The Analysis Of Game Interests In The Change Of The System Of Medical Treatment Charges

In general more than 20 years of the reform of the medical system is not smooth. The current medical system has a lot of drawbacks, which concentrated on the problem of "see a doctor difficult" and "see a doctor expensive" that the common people strongly expressed. So-called "see a doctor expensive", means that the extraordinarily rapid growth of medical treatment expenses exceeds the growth of people's income. The rapid growth of medical treatment costs is closely related to the system of medical treatment charges. This paper investigates and analyzes the practice of action and interaction of the government, medical institutions and patients on the reform of the medical treatment charges system, from the perspective of game interests, and trying to show the relationship between the process of game interests among the tripartite and the great expenses of medical treatment.In this paper, the research methods of text analysis and empirical investigation are used. The method of text analysis is used for analyzing the relevant policies of medical treatment charges since the founding of the new Chinese government. The method of empirical investigation is used for studying the practice on the policy text in the city of Hefei in Anhui province. The data of this paper is collected mainly by the method of deep interviews, with the assistance of the observation method and the check of the press and literature.In chapter 1, through the text analysis of the relevant policies of medical treatment charges since 1949, the changing process of government's policies is summarized in three stages: the "decline" charges stage emphasizing medical welfare, the "rise" charges stage stressing economic benefits and the charges stage of "control" high cost of medicine. These three stages give the reflection of the changes of the government's attitude and action on medical treatment charges, and they also imply the change of the government's interests goals in different period of time------from social welfare to economic benefits.In chapter II, through the investigation of the attitude and action on medical charges of the medical institutions in different stages, the changes are shown in action strategies which the medical institutions adopted when facing different institutional arrangements: from the first stage of "obedience" to the second phase of "advance" and herd profits, and then to the third stage of "superficial obedience" and "secret modifications." The author points out that the medical institutions' advantage of knowledge and information and its role as a health agent strengthened its game capability.In chapter III, through the investigation of the attitude and action on medical charges of the patients in different stages, the strategies of patients' countermeasures are showed when they face the different institutional arrangements and the action strategies that the medical institutions taking. Because of patients' role as dual clients and the lack of their interests spokesmen and etc., patients' status in the interests game board is doomed to be disadvantaged. Therefore most of patients have no choice but to choose obedience when facing the government's weak control and the medical institutions' modifications to system.Based on the analysis of the ex-three chapters, the consequences of game interests are summed up in chapter 4. Because of the government's strong capability and its weak control, and the modifications to system of the medical institutions, and the patients' dual position of disadvantages, four main consequences are caused: the high cost of medical treatment, the damage to the government's fairness, the plight of medical institutions and the increasingly tense relationship between doctors and patients.