Chinese Urban Poor Communities Of The Medical Assistance System Mode Of Operation

Medical assistance system, an important measure of Anti-social exclusion must be executed according to the theory of distributive justice and the theory of health equality. Its necessity and contribution have been testified in more and more countries.In view of the fact that current Basic Medical Insurance and the Urban Minimal Living Security System are inadequate to deal with the universal, serious and long-lasting medical difficulty of the poor, in early 2005, China's State Council decided to conduct pilot work of the medical assistance system for the urban poor. Exploring and constructing feasible operation mechanism is the most determinative factor of establishing a standardized and systematical urban medical assistance system across the country. Accordingly, study on this respect is demanding. This study attempts to comprehensively and fatherly analyze the community operation mechanism of the medical assistance system for the urban poor in China, and then probe into the countermeasures to improve the whole system.Based on literature studies and informant interviews, this research completes an all-around comparison of the community operation mechanisms in the UHPP project areas of Shenyang and the pilot areas of medical assistance system of TianJin. The conclusions are:Firstly, the community organizations in both pilot areas have comparatively fulfilled the function of identifying the medical assistance objectives, but they are weak in dynamically managing them. What's more, their advantages in participating in instituting the criteria of local medical assistance programs and regulating the health care services and the medical fund haven't been tapped. Secondly, all community health facilities have provided serials of medical assistance services and the assistance intensity has been greatly promoted. Nevertheless, they are expected to try hard to establish a more comprehensive health service system for the urban poor, which includs prevention, medical care, rehabilitation, family planning, technical guidance and so on. Thirdly, in the community supporting system for the community health services (CHSs), the community organizations have played the role of supplying and sharing human and material resources and mobilizing community residents'participation, but most of them haven't provided direct financial support to the CHSs. Furthermore, they didn't sufficiently function in the community financing, organizational coordination, supervision and evaluation of the local medical assistance programs. For the community health facilities, they should be widely involved in the mobilization of community residents. In a word, to a large extent, the insufficient integration of the community organizations and community health facilities has resulted in the truth that the medical assistance effects of the CHSs are not good enough.Despite that there is much to be improved, on the grounds of the logic supervision and evaluation model of Regional Health Planning, this study takes it for granted that the performance validity and the generalization of the community operation mechanism of the medical assistance system for the urban poor can be generally testified and its universal applicability can be fully demonstrated. However, more policy and economic support should be supplied by the government and the administrative disadvantages of the community organizations must be resolved in order to strengthen the community autonomy. In addition, the CHS should be developed to be a more open activity by inviting more organizations to participate in so that the community organizations and community health facilities can play better roles in medical assistance and the community operation mechanism will attain its perfection. What is more, the medical social worker should be integrated into the team of medical assistance.Finally, this study puts forward that, together with meliorating the community operation mechanism, the low-cost hospitals can be constructed into a valuable resource of medical assistance to make up the deficiency induced by the insufficient poverty assistance function of most hospitals. The integration of community operation mechanism and the low-cost hospital operation mechanism can be a most efficient way of conducting a standardized and systematical urban medical assistance system.