A Study On The Model Reconstruction Of Government Medical-care Regulation

Based on the learning and absorbing the research achievements of others, the research scope of this paper is focused on the field of government regulation of medical treatment market (narrow sense of the medical treatment market). This paper follows the basic principle which applies the basic analytical method from general-to-specific and from theory-to-practice of the combination of normative analysis and positive analysis, the combination of theoretical analysis and practical analysis, statistical analysis, comparing analysis, game analysis and mechanism design and other concrete research tools. The paper centers on the questions of Why and how to reconstruct the model and its system of government regulation of medical treatment market from beginning to the end. We do our best to develop a more systematic medical treatment regulation theory, explore the target model and basic way of the reform and rebuild the medical treatment regulation to provide the theory and policy for the reform of Chinese medical care regulation.Exclusion of the chapter one(Introduction) and chapter eight ( Conclusion, questions and prospect). The basic content and logic structure of the paper contains in this paper:Part 1: The first part is composed of chapter 2, reviewing the relevant theory and practice. The purpose is as follows: by review and rethought the practical process of the deregulation and reconstruction and its explanation, we can learn a lesson which is useful to our research. Through review and rethought of the theory and practice, we can have a clear idea about the actual connotation of the regulation, deregulation and the reconstruction. We can know the limitations of the current general regulation theory which is applied to the deregulation and reconstruction. Based on the theory of property rights and the concept of'public domain'of the new institutional economics, the paper firstly propose a general theoretical hypothesis named'public domain regulation'.'public domain'refers to the domain that property not having or nor having clear definition so the marketing mechanism fails. The basic logic of understanding deregulation and reconstruction is clear-property right—non-public domain—deregulation; ambiguous property rights—public domain—regulation restructure. These theoretical hypothesis make the concept of'public domain'explain all kinds of market failure and define the scope of the government regulation. It can avoid all kinds of theories of regulation attributing to the regulation restructure to the market failure and the pressure of powerful groups when it explains the deregulation, which attributes to the government failure which is lack of theoretical basis. At the same time, the theoretical hypothesis provides the basic theoretical framework for the further analysis and research in the medical care deregulation and reconstruction. Secondly, in this paper'public domain'is divided into'non-public domain'(private domain),'unidentified domain','identified domain'. Correspondingly, according to the different'public domain', we can choose the concrete regulation mode and regulation mechanism with different features. That is to say, to the non-public domain, we should cancel the direct regulation mode and carry on the indirect regulation mode and design the corresponding regulation mechanism; to the unidentified domain, we may deregulate or cancel the direct regulation and choose the indirect regulation model and design the corresponding indirect regulation mechanism. To the identified public domain, we should choose direct regulation of social regulation and design the corresponding the regulation mechanism. In this way, we develop a theoretical hypothesis and construct a basic analytical framework which is useful to the research of the deregulation and reconstruction. That is to say'define the scope—choose the model—design the mechanism'. The framework replenishes the limitations of the medical care regulation research problem which is lack of normative analysis to some certain degree.Part 2: The second part includes the chapter 3 and chapter 4, making an analytical and theoretical construct, which is the core and main part of the paper. By using the above theoretical hypothesis and analytical framework, analyzing all kinds of public domain in the medical care market and its regulation model and mechanism design, this part discusses the target model and system about government deregulation and reconstruction then develops the basic theoretical framework about the problem of the medical treatment deregulation and deconstruction.In chapter 3, by analyzing all kinds of public domain in medical treatment market and the choices of its regulation model, we discuss the target model of the medical treatment regulation reform and reconstruction to conclude that the model of the government regulation of medical treatment market should be the integration of all kinds of indirect economy medical treatment regulation model and the social medical treatment regulation. It can realize the organic whole of the combination of government and the market. That is to say'regulate-compete'model .In chapter 4, by analyzing the choices and designs of the medical treatment regulation mechanism, we discuss the system of the'regulate-compete', which is an organic whole of the series of indirect regulation mechanism and social regulation mechanism containing a series of indirect regulation mechanism and social regulation mechanism. All these comprise the medical price indirect regulation mechanism based on the yardstick competition, DRGs-PPS, high leveled indirect entry regulation mechanism, the assessment and monitor mechanism about medical treatment, the forced public mechanism about the medical treatment information, system of medical treatment insurance, illness risk sharing mechanism, perfect medical treatment relief system, medical treatment service gatekeeper system and so on.Part 3: The third part is mainly chapter 5, which is the positive analysis and theoretical testing. The part takes the three countries of England, America and Germany for example, and we make the positive investigation about the reform process of the three typical medical treatment regulation model. We analyze and discuss the current problem, the reform reason of the three medical treatment regulation model then conclude and summarize the reform characteristics and the common development trend of the typical national medical treatment deregulation and deconstruction. The analysis indicates that differences of the national conditions, the different problems in reform process of the original model of the medical service system and the government regulation, there is a common development trend of the medical regulation reform. They all try to release direct economy regulation and strengthen indirect and social regulation. They combine the power of the'visible hand'and'invisible hand'effectively by the regulation reform and reconstruction to construct a regulative model which is a combination mechanism of the government regulation mechanism and market competition mechanism. This common medical treatment regulation reform path and the consistency provide the positive base for the basic theoretical framework of the part two and provide application support for the choices of Chinese medical treatment regulation model reform way.Part 4: The fourth part including chapter 6 and chapter 7 is the application of the theory created by the paper to analyze the problems existed in Chinese medical care regulation.In chapter 6, we have a review and analyze the reform course, characteristics, current situation, current problem and the root cause of the Chinese medical treatment regulation reform. By analyzing, we have a clear idea that the Chinese medical treatment regulation reform transmits from the complete administrative direct economy regulation model of the planned economy period to modern regulation model of the market-oriented economy. The course should undoubtedly be the course of deregulation and reconstruction. But the Chinese government attaches more importance to the deregulation and neglects the regulation reconstruction. The problem of the Chinese medical treatment regulation is as follows: firstly, the direct economy regulation'offside'consequently leads the shortage of the medical treatment market competence. Secondly, multiple head regulation results in the lack power of regulation. Thirdly, lacking of indirect regulation and social regulation with technological mechanism leads to the ineffective use and unjust distribution of medical resource. That is, the excessive price of the medical treatment, unreasonable construction and lost control of the expenses, the coexistence of the medical treatment supplies nominal expansion and the shortage of effective demand, the coexistence of idle medical treatment resources effect and medical treatment market low operation efficiency, the decline of the medical treatment fairness and accessibility. These problems which are universally concerned by the people are reflected the problem of the lack of the medical treatment resources and high cost.In the chapter 7, we combine the basic principle and the lessons of the medical treatment regulation reform of the typical country and explore the target model and basic ideas. In my opinion, the Chinese target model medical treatment reform should be the model of the'regulate-compete', which is not the direct economy regulation but the indirect regulation and social economy regulation and the corresponding regulation institution and executing agency. It is neither the government leading regulation model nor the market leading regulation model but the integration of the government and the market, which can be prompt the competence and assure the impartial regulation model (figure 7-2.Ch7). The general idea of the Chinese medical treatment regulation reform is that: firstly, further loosening the direct economy regulation and prompt the market competition. Secondly, reinforce indirect economy regulation and social regulation and normalize market behavior. Thirdly, deepen the reform of the medical treatment regulation system and normalize the government regulation behavior.