Study On Policy Of Government Payment For Rural Public Health In China

China is a society that separate city and rural area. The rural living and working environment is different with city. Government set a separate policy system for rural health development for a long time.ⅠThe goals and backgroundSome cases make me consider about some questions that relate with government payment for public health, such as, Should government be responsible for rural public health? If the compensation is necessary, which ways could be taken? Which health insurance system is active? How to select for government? Can they change the live of population? We decided study on policy of government payment for rural public health. To answer these questions, we have to learn about the history and background of policy framework. Then, select few key issues to discus further and find the theories to support these views. Finally, put forward reasonable suggestions based on discussion and theories.According to these questions and contents, we have to make literature review firstly. The goal is learn about the policy history for rural public health payment, the challenges and selected revolutions. Which level government should pay responsibility for rural public health payment? How about the relationship between central and local government? From the government, we can learn about the flow backs and the obstacles for rural public health payment through key person interview. Through investigation for health care institutes, learn about the standards and ways of government payment for supplies. Finally, we explore the relationship between health status and government payment through checking the national investigation result. These social methods are simple and operated for the team. we can get the goals of study through these methods. In other sides, as we get the support from MOH, we can invite experts to evaluate the reports and give us more valuable suggestions in the whole process. The contribution of the study lie on identifying the framework of government payment for rural public health, help select the way of payment and explore development of rural health insurance system to direct the future policy selection.The increasing medical cost is the big challenge for Chinese health system. The increasing income level of individual is much lower than increasing medical expenditure level. In 1999, the individual income had increased by 288% and 222% in city and rural area than in 1990. Compare to clinical expenditure, the increasing rate is 625%. According to the data from National Bureau of Statistics of China, every family expends 1.92% of total income to health care service. In 1999, the rate had been 3.16%, and the poorer family, the higher rate. It is more difficult to compensate the health care service only depend on user fee. The health institutes face financial constrains and for the population, it is the necessary result of increasing self medical, decreasing the utility and access of health care. The equity of health care has been threatened and health demand could not be provided.From the result of the three health care investigations, the population covered by health insurance has decreased from 30.2% to 23.6% in 1993– 1998. The lack of health insurance is more serious in rural area. In 1993, the population that enjoys the health insurance is 12.8%, but just only 9% population could accept the health insurance. Most of the people have to pay for health care services that they need. The disease burden has been increased.That data show the health payment policy have some flow back for a long time, such as the payment framework is not good enough, the responsibility of government is not clear, the criteria of payment should be proved effectively, government should pay more attention to health care service in poor. Health payment policy is one of the key points in health reform progress. The evaluation criteria, such as access of health care, equity and effective, quality of health care, poor release, have been impacted by implementation of health payment policy. The effective health payment policy will make great contribution for the success of health reform.The essay interviewed the framework of rural health payment from 1949, analysis the reason of health payment by using economic theory, political theory, and discussing the payment relationship between different level governments, the format of provider payment, and the development of supply payment through literature review, question investigation and deeply interview.ⅡMethodsData collection methods: literature review, deep talking with key person, question investigationsData analysis method: describing and exploring, the concept and theory of economic, investment theory, cost theory, demand theory, limited resource, stakeholder analysis, valuable analysis.Quality control: In the design and prepare period, we invited expert to discuses the topic and took the pre-investigation for making sure the feasible and science. We try to select the right individuals and groups to investigate. Making sure the valuable second-hand material that had been collected from Analysis Report of National Health Services survey, etc.ⅢThe resultsDraft the government health payment frameworks in different periods through induction of history literature and analysis the frameworks by using political theory. Make sure the development and direction of health payment policy and get the common policy characters in different time. The goal of policy is more and more clear and detail. Compare to the two goals described in different periods, we can get the conclusion. The responsibility of different level government is more and more clear. The financial decentralization had been the basic of health payment policy. Government gradually becomes the main body of health payment from 2002. Payment has become the main action to attract excellent staff. The people began explore more financial payment for health care providers from just based on institutes ability. The shortage of the original format is that the health care providers will get more financial payment through increasing beds and staff. The modern criteria are based on output of health care and utility. These changes show the development of society.Analysis the important function, policy goal, coverage of research, challenge and standard of government health payment through using the theory of rural economic, public health, health investment, equity and effective. Discuss about the relationship among health provider, health insurance, utility of health care service and government payment. Finally, we get the basic theory framework of government health payment. Interview with policy makers and operators from different province and collect some key information to learn about the key impact elements, different character and problems.In western province, the health payment need be supported by central financial and the ability of local government is limited. Health payment focused on renew of equipments, but the quality of staff and service should be improved by taking right payment way. In middle province, the interviewer hope to increase the degree of financial transfer, change the structure of health payment, strengthen the input for township hospital and other public health institutes and build the sustainable system of health payment. In east province, local governments have enough ability to pay for the rural public health, but the payment direction is not clear and the waste is serious. From these results, we can get the conclusion that the low equity and effective of government health payment is common challenge. ⅣDiscussionsDue to the imbalance of health payment in different province, we classified the public health as four types. Global public health services (infection disease monitoring, STD and AIDS monitoring) usually are paid attention by international organization. National public health services should be paid by central financial. Regional public health and local public health should be paid by provincial and local government. In additional, central government should increase input to poor province and area through transfer payment.Discussing about the health provider payment, how to pay for the different providers is the main topic in the sector. Some evidences show that if the payment is reasonable, private providers effectively provide public health services; if the payment is unreasonable, public providers also provide unnecessary public health services. Due to the different style providers exist, we have several payment ways to select. We suggest that budget payment based on health demand, government purchase and separate of revenue and expenditure.Discuss about demand payment model. We describe and explain the structure of medical insurance, the political background of CMA and progress. We think that the clinical services should be the necessary item paid by government, design payment level according to health demand. Compare to the medical insurance in urban and rural area and describe the medical insurance in other countries for exploring the future way. Finally, put forward the basic budget principle for MFA and the development.As conclusion, in the framework, we try to explore the future policy development. Firstly, we identified government as the payer. The relationship between different level governments affects the development of policy. As building public financial system, the relationship between central and local government must have some obviously changes. It is the necessary future that clears responsibility and the balance of revenue and expenditure. Secondly, from economic theory, some indexes that show the health status and coverage of primary health care had improved. But we don't know whether the other indexes that show input also get reasonable increase or not. The policy development will focus on effective change the live of population through adjust the structure and basic direction of payment. Thirdly, there are some shortages of payment policy, such as lacking evidence for payment, but we have realized the problem. Contacting with discussion sectors, we compare different standards and ways of payment. The future policy will make more correct selection. Fourthly, the standards for government payment are not just the cost-effect ion. Political standards are another important standards. Government should be responsible for keeping the stable of society. So public health should share the financial resources with other public affair. Keeping sustainable development is another important goal for policy development.ⅤThe creation of studyDescribe the basic framework of rural public health payment policy From the new view, identify the relationship between public health payment and public financial system.Describe the policy for the future.