Research On Balancing Urban And Rural Medical Security Systems

Medical security system, as an important component of social security system, plays a key role in maintaining and enhancing the health situation of the members of the whole society, ensuring people's health rights and interests in a practical way, meeting their needs for basic medical service and alleviating the social problems such as "it is expensive to see a doctor" and "it is difficult to see a doctor" caused by the individual economic heavy burden. To balance the construction of urban and rural medical security systems, as one component of the "project that conforms to the aspirations of the people and meets their needs" of the new members of the government and also as an embodiment of the development strategy of "subsidizing agriculture with industry, motivating the rural development with urban area", is an organic component of the systematic project which "balance the construction of urban and rural employment and social security system", and a path to realize the strategic goal of "All the citizens benefit from medical security".In consideration of the important strategic significance of this work, the local governments in different areas have launched reform explorations in the field of medical security based on their local realities and have created many practice modes with local characteristics and regional characteristics. Although these reform modes only set a local example, some lines of thought which have common regularity might be used as reference or be referred to by later reformers. Hence, it is very necessary to sum up practice modes and to probe into theories. This paper tries to make a study on this problem and it is divided into six chapters.Chapter one Introduction. This part firstly reviews the current medical security system of our country from the perspective of a comparison between urban areas and rural areas, and finds that there is evident difference between these two areas in the category setting of medical security items, the expenditure level of medical security, the security mode and security degree of medical security. However, the author doesn't agree with the opinion that the structure of medical security system of our country is a typical "segmentation of urban and rural areas". According to the author, as the government has recently paid attention to the construction of medical security system and has made a lot of effort on solving the medical security problem of the villagers and immigrant workers who drift between the urban areas and rural areas, a structure of medical security system with "duality and three dimension" or "duality+three dimension" has been formed. Then this paper inquires in a certain degree all kinds of opinions on balancing the medical security of urban and rural areas in the theoretical circle of China. Based on this, the author brings forward his own understanding on the accurate intension and reasonable extension of "balancing the medical security of urban and rural areas". And according to him, as far as the relation between the concept of "balancing medical security of urban and rural areas" and the concept of "all citizens enjoys the medical security" is concerned, the latter is the final strategic goal to achieve by effort while the former is a path to realize this strategic goal and it is a "transitional form".Chapter Two The theoretical base for the balance of medical security of urban and rural areas. This part probes into the necessity and significance of balancing medical security of urban and rural areas from the perspective of subjects including welfare economics, Keynes economics, public economics, information economics, development economics, medical insurance and health economics, and finds that the reform in the field of medical security is necessary and urgent either from the perspective of welfare, redistribution, supply of public goods or from the perspective of incompleteness, adverse selection, moral risk and requirements elicitation.Chapter Three Comparison of international experiences on balancing urban and rural medical security systems. This part firstly analyzes the foundation time of urban and rural medical security systems of some countries and the phenomenon of "duration of lag", thinking that in the phenomenon of "duration of lag" the government decision maker's political idea on the construction of social security system is an unneglectable factor besides the objective conditions such as urbanization degree, industrialization phase, and macroeconomic sum which is closely related to this phenomenon. The author explains that political factors have an important impact on pushing the medical security system to realize "popularization" and sometimes they are decisive. Then this paper makes a comparison from the perspective of system content and global function of system among the four main medical security modes. At last, the author makes some analysis based on the research of performance of four main medical security modes made by Ding Chun, Saltman, al. and he thinks that none of these four medical security modes have the characteristics of a "perfect system". Therefore, the claim that "there is no perfect grail in medical security system" should be correct. Concerning the selection of medical security system mode of a country, the basic principle of "trade-off between equity and efficiency" should be observed and the actual national condition base should be considered accordingly.Chapter Four Main problems of medical security system of our country, reasons and the practices to balance the medical security in urban and rural areas. This part firstly analyzes the main medical security items such as basic medical insurance of urban employees, basic medical insurance of urban residents, new agricultural cooperative medical care and urban and rural medical salvation, thinking that either there is evident design defect in these systems, or it is urgent to establish a new one. Then, the paper introduces the policy measures and lines of reform thought on balancing medical security system in urban and rural areas in the typical areas such as Dongguan city of Guangdong province, Taicang city of Jiangsu province, Chongqing city and Chengdu city of Sichuan province. At last, the paper makes a brief summery on main practices of reforms in this aspect in many areas of our country, thinking that most pilot cities are concentrated in developed areas or they are main big and middle sized cities of our country with a strong government financial strength and high level of residents' individual income; concerning the key point of reform, they all select the integration of urban and rural residents'medical insurance systems; concerning the individual selection right of the insured, "the consumer's self-awareness" is more emphasized and the reciprocity between the treatment and level of personal payment is emphasized; concerning the reform of management system, the consolidated government administrative departments are more often used, the management platform is integrated and the coordination and cooperation between departments are emphasized.Chapter Five Empirical research on balancing medical security of urban and rural areas in Zhenjiang and Kunshan city of Jiangsu Province. This part mainly borrows the analyzing methods and analyzing tools adopted in "on-the-spot inspections" in many places of some province which applies new agricultural cooperative medical care with a technical inspection team of some city. Based on the detailed data collected on the spot from the investigated areas, the paper makes a thorough study on the global social economic situation, the basic condition of health resources, the constitution of medical security system, the function of current three medical insurance system, the main characteristics of balanced urban and rural medical security systems and main problems of systems of Zhenjiang and Kunshan city of Jiangsu province, especially in the aspect of the function of medical insurance foundation, the paper has made quantitative analysis from multiple perspectives. At last, this paper concludes that Zhenjiang city has a relative higher level of policy management in balancing the demand and supply of medical security system and in the expense compensation mode of medical service organization and it has a high level of specialized degree; while the characteristic of medical security system of Kunshan city, "high degree of social insurance", is impressive and worth borrowing and referring to for the developed areas.Chapter Six Some policy suggestions on the reform of balancing urban and rural medical security systems in China. This part makes detailed analysis on several key issues of balancing urban and rural medical security systems in China, trying to probe into relative reform measures through an analysis of "dissecting a sparrow" on several key issues in the process of medical security system reform in a way of "promoting work in all areas by drawing upon the experience gained on key points". Concerning the selection of final model of balancing urban and rural medical security systems in China, the paper firstly summarizes the idea of path selection and final model of the construction of balancing urban and rural medical security systems in the theoretical circle, then analyzes the systematic nature of the two sub-model of Japan and Germany in the social medical security model through system comparison, and at last the author brings forward the idea of realizing "all citizens benefit from the medical security system" indirectly through organized "negotiation" or "consultation" between associations guided by the government and by referring to the experience of Germany while keeping the current medical security system unchanged. Concerning the determination of reasonable capital raising level and adoption of correct capital raising policy, the paper measures and calculates the theoretically reasonable capital raising level and capital raising rate between 2008 and 2012 of the main social medical insurance systems of our country through quantitative model building, and the result shows that the capital raising level of urban employees' medical insurance should be lowered while the capital raising level of urban and rural residents'medical insurance should be improved. This result also accords with the problems reflected in the process of the function of current social medical insurance system. Concerning the building of united urban and rural medical assistance system, this paper proposes a series of reform measures including capital raising system, medical security service providing system and medical service providing system. At last, this paper concludes that it's also very important to quicken the reform step in the field of medicine and health.