| Health, as a fundamental human right, is necessary and indispensable to every citizen. Healthcare system is an important guarantee of human right to survival and development, and it is directly related to social stability and national security. Since the founding of the PRC, the basic medical and healthcare system has experienced a process of development and evolution, resulting in the establishment of a network of four systems, namely, public health, medical service, health care and drug supply security system. In April, 2009, the CPC Central Committee and the State Council issued the blueprint for healthcare system reform entitled “Opinions on Deepening the Health Care System Reform”(“Opinions” for short), declaring that the basic medical and healthcare system would be provided to the society as a public product to solve the problem of “Kan bing nan, kan bing gui”, hoping to achieve the goal that every citizen would have access to basic medical and health services. For the first time in the past over thirty years since the reform and opening-up, the basic medical and healthcare system, which was put forward in the new healthcare reform, has raised a people’s livelihood problem to a political level of “basic system”. There is no denying the fact that the value of the position and the direction of the reform of the Chinese government remain right in designing and promoting the new healthcare system. The establishment of the basic medical and healthcare system complies with the CPC’s ruling core philosophy, e.g. “building a party serving the interests of people” and embodies the political will of “good implementation, maintenance, and development of the fundamental interests of most people”.However, the current basic medical and healthcare system is inevitably defective and imperfect. The problems can be categorized into two layers, the first of which is about structure. In terms of supply and demand structure, the unreasonable allocation of health resources leads to the aggravation of the problem of “Kan bing nan, kan bing gui”. In terms of service structure, the service ability of grass-roots units is weak while large hospitals in big cities are overburdened. In terms of interest structure, medical service, basic medical insurance, and basic drug supply are developing unevenly, causing an unbalanced pattern of interests. The second problem lies in the mechanism. Although the overall direction is clear, the responsibilities of the three divisions are blurred, causing inefficiency of government leading, invalidity of market supply, imbalance of public welfare and motivation of public hospitals, and unfair degrees of people enjoying benefits from the messy medical and healthcare system. The existence of the above mentioned problems has hindered the healthy development of the basic medical and healthcare system, making it rather difficult to fulfill the goal that every citizen has access to basic medical and health services. How to select the basic reform path for the basic medical and healthcare system? How to realize reasonable allocation of medical and health resources between urban cities and rural areas, between different regions and different groups of people? How to alleviate the present problem of unaffordable access and medical impoverishment? How to improve the justness of the operation of the present medical system? How to bridge the gap between two separate paths in developing the system? How to better the construction of the medical and healthcare system which is supposed to cover both urban and rural residents? How to build an institutional framework of every citizen has access to basic medical and health services and how to deepen the feasible path? To answer these questions, a comprehensive and thorough investigation on and consideration about China’s national conditions, the existing problems and law of development is required. The justice theory demands that all social basic values(including freedom, opportunity, income, wealth and self-esteem, etc.) be allocated equally, unless the unfair allocation of one or all of the values satisfies every person’s interest. To put the justice theory into practice in the field of medicine and healthcare means that, in others words, the health justice demands that the medical and healthcare system respect the basic health right of every social being and the benefits of different groups got from the medical service. Therefore, within the scope of justice theory, the basic value position of the basic medical and healthcare system in our country lies in the efforts to make the public have equal chance, fair procedure and satisfying results of enjoying the basic medical and healthcare service. The realization of this goal, however, relies on the coordination and integrated planning of basic medical service system, basic medical security system, drug supply security system and public health service system within the framework of the basic medical and healthcare system.The basic medical and healthcare system being the research object, by means of such approaches as literature research, data analysis, inductive analysis, qualitative analysis based on quantities, and combination of theoretical and empirical analysis, the present paper mainly focuses on exploring the existing deficiencies and their root causes of the basic medical and healthcare system, then analyzing the necessity, feasibility and rationality of the structural integration of the basic medical and healthcare system driven by the so-called “San Yi Lian Dong”, that is, joint reformation for basic medical service, basic medical insurance, and basic drug supply security. By virtue of comparing typical pattern of healthcare system in foreign countries and the domestic pilot pattern of “San Yi Lian Dong” in certain places in China, we tend to absorb experience and enlightenment for deepening the medical and healthcare system. Under the guidance of justice theory and coordination theory, we are trying to find a path to deepen the reform of basic medical and healthcare system in terms of setting value goal, improving governance structure, top designing and institutional supplying. The paper falls into six parts and the main research contents and relevant conclusions are as follows.The first part is introduction, which is an overview of the background of the selected topic. Through the introduction of the necessity and reality of the basic medical and healthcare system, the paper highlights the significance of maintaining social basic goodness via promoting the development of the basic medical and healthcare system, making sure that every citizen has the equal right to enjoy the basic healthcare service. Secondly, it reviews and analyzes the status quo of the relevant researches both at home and abroad and also defines some concepts related to basic medical and healthcare system. Then, the justice theory, coordination theory and system theory are introduced to analyze the necessity of implementing the reform of the basic medical and healthcare system. Finally, the paper concisely introduces the main contents, research approaches and possible originalities.The first chapter is a summary of the basic medical and healthcare system. After offering a multi-dimensional analysis of the concept, connotation, characteristics and functions of the basic medical and healthcare system, the paper puts forward that the basic medical and healthcare system is a system guarantee of the basic medical service. Then, the paper recollects the historical development of the basic medical and healthcare system, categorizing it into four periods, namely, the embryonic period, the forming period, the growth period and the construction period. It also introduces the accomplishment achieved in the process of implementing the system, as well as successful experience in system development, including the facts that the government is an important force in pushing on the system, that institution is an important guarantee for maintaining the public’s health right, and that health justice demands full protection of the basic health rights of the underprivilegedThe second chapter examines the deficiencies of the current medical and healthcare system and probes into the root causes. First, it outlines the framework of the current medical and healthcare system, which consists of the basic medical service system and the public health system. The former then includes basic medical service, basic medical insurance, and basic drug supply security. There is no denying that China’s current basic medical and healthcare system reform has been a huge success. However, there are still some insufficiencies, which are mainly manifested in structural and mechanical aspects. The problem of “laceration” in the current medical and healthcare system has directly damaged the fairness of the public getting access to basic medical and healthcare service and impaired the operating efficiency of the system. Finally, the paper digs out the root causes of the deficiencies of the basic medical and healthcare system from the perspectives of government policy, public health demands, and the institutional system. Therefore, it is a daunting task to explore the deepening path of the reform of the medical and healthcare system.The third chapter makes a comparison on the typical healthcare system between different foreign countries and the current pilot models of “San Yi Lian Dong” in China. On the one hand, compare the typical healthcare system in such foreign countries as the United Kingdom, the United States, Germany, India and Mexico. After illustrating the historical development and system characteristics of various modes of healthcare system, also through the comparison between different systems, including fairness and efficiency, supply of medical service, and medical security, we’ve drawn the following lessons and enlightenments of the basic medical and healthcare system in our country: complete coverage of health care has become an international consensus on healthcare system reform; the healthcare system as a whole needs to be promoted; the administration system should be unified and legislation and government responsibility should be strengthened. As for our country, only by choosing the basic medical and healthcare system which suits national conditions, and thinking about various protruding problems in the progression of the reform with full respect for history and reality, can we take in beneficial experience from different systems and make up a prime plan for the development of the basic medical and healthcare system. On the other hand, the paper makes an analytical study of the present tentative practice of “San Yi Lian Dong” in the medical and healthcare system carried out by the government. The study mainly focuses on the tentative model in four cities, Shanghai, Fujian, Anhui and Shangdong respectively. Although the pilot areas have different modes of logic and different deepening paths, they do make contributions to the deepening of the reform of the basic medical and healthcare system. For example, “San Yi Lian Dong” is the inevitable trend of the structural integration of the basic medical and healthcare system; the government’s leading role is the powerful impetus to promote the model; to break the mechanism of “medicine for medical” is the key to the reform of public hospitals; to improve the capacity of grassroots medical services is the necessary foundation; such resources as people, money, material and information are the fundamental guarantee of the system innovation. Therefore, it is reasonable to draw a conclusion that “San Yi Lian Dong” is a necessary trend to fill in the gap of the uneven development of the basic medical and healthcare system.The fourth chapter offers an analysis of the necessity, feasibility and rationality of the structural integration of the basic medical and healthcare system in our country, which in essence is an exploration of the relationship between “San Yi Lian Dong” and the basic medical and healthcare system. First of all, the necessity of structural integration of the basic medical and healthcare system reflects the bottom line of the country’s political system, the complexity of the system itself, and the justification of eliminating the legitimacy of internal friction and improving efficiency of “San Yi Lian Dong”. Secondly, the feasibility of structural integration of the basic medical and healthcare system lies in the powerful political commitment of the country, in the successful demonstration of the reform of “San Yi Lian Dong” and the necessary conditions provided by the economic development. Lastly, the validity of structural integration of the basic medical and healthcare system lies in the joint of goal and means, the coordination between system and specific factors, and the unity of dream and reality. The paper further stresses the importance of bridging the uneven development of the basic medical and healthcare system, reiterates the leading position of the government in the reform, and realizes the internal regularity between medical treatment, medicine and medical insurance, thus having a good command of the wholeness and integrity of the system reform.The fifth chapter is the focus and the punch line of the whole paper. Based on the exploration and generalization of the previous chapters, this part conceives the path of deepening the reform of the basic medical and healthcare system, which mainly covers four aspects. Firstly, it puts forward that the in-depth reform of the basic medical and health care system needs a clear value target, including maintaining the basic, promoting equity, controlling the cost, and raising efficiency. Secondly, it points out that the in-depth reform of the basic medical and health care system requires an administration structure, government guidance, overall plan, balanced interest and gradual development. Thirdly, it purports that the establishment of the ideal of health justice should be guaranteed by the top-level design, and the structural problems should be eliminated through constructing a new pattern of management of “government maintaining the basic, market raising efficiency, and society promoting equity”, perfecting the basic medical and health care system and providing human resources, goods, information, legal system and other necessary guarantee for the development of the system. Fourthly, it argues that the frame construction of health justice ought to be guaranteed by the institutional advantages. The structural and institutional problems that appear in the process of the reform should be tackled from three perspectives, that is, to clarify the duty of the government, to promote the reform of healthcare administration in place, and to optimize the basic medical and health supplies mechanism. |
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