| Health is an important objective for individuals and society as a whole. Health insurance, an important way to deal with health risks, is an essential part in the happiness index. Nowadays, the reform of health insurance system central to our pursuit of health has become an important policy objective in many countries. Does the achievement of health depend heavily on government’s arrangement, or citizen’s endeavor, or the combination of these two factors? Different choices probably determine different pathways. In April,2009, Chinese government launched a new medical and healthcare reform by issuing "CCCP and the State Council’s Guidelines about How to Deepen the Medical and Healthcare Reform"; in August2012, the Ministry of Health and other five Ministries and Commissions issued "Guidelines about How to Implement Critical Illness Insurance for Urban and Rural Citizens". Thus Chinese government have sent a clear signal that while the Government will direct the development of health insurance system, it will also incorporate the forces of market to implement the system together. In this context, this dissertation chooses the topic of China’s health insurance system. It will focus on the direction of reform, i.e., the combination of government and market, and discuss how the basic demand of health could be met and implemented.I will use literature review, comparative study and historical study to deal with the subject. My analytical framework and theoretical foundations include, not confined to, health economics, health resources allocation theory, public goods supplier theory, and social equality of healthcare. I will focus on three major topics: the development of China’s health insurance system, its difficulties, and the direction for reform. The dissertation is divided into five chapters:theoretical analysis of health insurance system, historical development of health insurance system, practice and difficulty of China’s health insurance system, internal comparison of health insurance system, direction for China’s health insurance system reform.1. Historical Development of Health Insurance SystemI will review the history of health insurance system in China and in the world as well. Globally, the health insurance system underwent three stages:disease insurance, medical care insurance, health management. There are three features worthy of special attention. First, two transitions, one from disease insurance to medical care insurance, the other one from disease insurance to health management, bring about the fundamental change in the scope and nature of health insurance. Second, the formation of social insurance system with government involvement leads to a more sophisticated health insurance system and helps it more perfect and mature. Third, the crisis in the health insurance system in Western countries triggers the development of market mechanism for health insurance system. In China, health insurance system is developed in the context of economic transition, transformation of government functions, and market-oriented reform; it went from national welfare in the early years of PRC, to reformative adjustment in the process of economic institution transitions, finally to the nowadays direction for development of multi-level medical and healthcare system. China’s health insurance system has distinguishing features in three dimensions of system pattern, health financing, and implement pathways. Its most important feature is that it is a system led by government and supplemented by market.2. Difficulty of China’s Health Insurance SystemIn more than sixty years of development and exploration, leading by government is the drive of China’s health insurance system, evident both in the from top to down macro-level of reform motivation and system design and in the micro-level of market management and access regulation. However, market forces has emerged from nowhere and has grown stronger, becoming an essential part of health insurance system. In the combinative action of these two forces, the health insurance system has developed toward a system led by government and modestly supplemented by market. But in this pattern, the government is reluctant to exit from competitive industry and leave room for market. And market-oriented commercial health insurance has been suppressed due to the lack of efficacious support from government’s policies. Today, China’s health insurance system is not satisfactory and has some blatant weaknesses:inequality, unsustainable development, the lack of resilience in the health risk sharing.3. Direction for China’s Health Insurance System ReformI will compare three major health insurance systems in the world, which are American market-oriented pattern, Britain’s government-led pattern, and Germany’s social medical insurance pattern. I will demonstrate the following propositions:The choice of health insurance institution in a country is determined by several factors, including not only government will, but also cultural sediment, economic power, and development of the country; Any relatively sound health insurance system is a combination of several patterns, which include public medical welfare, social medical care insurance, civilian medical philanthropy, and commercial health insurance; For objective:the general objective of China’s health insurance system should be "Everyone Enjoys Health", which is global current, is necessary for the change in health thinking, and is required for building a country with strong human capital.For the relation between government and market:For the development of combination of government and market, the government should turn some health care responsibility to market institutions, market institutions should participate in the health care task led by government, and the government health care services should be underwent the market reform. In this connection, market should be allowed to play an important role.For value and assessment:We should value equality and efficiency as well, attempting to maintain an equilibrium of equality and efficiency. By delimiting the boundary between government and market in the development of health insurance system, we should let commercial health insurance play a full role and increase the value of health insurance system.The major conclusions of this dissertation are:1. The relation between government and market is very important in the development of health insurance system. The participation of government and the drive of market play important roles in the development of health insurance from disease insurance to medical insurance and then to health management.2. The transition of health insurance system from the institution led-by government and supplemented by market to the institution with a combination of government and market is sorely needed.3. The objective of health insurance system should be "Everyone Enjoys Health", not merely "Everyone Has Basic Medical and Health Care Service"; it is important to combine the government and market as far as the relation between government and market is concerned; and our value should be placed on the equality and efficiency as well. |
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