| Basic medical insurance system shows significant differences in many rural and urban areas, such as the system coverage, mandatory insurance, financing methods and standards, treatment standards, management system and other urban and rural characteristics. Urban and rural basic medical insurance system not only affects the health of citizens, but also raises a series of social problems. " Seeing a doctor is difficult, Seeing a doctor is expensive" phenomenon is one of the best proves. Although there are some existing research in domestic and foreign that make some good try in revealing the feature and reasons of the basic medical insurance system for urban and rural dual, constructing and perfecting the theory frame of urban-rural integration of the basic medical insurance system, it is not comprehensive and thorough enough in general, ignoring some important problems, such as what is the connotation of integration of rural and urban basic medical insurance? How to develop standards and indicators of the integration of rural and urban basic medical insurance system? What is the mechanism the integration of rural and urban basic medical insurance run for? What are the factors that hinder the universal coverage and the integration of rural and urban basic medical insurance? What is the core philosophy of integration of rural and urban basic medical insurance? What role dose health finance play in rural and urban integration of the basic medical insurance? And how to promote the process of universal health care and basic medical insurance for urban and rural integration? It is obvious that the solution to these key issues is significant for us to form a deeper understanding of the basic medical insurance in China’s urban and rural integration. Therefore, based on the existing research both at home and abroad, this article use theory and application of health standards of consumer fairness index decomposition method to conduct a comprehensive and systematic research of the integration of basic medical insurance for urban and rural areas in order to perfect the framework of the integration of rural and urban basic medical insurance theory, and provide some scientific policy advice to our national health care, the practice of rural and urban basic medical insurance and medical and health system integrationThe whole text contains seven chapters, in addition to the first chapter outside the introduction, the second to the third chapter is the analysis of the basis and premise:The second chapter is about the integration of rural and urban basic medical insurance theory; The third chapter is the mechanism analysis of the integration of rural and urban basic medical insurance. Chapter four to five is about the specific study of Chinese urban and rural dual structure of the basic medical insurance system evolution, using comparative and empirical analysis from the system to analyze the unfair effect of basic medical insurance system in two levels, urban and rural, presenting a full command of the core ideas that health equity in urban and rural consumption is the basic premise and the end result both the theory of health insurance integration. The fourth chapter utilize a view of institutional change, institutional comparison, source inspection, and system innovation to conduct a comprehensive study of the history and current situation of urban-rural and other basic medical insurance system; chapter five takes health spending equity theory as a guide, using a variety of index decomposition method to synthesize the gap between rural and urban health consumption, quantifying the impact effects of the basic medical insurance system for urban and rural. Chapter six to Chapter seven is the conclusion and policy recommendations of the whole article, this chapter proposes the overall integration and specific policy recommendations of basic medical insurance, drawing on the experience of typical countries. Chapter six sums up the Nordic, Continental Europe, East Asia and Latin America, four universal health care models and refine valuable experience from the perspective of universal health care factors, basic medical insurance system and government accountability arrangements; Chapter seven of this article is the policy recommendations part. This chapter aims to perfect the integration of rural and urban basic medical insurance policy system from the view of basic principles, overall concept of integration of basic medical insurance for urban and rural areas, system integration and convergence, consummation of the health finance, integration of urban and rural medical assistance.This article attempts to step through empirical analysis and normative analysis to draw appropriate conclusions and policy recommendations. First, the article use economic theory to build the theoretical framework of basic medical insurance for the integration of urban and rural and make theoretical basis of the article theme through the conclusion of the welfare economics, public goods theory and the theory of the dual economic structure. On the basis of these, the article points out clearly that universal health care is the essence and basic strategy of China’s new medical reform and the process of basic medical insurance for urban-rural integration is an important stage in development of universal health care; Secondly, this article analyse the system change of China’s basic medical insurance for urban and rural and explore the gaps of dual Medicare pattern of insured object, financing methods and standards, treatment standards and organizational management from the economic, institutional, financial institutions and ideological point of view to analyse reasons for the formation pattern of the urban and rural health care and others. In addition, innovation and practice are summarized and evaluated by integration of various localities of basic medical insurance for urban and rural areas. Again, this article conducts normative analyse for a fair idea of the use of health spending patterns of Medicare dual and combine with various index decomposition method within the urban and rural health to make an empirical analysis of urban and rural consumption. Finally, the article sums up and draws experience and lessons learned in a typical national basic medical insurance in urban and rural integration, proposing the integrated development of rural and urban basic medical insurance mode selection and system design and giving some recommendations of a complete set of health fiscal policy from the perspective of finance.This article comprehensively adopted the following methods:first, combining qualitative analysis with quantitative analysis method. In the process of researching China urban and rural basic medical insurance integration, qualitative analysis is mainly used in the insurance of social medical treatment, the basic theory of Chinese urban, rural basic medical insurance historical evolution and the causes of the dual medical insurance pattern; but quantitative analysis gives priority to the difference of the basic medical insurance for urban and rural. Second, multi-discipline research method.In theory, the article is based on economics, politics and sociological theory and basic ideas, proposing to establish and perfect China’s urban-rural integration framework of the basic medical insurance system of the basic concept in specific policy suggestions, comprehensive statistics, management and insurance relevant knowledge. Third, combining empirical analysis with normative analysis method. This article uses empirical analysis method to evaluate China urban and rural social security system, especially in three selected areas of eastern and western, which is a kind of mode typical of the urban and rural basic medical insurance integration as examples of empirical study to investigate in order to describe the basic medical insurance in urban and rural areas in the real situation of China. The article transits reasonably from the justice theory to the health justice theory in order to emphasize the fair orientation during the process of basic medical insurance of urban and rural integration and puts forward reform strategies and suggestions with health fair which as the goal of urban and rural basic medical insurance in view of real problems existing in the current operating system featured by "fragmentation" and gaps between urban-rural areas. Fourth, comparative analysis. From comparison between the different foreign medical security model, institutional framework, universal coverage process, urban and rural integration and cohesion carries, the article discusses the general rule of medical insurance development operation and absorbs lessons of foreign social security system and use their beneficial experience, especially the management methods implemented under developed countries of social medical insurance mode under Operational mechanism of market economy and at the same time makes comprehensive analysis to reform pilot innovation both on the domestic urban and rural integration of basic medical insurance in order to find learning experience.Innovation in this article shows in the following three aspects:First, the article put the special nature of health care market which result in market failure and government intervention in health care market activities of government failure as a starting point and analyse the general law of social health insurance model, pointing out that universal coverage is the general direction and basic strategies of reforming health care and universal coverage of urban and rural integration is an important stage in the process of insurmountable, and also pointing out that breaking the current pattern of urban-rural health insurance to achieve universal health care on a full sense is of great significance in detail. The second depends on the analysis of the operation mechanism of the integration of urban and rural basic medical insurance, trying to build indicators and evaluation methods of the integration of the urban and rural areas of basic medical insurance system. Index system can be divided into three systems, fair systems, efficient system and the government responsibility system. Third, the article uses Theil index, Gini coefficient and Atkinson index to make decomposition analysis of urban and rural health consumption inequality, pointing out that it has a significant impact on the urban-rural disparity in Medicare payment levels, payment levels, management structure and other factors on health spending of urban and rural residents equality.In the last few years, the internal health inequality of rural and urban consumption is narrowing, which is the main benefit from the rural and urban basic medical insurance system of operation and implementation. The deficiency of this article manifest in the following two aspects:First,this article, which utilizes related index decomposition of study method to investigate the health fair utility of consumption in terms of quantitative analysis of the basic medical insurance system for urban and rural areas,does not use more methods for modeling and testing of econometrics in depth. Those are the problems that need to further explore in the follow-up studies, the design and evaluation methods of integration of basic medical insurance for urban and rural index system need to be combined with the real data of China to do deep and systematic examination and amendments. Second, integration of rural and urban basic medical insurance is a complicated systematic project, it will closely related to the conduction of our current health system reform and the medical health system will certainly involves all levels of government finances, health, labor and social security, education Home and other multi-sectoral coordination linkage, therefore, the propose on part of the policy measures in the systemic and operational aspects are still remain to be further strengthened. |
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