Study On The Eainess In The Operation Of The New Rural Cooprrative Medical System (the NCMS)

Before 2003 when the pilot projects of the New Rural Cooperative Medical System(the NCMS) were launched all over China, a large number of farmers has been wandering on the edge of the social medical security system, and the phenomenon of "difficulties and high expense in medical care" and "poverty caused by illness" are widespread in rural areas. The implementation of the NCMS not only relieves the pressure of farmers in health care, but also contributes to the realization of social justice.Taking the participating farmers of the NCMS as the research subject, based on questionnaire and case interview, this thesis uses social justice theory, including dimensions of fair start, fair process and fair result, and empirical investigation. It intends to give a quantitative analysis on the fairness issues in the operation of the system, the residents’ concept of fairness and its influencing factors in Z Village, Hubei Province. Then some policy suggestions to improve the fairness and sustainable development of the system will be proposed.The study found that fairness is the basic value of the NCMS, the inner requirement of moral primacy and the essential attribute of the system. The NCMS being the basic one in China’s social security system, social fairness is the most fundamental basis; "fair bottom line” is the lowest fair rules that needs to be adhered to. Fair principle is important for the design and operation of the system; fair system arrangement is a basic right of the social members and the premise and assurance to the realization of fair chance.During the operation of the NCMS, fairness is mainly reflected in three aspects, including fair start, fair process and fair result. Specifically speaking, 1.(1) As for fair start, universality is realized through the wide coverage, high participation rate and relatively balanced medical resource allocation of the system. However, the risk of the "Matthew Effect" exists at the same time.(2) As for fair process, financing proportion distribution is reasonable; the reimbursement program is specified and convenient. There are also problems such as uncertain financing, unreasonable compensation and fabricated supervision.(3) As for fair result, it expands the benefited range of the rural medical service and secures the health care, but the income redistribution effect is insufficient and level of security is low. 2. The current perception situation of the farmers in the system include fairness perception of the financing mechanism, fairness perception of government’s behavior, and fairness perception of medical services. In detail,(1) The diversification of the financing mechanisms and the "Tunnel Effect", the realization of fair participating opportunity make the farmers’ fairness perception of the financing mechanism high.(2) Lack of reasonable and economic compensation scheme reduces the performance of the compensation mechanism, accompanied by the risk of "Adverse Selection", and lowers the farmers’ fairness perception of the compensation mechanism.(3) Unclear power and responsibility of the basic government unit and weak supervision and management make the farmers’ fairness perception of the government’s behavior relatively low.(4) Good service delivery capacity of the health service institutions and improved availability and accessibility of health service make the farmers’ fairness perception of medical service relatively high. 3. There are several factors influencing the farmers’ fairness perception of the NCMS.(1) As for the personal features of the farmers, the age of the participating farmers, the number of the old and the young, education background, the overall healthy conditions of the family members and family income on medical expenditure are notable ones.(2) As for the system operation effect, the expense compensation mechanism, the government’s service behavior, the financing mechanism and medical service behavior have significant influence on it. 4. There are several countermeasures and suggestions put forward to promote the fairness of the NCMS. Based on the theoretical and empirical analysis, in view of the problems in the operation of the system, suggestions are proposed in the thesis.(1) There should be multi-level propaganda to improve farmers’ cognitive level of the policy and realize fair participation opportunity.(2) The "starting paying line" of expense reimbursement should be cancelled or lowered to expand the benefit coverage, improve the benefit level and achieve fair benefit of participation.(3) Market competition mechanism can be introduced to improve the service capabilities of the designated medical institutions and to narrow the health care resources gap between the city and the country.(4) Improve the medical assistance system and adopt the secondary compensation for the rural disadvantaged, to promote the implementation of fair results of the NCMS.(5) Promote the reform of the household registration system to achieve effective docking of urban and rural health care system.