On The Non-equalization In Chinese Basic Public Health Service In Urban-Rural Areas

In the new century, the most important progress of human health due to the development of public health. For national health, prevention is better than cure. An essential public health service system which covered all the people is of vital importance. And a good basic health spending, is announced the government's unshakable responsibility, the government's public health expenditure in relation to the accessibility, quality of health service and the national right to due the fairness of the health service. Since the founding of New China, the Medical and health service system in China is developing rapidly, while the development of essential public health service obviously didn't keep up with the pace of economic growth. Owing to inveteracy of traditional idea of regarding treatment as superior to epidemic prevention and economical calculating of no-economy, the compensation mechanism of Chinese basic public health service system is serious not equal. Among the deep lessons left by SARS crisis, the most important one is that a perfect basic public health service system is necessary. In 2003, Chinese government put forward the construction goal of the public health system: To take about three years time, establishing and perfecting the country public health emergencies emergency disposal system, disease prevention and control system and the health law enforcement supervision system. With a longer period of time, perfect our country's rural health care system, urban basic medical service system, health science popularization system and financial resources security system.This paper summarizes the results of previous studies; it defines the concept of public health expenditure which is the main intervention form of public finance, and the equalization in Chinese Essential Public Health Service in Urban-Rural Areas. Under conditions and economic development restrictions, China's essential public health services mainly refers to the public health services which provided by some grassroots health care institutions as institutions of disease prevention and control, community health service centers, health clinics in towns and townships. So the equalization in Chinese Basic Public Health Service in Urban-Rural Areas means the essential public health service supply can basically meet "the bottom line needs" of urban and rural residents, thus the National health can be guaranteed. In a word, basic public health service is a kind of public goods, it requires the government responsible for providing or intervention its production and configuration. And public fiscal expenditure is the main method for government.In China, basic public health service has a great disparity between urban and rural areas. In planned economy period public health had been in priority development of status, however under the influence of "scissors gap", Chinese urban and rural essential public health service level was low. After Reform and Opening-up, the health service system gradually transforms for the market orientation, township public health service agencies decreased rapidly. In conventional medical institutions, disease prevention and health care and other departments those who provides essential public health service was constantly to be weakened, meanwhile allied health defense and health care organization's ability is limited and unable to meet the social demand of public health services. After "SARS", many basic public health service projects started in succession, and the results were significant, but due to the reasons such as fiscal decentralization, the developments of public health service system in urban and rural areas are obviously unbalanced.In chapter Two, this paper analyzes the basic public health differences between urban and rural areas at the present stage. First, the composition proportion of Chinese total health expenditure has been changing a lot. The proportion of the government and social health investment is on the decrease, while the ratio of personal health spending increasing quickly. Second, about the usage structure of government expenditure on health, the ratio of public health care outlay is showing a annual decline trend while the proportion of socialized medical care outlay is increasing. Meanwhile, China's urban and rural residents' healthy consumption level disparity is growing larger. In financing, financial aids and superior government appropriations for the urban health care institutions are a lot more than the same kind of mechanism in rural area. And in this case, Chinese urban and rural public health services and facilities distribution are not reasonable. On the accessibility, the gap between urban and rural public health agencies is obvious; it's more difficult for rural residents to get the medical treatment. In human resources, public health service quantity and quality of urban-rural gap is still huge. Observing the development of the basic public health service project in urban and rural areas, there still have great inequality in urban and rural areas which should not be ignored.In Chapter Three, this article describes the analysis on efficiency and effect of public health expenditure in urban-rural areas, then find out the main factors of the non-equalization in essential public health services for urban and rural residents and the degree of influence of each factor. In this study, this chapter detailed the public health expenditures, analyzes the efficiency level of the basic public health expenditure in the rural in DEA method. And we find that the gap between urban and rural public health expenditure does a significantly impact in urban and rural residents' personal health spending. And to meet public health needs of urban and rural residents at this stage, China needs a massive increase in expenditure on public health in rural areas, and the structure of expenditures needs to be improved.Through the above analysis, we find out that the reasons which cause the inequality of public health services in urban and rural areas mainly include: the urban-rural separation of essential public health service which brought by the " Urban-rural dual structure "; the significant income gap between urban and rural residents; There is a deviation of basic public health finance, all levels of government financial authority and powers does not match and the financial transfer payment system is also not perfect; The absence of government guidance functions. To solve these problems, we must do the following things: Firstly, balancing urban and rural development, to break the urban-rural dual structure of the public health service system; secondly, we need to create an effective public finance system, a clear division of responsibilities of all levels of government, and we should improve the fiscal transfer payment system in China; thirdly, we should Increase government investment in public health, and gradually adjust the structure of the national infrastructure; fourthly, building a service-oriented government and trying to correct the Government's own position in public health services.