Health Resource Allocation To The Legal System

The medical structure reform in china matters the health, lives and happiness for 1.3 billion Chinese. The success of Chinese medical structure reform is determined by whether it is fair to allocate medial resources. It is a very tough issue in theory and practice for how to allocate medical resources fairly for its importance and specialty. The author develops this issue centered by how to construct legal institutions on the allocation of medical resources to ensure the fair realization of citizens' right for health. This thesis sets its foot on the current medical resources allocation, tries to explore and construct the medical legal institutions suitable for Chinese things.The whole thesis consists of three large parts. First is the introduction, which introduces the medical resources allocation and its legal system as a base for research and pre-conditions. Second is the foundation (chapter II and III), which explains health fairness, analyzes the structural approach on fair allocation of medical resources, and proposes that health fairness is the modern concept for legal institutions on medial resources allocation, and "regulated marketization" is the structural selection to allocate medial resources fairly. This part is the basic theoretical foundation to analyze the deficiency on medical resources allocation legal system and to construct specific institution. Last part is the institutions (chapter IV to VI), which is the second thought and re-construction on medical resources allocation legal institutions, including second thought and reconstruction on funds collection legal institutions for medical service based on fairness, legal restraint on providing medical services to the higher bottom based on fair medical supply, and the legal control on the medical acts of the suppliers based on fairness on application. Following the above logic, the whole thesis consists of 6 chapters.。Chapter I is the introduction on medical resources allocation and its legal institutions. This chapter is the preconditions and base for the whole thesis, which defines medical resources and medical resources allocation with the help of semantics, jurisprudence and economics, and discusses the definition on medical resources allocation legal institutions. First, the concept of "resource" is discussed with an affirmative thought on modern concept of resources concept. Here it discusses the character of resources such as rarity, usefulness, proposes the concept of "medical resources" with the help of medical treatment definition which is the collection for all elements and factors supplied to the medical agencies for providing medical services or to the medical service demanders to fulfill people's health demand under certain social economic conditions. Second, the author analyses the economic implications for resources allocation, which refers to that "certain social relationship comes from different social bodies allocating some resources within certain fields among different social entities in accordance with different law", and proposes legal implications on resources allocation which refers to "a certain social relationship coming from the allocation of medical resources among different social bodies such as government, medical agencies, and citizens". Third, the author analyzes the dependence of medical resources allocation on legal institutions, believing that the nature of medical resources allocation implies the necessity for legal institutions, and legal institutions have tool value in the process of medical resources allocation. The author also proposes the definition on medical resources allocation legal institutions, analyzes the characteristics on its regulating objects, and discusses the formation of medical resources allocation legal system which is a unity of medical service funds collection institutions, medical service delivery institutions, and medical service using institutions.Chapter II is the modern concept on medical resources allocation legal institutions. This chapter analyzes the health fairness on medical resources allocation from three aspects. First, it is defined from result fairness and opportunity fairness to define health fairness, pointing that health fairness is a unity between reality and ideality, history and heritage, comparatives and absoluteness. The legal nature on health fairness is revealed by fair protection on citizens' health rights and the empirical fairness in economic law perspective. The author pointed out its specialty and legal nature. Second, the reasonable requirement on medical resources allocation is fulfilled from three principles: quality, discrepancy, and compensation, which becomes the basic principle for medical resources allocation legal institutions. The author also proposes that under the context of medical resources allocation, health fairness is represented by the balance between patients' health protection and medical economic compensation, the balance between the medical priority for the weak and the health for all the citizens, and also explains the unity between fairness and efficiency from theoretical and empirical perspectives bearing the following idea in mind: waste in medical resources is unfair by empirical analysis. Fourth, the author finds empirically that the reason for unfair health right lies in the unfairness in medical funds collection, medical service delivery and medical service utilization. The author also analyzes the fair realizing process for health fairness, proposing that process on medical resources allocation fairness is a continuing one. The author points out further that the medical resources allocation institutions should include institutions to secure fairness on funds collection, supplying and utilizing, which provides logical basis for the specific legal institutions discussion in Chapter IV, V, VI.Chapter III is the institutional selection for medical resources fair allocation, which focuses on government and market. This discusses the medical resources allocation institutions should follow the way of regulated market form two perspectives. First, the author introduces the fallacy on the relationship between government and market in the process of medical resources allocation, that is, market failure and government failure existing at the same time in practice, and the contradiction between government-orientation and market-orientation, and further proposes the institutional selection of "regulated market". The author also analyzes the institutional selection theoretically from fairness and efficiency perspective and the specialty on medical service and market. This is proved empirically by medical reform in Suqian domestically and international medical reform instances. This chapter discusses government responsibility in the institutional selection on regulated market, clearly defines government obligations in funds collection, purchasing, government planning and supervision with the basic legal principles for government obligation.Chapter IV is a second thought and reconstruction on medical service funds collection legal system, which focuses on fairness on funds collection. This chapter sets its foot on the fairness on funds collection, rethinks and re-constructs the legal institutions on this aspect under international comparison analysis and empirical analysis. The author first analyzes the implications and functions on funds collection on medical resources, fairness for medical services funds collection, and believes that the medical service funds collection should reveal the fairness from horizontal and vertical perspectives. Then, the author analyzes the mode on funds collection from fairness, efficiency and adaptability, finding the advantages and disadvantages for each mode. The author also considers empirically from the perspective on domestic medial service funds collection, pointing out its deficiency. In the last part of this chapter, the author proposed the improving advices for the major legal institutions on urban and suburban medical resources funds collection, and proposed a new institution design. Chapter V is the legal restriction on medical services delivery system highly concentrated at the upper side, which focuses on supplying fairness. This chapter sets its foot on the fairness on medical services supply, carries out its dissertation centered on the constructive balance in medical services delivery system to rethink and reconstruct the legal institutions on medical services delivery. It first analyzes the upper side concentration on medical service delivering, which evidently affects the supplying fairness for medical service. Then it discusses the institutional reasons on highly centralized arrangement, pointing out that the key deficiency lies in the lack of reasonable medical agencies compensation institution, doorkeeper arrangement, effective institutional regulation institution. To overcome this difficulty, the government may select an institutional arrangement to combine the government control and market together. The author then rethinks and reconstructs the regulatory arrangement with public power involvement, district medical programming institution, pointing out that there are many deficiencies in current district medical programming institutions, such as no legal position, vague legal stipulation, no procedural stipulation and other deficiencies in implementation, supervision and evaluation. Then the author points out the advice on institutional construction on every step of. I n the following part, the author proposes the difficulty faced with the legal institutions on community medical service and village medical service. The key to realize supply fairness is to improve medical services in the very local level. The author also points out the difficulty in urban district medical services in institutions on compensation personnel building, and double diagnosis transfer, pointing that the institutional difficulty for suburban medical service system. In the end, the author proposes his advice to reconstruct Chinese local medical services legal system, building village community medical service institution, reconstructing local medical service compensation institution, building full-section doctors institution, and reconstruct the double diagnosis transfer institution.Chapter VI is the legal control on acts from medical suppliers, which focuses on the utilization fairness. This chapter sets its foot on the medical service utilization fairness, centered on medical moral risks, pointing out the institutional arrangement on medical acts from suppliers. It first analyzes the reasons for high occurrence rate on medical moral risks, pointing out its influence on the supply of medical services, and pointing out control from the supplying is the necessary choice. In the following part, the author analyzes the way to control medical acts from the supplying, such as establishing the safeguard for the doctors' free prescription with certain procedural institutions to control the abuse of doctor's prescription rights. In this chapter, the author also proposes such arrangement to overcome the abnormal medical acts from medical agencies as overcoming information dissymmetry, establishing third party purchasing institution and institutions on controlling free use of large medical equipment..