the relevant provisions of the Constitution. Meanwhile, for the first time, the positive human rights attribute of “citizens’ right to health” and the responsibilities of the State and governments at all levels to realize it are clearly defined at the legal level of the Constitution. This is the difference from the human rights protection rules in civil laws.

3 保障机制与措施

3 Safeguard Mechanism and Measures

3.1 投入机制

3.1 Input mechanism

要切实履行发展医疗卫生与健康事业的职责，单有伦理认知下的对国家和各级政府法律赋权和赋责，只是明确了权力的目标，《基本医疗卫生与健康促进法》据此明确要建立适度的医疗卫生与健康事业投入机制，这是一切事业的基础。主要落实在第七章的资金保障规制，例如第八十条，成为整部法的支撑性内容。该条系承续第一条、第四条、第五条、第六条等诸战略定位“目标”条的内容，发展医疗卫生与健康事业的法律职责须由各级人民政府切实履行，则必须确保应有的投入机制。政府预算是政府的基本财政收支计划，是投入的起点。预算的投入导向，明确为主要用于保障基本医疗服务、公共卫生服务、基本医疗保障和政府举办的医疗卫生机构建设和运行发展。

The legal empowerment and responsibility of the State and governments at all levels under the ethical cognition only clearly define the goal of power, which is insufficient to effectively fulfill the duty of developing medical and health services. The Law clearly defines the establishment of a moderate investment mechanism for medical and health services, which is the foundation of all services. The capital guarantee regulation in Chapter 7, such as Article 80, has become the supporting content of the whole Law. This article inherits the contents of the strategic positioning “objective” articles including Articles 1, 4, 5 and 6. The legal responsibility for the development of medical and health care must be effectively performed by the people’s governments at all levels, and the proper investment mechanism must be ensured. The government budget is the government’s basic financial revenue and expenditure plan and the starting point for investment. The budget is mainly used to ensure the construction and operation of basic medical services, public health services, basic medical security and government-run medical and health institutions.

据新华社2018年12月24日报道，受国务院委托，财政部部长刘昆24日向全国人大常委会作国务院关于财政医疗卫生资金分配和使用情况的报告时介绍，财政部将会同国家卫生健康委等有关部门，进一步加大投入力度，推动建立适合我国国情的、可持续的医疗卫生投入长效保障机制。国家进一步加大各级财政对基本医疗卫生的投入力度，把基本医疗卫生制度作为公共产品向全民提供。完善与公立医院发展相适应的政府投入办法，全面落实政府对符合区域卫生规划的公立医院投入政策，指导地方在清理甄别的基础上稳妥化解符合条件的公立医院长期债务。而源头之水，则在于政府主导的医疗卫生多元筹资机制的持续作用。同时，严格执行预算法等法律法规，加强制度建设，提高资金使用管理的科学性和规范性。继续优化整合医疗卫生项目，避免财政资金的重复投入和低效使用，全面推进预算绩效管理。

According to the report of Xinhua News Agency on December 24, 2018, entrusted by the State Council, when presenting the State Council’s report on the allocation and use of financial, medical and health funds to the Standing Committee of the National People’s Congress on the 24th, Minister of Finance Liu Kun said that the Ministry of Finance will, in conjunction with the National Health Commission and other relevant departments, further increase investment and promote the establishment of a long-term guarantee mechanism for sustainable medical and health investment that is suitable for China’s national conditions. The State has further increased financial investment in basic medical and health care at all levels and provided the basic medical and health system to the whole people as a public product. Efforts will be made to improve government input methods suitable for the development of public hospitals, fully implement government input policies for public hospitals that conform to regional health plans, and guide local governments to steadily resolve long-term debts of eligible public hospitals. The source lies in the continuous effect of the government-led multi-financing mechanism for health care. Meanwhile, efforts should be made to strictly implement the Budget Law and other laws and regulations, strengthen the system construction, and improve the scientific and normative management of the use of funds. Continue to optimize and integrate medical and health projects, avoid repeated investment and inefficient use of financial funds, and comprehensively promote budget performance management.

据国家卫健委官网2020年6月6日公布的《2019年我国卫生健康事业发展统计公报》，2019年深化医改取得重要进展，城乡居民健康水平持续提高。居民人均预期寿命由2018年的77.0岁提高到2019年的77.3岁，孕产妇死亡率从18.3/10万下降到17.8/10万，婴儿死亡率从6.1‰下降到5.6‰。取得了举世瞩目的卫生健康成就，为本法的实施，奠定了坚实基础。

According to the Statistical Bulletin on the Development of China’s Health Care in 2019 published on the official website of the National Health Commission on June 6, 2020, important progress has been made in deepening medical reform in 2019, and the health level of urban and rural residents has continued to improve. The average life expectancy of residents increased from 77.0 years in 2018 to 77.3 years in 2019, the maternal mortality rate decreased from 18.3/100,000 to 17.8/100,000, and the infant mortality rate decreased from 6.1 ‰ to 5.6 ‰. Remarkable achievements have been made in health, laying a solid foundation for the implementation of this law.

要求各级人民政府应当切实履行发展医疗卫生与健康事业的宪法职责，坚持保基本、强基层、建机制和全覆盖、多层次、可持续方针，坚持统筹安排、突出重点、循序渐进的路径，并随经济社会发展、财政状况和健康指标的发展而与时俱进，以公立医疗卫生服务体系为主，保障基本医疗服务、公共卫生服务、基本医疗保障的建设和运行发展，不断满足人民日益增长的美好生活和健康维持需要。第八十条较好地体现了健康权的积极人权定位，明确了国家实现的责任与途径。上述内容也是宪法公民基本权利条款的细化与激活，具有了司法层面的效力。因此，出台《基本医疗卫生与健康促进法》直接的便利之处就是服务于司法层面的救济。作为第四条、第五条、第六条那些目标落细落实的措施，第八十条是整部法的关键所在，使得公民的宪法权利成为了可通过司法救济的法律权利！

It is required that people’s governments at all levels should earnestly perform their constitutional duties of developing medical and health services, adhere to the principles of protecting the foundation, strengthening the basic level, establishing mechanisms and upholding full coverage, multi-level and sustainable development policies, sticking to the path of overall arrangement, highlighting key points and maintaining gradual and orderly progress. With the development of economy and society, financial situation and health indicators, efforts should be made to keeps pace with the times and focus on the public medical and health service system to ensure the construction and operation of basic medical services, public health services and basic medical security, and continuously meet the growing needs of the people for a better life and health maintenance. Article 80 better reflects the positive human rights orientation of the right to health and defines the responsibilities and ways for the State to realize it. The above contents are also the refinement and activation of the constitutional provisions on the basic rights of citizens and have judicial effect. Therefore, the promulgation of the Law is to serve the relief at the judicial level. As a measure to implement the objectives of Articles 4, 5 and 6, Article 80 is the key to the whole Law, making citizens’ constitutional rights legal rights that can be remedied through justice!

第八十条也是促进基本公共服务均等化国家实践的法治化样本。2012年7月，《国家基本公共服务体系“十二五”规划》正式颁布实施，这是我国第一部国家基本公共服务总体性规划，各地也陆续颁行促进基本公共服务均等化的综合性或医疗卫生等专门性的地方性政策规范。“基本公共服务均等化”源自“十一五”规划纲要，经过十六届六中全会《中共中央关于构建社会主义和谐社会若干重大问题的决定》的阐述、十七大报告的强调、“十二五”规划纲要的细化、十八大报告的推进，以及十八届三中全会《中共中央关于全面深化改革若干重大问题的决定》的重申，已成为我国针对改革发展过程中在区域、城乡、群体之间出现的基本公共服务供给失衡问题采取的一项有针对性的中国特色的政策措施。十九届四中全会公报明确提出，要坚持和完善统筹城乡的民生保障制度，同时，针对“幼有所育、学有所教、劳有所得、病有所医、老有所养、住有所居、弱有所扶”等提出健全国家基本公共服务制度体系。第八十条实为促进基本公共卫生服务均等化政策的法治化规制样本。 唯有在法治的保障下，全体公民依法享有均等化的基本公共服务是其基本权利得以实现的反映，政府依法促进基本公共服务均等化是其宪法责任得以实现的反映。在社会权利的保护上，我们国内当下可能确实只有行政救济程序而没有司法救济程序。公民的社会权利，以及国家的责任，除已为全国人大常委会批准的《经济、社会、文化权利国际公约》外，只在《宪法》里有比较简洁的表述。在司法化的层面，民生保障领域细化立法不足，尤其是健康权保障方面，《基本医疗卫生与健康促进法》之外迄今并无一部规制性母法用于明确各级政府、各个部门和公民的义务与权利，以及用于司法救济。早在1955年，最高人民法院曾就法院在判决中可否援引宪法问题作过一个司法解释，不同意在审判中直接引用宪法条文，各级法院至今仍在遵循这个原则。二战以来，“宪法基本权利的直接效力”已成为世界性的一项宪政惯例，而我国宪法基本权利尚无直接法律适用的效力，即公民不能依据基本权利提起诉讼，所以，国家机关履行义务的动力不足，进而导致基本权利实际上只是国家的“恩惠”。在我国实现宪法基本权利直接效力之前，推动宪法基本权利法律化（如在《执业医师法》中明确“待遇、教育”等等方面的权利规定），使基本权利经立法后取得司法效力，公民的基本权利才能真正有法律上的保障。而各级政府、各个部门和公民的义务与权利不明确的话，新的《行政诉讼法》第12条第一款第十项确立的行政给付诉讼制度也会是无源之水，没法实质启动。因此，要切实落实本次卫生与健康会议精神，可靠推进实质性医改，我国亟待出台规制各级政府、各个部门和公民的健康义务与权利，和用于健康权司法救济的基本医疗卫生母法。《基本医疗卫生与健康促进法》的出台并于2020年6月1日施行，尤其是第八十条赋予的国家和政府及各关联主体的责任与义务，为司法化解决健康权保护奠定了基础。

Article 80 is also a legal sample of national practice to promote the equalization of basic public services. In July 2012, the 12th Five-Year Plan for the National Basic Public Service System was officially promulgated and implemented. This is the first overall national basic public service plan in China. Various localities have also successively promulgated comprehensive or specialized local policy norms such as medical and health care to promote the equalization of basic public services. The “equalization of basic public services” originates from the outline of the 11th Five-Year Plan. After the exposition of the Decision of the CPC Central Committee on Several Major Issues Concerning the Construction of a Socialist Harmonious Society by the Sixth Plenary Session of the 16th CPC Central Committee, the emphasis of the report of the 17th CPC National Congress, the refinement of the outline of the 12th Five-Year Plan, the promotion of the report of the 18th CPC National Congress, as well as the reaffirmation of the Decision of the CPC Central Committee on Several Major Issues Concerning the Comprehensive Deepening of Reform of the Third Plenary Session of the 18th Central Committee, it has become a targeted policy measure with Chinese characteristics adopted by China in response to the imbalance i,n the supply of basic public services among regions, urban and rural areas and groups in the process of reform and development. The Communique of the Fourth Plenary Session of the 19th Central Committee clearly proposed to adhere to and improve the people’s livelihood security system that coordinates urban and rural areas. Meanwhile, it proposed to improve the national basic public service system and make steady progress in ensuring people’s access to childcare, education, employment, medical services, elderly care, housing, and social assistance. Article 80 is a legal regulation sample to promote the equalization of basic public health services. Only under the protection of the rule of law can all citizens enjoy equal basic public services, which reflects the realization of their basic rights. The government’s promotion of equal basic public services in accordance with the law reflects the realization of its constitutional responsibility. In the protection of social rights, there may indeed be only administrative relief procedures and no judicial relief procedures in our country. Apart from the International Covenant on Economic, Social and Cultural Rights, which has been approved by the Standing Committee of the National People’s Congress, citizens’ social rights and the responsibilities of the State are only expressed in relatively concise terms in the Constitution. At the level of judicialization, there is insufficient detailed legislation in the field of livelihood security, especially in the protection of the right to health. So far, there is no regulatory parent law other than the Law to clarify the obligations and rights of governments at all levels, departments and citizens, as well as judicial relief. As early as 1955, the Supreme People’s Court made a judicial interpretation on whether the court could invoke the Constitution in its judgment. It did not agree to directly invoke the constitutional provisions in the trial. Courts at all levels are still following this principle. Since the WWII, “the direct effect of the basic constitutional rights” has become a worldwide constitutional convention. However, the basic constitutional rights in our country have no direct legal effect, that is, citizens cannot bring lawsuits according to the basic rights. Therefore, the state organs have insufficient motivation to fulfill their obligations, which leads to the basic rights being only the “favor” of the State. Before China realizes the direct effect of the basic constitutional rights, it is necessary to promote the legalization of the basic constitutional rights (for example, the “treatment, education” and other rights provisions are clearly defined in the Law on Practicing Doctors) so that the basic rights can obtain judicial effect after legislation, and the basic rights of citizens can be truly protected by law. However, if the obligations and rights of governments at all levels, departments and citizens are not clear, the administrative payment litigation system established in Item 10 of Paragraph 1 of Article 12 of the new Administrative Litigation Law cannot be launched in substance. Therefore, in order to effectively implement the spirit of this hygiene and health conference and reliably promote substantial medical reform, China urgently needs to enact a basic medical and health mother law to regulate the health obligations and rights of governments at all levels, departments and citizens, and to use it for judicial relief of the right to health. The promulgation of the Law and its implementation on June 1, 2020, especially the responsibilities and obligations of the State, the government and various related subjects conferred by Article 80, have laid a foundation for the judicial solution to the protection of the right to health.

3.2 监管措施

3.2 Regulatory measures

《基本医疗卫生与健康促进法》《第八章  监督管理》、《第九章  法律责任》是各主体，特别是各级政府及其部门履职尽责的导轨。

Chapter 8 Supervision and Administration and Chapter 9 Legal Liability of the Law play a guiding role for all subjects, especially governments at all levels and their departments, to perform their duties and fulfill their responsibilities.

例如第八十一条规定了县级以上政府通过各种方式加强资金的监督管理。明确了各级政府监管投入资金的方式和手段有预算、审计、监督执法、社会监督等方式。

For example, Article 81 stipulates that governments at or above the county level shall strengthen the supervision and management of funds through various means. It makes clear that the ways and means for governments at all levels to supervise and invest funds include budget, auditing, supervision and law enforcement, social supervision, etc.

第八十条要求政府的投入“主要用于保障基本医疗服务、公共卫生服务、基本医疗保障和政府举办的医疗卫生机构建设和运行发展”。这么一个额度巨大的款项，必须科学使用和严加监管。其基点，是政府预算。政府预算是经法定程序批准的各级政府年度财政收支计划，反映政府的施政方针和社会经济政策，规定政府活动的范围和方向。也是投入科学性、合理性的保证与后续监管的依据。社会保障预算是政府介入社会保障活动，加强社会保障资金管理的重要手段和工具，它可以全面、准确地反映政府财力支持社会保障的总体情况，便于人民监督和体现政府的实际努力。社会保障资金管理是社会保障制度安全有效可持续运行的物质前提。主要内容包括筹集社会保障资金，资金来源一般为单位和个人缴费、国家财政支持、私人和社会团体捐助等；给付社会保障待遇；管理运用社会保障资金，即妥善地保管和安全可靠地运用资金；建立社会保障预算，即国家用来反映各项社会保障资金，包括政府一般性税收收入安排的各项社会保障资金和养老、失业、医疗、工伤、生育保险及住房等各项基金收支活动的计划。

Article 80 requires the government’s input is “mainly used to ensure the construction, operation and development of basic medical services, public health services, basic medical security and medical and health institutions”. Such a huge amount of money must be used scientifically and strictly supervised. The basic point is the government budget. The government budget is the annual fiscal revenue and expenditure plan of governments at all levels approved by legal procedures, which reflects the government’s policy guidelines and social and economic policies and stipulates the scope and direction of government activities. It is also the guarantee of scientific and reasonable input and the basis for follow-up supervision. Social security budget is an important means and tool for the government to intervene in social security activities and strengthen the management of social security funds. It can comprehensively and accurately reflect the overall situation of government financial support for social security, facilitate people’s supervision and reflect the actual efforts of the government. The management of social security funds is the material premise for the safe, effective and sustainable operation of the social security system. The main contents include raising social security funds, which are generally from units and individuals, state financial support, donations from private individuals and social organizations, etc.; paying social security benefits; managing and using social security funds, that is, properly keeping and using funds in a safe and reliable manner; establishing a social security budget, which is a plan used by the state to reflect various social security funds, including various social security funds arranged by the government’s general tax revenue and various fund revenue and expenditure activities such as pension, unemployment, medical care, work injury, maternity insurance and housing.

 国家实行审计监督制度。1994年8月31日第八届全国人民代表大会常务委员会第九次会议通过了《审计法》，自1995年1月1日起施行。国务院各部门和地方各级人民政府及其各部门的财政收支均依照《审计法》规定接受审计监督。与此配套，有审计署规章《审计署关于内部审计工作的规定 》。

The State implements an audit supervision system. On August 31, 1994, the Ninth Meeting of the Standing Committee of the Eighth National People’s Congress passed the Audit Law, which came into force on January 1, 1995. The financial revenues and expenditures of various departments of the State Council, local people’s governments at all levels and their departments are subject to audit supervision in accordance with the provisions of the Audit Law. Besides, there are the regulations of the National Audit Office, namely Regulations of the National Audit Office on Internal Audit Work.

 国家或有关部门或上级部门下拨的具有专门指定用途或特殊用途的资金。这种资金都会要求进行单独核算，专款专用，不能挪作他用。各地各级财政部门均有财政专项资金使用和监督的规制。自2012 年5 月1日起施行的《财政部门监督办法》（财政部令第69号）规定，财政部门依法对财税法规、政策的执行情况;预算编制、执行、调整和决算情况等事项实施监督。

Funds allocated by the State or relevant departments or higher authorities with special designated purposes or special purposes will be subject to separate accounting and cannot be used for other purposes. Financial departments at all levels have regulations on the use and supervision of special financial funds. The Measures for the Supervision by Public Finance Departments (Decree No.69 of the Ministry of Finance), which came into force on May 1, 2012, stipulates that financial departments shall implement fiscal and taxation laws and policies in accordance with the law. Budget preparation, implementation, adjustment and final accounts and other matters shall be subject to supervision.

政府投入资金的监督管理，有法定的预算管理、审计、监督执法等固有途径，也少不了社会监督。尤其是舆论监督，具有全时段、无死角的特点，可以配合、协同审计、监督执法等监管手段，弥补其不足，协同作用，是强化监管必不可少的手段。

The supervision and management of government investment funds are subject to legal budget management, auditing, supervision and law enforcement, as well as social supervision. In particular, supervision by public opinion has the characteristics of all time and full coverage. It can cooperate with auditing, supervision and law enforcement and other supervision means to make up for its deficiencies. Synergy is an essential means to strengthen supervision.

国家、各级政府的实现义务，是《基本医疗卫生与健康促进法》的最大亮点，对此，专有一条监督规制，第九十条，系承续第八十条政府投入保障责任的规制，是其他卫生专门法难以承载的内容。规定县级以上政府有关部门如果未履行医疗卫生与健康促进工作相关职责的，则本级政府或者上级政府有关部门应当对其主要负责人进行约谈。如果地方政府未履行医疗卫生与健康促进工作相关职责的，则上级政府应当对其主要负责人进行约谈。被约谈的部门和地方人民政府应当立即采取措施，进行整改，而非约谈之后可以蒙混过关。同时，约谈情况和整改情况纳入有关部门和地方政府工作评议、考核记录，对当事人的仕途，产生负面影响。

The realization obligation of the State and governments at all levels is the highlight of the Law. To this end, there is a special supervision regulation. Article 90 is a regulation that inherits Article 80 of the government’s investment guarantee responsibility and contains contents that cannot be stipulated in other special health laws. It is stipulated that if the relevant departments of the government at or above the county level fail to perform their duties related to medical and health promotion work, the government at the corresponding level or the relevant departments of the government at a higher level shall interview the main person in charge. If the local government fails to perform its duties related to medical and health promotion work, the higher-level government shall interview the main person in charge. The interviewed departments and local people’s governments should take immediate measures to make rectification, instead of slipping away unpunished. Meanwhile, the interview and rectification shall be incorporated into the work appraisal and assessment records of relevant departments and local governments, which will have a negative impact on the official career of the parties concerned.

《基本医疗卫生与健康促进法》定位是基本医疗卫生与健康促进领域的基本法，内容宜相对宏观和具有方向性、目标性，原则性地阐明基本准则和基本要求，点明重要的核心性基本制度，重在明确国民健康权利和国家及各级政府的实现义务，及其他各类主体的责权利，明确兑现的大政方针即可。过于细节性的内容，尤其是针对具体违规事务的罚则，一般宜放在《基本医疗卫生与健康促进法》授权制定的配套专门法律法规里规范，不宜侵夺和零散堆砌配套的专门法律法规的具体罚则内容。但是，针对各级政府及其部门的未履行医疗卫生与健康促进工作相关职责的惩戒性、督导性条款，则必须在《基本医疗卫生与健康促进法》里予以明确。因此，第九十条内容十分必要和重要。

The Law is defined as the basic law in the field of basic health care and health promotion. Its contents are of guiding significance and of certain direction and objectives. It clarifies the basic principles and requirements, points out the important core basic systems, identifies the national health rights and the realization obligations of the State and governments at all levels, as well as the responsibilities and rights of other subjects, and defines the major policies to be fulfilled. The detailed contents, especially the penalties for specific violations, should be regulated in the supporting special laws and regulations authorized by the Law. Specific penalties of the supporting special laws and regulations should not be ignored or meaninglessly regulated. However, disciplinary and supervisory provisions for governments at all levels and their departments to fail to perform their duties related to health care and health promotion must be clearly defined in the Law. Therefore, the content of Article 90 is necessary and important.

4 惩处追责规则

4 Punishment and Accountability

监督监管之外，必须有刚性的失职、渎职惩处追责规则。《第九章  法律责任》，共9个条目，第九十八条最为重要：

In addition to supervision and regulation, there must be rules concerning punishment and accountability for dereliction of duty or malpractice. Chapter IX Legal Liability has 9 items, of which Article 98 is the most important:

违反本法规定，地方各级人民政府、县级以上人民政府卫生健康主管部门和其他有关部门，滥用职权、玩忽职守、徇私舞弊的，对直接负责的主管人员和其他直接责任人员依法给予处分。

In violation of the provisions of this Law, if the local people’s governments at all levels, the health departments of the people’s governments at or above the county level and other relevant departments abuse their powers, neglect their duties or engage in malpractices for personal gain, the directly responsible personnel in charge and other directly responsible personnel shall be punished according to law.

这是政府及相关部门直接负责人员的违法责任。相较于第九十条的主要针对政府或者部门履职不到位，第九十八条则针对的是具体公务人员的不法作为，即政府或其有关部门的直接负责的主管人员涉嫌滥用职权、玩忽职守、徇私舞弊的，必须依法问责。

The directly responsible personnel of the government and relevant departments shall shoulder the corresponding responsibilities. Compared with Article 90, which is mainly aimed at the failure of the government or departments to perform their duties properly, Article 98 is aimed at the illegal acts of specific public servants, that is, if the directly responsible person in charge of the government or its relevant departments is suspected of abusing his power, dereliction of duty or engaging in malpractices for personal gain, he must be held accountable according to law.

对于涉嫌犯罪的行为，主要有《监察法》统领性规制。除此而外，公职人员滥用职权、玩忽职守、徇私舞弊，还有党纪政纪惩处。特别是，《刑法》对此详细规定了不同情形的刑事责任。滥用职权是指国家机关工作人员故意逾越职权，违反法律决定、处理其无权决定、处理的事项，或者违反规定处理公务的行为。如果该行为致使公共财产、国家和人民利益遭受重大损失，则可能构成滥用职权罪。玩忽职守是过失的主观心态，主要是指国家工作人员工作中严重不负责任的行为。若由此导致国家和人民生命财产受到重大损失，则可能构成玩忽职守罪。具体见《刑法》第397条第一款规定。而“徇私舞弊”行为，并不单独构成“徇私舞弊罪”，系指为徇个人私利或者亲友私情的行为，主观方面是故意 ,即“明知”不可为而为，是滥用职权、玩忽职守罪的加重情节。《刑法》第397条第二款规定：“国家机关工作人员徇私舞弊，犯前款罪的，处五年以下有期徒刑或者拘役;情节特别严重的，处五年以上十年以下有期徒刑。本法另有规定的，依照规定。”由于这种行为是从个人利益出发，置国家利益于不顾，所以主观恶性要比第一款的规定严重，故本款规定了较重的处罚。

Any suspected criminal acts shall be punished according to the regulations of the Supervision Law. Moreover, public officials shall be given punishments by administrative and Party discipline agencies for abusing power, neglecting duties, or engaging in malpractices for personal gain. In particular, the Criminal Law specifies criminal responsibility in different situations. Abuse of power refers to the behavior of state functionaries who intentionally overstep their powers, violate legal decisions, handle matters that they have no right to decide or handle, or handle official duties in violation of regulations. If the act causes heavy losses to public property, the interests of the State and the people, it may constitute a crime of abuse of power. Dereliction of duty is the subjective mentality of negligence, which mainly refers to the serious irresponsible behavior of state functionaries in their work. If such act causes heavy losses to the lives and property of the State and the people, it may constitute a crime of dereliction of duty. See Article 397, Paragraph 1, of the Criminal Law. The act of “engaging in malpractices for personal gain” does not constitute the crime of “engaging in malpractices for personal gain” alone. It refers to the act of indulging in malpractices for the benefit of himself or relatives and friends. Such act is out of subjective intent, that is, “knowing” that he cannot do it but do it, which is an aggravating circumstance of the crime of abuse of power and dereliction of duty. Paragraph 2 of Article 397 of the Criminal Law stipulates: “Any functionary of a state organ who commits the crime mentioned in the preceding paragraph by engaging in malpractices for personal gain shall be sentenced to fixed-term imprisonment of not more than five years or criminal detention; if the circumstances are especially serious, he shall be sentenced to fixed-term imprisonment of not less than five years but not more than 10 years. Where there are other provisions in this Law, such provisions shall prevail.” Since this kind of behavior is based on personal interests and ignores the interests of the State, the subjective malice is more serious than the provisions of Paragraph 1, so this paragraph stipulates heavier punishment.

5 结束语

5 Concluding Remarks

理解一部法律，必须抓纲举目，并且深入法条字面的背后去爬梳立法的背景，精准掌握立法目的，才能通盘完整地准确掌控这部法律。非如此，则不可能学法、知法、守法、用法，也就很可能枉法、犯法。《基本医疗卫生与健康促进法》建基于人权的最重要组成部分健康权，定位其于积极人权属性，据以配置国家和各级政府的实现职责，以及保障机制和措施，辅之以监督与制裁规制，整部法律定位清晰、理念高蹈，结构谨严、层次分明。循此主线学习、领悟《基本医疗卫生与健康促进法》精髓，可收事半功倍之效。

To understand a law, one must grasp the outline, master the legislative background, and accurately grasp the legislative purpose, so as to fully and accurately understand the law. Otherwise, it is impossible to learn, know, abide by and use the law, and it is also likely to pervert and break the law. The Law of the People’s Republic of China on the Promotion of Basic Medical and Health Care is based on the right to health, the most important component of human rights, and defines it as a positive human right attribute. It aims to stipulate the realization responsibilities of the state and all levels of government, as well as safeguard mechanisms and measures, and supervision and sanction regulations. The Law features a clear orientation, lofty ideas, a cautious structure and clear levels. If you learn the Law based on such main line, you may understand the essence and achieve twice the result with half the effort.

                2020年8月27日晨

                Morning of August 27, 2020

 （摩罗编辑）