Study On The Development Of Rural Cooperative Medical Scheme In China

Based on the reform of Rural Cooperative Medical Scheme(RCMS)in China, the dissertation has discussed the policy implications on perfecting the rural health security institution with the guidance of sustainable development concept. There are two main streams in the study, macro- and micro-level. On the macro stream, firstly, it discusses the developing history, current status of the RCMS, as well as the information of health care supplier-rural health service system. Then, it analyzes the institutional operating mechanism and the internal obstacles to its sustainable development of the new RCMS. On the micro stream, it, firstly, explores the health conditions as well as its determinants of rural citizens in China, based on CHNS data with the help of econometric methods; and then it is followed by another positive-analysis method, which utilizes GINI decomposition analysis and Shaanxi rural consumption data. Based on the macro- as well as micro-level study on the internal- and external obstacles to sustainable running of the new RCMS, the paper finally proposes some policies in finalizing the sustainable development of the newly rural medical schemes in China.There are eight chapters in this dissertation.CHAPTER ONE INTRODUCTION. It introduces the purposes and implications of the study, the study guidance and methods used in the paper, followed by the literature review. CHAPTER TWO ECONOMIC THEORIES OF HEALTH SECURITY INSTITUTIONS.It discusses the related theories on health security institutions which include: the determinants of health and health indices, illness risk theory and medical health theory, market failure and information economic theory, human capital theory and health investment theory, public policy theory and welfare economic theory, health equality and anti-poverty policy, institutional theory and sustainable development theory. These theories have shed some light on the study of health security system.CHAPTER THREE ANALYSIS ON THE DEVELOPMENT OF COOPERATIVE MEDICAL SCHEME IN RURAL CHINA BASED ON INSTITUTIONAL ECONOMICS. First, it analyzes the different stages of the rural cooperative scheme, compared it models in different developing stages. And then, it discusses the developing path and the necessity of the institutional innovation of the rural health security. It regards that the path choice, which was driven by social ideology of solving the heath security problems in cooperative way, promoted the development of rural cooperative medical scheme and created the innovation in a new way.CHAPTER FOUR THE DEVELOPMENT AND CURRENT STATUS OF BASIC HEALTH CARE SYSTEM IN RURAL CHINA. First, it discusses the functions of three-tier health service system in rural China. Then, it reviews the development of the system and summaries its characteristics in different stages, so as to provide the necessary information for next chapters which focus on the external obstacles and the policy-making of sustainable development of the new RCMS.CHAPTER FIVE OPERATING MECHAMISM OF THE NEW RCMS. Firstly, after reviewing the characteristics of the new RCMS, it discusses the operating system of the new RCMS in the aspects of funds collection and its management, health subsidy and monitoring system. Then, with the help of field survey, it demonstrates the main problems of the system on institutional design and policy implementation, which is regarded as the internal obstacles of sustainable running of the new RCMS. The study shows that fund collection on the county level may hold back the development of the system itself, there is a dilemma of enlarging the coverage of the beneficiary and improving the percentage of the subsidy on health expenditure, appreciation of the fund is also neglected, and the organizing system dictated under the health department of the government should be reviewed.CHAPTER SIX RURAL CITIZEN'S HEALTH DETERMINANTS AND RURAL FAMILIES'HEALTH CARE EXPENDITURE ANALYSIS. Firstly, it analyzes the regional disparity of health conditions and its determinants of the rural residents in China with the help of Ordered Logit Model; secondly, it utilizes another positive-analysis method, which is based on GINI decomposition analysis and Shaanxi rural household living expenditures data. It finds that the health conditions have been deteriorating, the health conditions of the elder and the women are worsened compared with their counterparts. Education and income leval have positive effects on improving the health conditions, while age, chronic illness, and bad living environments are negative effects. It also demonstrates that low income rural families'expenditure on health care is shirking with the help from the new RCMS, through health care service is still luxury to them.CHAPTER SEVEN EXTERNAL OBSTACLES TO THE SUSTIANABLE DEVELOPMENT OF THE NEW RCMS. With the help of data from national health survey organized by Ministry of health as well as the date from project survey which the author participated, chapter seven discusses the external obstacles to the sustainable development of the new RCMS. It asserts that the obstacles are from four sources. Specifically, there are: rural population themselves (including their worse health condition, the diversified purposes in participating the scheme, the resident's confidence and willingness to pay for the scheme, as well as widening income gap in terms of rural family basis), government administration and its institutional design (including the limited investment on rural public health, the conflict between grave illness subsidy and health care demand ), problems of the basic health care system in rural China (including shortage of heath talent, improperness of the talent structure, distorted subsidy system and wrong positioning of village clinics), as well as elements from socio-economic changes(including the aging population, urbanization, rural social security system, etc)CHAPTER EIGHT POLICY IMPLICATION OF THE RURAL HEALTH SECURITY SYSTEM. Based on the review and discussion of the conclusion from above chapters, it presents three steps in perfecting the rural health security system in order to setting up a urban-rural integrated cooperative health security system; besides, it proposes some suggestions for the policy makers on improving the operating mechanism, on optimizing the public health investment, on re-positing the functions of rural village clinic, on cultivating health technical talents, and on improving farmers income with a sustainable way, etc.