Research On The Further Reform Of Health System In China

In order to solve the problems of the lack of health resources and high cost inChina, the government has dertermined to increase fiscal inputs to lead the furtherreform process of health system. However, stake holders including government oftenplay as dual role, sometimes they play as stepping stone, and sometimes they play asstumbling block. Thus, there exist a key problem must be solved, that is howgovernment shoud draw up and implement the Plan to input and how various stakeholders shoud contend for property rights rationally within these inputs, the actions ofvarious stake holders so can spontaneously promote the formation and operation ofhealth system according with the level of socal development in China.For the above problem, this paper redefine the concept of health system from theperspective of division and evolution, put forward the hypothesis of it’s evolutionalmechanism based on the redefinition, analyse the charictersitcs of division, efficiency,and rights configuration, whithin health system evolving to operate resonably based onthe evolutional mechanism hypothesis, and give some beneifit advice to the furtherreform of health system in China based on the conclusion of analysing. The chiefcontents and results are as followings:As for the redefining of the concept of health system, with the reanalysing of theinternal conponents, as well as inside-outside relationships of health system, and withthe that of the classification and attributes of stake holders, this paper draw theconclusion that the health system evolved and generated in the special developmentprocess within a special background society is the result of equlibrium of selecting andcontracting on various division activities by all stake holders who will spend money,including governments and officials in each level in “three medicals”, under restrictionsand opportunities of rights confihuration, technical conditions and total money fundingresulted from the nesting process of health system with it’s social bacground, accordingto payers’ willingness.As for the hypothesizing and expressing of the evolutional mechanism of healthsystem, based on the dynamic concept and the inside-outside relationships model ofhealth system, this paper draw conclusions that: division interests included in the actualpayment of payers in the side of demand, that is division interests included in the fiscalinputs and other hygienic payment caused by fiscal inputs, are the original driving forces for spenders in the side of supply to select and contract on various divisionactivities rationally with their expert knowledges, and so for the health system to evoleto nest within it’s social background; rational selecting and contracting on variousdivision activities are essentially the the economic comparison between collective andindividual decision-making mechanism of spenders in the side of supply; theevolutional mechanism of health system may be expressed theoretically andnormativelly through the variational design of constraint conditions and opportunityspace of the spenders’selecting and contracting on various division activities.As for the explaining for the charictersitcs of division and efficiency for healthsystem, based on the further analysizing on the hypotheses and express of theevolutional mechanism of health system, this paper draw conclusions that: as far as thedemand side be concerned, since health system should have some “planned”charictersitcs of division and efficiency, so the total sum of fiscal input and otherhygienic payment equals the total sum of the “planned” payment by the society andindividuals on each division node; as far as the supply side be concerned, since fiscalinput and other hygienic payment will drive the micro-subjects and functional subjectsto select and contract rationally on division activities, and orderly drive themicro-foundation, management system, legislation and judicature system in the healthsystem to generate and evolve, so the actual distribution of health fiscal input and otherhygienic payment will constitue the “planned” income of every stake holders from thesupply side on each “planned” division node; as far as both sides simultaneously beconcerned, the “planned” payment should equal the “planned” income on each divisionnode when health system according with the level of socal development ecolve tooperate reasonably.As for the explaining for the rights configuration to a reasonable operating healthsystem, based on the endogenous relation between the efficiency charictersitcs and thepermission level at each division node, and on the theories of tragedy of commons andtragedy of anticommons, this paper draw conclusions that using rights should becoordinated with exclusive rights in each “sub-bundle-of-rights” within the whole“bundle-of-rights” in health system if health system evolve to operate reasonably.As for the giving advice to solve the problem put forward first above in the processof further health system reform in China, based on the difference comparing conclusionof rights configurating charictersitcs and rights delimitating behaviors within the bundleof rights of health system between the situation of health system already evolved to accord with the development level of it’s social background and that of health system inChina being experiencing to be transformed, this paper draw a conclusion that thefurther reform of health system in China should strengthen the configuration of usingrights and weaken that of excluding rights within those sub-bundle of rights in insuranceproviding area and in health care service proving area, on the other hand in medicineproviding area. According to this conclusion, for solving the problem of howgovernment shoud draw up and implement the Plan to input and how various stakeholders shoud contend for property rights rationally within these inputs, this paper givefurther advices as followings:The positive fidcal policy should be formulated from the overall demands of socialand individual development and even can be “legalized”, instead of seeking foundationand countermeasures from traditional public choice theory. It also should be formulatedin the way that let division interests drive micro-subjects and functional subjects toselect and contract on division activities expected by society and individual according tothe rule of Pareto Improvement so that it can be carried out from the perspective ofendogenesis of the health system which coincides with social development process.All micro-subjects and functional subjects may select and contract spontaneouslyon division activities relating to their expert knowledge from the perspective offulfilling all kinds of division activities of meeting citizens’ needs of various health careservices and relating insurance services instead of waiting for the “the separation ofadmistrating and implementing” and “the separation of health care providing andmedicine providing” idly. In this way, they should strive for, especially should legalizefor their own property rights from newly added fiscal inputs and other hygienic paymentcaused by fiscal input, according to the symmetrical rule of “power and responsibility”mirrored from the planned “responsibility and power” of payers including financialdepartment in demand side.At last, research innovations in this paper include: redefining the concept of healthsystem; theoretical explaining of rights configuration for health system evolving toaccord with the level of social development by the theories of tragedy of commons andtragedy of anticommons; giving advice for the further reform of health system in Chinafrom the perspective of how government shoud draw up and implement the Plan toinput and how various stake holders shoud contend for property rights rationally withinthese inputs.