Analysis Of The Responsibility Of Government In The Supply Of Medical Services In China Under The Public Economic Perspective

After the founding of the government, China's medical and health services established supply-based service model, in this mode, the residents generally enjoyed free or low-cost medical services; with the implementation of reform and opening up in 1978, medical and health services with the economic system in the lead, have gradually added to the reform. The Government has gradually expanded the autonomy of public medical institutions, implemented various forms of contract responsibility system and encouraged social resources to raise funds to develop medical undertakings. In this process, the overall supply of medical services and level of medical technology have greatly improved, but the problem gradually emerged: "seeing a doctor is difficult, expensive," the relationship between doctor and patient become intense. In 2005 a research report of the State Council Development Research Center on the health reform proposed the conclusion of the unsuccessful health-care reform, and parties attracted widespread attention to it. The government's position responsibilities, medical services and product attributes once again become the focus of attention. In 2009 the State Council promulgated the "on Deepening the views of medical and health system reform" and "deepening the medical and health system reform the 2009-2011 Implementation Plan," and made a clear return to the "health of the public welfare" and the government functions and responsibilities.From the public economic perspective, taking the supply of health care services in the governmental responsibilities as the research object First of all on the public product characteristics for the illustrations of connotation, pursuant to the common products have two basic properties, that is, the consumption of non-competitive and consumption of non-exclusive. It can be broken down into pure public goods, quasi-public products and mixed products; For different types of public goods, it should be taken with the combination of government and market supply mode. On the different levels of health care products division, a property can be divided into public health services, basic medical services and non-basic medical services. The author believes for pure public goods nature of the public health service, such as: environmental health improvements, the government has full responsibility; for a quasi-public goods nature of health care services, such as immunization, etc., due to its strong spillover effect, generally, which should also be supplied by the Government, to guarantee the supply of the quantity and quality; for basic medical services to people's livelihood, government also have responsibilities.By the representative of the United States, the United Kingdom, Germany and Singapore, on its service supply mode of analysis and comparison of the reform measures, particularly in its evolution during the change of government responsibility, and management methods, institutional innovation of reference, it can give some references to the reform of our medical services: Make the Government's responsibility clear, make the market work effectively, make the "third party" organization act in the supply of medical services and supervision and make the multiple levels of medical service system perfect. You can also reference the American DRGs system, the German public contracts, the British GP mode, Singapore's double medical services systems, etc.Through the comparison of government investment in China, the cost of national health and medical resources, we found that what our Government has invested in health costs is lower, 2006 the Government health investment accounted for 40.7% in the health expenditure, while in the same year the means of the WHO Member States is 62.8%, higher than our country; 59.3% in 2006, higher than the mean of 37.2% in the Member States; and Chinese residents average medical resources is below the world average, per million health care workers, beds of 10 and 22, below the mean of WHO Member States 2.9 times and 1.1 times. In the analysis of health costs and resources in the domestic situation, we found in health costs, there was a great gap between all parties, in the medical resources there in urban and rural areas. From 2000 to 2007, the city's per capita health expenditure growth rate of 1.8 times, per capita expenditure increase rural 1.6 times, 2007 urban population and per capita health expenditure for the rural population is 4.25. At the same time, the eastern region focused on the vast majority of high-quality resources, owned 48.3% of top three hospital and 41.3% of dimethyl hospital, its medical staff number is 1.3 times of the central region, which is 1.1 times of the West,. And high-quality resources are concentrated in Beijing, Shanghai and other large and medium-sized cities. In addition, medical institutions, as well as various hospitals in the highly educated, highly professional staff number is much higher than that of the other community health centers and rural hospital, various hospitals have Bachelor officers whose practitioners 22.7%, namely Township Hospital and community health centers in 10.3 times and 1.9 times, various hospitals have Deputy High above title staff accounted for its number of employees, 9.6% were Township Hospital and community health centers in 12 times and 2.4 times. Through the analysis of the phenomenon, we conclude that medical services supply of low level and the root cause of the imbalance lies in Governmental attribute on medical services product is not accurate and there is a lack of responsibility and offside in the supply of the services.The author believes, based on national conditions, the experience of other countries reform experience in medical services of the supply side, the Government should supply medical services from the scope definition, on different levels of the supply of medical services in the ways, medical determination of the price of service supply, supply efficiency gains and to strengthen the supply of regulatory aspects. Perfect construction of health service system network, strengthen community health centers, towns of supply of hospital, increase government health investment and encourage social capital investment; information and networking, establish a national health database, such as medical and public hospital; trying to bring in a third-party billing system, third-party monitoring mechanism; lessons from British GP mode, USA MCO on medical services using an evaluation system, try on medical services personnel in the implementation of the work, and so on.To achieve a wide range of medical services supply of high quality and efficiency, various systems and measures co-ordination of medical services is needed. Taking the medical service product attributes this analysis as a starting point, only the supply of services, duties and responsibilities of Government are expounded, and proposals on completing the Governmental responsibilities and achieving a wide range and the effective supply of personal views on the reform of China's medical services are proposed, and we hope that these will make some contribution to research.