The Study Of The Management Of Government Input In The Health Service Sector In China

After over thirty years of reform and development, China has established relatively refined public health service system, medical service system, medical guarantee system and pharmaceutical supply guarantee system. The medical and health service industry has embraced a brand new stage of development. Nevertheless, given the evolving aging problem, rapid development of applied new medical and instrument technologies, diversified needs and fast growth of medical and health services, China’s medical and health industry is facing numerous challenges. Globally speaking, no country’s medical and health system is perfect, and no country’s medical and health reform remains static. Countries in the world have always been promoting their own medical and health reform. Reform and adjustment of government input management is an important component of the whole reform package.Scientific management of government input is crucial for the healthy development of the health service sector. Given the insufficient health service resources, this dissertation, through the study of the management of government input in the health service sector, explores how the effective management of government input can ensure equality and availability of the distribution of health service resources, enhance the efficiency and effectiveness of the use of health service resources and promote the healthy and sustainable development of the health service sector.Building on Part One of Introduction, Part Two reviews the domestic and foreign literature covering five aspects, including the entities that make input into the health sector, the funding of medical insurance, the direction of input for health reform, the distribution of medical and health resources and the management system of the health sector, which lay a solid foundation for the research of the management of China’s government input in the health sector.Part Three focuses on the relevant theories of health service sector. Through the research of theories on public goods and health economics, this part underscores the inevitability of government dominance in the health service sector. The research on the institutional and behavioral economics, information asymmetry and agent shows that the government is responsible for the input into the health sector and that the limits of its responsibilities shall be noted. The information asymmetry of the health sector requires the government to take action against the occurrence of monopoly and supplier-induced demand. The research on theories of institutional design reveals that the intrinsic traits of the health sector determines that only by coordinating different interests through the right mechanism can we ensure the healthy development of the sector. Part Four looks at the health reform in developed and developing countries, including transition countries, to make in-depth study and comparison of the management of government input in the health sector by various countries. On one hand, the horizontal comparison is made on a few representative countries to study the impact of different ideas, size, efficiency and effectiveness of the government input by countries of different social morphology; on the other hand, the summary of the experience of the management of government input by different countries highlights the commonality and difference in the management of government input to identify experiences and lessons for China.Part Five provides an overview of China’s management of government input in the health sector. This part describes and analyzes the state of China’s health sector from three dimensions, namely the evolution of China’s government input, the quantitative analysis and the summary of progress and problems. Such an analysis sheds light on the background and rationale of the old management system, the reasons of reform and the present problems. In addition, this part identifies the problems that merit special attention with a view to resolving them in the future.Part Six to Part Nine, which are the key to this dissertation, further extend, expand and sum up the previous five parts. Part Six, based on the forgoing research, describes the issues to be considered in policy design, the basic principles for the sector’s development and the ideas of reform going forward for the purpose of promoting the healthy development of the sector. Part Seven and Part Eight define the responsibilities that government should hold in establishing and improving health service system and medical guarantee system. Part Nine, in view of the management of the existing government input, recommends the establishment of the "SASAC of the health sector" in order to transform the management of public hospitals’ assets into capital management.The dissertation makes innovative contributions in the following four aspects.First, from the perspective of the government input management, the dissertation analyzes the features of market, products, and appeals of all the parties concerned in the medical and health service sector and identifies the role of government therein. Based on this, the responsibility of government to invest in healthcare and the impact of government financing and investment management on health are determined, which lay a theoretical foundation for the operation and performance of a government-dominant health sector and proposes the theoretical basis that the responsibility of government investment is limited.Second, the dissertation believes that it is not scientific to make simple comparison of the government investment size by different countries. The health expenditures of various governments are comparable only when these countries are of the same development model and in the same development stage, and constructive conclusions can then be drawn on. This dissertation, through comparative data analysis of categorized groups of countries based on three different medical insurance models, concludes that the size of government input in the domestic medical and health sector is basically appropriate.Third, the dissertation adopts regression analysis model to study on factors affecting government expenditures on healthcare. The thesis chooses five variables for regression. The finding is that aging population and economic development level are the most influential indicators for health expenditures. Therefore, with improvement of economic development and the coming of aging, it is predicted that the health expenditure ratio by the Chinese government will increase.Fourth, it proposes that health SASAC manages government stock investment in hospitals. At present, there is no separation between administrative affairs and professional business in public hospitals. The government does not perform the due role of contributor in managing its stock investment in public hospitals. This dissertation believes that for public hospitals, only when the transition from asset management to capital management is realized, when the corporate governance structure is optimized, and when the government supervision mechanism on state owned capital of hospitals is improved, can the sound development of public hospitals be achieved, and an level playing field and win-win cooperation be created for private capital accessing to the health sector to form a diversified patterns of hospitals.