Research On Reconstruction Of Chinese City's Medical Security System

Since 1998, the reform of Chinese city's medical security system have been carried on all over the country for 7 years until now. The focus of this reform is erecting basic medical insurance system for city employees. Due to system designing's faultiness and being restricted by outside medical system, the reform not only didn't achieve its anticipative effect, but also got itself into a corner. This dissertation is based upon the characteristics of medical & sanitation domain, combines with society and economy vicissitudes during Chinese economy transformation, finds out the sticking point of existing system, draws lessons from other countries'experiences with a view to the situation of China, puts forward the concrete route and policy opinion of system reconstruction.This dissertation is composed of the prefect and six chapters.The prefect summarizes the significance of this subject, the domestic and international research status, the study aim, research methods and the contributions this thesis strives to make.Chapter One: Review the History of Modern Medical Security System's Emergency and Development.Behind every institution there are certain theory elements and idea origin, so do medical security, and it is theory elements and thought origin that support the medical security system's transformation from ancient scattered medicaid measures to modern ones whose core is social medical insurance. The theories interrelated with medical security cover politics, economics, ethnics, demotics realm and so on, includes: (1) medicine ethic thought, such as life morality which is exemplified by life sanctity theory, life axiology and life quality theory , and medicine humanitarianism which comprises deontology, virtue theory, commonweal theory and right theory; (2) economics theory, such as risk theory, economics liberalism thought, government intervened thought, welfare economics thought, public economics thought and human capital theory; (3) politics and demotics theory, such as government powers& functions theory and community justice theory. Besides summarizing the theories and thoughts related to medical security system, the author also traces back the emergency and development history of modern medical security system which sprouted in Britain during 17th century to 18th century and was established firstly in German in later 19th century and popularized after the 2nd world war. In this chapter ,the author draws a conclusion: every countries'medical security system had formed under certain social economy background and conditions, and its formation had been influenced by certain theories and thoughts, this means system can but be used for reference and couldn't be copied, so Chinese city's medical security system must be established in Chinese situation.Chapter Two: The Evolution of the Coming Into Being and Development of Chinese City's Medical Security System.Though in Chinese city society the true establishment of modern medical security system the core of which is social medical insurance began in later nineties of 20th, in the era of the Northern Government and the Nanjing National Government China had seen the experiment of taking practice and enacting law on modern medical security system, at the same time the hygiene enterprise in liberated areas and citadels controlled by Chinese Communist Party also did great contribution to unveiling the purdah of modern medical security enterprise in China. Thenceforward after long-term development and transform modern medical security system which had Chinese characteristic had been established in later 20th ultimately. Seeing about this course can help us recognize the notion and policy evolution of medical security of China, and has historical reference value to reconstruction of city's medical security system, at last it also strengthens the point of view: no matter what type medical security system is outcome of certain social economy situation, the system reforms cannot but according to the request of history development. Therefore, once the surroundings change, the system should be changed accordingly, prevenient effect of the system can't be taken as sufficient reason of its existence in the new situation.Chapter Three: The Sticking Point of Chinese City's Medical Security System and the Evaluation On System Reform.In this chapter the author firstly analyze on conventional city medical security system whose main content is public health service and labor health service, through in-depth analysis, the author is cognizant of following understandings: (1) the third part payment mechanism is the institutional root of expense rising; (2) the labor health service is not sustainable because its unified raising is based on single enterprise; (3) there exists obvious virtual social inequality on medical security treatment; (4) current system is short of normative medicaid institution and public health system; (5) city medical security system is influenced by medical system; (6) the initial establishment and forepart development of conventional system was suitable to the situation of China by and large. For conventional system had spanned the social economy transformation of China, as a result it had presented different effect under different social economy system, so it's necessary to compare conventional medical security system's function under planned economy with that under market economy, thereout the necessity of reform the conventional city medical security system can be educed. Although from the mid 80's in 20th our country began to carry on the experiment and reform on city medical security system in some cities, and spread the system reform which gave priority to the establishment of basic medical insurance system for employees in cities to the whole country, but the effect was not obvious. In this chapter the author gives a comprehensive analysis and estimation for the effects and shortcomings of these system reforms, furthermore takes the example of Wuhan's reform of social medical insurance institution and illuminates that the current city medical security system has been close to reconstruction through empirical research.Chapter Four: The Target Rebuilding of City Medical Security System.Many problems emerged during the function process of current medical security system have been already gestated in the target of the system in fact, this is the token of system target's being unclear and not reasonable, therefore the reconstruction of city medical security system must start with rebuilding the system target. Medical & sanitation domain in which medical security system has been has its own characteristics, these characteristics influence the establishment and function of medical security system directly, especially to social medical insurance which is the core of modern medical security system. Medical & sanitation domain has particular complicacy, it is reflected outstandingly through that the consume objects of this domain-------medical treatment & health care and medical insurance has their respective characteristics on their demand and supply. Otherwise being influenced deeply by ethic morality and value judgment is also an important characteristics. These characteristics is of great meaning to enactment of system target and even has determinant influence, so they can't be leave out of account when government determine system target. According to the particularity and inherent law of medical & sanitation domain as well as weighing between equity and efficiency in medical security, we can define the concrete target of city medical security system as following: giving priority to equity, giving consideration to efficiency, realizing city medical security system's sustainable development, maximizing social health welfare. Chapter Five: The Trends which City Medical Security System Reconstruction ought to have.To a certain degree, reconstruction of city medical security system means to overthrow prevenient system, thus it doomed to some radical changes: at first,"market-directed"policy tendency of medical security must be changed, government should play more important role in this domain; secondly, whereas many problems emerged from the running of Chinese city medical security system are due to the inherent defect of current medical system, accordingly thorough reform of medical system must be carried on; thirdly, to realize the sustainable development of social economy and medical security by mutual interaction between them; fourthly, to take giving priority to equity and giving consideration to efficiency as direction of guiding, and to consider city medical security system's balanceable development among different areas during system reconstruction; lastly, to take the mutual cooperation between city medical security and other social security items as one of new system's development tendencies.Chapter Six: Reconstruction of Chinese City's Medical Security System. This chapter is summary and conclusion of the whole article actually, it is the research on system construction route. Alike any other institutions, enacting city medical security system also must follow some principle, this is not only determined by the speciality and objective laws of medical & sanitation domain, but also internal request to guarantee system function effect and realize system's sustainable development. The principle to reconstruct city's medical security system includes: to carry on medical system reform simultaneously, to base itself upon medical security various items'characters and functions, to realize effective cooperation between government intervention and market mechanism, to draw lessons from other countries'experiences rationally on the basis of Chinese situation. On the foundation of definite system reconstruction principle, redesign city medical security system model frame from three aspects, i.e. city medical social insurance, city public health and city medicaid. In the end, the author put forward policy advice on fostering and improving exterior environment of city medical security system.