Research On Sustainable Development Of New Rural Cooperative Medical Schemes Of China

BackgroundThe problem about peasant, countryside and agriculture has been a comprehensive and strategic issue of China for a long time. Although the reform of China was started from the countryside, in the present this problem is still the one to which Chinese government should pay the great attention. We know China is a great country of agriculture. If the health condition of peasants can not be improved roundly, the development of Chinese economy will meet the enormous influence and restriction.The risk of illness is uncertain. It should be more dangerous to those peasants who have the lower incomes. But the present situation is that the most part of Chinese peasants can not obtain the medical security because of the affection of structure difference between cities and countries, which has already caused not only the great inequity of Chinese system of health funds raising but also the worse operation of rural medical service system directly or indirectly. The result of this situation is that illness becomes the one important reason of peasant poverty. It is still very severe that peasants become poor because of diseases and fall into the poverty again because of diseases. Most of peasants are in the condition that they are afraid of diseases and can not afford the diseases. But they often suffered from diseases. They need the health security urgently.Rural cooperative medical scheme is the one basic policy of Chinese rural medical security. But now this policy is confronted with the conjuncture of survival and development. In 1960s-1970s, it once brought the great benefits to most of peasants and was also called Chinese Model by WHO and World Bank because of its biggest benefits and the least investments. However, after reforming and opining the door, this scheme began to decline very quickly and it was only reserved in the less part of China and the covering range was also very narrow. Since 1990s, Chinese government has already tried to rebuild and recover this scheme. But it did not obtain the prospective effect, and even did not get the target put forward by the Chinese government and State Department in January of 1997, which was that we should try to build the more kinds of cooperative medical system in the most part of rural areas before 2000. In fact, in the middle time of 1990s, some rural areas began to do the pilot works according to the policy, but in the end of 1990s and at the beginning of 2000s these works fell into the awful situation because of many factors, even were blocked.Confronted with such a severe condition of rural health, Chinese government put the problem of peasant medical security to the important schedule of official business. In 2002 Chinese government and State Department published the decision about strengthening rural health work. Afterwards, Ministry of health, Ministry of civil administration and Ministry of finance published the instruction about developing experimental work of new rural cooperative medical schemes (NRCMSs) and required to build NRCMSs. Since the experimental works, many areas have got the considerable effect. But many researches also showed that there were still many problems in experimental works. Furthermore, it is still uncertain whether this policy may come into the normal track and can be implemented fluently. We should obtain experiences and lessons from the standpoint of history and analyze the influencing factors of sustainable development of NRCMSs so that we can explore the new path to develop NRCMSs.ObjectivesGeneral objectivesThis paper pretended to analyze NRCMSs comprehensively, research the problems in the experimental works of NRCMSs and influencing factors which restricted the sustainable development of NRCMSs, explore the rootstock, generalize the historic experiences, put forward the strategies and policy advices to accelerate the sustainable development of NRCMSs in the condition of socialistic market economy and provide the policy evidences for the macroscopical adjusting and microcosmic administration of Chinese government.Concrete objectivesI. From the macroscopical standpoint, analyzed and evaluated the historical evolution of Chinese rural cooperative medical schemes and expounded the necessity, imminence, hardship and feasibility of popularizing NRCMSs in the present situation and discussed the development potential and tendency of NRCMSs .2. Researched the theories which should be necessary to research the sustainable development of NRCMSs , analyzed the influential factors of raising funds of NRCMSs and discussed the policy foundation of NRCMSs and operation mechanism to resolve the problem that peasants became poor because of diseases and fell into the poverty again because of diseases.3. Study the present situation and problems of NRCMSs, Analyzed the different influential factors and rootstock of supporting sustainable development of NRCMSs and elaborated necessary conditions of supporting sustainable development of NRCMSs.4. Explored the academic evidences and policy advices which had the theoretical evidences and the actual guiding significance to accelerate the sustainable development of NRCMSs in the condition of socialistic market economy.Methods1. Method of combination of theory analysis and demonstration research, which included the combination of history retrospection and actuality evaluation, the combination of conclusion analysis and deduction analysis, the combination of macroscopical analysis and microcosmic analysis.2. Method of references review. This paper retrospected the references about rural cooperative medical systems and researched and analyzed these materials.3. Method of system economics. This paper used this method to analyze the effect of evolution of system environment on NRCMSs.4. Method of case study. This dissertation chose the typical case of NRCMSs of Ningxia to analyze and research NRCMSs.Contents1. The development course and historical appraisal of traditional rural cooperative medical schemes of China.2. The development experiences and apocalypse of rural health security systems of other foreign countries.3. The theoretical viewpoint which are necessary to the research of NRCMSs.4. The influential factors of fund raising of NRCMSs. 5. The main operation model of NRCMSs of China in the present.6. The research about the actual situation of operation of NRCMSs.7. The reformation duties which should be necessary to the sustainable development of NRCMSs.8. The influential factors of sustainable development of NRCMSs.Characteristic and Innovative points of researchThis research aimed at the sustainable development of NRCMSs which had the great significance in the present society. It had the tight connection with relative policies of rural health development of China. It had its own characteristic in the study field and selection point of view. It had the next innovation points.1. It used several comprehensive methods to do the systemic analysis and research of theories and cases.2. This dissertation used the principle of system economics to analyze the effects which the change of system environment had on rural cooperative medical system. From the viewpoints of system project, system confliction, system vacuum, system change, system configuration and system efficiency, it explored the development and evolution of NRCMSs.3. It thought that we should develop the community mutual and complementary health system and connect NRCMSs with rural health salvation system, and strengthen the connection of health security system between cities and counties, and strengthen the law construction and technology support. In order to ensure the ratio of joining NRCMSs and fund raising level and to reduce the adverse selection, we should implement the principle that all peasants must join NRCMSs.Main results1. The development process of Chinese rural cooperative medical schemes included the germination phase (from 1938 to 1955), the form phase (from 1955 to 1966), the development and blossom phase (from 1966 to 1978), the eclipse phase (from 1978 to the end of 1980s) and the recover phase (from 1990 to 2002).2. The reasons of decline of traditional rural cooperative medical schemes included the affection of structure difference between cities and countries, the environmental change of rural economy and society, the inherent flaw of system itself and the thought confusion at the beginning of reform. 3. It specified the necessity, imminence, hardship and feasibility of the construction of NRCMSs. Our society should cognize this situation roundly.4. The dissertation analyzed the policy foundation and operation mechanism of NRCMSs and thought that the objective of building NRCMSs should be to prevent peasants from becoming poor because of illness and prevent them from falling into poverty again because of disease.5. This dissertation thought that we should research NRCMSs from some theoretical viewpoints, for example, theory of community fund raising, theory of system economics, theory of risk management. It also explored the academic evidences of necessity of government interference.6. The influential factors of fund raising of NRCMSs were composed of health factors, politics factors, economy factors, society factors, culture factors and project of system.7. The models of NRCMSs were composed of inpatient management pattern, improvement management pattern, cooperative management pattern of individual account and county account, cooperative management pattern of family account and social fund raising, management pattern of insurance company. In these models, inpatient management pattern is the main model.8. The experimental works showed that there were some differences about attending ratio, compensation ratio, services utilization and funds administration among the north part, middle part and west part of China. Attending ratio of three regions have no the great difference. Compensation ratio is relatively higher in the health institutions with the lower grade. The hospitals of townships are greatly utilized in the middle and west areas of China. But the hospitals of counties are greatly utilized in the east part of China. As for the fund management, the proportion of risk fund of the health finance in the east region is higher than that in the west and middle region.9. The NRCMSs of Ningxia has obtained the gradual development. The government of Ningxia paid the great attention to this system. Peasants got the more benefits from NRCMSs. But there were still some problems. For example, the higher cost of fund raising, the lower attending ration, the lower cognition of peasants and the lack of restrition and supervision to health institution, which caused the fast increasing of medical fees and was adverse to risk control of funds.10. The main influential factors of sustainable development of NRCMSs included the next points.(1) The problem of duty fulfillment of different governments.(2) The ability and aspiration of payment of peasants.(3) The manner of voluntary payment and the problem of adverse selection.(4) The contradiction among illness risk control and moral risk control and justice of raising funds of health service.(5) There were not only advantages but also disadvantages about the severe illness insurance and outpatient insurance.(6) The establishment of relative laws was late to NRCMSs .The administration and supervision of insurance system were nonstandard.(7) How to choose the medical service organizations of NRCMSs.(8) Faith problem of peasants.(9) The effect of traditional culture on the behavior of peasants.(10) The effect of rural oldest-old on the NRCMSs.(11) The phenomena of fraud and abuse among those peasants who do not take part in NRCMSs.11. The sustainable development of NRCMSs put forward the new duties and requirements and challenges to matching reform of rural health work of new time. We should connect NRCMSs with rural health salvation system, and strengthen the connection of health security system between cities and counties, and strengthen the law construction and technology support.Suggestions1. Confirming the duty of government.2. Implementation of compulsion principle of attending NRCMSs and decreasing the phenomena of adverse selection.3. Accelerating the process of formulating laws of NRCMSs.4. Building the rational mechanism of raising funds and compensation.5. Developing the mutual and complementary health of community and advocating the attempt and multiplicity of system model.6. Enlarging propaganda and strengthening the faith of peasants.7. Boosting the associated reforming of medical treatment, health insurance, curative and public health.8. Controlling the phenomena of fraud and abuse effectively. 9. Strenghtening the information and network construction of NRCMSs.10. Implementation of rural health salvation system in the poor areas.11. Developing the rural economy greatly.