Research On Value Compensation And Payment For Basic Medical Service In China

The supply-demand relationship of basic medical service has a dual feature,both of market transaction as ordinary goods and of humanitarian relief,which should be coordinated rather than being conflicted in modern economic system.If the provision of basic medical service is to be entirely dependent on the market and to realize through the market mechanism the value compensation and payment of costs and fees,then it may lead to market failure to certain degree,such as insufficient provision and expensive consumption and may also greatly influence the satisfaction of citizen's need and the development of human capital.Therefore,the government and medical insurance organs should intervene to ensure through top designs the public interest of the publicly-owned medical organs and to find a mechanism of agency provision suitable for China's conditions.Reforms of social medical insurance may promote reciprocal support and loss sharing while at the time it can encourage both the supplier and demander to save medical resources and put under control the increasing medical expenditures.Only continuing with the reforms of supply-side and the third-party payment will make sure that both urban and rural residents can enjoy indiscriminate basic medical service and medical security.On the ground of national conditions of social structure and economic development and under the constraint of given property,contract and information,this dissertation tries to imbed the provision and value compensation of basic medical service in the market economy and progressive market-oriented reform in China and to find the reasonable solution to medical care problems.The whole paper is divided into 7 chapters.Chapter 1 is the Introduction which clarifies the advanced academic achievements through a systematic literature and the proper perspective as well as its significant points and difficult points.Chapter 2 and Chapter 3 serve as the qualitative analysis and establish the theoretical framework through the discussion of various corresponding theories and institutions,which form the prerequisite and foundation for further research and can be regarded as significant points and difficult points for the whole paper.Chapter 4,Chapter 5 and Chapter 6 constitute the quantitative analysis and reveal through experience data the provision responsibility and efficiency condition of basic medical service for the government,the medical insurance and the market.From the perspective of property transfer and value compensation,the utility goals and economic behaviors are studied for all the parties involved in the provision of basic medical service.Chapter 7 is the Conclusion including some policy suggestions.The followings are the details.Chapter 1 as the Introduction expounds on the background and necessity of this research,the literature,research contents and method,etc..The literature traces back and makes an assessment of relevant academic works relating to basic medical service from 5 aspects,including health demand and demand for medical care,the provision mechanism of basic medical service,formation of and compensation for costs and fees,pricing mechanism and price regulation,contribution and compensation-payment mechanism of medical insurance.In this way,it points out the direction for research break-through.Chapter 2 traces the evolutionary process of various theories of price mechanism.From Marshall's theory on price equilibrium to Lindal's model of voluntary provision of public goods or Samuelson's optimal efficiency for provision of public goods,Tiebout's model of voting on foot,Musgrave's model of budget-based provision of public goods,all these theories serve as the guide with regard to theoretical explanation and methodology for the development and optimization of basic medical service as quasi-public goods.In modern economy,there exist both the mandatory transaction market controlled by public power and the free goods market for China's basic medical service.In the extensive sense,the price for basic medical service takes several forms of value,including tax,fees and prices.The inference for the function of health production and medical demands is made on the base on Grossman' function of health demand and Becker's function of family production in order to seek the solution for optimal Pareto's efficiency.Both the natural and social characteristic of medical service are defined,the uniqueness of medical service and medical market is illustrated;then,it is pointed out that the basic medical service belongs to equity goods and club goods and it should be jointly-provided by the government and the market.Its provision follows the logic of “ public finance + contractual governance + market mechanism”.After the observation on China's practice of pricing subject,pricing method and price regulation,it is found that government-determined price has been adopted for basic medical service primarily on the base of variable cost by medical organs,which inevitably results in insufficiency of compensation for medical organs and calls for subsidies by the government.This chapter aims to establish a theoretical framework for further research in the following chapters..Chapter 3 makes an analysis of the formation,compensation and attribution of the costs and fees for basic medical service,which include that borne by the supplier and that by the demander.The costs and fees for supplier primarily include 8 kinds,the value of which is compensated through governmental finance and collection of entrepreneurial fees;the costs and fees for demander include both express and implied ones,for each of which some examples are given to measure the scale of expenditures.Value compensation and payment of medical costs and fees include both the collection of contribution to medical risk assets and the payment of fees for medical service,for which there exists an inherent settle-and-clear system of medical service.There are 6 models for the compensation and payment of the costs and fees for basic medical service,depending on different economic and social conditions,among which the “demander + social medical insurance + supplier ” model is a best choice for China at this historical stage.Special medical risk assets are formed through tax,insurance contribution and medical consumption by individuals,families and businesses,which eventually flow into various medical organs and are ultimately converted to provision of basic medical service.On the micro-level,families and businesses become the ultimate bearer of medical costs and fees,while on the macro-level,they are borne by governmental medical expenditure,social medical expenditure and individual's medical expenditure.Chapter 4 makes an observation of the institutional evolution as well as measurement and assessment of efficiency of China's governmental investment on basic medical service.Using Theil Index and DEA-Tobit efficiency model,an analysis of the equality and efficiency is made for governmental investment on medical service.It is found that governmental investment brings basic medical service the feature of governmental welfare and public interests;therefore,the government should strengthen its support and improve the structure of support.Chapter 5 makes respectively an analysis of the 3 main social medical insurances,that are the urban-workers medical insurance,the urban-residents medical insurance,the rural-farmers medical insurance,and also a discussion of the undergoing integrated-residents medical insurance.The following fact is found through the regression research of the medical data of 12226 patients that social medical insurance may smoothen the capacity gap in medical consumption,release medical demand and promote the increase of medical consumption.The third-party payment system lacks incentives to save and control medical expenditures for both the supplier and the demander and may result in moral hazards such as excessive medical care.Reforms on medical payment are needed and various payment models such as PPS may be combined to achieve simultaneously the goals of curbing medical expenditures,safeguarding service quality and protecting patient's health.Chapter 6 carries out the study of compensation and payment by the market.It is pointed out that both “market failure” by market-oriented provision and “provision inefficiency” by publicly-owned medical organs co-exist under China's market economic conditions,which lead to obvious “water-bed effect”,serious medical rent-seeking and corruption as well as price regulation paradox in medical market.With the game model,the rent-seeking and rent-accepting behaviors by special interest groups are analyzed to find an optimal strategy portfolio for all participants in the process of provision of basic medical service.The key to effective provision of basic medical service is to strengthen its supply-side reform,to improve its compensation mechanism and to practice more price regulation.Chapter 7 is the Conclusion.By mechanism design,the dual feature of both market transaction and of humanitarian relief can be coordinated.Through reshaping the compensation mechanism of basic medical service,the feature of public welfare can be reattributed to publicly-owned medical organs,and the problems of adverse choice and moral hazard in the provision can be resolved;also,the responsibilities of contribution by the government,the society and the market as well as the equality and efficiency can be coordinated and balanced.The main opinions and conclusions include the following :(1)“Market mechanism + public finance + contractual governance + transaction reimbursement + health efficiency ” constitutes the logic formula for research of basic medical service in market economy.Incentives stem from division of administrative power and fiscal power.(2)The production of basic medical service is a technical process,the cost and efficiency of which can be settled and cleared,calling for adequate compensation and reasonable profit.The provision of basic medical service belongs to the category of transaction and beneficiary and consumers do not pay accurately as much as equal transaction principle requires,resulting in the contradiction of price and value.The compound model of compensation like “government's fiscal support + social medical insurance payment + individual's payment by cash” is an institutional arrangement of expenditure sharing of equity public goods,which reconciles the paradox between production and provision of basic medical service.(3)Value compensation of basic medical service include both compensation and payment,deriving into questions such as whom to be paid,who pays,capitals to be collected and borne.From the perspective of the capital flow,families and businesses become the ultimate bearer of costs and fees of basic medical service on the micro-level while governmental medical expenditure,social medical expenditure and individual's medical expenditure by cash are the ultimate forms of macro-level attribution of costs and fees.(4)Governmental medical expenditure of basic medical service can take two approaches for the style and structure of investment,which in the essence are government's responsibility to provide basic medical service,to reduce economic burden for participants and to improve the accessibility and equality of basic medical service.(5)The establishment of social medical security is instrumental to smoothen the capacity gap among consumers of basic medical service,to enhance the market for medical consumption and to expand those unaffordable medical consumption and release medical demand.(6)China's medical system,medical price policy and interest groups' behaviors together result in the distortion of medical price and the existence of waterbed effect.Taking into consideration the interest groups conducts of collusion and game,the Chinese government should strengthen the supply-side reform of provision of basic medical service,to reshape its compensation mechanism and to implement price regulation more effectively.