I. Background of the formulation of the Nine Guidelines

  In December 2013, the former National Health and Family Planning Commission (NHFPC) and the State Administration of Traditional Chinese Medicine (SATCM) jointly issued the Circular on the Issuance of the “Nine No-No's” on Strengthening the Construction of Healthcare Ethics (hereinafter referred to as the Nine No's), which plays an active role in guiding the construction of the style of the healthcare industry, and resolutely corrects the behaviors that harm the interests of the public in healthcare. (hereinafter referred to as the “Nine Disallowances”) has played a positive guiding role in strengthening the style construction of the medical and health care industry, seriously improving the discipline of the industry, and resolutely correcting the behaviors that harm the interests of the public in medical and health care. In recent years, the CPC Central Committee and the State Council have put forward a series of new requirements for strengthening the construction of style in the medical and health care industry. In order to further enhance the sense of responsibility, mission and honor of the staff of medical institutions, standardize practice behavior, promote the professionalism of medical and health personnel in the new era, guide the formation of a clean and upright industry environment, and ensure the high-quality development of medical and health care undertakings, the National Health Commission, in conjunction with the National Health Security Bureau and the State Administration of Traditional Chinese Medicine, in response to the current outstanding problems in the field of health care that have been strongly reflected by the public, in the “nine disallowances”, the State Council has adopted a series of new requirements for the construction of medical and health care industry style. On the basis of the “Nine No-No's”, the State Healthcare Commission, together with the State Medical Security Bureau and the State Administration of Traditional Chinese Medicine, jointly formulated and issued the “Nine Guidelines for the Integrity of Staff of Medical Institutions in Practicing Their Jobs” (hereinafter referred to as the “Nine Guidelines”).

  II. Scope of Application of the Nine Guidelines

  The Nine Guidelines are applicable to the staff of medical institutions, including but not limited to health professionals and technicians, administrators, logistic personnel, and other social practitioners who provide services in medical institutions and accept the management of medical institutions.

  Main contents of the Nine Guidelines

  Nine Guidelines” adhere to the positive advocacy, negative warning parallel, is for all staff in the medical institutions of the clean practice of basic normative documents, is the industry morality, practice norms, the masses of the concrete presentation of the demands, reflecting the ‘whoever is in charge of who is responsible for’ ‘management of the industry must be in charge of the style of the industry,’ the requirements of industry management. It embodies the requirements of industry management of “whoever is in charge is responsible”, and draws the bottom line of basic behavior for the majority of medical personnel.

  Each guideline in the Nine Guidelines first advocates requirements and then lists prohibited behaviors. Specifically: legal pay for work, do not accept commercial commission. Strictly abide by the principle of honesty, do not participate in fraud and insurance fraud. Practice medicine according to the norms, do not carry out excessive diagnosis and treatment. Comply with work procedures, do not accept donations in violation of the law. Abide by the principle of confidentiality and do not disclose patients' privacy. Obey the needs of treatment, do not profitably refer patients. Maintain the order of treatment, do not undermine the fairness of medical treatment. Build a harmonious relationship, do not accept “red packets” from patients. Abide by the bottom line of communication, do not accept corporate kickbacks.

  The Nine Guidelines take whether the behavior of the staff of medical institutions is for personal gain as the evaluation and judgment standard, and explains the specific performance and connotation of the prohibited behaviors. The Nine Guidelines emphasize the main responsibility of medical and healthcare institutions for the management of ethical practices, as well as the supervisory responsibility of health departments at all levels for the management of ethical practices. In particular, it emphasizes the accountability of administrative departments and heads of healthcare institutions that fail to implement the Nine Guidelines, reflecting the convergence of regulations, discipline and law, and enhancing the effectiveness of the policy.

  The “Nine Guidelines” is an upgrading and improvement of the “Nine Prohibitions”.

  After the publication and implementation of the Nine Guidelines, the “Nine No-Nos” were abolished at the same time. Nine Guidelines” is in the ‘nine prohibited’ from the core of strict governance based on the upgrading and improvement of the content to the form, specifically expressed as:

  (a) Covering all the requirements of the “nine prohibitions”. The “nine prohibitions” in the “no personal income of medical and health personnel linked to income from drugs and medical examinations,” “no illegal fees” is summarized in the “no excessive diagnosis and treatment”. No over-diagnosis and treatment”; ‘No billing for commission’, ‘No prescription for commercial purposes’, ‘No participation in sales activities and illegal release of medical advertisements’, ‘No illegal release of medical advertisements’ and ‘No illegal release of medical advertisements’. “No illegal private procurement and use of medical products” is categorized as ‘no acceptance of commercial commission’. The “nine prohibitions” of “no acceptance of patients' red packets”, “no acceptance of kickbacks, no illegal acceptance of social donations” and so on, the “Nine Guidelines” adopted in its entirety, emphasized, and the scope of application is made clear. The scope of application has been clarified.

  (ii) Supplementing and expanding the content. Supplementary prohibitions have been made on new issues and new situations and new manifestations of old problems. New contents such as “not practicing over-diagnosis and treatment”, “not participating in fraud and insurance fraud” and “not profitably referring patients” have been added; as well as “old problems” such as recommending out-of-hospital purchase of medicines, promotion of non-medical commodities, and Internet medical care. The new manifestations of “old problems” such as “no acceptance of commercial commissions” in the Nine Guidelines make comprehensive requirements to maximize the coverage of the various types of commissions that may arise.

  (C) Clearly define the corresponding punitive measures. In accordance with existing laws and regulations, Party rules and departmental regulations, the reference basis for penalties for violating the Nine Guidelines has been increased. For those who violate party discipline and political discipline, they will be transferred to the disciplinary and supervisory organs to be given party disciplinary and political punishment; if they are suspected of committing a crime, they will be transferred to the judicial organs to pursue criminal responsibility. For the violation of the Nine Guidelines behavior is frequent or cause bad social impact and other serious consequences of the person in charge of the medical institution, in accordance with the relevant provisions, be held accountable.

  (D) provide for specific ways of implementation. Learning and training, supervision and implementation, investigation and notification, constraints on the assessment as a means of four measures to carry out the implementation of the “Nine Guidelines” to ensure that the policy requirements are implemented in detail.