Study On The Cooperative Medical Service System In China's Rural Areas

The"Shortage Economy"age, which had harassed the Chinese people for a long time,is evolving into a"relative surplus"one;the problem of feeding the people has been solved. However,the farmer's expenses on medical treatment are continuously increasing; and they are served by low-quality medical institutions in the rural areas. There are more and more cases of causing poverty by diseases. Thus, aiming at building an integrated, comparatively well-off and harmonious society, it is urgent for the theorists and practitioners to build an effective and extended rural medical service system and to solve the problem of farmer's expensive hospitalization. In this dissertation, I, on the basis of summarizing relative literature both home and abroad, reviewed the evolution of the cooperative medical service system in China's rural areas, studied the beneficial experiences of the medical service system abroad, and analyzed the validity of rural medical supply and ensuring level of present systems from four aspects, namely, the supply and demand of China's rural medical market, the operating pattern of rural cooperative medical service, the operating mechanism of rural cooperative medical service as well as the cruxes and rubs in rural cooperative medical service system reform. Meanwhile, theories of management science and economics are applied pertinently to help advance a series of policy suggestions including systematic supply, system construction and supervision of constitutions. This plays a very significant role in building a new type of cooperative medical service system, in solving shortage supply of rural medical service and in reforming medical and health-care systems of China.The dissertation is composed of nine chapters.Chapter one is the introduction. In this chapter, I expatiated the background and significance of selecting this topic, the cooperative medical service in China's rural areas, analyzed in an all-round way the relative studies both home and abroad, determined the study pivot and direction, and made indispensable explanation on study clues and methods as well as the possible innovations.Chapter Two is on the basic theories of rural cooperative medical service system. Medical service, as health consumer goods, determines the particularity of the medical market. In other words, its nondeterminacy, dissymmetry of information, and exteriority directly cause market's failing to satisfy the requirements demanded by Pareto-optimality. In this part, theories such as those of disease risk, social insurance, medical market failure and state intervention, cooperative economy as well as rural medical service social security, were discussed in detail, which paved a solid way for developing the following content.Chapter Three is on the evolution and status quo of the cooperative medical service in China's rural areas. Since its birth, cooperative medical service has undergone four phases, namely, growing, refulgence, declining and re-growing. It was once praised by the WHO as"the sole paradigm of developing countries to come up with medical and health-care outlay". But in 2000, China was reduced to one of the most unfair"financial burden:"countries in the health-care system, being .No. 188 among the 191 countries. This part summarizes and epitomizes the change of the cooperative medical service system in China's rural areas, probes into the reasons of its declination; it also makes a preliminary appraisal and analysis on a new type of cooperative medical service system and pointed out its defects. The defects include: reverse payment transfer caused by financial subsidy and volunteer participation, bigger reverse choice risk, failing to favor the farmers and difficult controlling of expenses, etc.Chapter Four is on medical service systems abroad and their revelations. It is indispensable to use the experiences of developed countries for reference, if we desire an improved rural medical service system. This chapter mainly studied the basic ways and their advantages and disadvantages of foreign countries in dealing with medical service and security matters, probed into and summarized the beneficial experiences and lessons from foreign countries during their building rural medical service and security systems. The successful practices include: clarification of government's function and duties on public health, a full play of the roles of non-governmental organizations as well as of market mechanism, expansion of the channels and efficiency of fund-raising for public health, and building of an interior stimulating mechanism of payment. These good practices are very significant references for China's rural medical security.Chapter Five is on supply-demand analysis of China's rural medical market. China's rural medical market is very particular because of its city-countryside binary economic constitution. This chapter discussed this from four angles, namely, general, supply, demand and equilibrium of supply and demand respectively. The conclusion is that the medical demand cannot be satisfied effectively, that the medical supply is in a very bad condition, that there is shortage of investment by the Government, and that the farmers suffer from very heavy medical burdens. It is the bounden responsibility of the Government and society to coordinate related systems and arrangements so as to provide the farmers with favorable medical security. Chapter Six is on China's rural cooperative medical service patterns. The aim of cooperative lies not in"cooperation for cooperation's sake."Therefore, all kinds of cooperative medical service patterns is endowed with inevitable defects. This chapter analyzes the factors influencing cooperative medical service patterns, and to probe into the innovative ways and future developing trend of China's rural cooperative medical service patterns. This is significant to supply references for the Government to choose fitting medical service reform mode, and to promote the integrity of city-countryside medical and health-care system.Chapter Seven is on the operating mechanism and it evaluation of China's rural cooperative medical service. Fund-raising is the first and fundamental problem in cooperative medical service, while compensation, stimulating and check is directly related to the farmer's enthusiasm along with the duration of this system. Therefore, effective operation of cooperative medical service system relies heavily on fund-raising mechanism, compensation mechanism and stimulating and check mechanism. This part probes into the evolution and constitution principles of the fund-raising mechanism of cooperative medical service, put forward related improving measures, analyzes the connotation and principles of the fund-raising mechanism of cooperative medical service, evaluated objectively the present pattern, and pointed out the problems that should be noted when choosing compensation mechanism, put forward stimulating mechanism from the angles of the farmer, the managerial personnel as well as the medical service man, and mainly discussed the check mechanism for the medical institutions, medical service quality and cooperative medical funds—intensifying supervision and management.Chapter Eight is on the rubs in China's rural cooperative medical service reform. Cooperative medical service reform is a complicated, systematic program, which involves several subjects such as the State (the Central Government), local government, medical institutions (including medical managing departments), and the farmers. There are many and hard cruxes and rubs. This part proceeded with each individual subject, anatomized its individual economic behaviors and pointed out their inadequacy. It is discovered that the State did not make a full play of its subject responsibility, that the local governments are beset with small financial capacity, that the medical services are busy with their own profits, and that the farmers are lack of confidence because of low income; they are the main reasons. This discovery provides a theoretical basis for cooperative medical service reform to choose the direction, the breach and the pivot.Chapter Nine is on the overall scheme and supportive measures for China's rural cooperative medical service system reform. On the basis of studying the nature of cooperative medical service and with system change theory and model analysis, I pointed out that approach choice of cooperative medical service system reform should be a forced system change. It held that the system supply level should put stress on both its interior and exterior system construction; the pivot of its interior system construction lies in cultivation of morality and values, while its exterior system construction covers several aspects such as government financial investment system, medical labor resources system, and hospital independent directoration system. A three-level prevention and health-care network is suggested to strengthen system construction. Some effective measures are put forward as supportive measures, such as to use distance medical service to make up the insufficient medical resources in the rural areas. A series of policy suggestions are put forward from aspects like systematic supply, system construction, mechanism ensuring and supportive measures.