Study On Demand Of New RCMS And Its Institutional Innovation In Less Developed Area In China

The estabilshment of the New-RCMS for rural resident is an important work of CCP and the government,and the objective of this work is to achieve wholely coverage of all rural resident in 2010.The difficulty of this objective is whether th poor provinces can accieve it.On the basis of Von Neurnann & Morgenstern Expected Utility and Institutional Economics Theoretics,this study firstly analyzed the process and mechanism of the operation of the new rural cooperative medical scheme(new-RCMS),and then theoretical and econometric framework were developed to find the determinant factors of the farmer's observable demand and latent demand upon health insurance. Thirdly the institutional ecomomics theory was used to analyze the institutional change pathway, different patterns of RCMS also were compared and the principle of institunianl innovation was given.The main data source of the study were a questionaire survey on the 4 of 8 pilot counties of Guizhou Province and a field survey of 241 rural households of 5 counties in Guizhou province,and the main methods in identifying the real demand and willingness to pay(WTP)for the new-RCMS and their determinants were Contingent Valuation Method(CVM)which was popularly used by enviroment economist.the study aims to identify the real demand and willingness to pay(WTP)for the new-RCMS and their determinants,and to provide policy recommendations for expanding the demand and developing new-RCMS sustainably.The main conclusions are as follows:1.New -RCMS had the characteristics and governance structure flaw of nonprofit institution.An evaluation index sytem was developed using process and result method,and the survey and assessment of opeation of the pilot new-RCMS in 4 counties demonstrated that Guizhou's new-RCMSs performed worser than other sampled pilot schemes excecpt Cishui city, and all the new-RCMSs had the disadvantages of low reimbursement rates,unreasonable deductibles and low benefits,but the funds contributed by farmers and donated by the different levels of govenments were quikly raised;2.A theoretical framework developed in analyzing the relationship between the demand of health,health care and health insurance shows that health insurance demand was a derived demand from demand of health,health care,the fators influencing a rational famer in making decision of purchasing or participating a health insruance should include the probability of illness,risk attitude, medical care cost,the probability of seeking health care,insurance premium,compensational level of seeking health care and the income level.Demographic characteristics and characteristics of local community were also included.3.Three income sources of the sample farmers were off-farmer work income,bussiness profit and inome from planting in turn,and the main expenditure items of rural families were food, children's education and health care cost.And the ability to pay did not restrict the williness to pay in making decicion in participating or purchasing health insurance.Descriptive analysis suggested that determinant in purching commercial health insurance were demographic characteristics at individual level,demographic characteristics at family level and characteristics of local community. Econometrical analysis showed that the statistical positive determinants were the road,whether or not purchasing off-farmer work insurance and risk attitude,and the negative determinant was per capita land.The dsecriptive anlysis also showed there were alike determinnats affecting the participating the new-RCMS,but the rule was somewhat different:the negative determinants were education years,per capita land,the logarithmic distance between the town hospital and family at 99%confidence level,and persons of the extended family had the 'crowded out" effect at 90% confidence level,the nationality had the positive effect at at 90%confidence level.4.By scientific and elaborate questionnaire design and field survey management,the open ended method of CVM was used to investigate the willness to join(WTJ)and willness to pay(WTP)for a proposed new-RCMS with a 50%-copayment rate,the WTJ rate of sampled individuals was 84.44%,87.22%and93.33%at different government subsidy levels(0,20,40RMB), and the mean and mode of WTP was 10 RMB per capita per year and average WTP were 13.35, 13.74,15.68RMB per capita per year at different government subsidy levels(0,20,40RMB).The level of government subsidy did not affect the WTP very much.The copayment rate of 50%was accepted by 27.93%of total sample houshold.5.Econometric analysis suggested that the negative factors affecting determinant WTJ were nationality and road status under the no government subsidy,and land per capita also showed a negative effect under 20RMB government subsidy,and there was no statistically factor affecting WTJ under 40RMB government subsidy.OLS analysis showed that the age,educational years and medical expenditure had positive effect on WTP,and nationality bad the negative effecet without government subsidy.Under 20RMB government subsidy,the scale of family,logarithmic distance between the town hospital and family,whether or not puchasing commercial insurance were the positive determinants of WTP.Under 40RMB government subsidy,the age and risk attitude were the negative facors affecting WTP,and the nationality and whether or not puchasing commercial insurance were the positive determinants of WTP.6.Basing upon the change pathway analysis of the New-RCMS,the study suggesed that the RCMS must take instutional innovation,and the principles of instutional innovation were as follows: (1)the principle of govermnet leading,(2)the principle of corresponding with local institutional environment,(3)the principle of sustainable development,(4)the principle of taking family as unit and establishment of family account(5)the principle of voluntary and prompting.And the characteristics of less developed area also should be considered in choosing the pattern of rural medical security system.To accomplish the target,the policy suggestions are as follows:1.Taking account of the difficulty of public finance of Guizhou Province and the 40RMB was the ideal government subisdy level to expanding the demand for new RCMS,the policy recommendation here is to strengthenthe government subsidy especailly subsidy from central government.2.To enlage the insurance coverage of RCMS and to reduce the copayment rate of RCMS.The Specific policy is to give the operating guid for the operation of new RCMS,and the copayment rate is set at 50%.3.The income of farmer did not restrict the williness to pay in making decicion in participating health insurance,but the road status and the village sanitary station were the factors affecting participating,so in a short run,to expand the demand for new RCMS some pubilic intervention such as improving the investment in health sector.From the institutional innovations aspect the "three in one" model could be choosed.4.Taking accout of commercial health insurance company to design and management the RCMS.There are some factors affecting the demand of commercial health insrnance and RCMS,and the inistituitional innovation of RCMS can take accout of commercial health insurance mechanism.5.Guizhou is the third large minority nationality province in China,and the minority had its characteristics in paticipating the RCMS.To strenthing the welfare of minority nationality,maybe the compulsory paticipating model can be experimented in Guizhou Province.The originalities are as follows:1.Basing upon the summing up of utility theories,a theoretical and econometric framework was developed in analyzing the demand of health insurance,and the the governing flaw was analysed.2.In empirical study,the CVM was used in observing latent demand of RCMS,and the government subsidy level was used as an agent of the insurance premium,and new empirical evidence was given.3.A simple and practical appraisal index was development for the purpose of evaluatation of the New-RCMS.