Study On The Demand For Medical Care In Rural China

Medical care and people's health is one of the issues that the government, scholars and the public concern most for a long time. The characteristics of externality, asymmetric information and uncertainty have lead to market failure of the medical care market. And being a quasi-public product, the rural medical care service determines that government is of vital importance in the medical care system. The government must play the role of guardians to carry on the management of the rural public medical care service, which includes to ensure the satisfaction of residents' demand in this service, the low level of economic burden of medical treatment and the improvement of people's health.Since the founding of China, the undertaking of rural medical care has developed rapidly and the government has been dedicated to construct a service network of three levels that almost cover the whole countryside. Accomplishments have been made in improving our people's health, which has been regarded as a model among developing countries by WHO. However, rural medical service has undergone great changes since 1980's. The undertaking of rural medical care developed slowly, the public health centers in towns encountered brain drain and fund shortage. The Cooperative Medical System lost its support from collective economy and gradually deteriorated because of management problems. Rural villagers were no longer covered by medical insurance. Especially since the 1990's, the phenomena of becoming poor and falling into poverty again were prominent. The contradictions between medical service's supply and demand were mainly "the great difficulty and the expensive cost of receiving medical treatment". According to the other evidence, the disease burden of rural resident has been increase, especially, the burden of the low income resident is very heavy. And the result of national health service survey reveal that the need of the medical care has been increased, but the utilization of them has been decreased since the 1990's.In recent 30 years, scholars in China and abroad paid attention to the issue of medical treatment reform and focused their researches on how to control total medical cost and fairness while better realizing the maintenance of people's health and the behavior of family's or individual's medical treatment consumption, respectively at the macroeconomic and microeconomic level, which brought useful conclusions. Research on demand is the essence of health economics researches. The purpose of demand analysis in this paper is to discuss how should our society and individual allocate the limited medical treatment resources for the usage of medical treatment service, to analyze the characteristics of rural residents' behavior in the demand of medical treatment service and the issues of medical treatment service's availability and residents' obtainment. It also focuses on the role of economic factors in the issues above, including people's income, medical service price and how medical insurance influences people's demand. All of these researches offer explanations to how the utilization of medical service changes and how different health demand is among people with different characteristics, which helps policy-makers understand how can different means of intervention affect people's demand of medical service and their state of health. What's more, the research conclusions of medical insurance's influence on medical demand in this paper provide scientific basis for the current rural medical treatment reform and New Rural Cooperative Medical System promotion.It is very difficult to measure the demand for the medical care, the literature make the utilization,frequncy and the expendicture as the demand. Generally speaking, people face a series of choices when they look for medical service: the first is to weigh emergency of the disease, economic ability of the family, opportunity cost and many other factors before making the decision of whether to go to the hospital; the second is to decide the way of receiving treatment, such as which hospital to choose; the third is to choose what kind of treatment to receive and the expenditure according to the doctor's suggestion. These three aspects of demand behavior constitute the positive analysis of this paper. Considering the process interity and homogenesis of research method, this paper entitles the three aspects of demand behavior covering whether to receive treatment, type of medical service and expenditure level as residents' utilization of medical service. On the other hand, it regards residents' choice of medical service unit as anther aspect of demand behavior. This paper is divided into eight chapters and the main contents and conclusions are as follows:Part 1: the supply-demand analysis of the medical service market, the model construction of medical service demand and the calculation of income and price elasticity of medical service demand.The growth of population, income and the speeding up of aging process accelerated the increasing demand in medical treatment demand, which promoted the rising of medical service price. As a result, the cost of medical service increased.Based on the data collected from national health service investigation which has been carried out for three times, this paper elaborates the background of research, limns China's urban and suburban medical service market and describes the outlook of rural medical service market, illustrates the existing problems of China's rural medical treatment and causes of such problems and incisively depicts the changes of supply, demand as well as price of China's rural medical market in recent years and the sources of these changes. The dissertation also constructs the model of rural medical service demand and calculates the income elasticity of medical service demand is 1.31 and the price elasticity is -0.76 based on the overall data of medical market, which indicates medical service demand is sensitive to residents' income changes but not to price fluctuations. Thus, the increment of residents' income can significantly improve demand in medical service while price fluctuations can only lead to small changes in demand.Part 2: the positive analysis of influence factors of Chinese rural residents' medical service utilization based on Four-Part Model.This part first analyzes the statistical characteristics of medical expenditure distribution, discusses the questions of medical expenditure variable's normal distribution, zero medical expenditure and choices of sample. Based on these foundations, this dissertation illustrates the econometric basis and adaptability of doing regression with Four-Part Model. This model helps us figure out factors which influence whether rural residents receive medical treatment, their choice of the type of medical service, the determinants of medical expenditure and the role that income, price and medical insurance have played in it as well. The conclusions are as follows:Firstly, because of the scarcity and irreplaceability of medical treatment service, the seriousness of the disease directly determinates residents' demand in medical service. The price of medical service has a significant influence on whether people choose to receive medical treatment and it's also an important determinant of outpatient service disbursement and hospitalization disbursement. When a patient enters the medical market, his or her choice of outpatient medical service or hospitalization disbursement is related to personal income level. Besides, the quality of medical service, cost of time, people's way of living, their age, scale of family also have influence on behavior of demand in medical service.Secondly, the results of positive analysis show that income factor lacks elasticity in outpatient medical service compared with that in hospitalization service while the price factor lacks elasticity relatively in hospitalization service in comparison with that in outpatient medical service. Since medical treatment expenditure is determined by the two aspects of quantity and price, the conclusions above can also be interpreted as: the effect that the increment of income has in improving the utilization of hospitalization service for residents is greater than that of outpatient medical service while the effect that the reduction of medical treatment service price has in improving the utilization of outpatient medical service for residents is larger than that of hospitalization service. Therefore, in pursuing the dual goals of guaranteeing that our patients don't give up their rights of receiving necessary medical treatment when facing economic difficulty while preventing excessive utilization of medical treatment service due to price cut, our corresponding medical treatment insurance policy should give priority to the development of hospitalization service.Thirdly, insurance can enhance residents' utilization of medical service. But because of its low elasticity value, the improvement is limited. Patients who enjoy medical insurance tend to choose hospitalization medical service. The influence insurance has on residents' utilization of hospitalization service is also related to their income. People with medium income level and insurance tend to choose hospitalization medical service while in the group with high level of income, insurance doesn't take on similar tendency any more. What's more, medical expenditure and the coinsurance rate don't have a close relation between each other. The effect that medical insurance has on medical service demand is it reduces medical service costs for the residents to some extent and theoretically it helps alleviate residents' economic burden. However, because of the existence of moral hazard and the phenomenon of supply inducing demand in medical insurance, price cut may lead to excessive demand of medical service, as a result, medical insurance may not alleviate people's economic burden eventually. Thus, we have to regulate the behavior of doctors and patients, strictly control the phenomenon of supply inducing demand, otherwise, the implement of medical insurance will exacerbate people's economic burden.Part3 : the analysis of people's choice of medical treatment unit.Facing income constraints and same disease characteristics, people are more willing to go to institution with high level of medical service quality. Analysis shows that patients with good economic status will either choose self-cure or at least go to the county hospital because of high opportunity cost; on one hand, medical insurance has improved patients' utilization of medical service at a higher level; on the other hand, the regulations of fixed medical treatment institutions and strict medical treatment transfer institutions in medical insurance have constrained people's excessive utilization of medical service, resulting that patients with medical insurance tend to receive treatment in the village clinic or county hospital. Strengthening the construction of rural medical service and fundamental public health service, raising the quality of doctors who are at grass root level and that of medical service so as to make it more convenient for villagers to get reliable medical service and alleviate the issue of "the great difficulty and the expensive cost of receiving medical treatment".