Institutional Change And Practical Dilemma Of Rural Health Care In China

At present,the government led rural new medical reform is mainly manifested in a large number of public financial input and intensive system construction.However,these measures have not achieved the expected goal,and there are obvious policy deviations,and eventually caused an unexpected result of the dissatisfaction of the government,the patient(Society)and the hospital(Doctor).The unexpected result of this policy constitutes the source of the author’s problem consciousness.The main objective of this paper is to analyze and explain the policy deviation in the rural new medical reform policies and to explain the policy deviation and put forward the corresponding solutions.This paper is based on the field survey of the common agricultural county in Fuxian,the central and western part of China.It adopts the research path combining the longitudinal historical changes and the horizontal institutional practice analysis of the two dimensions,and probes into the problems arising in the process of rural new medical reform under the leadership of the government,and tries to put forward the corresponding solutions.As the development of rural medical and health undertakings is "embedded" in the national top-down health care system reform and the background of economic and social change from the bottom to the bottom of the countryside,the supply process of rural medical and health services can not only be regarded as an economics or guard that examines the relationship between the government and the market.It can also be regarded as a sociological issue that looks at the relationship between state and Society(or between state and peasant).As the problems facing the new rural medical reform are far beyond the interpretation ability and understanding of the "government market" framework,the introduction of the "state society" framework will help to deepen the understanding and provide more pertinent and effective guidance and suggestions for the concrete practice of the new rural medical reform.In the sociological sense,the "state society" analysis framework is mainly concerned with the entry of modern factors,including modern markets and modern governments,which are mainly based on state power,including modern markets and modern governments,in the process of rural society with traditional characteristics,including the elements of social structure,culture and norms.The responses,functions and coping styles of traditional social factors.Among them,special emphasis is placed on the role and value of traditional social factors and mechanisms in this modernization process.In terms of the research theme of rural new medical reform,the government led health system must achieve a certain balance between the government,the market and the farmers(Society),especially to arouse the subjectivity and enthusiasm of the farmers and the village community themselves.The author believes that top-down government led and village based farmers’ cooperation constitute the main mechanism of the supply of rural medical and health services.Under the framework of "state society",this article mainly starts from the two dimensions of the longitudinal rural health development process and the horizontal rural new medical reform system practice.First,it examines the course and model of the construction of rural medical and health services in the two stages before the new medical reform,and the second is to examine the agriculture under the government led by the government.The practice and difficulties of the three main systems in the new stage of village medical reform.The first is the first stage,that is,before the reform and opening up.In the process of building modern health,the national government has not only failed to reflect the leading role of the government,but also,more importantly,does not take farmers as the standard,actively mobilize farmers,and promote the active participation and subjectivity of the farmers,which is the fundamental reason for the present generation of health undertakings in the national government.The rural medical and health undertakings in the collective age mainly adopted the method of combining the administrative leading system with the peasants and the village community standard mechanism,and finally quickly and effectively promoted the modern medical and health undertakings into the rural society,and made great achievements.The second is the investigation of the second stage,namely,the old medical reform before the reform and opening up to the new century.Through the introduction of the market mechanism,the vitality of health services has indeed been enhanced,health institutions and health personnel have increased,health service capacity and quality of service have been significantly improved;however,the emergence of market failure and the prevalence of three levels of health and health in different regions and county and rural areas The gap between organizations is becoming larger and larger,and the problem of unbalanced development is becoming more and more obvious,which seriously affects the coordinated development of rural health services.The problem of "difficult to see and expensive" has become increasingly prominent and becomes the unbearable weight of the people.Finally,the third stage,namely,the new rural health care reform led by the government since the new century.The three main systems in the new rural health care reform under the leadership of the government have not been able to achieve the desired goal well,that is,the phenomenon of policy deviation.The key reason is that in carrying out the principle of government led,it is not able to take into account the objective reality of the countryside and mobilize the inner enthusiasm of the peasants.However,the author does not explain and deduce in a general way,but discusses the three systems in the new medical reform:First,on the issue of rural health personnel under the leadership of the government,the author believes that the current system of medical practitioners in urban and rural areas is divorced from the objective reality of the countryside,which is the key reason for the shortage of rural health talents.Second,on the issue of the burden of medical expenses for farmers under the government,the author finds that the increase in the amount of financing of the NCMS does not reduce the burden of the farmers’ disease,but keeps the burden of the farmers’ disease continuously kept on the level of expenditure that does not protect them from falling into poverty.The new rural cooperative system is the basic system orientation and the tendency to regard the NCMS as the social medical insurance,which not only violates the objective reality of the rural economic and social development,but also does not conform to the basic law of the disease treatment.Third,on the issue of the equalization of public health services in rural areas under the leadership of the government,the author finds that the services of the equalization of basic public health services are mainly supplied by the way of project system,which greatly strengthens the "top-down decision mechanism" within the government,leading to the participation of farmers in decision-making.There is a serious shortage of space and subjectivity.For the difficulties encountered by the current government led rural new medical reform,we must surpass the perspective of "government-market" and introduce the "state-society" analysis framework which emphasizes the social mechanism.In the latter opinion,the establishment process of modern society is essentially the process of the diffusion and establishment of modernity in the whole society.However,in this process,market mechanism and administrative mechanism can not naturally generate new social order.This is because the market mechanism and the administrative mechanism are lack of self-discipline,so they all have the possibility of excessive expansion and overstepping in the social field,that is,the market failure and government failure in the field,thus resulting in the further chaos of the social order.Therefore,in the process of the transformation of a society from traditional to modern,people may not only face the problem of market failure,but also not only the problem of government failure,but also the problems of the market and the government at the same time.In this regard,the "state-society" paradigm emphasizes the need to surpass the market and the government and reflect on the market mechanism and government mechanism from the perspective of society,so as to provide creative ideas for the final achievement of the social order.In this view,various systems of rural new medical reform have encountered various difficulties and problems in the process of practice.The main reason is that they are not able to reflect the standard principle of farmers,the peasants’ participation and subjectivity are seriously inadequate,and the differences in rural society have not been given basic attention and sufficient in decision-making.It shows that farmers’ demand preferences can not be effectively expressed and responded.In order to improve the basic principle of government led by the proper decentralization of decision-making power,the author should emphasize the importance of the farmers and the village community in the field of medical and health.The rural medical and health policies should be based on the peasants and form a top-down country through the effective grouping of farmers.The platform and capability of various health policies and resources.In a word,on the one hand,we should continue to adhere to the basic principles led by the government.On the other hand,we should especially emphasize the basic strategy based on the farmers,that is,the objective situation and actual needs of the rural areas as the benchmark for the reform of the health system,and pay special attention to the internal initiative and initiative of the peasants in the village community.It is the main direction to establish the "government led farmers participation model" as the next practice of the rural new medical reform,which is the "Chinese characteristic" in the overall goal of "building a modern medical and health cause with Chinese characteristics".