| Justice is the core proposition of political science research.Numerous philosophers,ethicists,and politicians from all over the world have taken social justice as the principle of an ideal society.At present,social fairness and justice have been fully embedded in all fields of society as the value pursuit recognized by the international community,the health field is no exception.The study of justice in politics and the concern about life and health have a deep historical origin.Every important achievement of justice theory can be applied to the field of life and health.According to the historical experience,the realization of health justice depends on the state’s institutional arrangements for the health security of all members of society,of which medical services are one of the key contents.Medical service is a kind of public need,which should be guaranteed by the state through institutional arrangements.But in reality,when the government is unable to provide all medical services,it usually chooses to provide some medical services to the whole people.This part of medical services is endowed with the characteristics of public goods under the national institutional arrangements,which can be called "basic medical services".But can not be ignored is that basic medical services are obviously competitive and exclusive when utilizing services.This requires the government to abandon its property of private goods through certain institutional arrangements,and endow it with the property of public goods by realizing "scale effect" and increasing "exclusive cost",so as to embody health justice.In view of this,what it should be that the government provides basic medical services fairly for all members of society by following the principle of social justice to construct certain institutional arrangements,so as to realize the equality of rights,opportunities,processes and results.The institutional arrangements the government construct is the object of this study:“the basic medical service system”.To study the basic medical service system from the perspective of social justice,the first step is to sort out the relevant theoretical origins.This article mainly analyses the important value of the theory of Social Justice,public goods,institutional change,public choice and differentiated society.Justice has a long history as human beings,and has different connotations with the development of society.The organic combination of theoretical nutrients between Rawls’ theory of justice and Amartya Sen’s,provides a profound theoretical basis and practical operational guidance for the construction and reform of China’s basic medical service system.The theory of public goods tells us that the responsibility for the supply of public goods should be borne by the government,and at the same time,it tells us how to avoid the "tragedy of public land" of pure public goods and "overuse" and "crowding effect" of quasi-public goods.The theory of institutional change reveals the phenomenon of "path dependence" in the process of institutional change,which has direct reference value for the construction of basic medical service system.The theory of public choice has direct help to the analysis of the problems existing in the current basic medical service system by the interpretation of "collective action logic" and the analysis of the conduction between political parties,interest groups and public policies.The description of the phenomenon of "interest differentiation" and "social stratification" in our society and the discussion of "justice of difference " in the theory of differentiated society have strengthened the necessity and practical significance of in-depth study on the just distribution of basic medical services.This article focuses on the medical service system in China from the second chapter.From the point of view of the current medical service system in China,the government is unable to convert all medical services into public goods,and can only focus on basic medical services.This situation has profound historical roots and realistic considerations.From the perspective of historical changes,the medical service system before the reform and opening-up which has the characteristics of "state-led,wide-coverage,low-level,strong fairness" gradually withdrew from the stage of history with profound social changes.After the reform and opening up,along with the reform of ownership structure,the reorientation of government and social relations and the continuous differentiation of social structure,China’s medical service system has gradually moved towards a market-oriented development path.Although the medical and health undertakings have made rapid development,the fairness of medical serviceshas also declined,leading to a more serious problemof "poverty caused by illness and poverty return due to illness".At the same time,because of differences in urban-rural,regional and income,there are differences in the supply capacity of medical services in different regions and the demand and access capacity of medical services.As a result,people always have certain and inevitable differences in health equity.This difference has been strengthened because of the shortcomings of institutional arrangements,which highlights the severity of the problem of insufficient supply and unequal distribution of medical services in China.After deep thinking,a basic consensus has been reached: it is inappropriate to provide medical services in a market-oriented way,and the medical service system should return to public welfare.However,due to the limit of economic development and state financial capability,it is not appropriate for China to implement the British-style free medical care for all.The feasible way China choose is to ensure that every citizen enjoys basic medical services.Reasonable allocation of medical resources,equal opportunities for medical treatment and fair results are important goals for China’s medical reform so that the limited medical resources can maximize social justice.In this context,a new round of health care reform in China began in 2009,which clearly put forward the basic principle of "basic medical and health system as public goods to provide to the whole people".The reform takes "basic medical and health services for all" and "achieving health equity" as important reform objectives.The Communist Party of China and the government have always paid close attention to the life and health of all the people.They have incorporated "basic medical and health services for all" into the Outline of the "Healthy China 2030" Program,which has risen to the height of national strategy.The new health care reform is undoubtedly in line with the national conditions and the principle of justice.However,in the face of regional differences and strong institutional inertia,the reform of the basic medical service system is obviously difficult to achieve overnight.At present,the new health care reform has been implemented for ten years.What is the effect of the reform?Has the goal of reform been achieved? Has the existing problems in the medical service system been thoroughly solved? Does the basic medical services provided by the government conform to the principle of justice? If not,how to reform? The research and analysis of these problems in this article is very urgent and important.In the third chapter,based on the principle of social justice,this article analyses the current basic medical service system and reform practice in China,and finds that although the new health care reform has made exciting achievements,there are still four shortcomingsin the social justice of the basic medical service system: First of all,the lack of justice in the right to basic medical services.Everyone’s right to basic medical services lacks legal protection.Under the influence of "individual differences,social status,economic capacity",there are significant differences in the "viability" of access to basic medical services among different groups of people,which undermines the equality of rights.Secondly,the lack of justice in the supply of basic medical services.It is mainly manifested in the insufficient total medical resources,the failure of Partial policy and the imbalance of medical resources allocation.It is specifically manifested in the unchanged logic of profit-seeking behavior fundamentally of medical service providers.The growth rate of per capita medical expenses is still higher than that of per capita disposable income.the effect of reform by interest groups,the imbalance of resources between regions and urban and rural areas,and the functional dislocation of medical institutions at different levelsstill exist.Thirdly,the lack of justice in the distribution of basic medical services.After the extinction of graded diagnosis and treatment,it is difficult to rebuild.Disordered medical treatment has strongly hindered the equal opportunity in the distribution of basic medical services.The efforts to rebuild the graded diagnosis and treatment system,such as permission for multi-point practice and the establishment of medical consortium,still face many institutional barriers and practical difficulties.Finally,the lack of justice in the payment of basic medical services.The basic medical security system embodying the Principle of Justice also has problems such as "non-national overall club barriers,lack of fairness under the principle of equality and non-compulsory financing undermines equality of opportunity".These four shortcomings show that the basic medical service system in China has not yet realized the equality of rights,opportunities,processes and results.So how should the basic medical service system conform to the principle of social justice be constructed? Chapter IV starts with the medical service system of the main typical foreign countries(the UK’s free medical service system,the USA’s market-led system,the German government-led system and the Singapore’s complementarity of public and private functions),and proposes that the basic medical service system should cover the reasonable core of "equal rights,equal opportunities,fair distribution,government-led system and respect for national conditions".On this basis,this article puts forward that the basic medical service system of justice should realize "rights justice,supply justice,order justice and guarantee justice".That is to say,everyone are legally given the right to enjoy basic medical services fairly,the supply system of basic medical services is reconstructed with the regional longitudinal medical association as a unit,the distribution of basic medical services is guaranteed fairly by compulsory graded diagnosis and treatment,and the results are guaranteed fairly by paying in full with the basic medical insurance fund.At the same time,through an in-depth analysis of the political,economic and social feasibility of the basic medical service system,it can be found that: the solemn commitment made by the Communist Party of China to the people and the leading position of the chinese government endow the basic medical service system with political feasibility.The enhancement of public financial capacity in China provides a solid economic basis for increasing financial investment in basic medical services.The financial investment in services provides a solid economic foundation.The expectation of the people for the integration of the medical insurance system and the institutional evasion of the reform risk have laid the foundation for the social feasibility of the basic medical service system.But it is a systematic project to make up for the deficiency of justice.In order to realize "right justice,supply justice,order justice and guarantee justice" thoroughly,We need to have a clear understanding of the problems and challenges,adhere to the principle of "balance between reform and stability" simultaneously in the process of promotion.The first is to speed up the legislative process and give people the right to enjoy basic medical services fairly.The second is to speed up the integration of medical resources,build close medical consortium,and strengthen the role of supply in guiding demand.The third is to implement compulsory graded diagnosis and treatment to solve the problem of disorderly medical treatment with reasonable procedures.The fourth is to improve the basic medical security system with compulsory participation of all members of society,which can establish a fair way of financing medical insurance and increase the proportion of payment until full payment gradually.There are many problems and challenges in the process of justice promotion,such as the path dependence of fragmentation in resource integration,consensus differentiation under different needs,adverse selection and moral hazard,over-treatment risk caused by underlying rules and the risk of infiltration and kidnapping of special interest groups inthe process of policy implementation.As a result,to Promote the current basic medical service system to justice requires top-level design by the central government,the participation of relevant reform parties in the detailed design of the reform plan to enhance the system consensus,the breakdown of institutional barriers to resource integration by institutional rationality,the enhancement of basic medical service security capacity by overall national planning,the breakdown of the incentive of over-treatment by innovation of regulatory mechanism,the dislocation between private hospital and public hospital,and ultimately achieve the just goal of "equitable access to basic medical services for all". |
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