Health Justice Thinking:Promote The Reform Of The National Basic Medical Insurance System In China

The basic medical insurance is an important safety net for human survival and development,relating to the stability of the society and development of the country. Since the 1950 s, China’s basic medical insurance system has undergone a process of reform and development, and gradually established three systems, containing the basic medical insurance for urban employees, the new rural cooperative medical insurance system, and the basic medical insurance system for urban residents.The institutional framework of universal basic medical insurance system formed basically.However, the current system of health care policy system still exist problems. The system present a split and decentralized state(three system coexist and there are large differences among three system). The design and arrangement of the current system present a fragmentation pattern and platter structure. There is a big gap in terms of the level of medical treatment. The above all hinder the formation of a unified national policy. Therefore, the issues how to choose the model of basic medical insurance system, how to achieve coordinated development between urban and rural areas and among different groups, how to make the basic medical insurance system achieve coordinated development in system design, system operation, policy promotion, management optimization and other aspects, how to achieve full coverage and sustainable development objectives, and how to better highlight the justice of health and social need to be thought on the basis of studying national conditions and the rules of the development of the system. Justice requires system and rules to respect the fundamental rights of all citizens and consider the legitimate interests of different groups.Thus, building a universal basic medical insurance system in the perspective of health justice is to ensure the universal access to basic medical insurance rights fair, and there will be no citizen marginalized for various reasons on the basic medical insurance issue. The foothold of the action is the justice of health and social, which helps to improve citizens’ health fair and promote social harmony.In this paper, the author chooses the universal basic medical insurance system as a specificstudying object, carry out qualitative analysis on the basis of quantitative through literature research,data analysis and inductive analysis. The paper focus on the the institutional defect and analyze the necessity of constructing a universal basic medical insurance system. It get inspiration of building a universal basic medical insurance system through comparative analysis of domestic and foreign typical medical insurance system model, and study the evolution of the system, institutional defects and the construction of institutional paradigm(connotation, principles, values, target, etc.) through the institutional analysis, and finally tries to give a feasible path to build a universal basic medical insurance system and the specific measures. The full text is divided into seven parts, and the main research contents and conclusions are as follows.The first is the introduction. This part Introduces the background of the selected topic, and highlight the significance of promoting the construction of a universal basic medical insurance system and ensuring the universal access to basic medical insurance rights fair through introducing what the medical insurance system ought to be and the actual presentation. Then the author review and comment on the research status and define related concepts, highlighting the main contents,research methods and innovations of this paper.The first chapter disserts the theoretical origin of the universal basic medical insurance system.Justice theory, public goods theory, public choice theory and institutional change theory take an important role in guiding and promoting universal basic medical insurance system. This part analizes the rationality and necessity of implementing the universal basic medical insurance system through in-depth study of the theory. It also uses the theory to interpret that the universal basic medical insurance system is the institutional choice for the subject of public choice to maximize welfare and path dependence of the evolution of current system and emphasizes the government’s responsibility in the institutional innovation and change.The second chapter selects typical international medical insurance model, including the UK,Germany, USA, Singapore, India and Russia, expounds the development evolution and characteristics of the various medical insurance system model, then conducts a comparative study on system mode, management mode, etc., and draw on reference and inspiration to build a universal basic medical insurance system in our country, including public interests expressed by the national political will and fund channels in support of the public expenditure and public finances. Systemconcept affect the system trajectory and system trajectory also reflects changes of system concept.The implementation of the system is safeguarded by legislation and administrative management.Institutional arrangements closely linked with the the country’s political, economic and cultural. Our country can only choose a medical insurance system suitable for its own economic, social, political,and historical culture, think about construction of China’s basic medical insurance system and various actual problems currently exist on the basis of full respect for the history and reality. We can consider selecting different aspects from different system to form a complete solution that is most suitable for our own country, in order to better reflect health justice.The third chapter review and evaluate of the development of the medical insurance system of our country, mainly including the evolution and development direction of the three system containing the basic medical insurance for urban employees, the new rural cooperative medical insurance system, and the basic medical insurance system for urban residents. There is no denying that the gradual construction of the three system make up for the defect of inadequate coverage of medical insurance system and preliminary realizes "universal health care". However, there exists deep institutional defects in the three basic medical insurance system, mainly in system design,system supply, system operation and system security level, directly undermining the fairness of the medical insurance system, damage to the operating efficiency of the medical insurance system.Thereby establishing and perfecting universal basic medical insurance system will be a daunting task of reform of China’s medical insurance system in the future.The fourth chapter analyzes and compares the current exploration practice of the local government for the universal basic medical insurance system.According to different economic and social development level, the local government carried out early exploration and practice of the construction and operational mode of the universal basic medical insurance system. Affected by regional economic development, urbanization and institutional basis, there are different evolutionary paths for basic medical insurance system in different regions. This part mainly selects four areas of system models for analysis and comparison, respectively, Dongguan, Taicang, Shenmu and Jiaxing.Though the pilot areas have different logic and evolution path of system modes, they provide practical experience for the construction of the universal basic medical insurance system, such as unifying administrative institutions, integrating information management and guaranteeing fund running smoothly, etc. It is the inevitable trend of development of fragmentation system to realizethe universal basic medical insurance system.The fifth chapter mainly analyzes the key points of the universal basic medical insurance system, mainly containing system model, public values of system, system principle, target and the feasibility of the system implementation and so on. This part furtherly clarify the necessity and strategic significance of implementing the universal basic medical insurance system on the basis of the above. First of all, through elaborating the connotation of the universal basic medical insurance system model, and analyzing its similarities to and differences with the current system of "universal medicare", it reflects the essence of innovation paradigm.Then the author analyses the public value orientation of institution from the perspective of political science, namely adhering to health justice and stick to the bottom line. Again, the author elaborates that the system follows the principle of fairness, Moderate Whitney, enforcement, combination of rights and obligations, and sustainable development. Fourthly, the author clears the system target- "Ensure everybody equal access to a basic medical insurance". Eventually the author discusses the feasibility of the system implementation from four aspects of politics, economy, society and system.In the chapter six, the author thinks about the ideas and gradual steps to push forward the reform of the universal basic medical insurance system in China. We mainly adopt the gradual path of "three steps". The first step is to integrate of urban and rural basic medical insurance system oriented by balancing urban and rural system. The second step is to integrate the urban and rural basic medical insurance and basic medical insurance for urban employees aiming at bridging system differences. The third step is to build "universal basic + complement medical insurance" in order to realize health justice. Although the reform is gradually promoting, there still exists various obstacles,containing obstacles of cohesion, jurisprudence, resources, technique and "shock barriers" in the process of institutional change.Reform is not achieved overnight. We can neither overemphasize differences between the system, nor unified path selection. We should admission that the system of differences is the preparation stage to push forward the reform of the universal basic medical insurance system in China. Therefore specific measures to achieve health justice of putting forward the reform of universal basic medical insurance system in our country should be proposed according to the institutional defects and obstacles. They include promoting system integration through top-level design, establishing stable and long lasting financing mechanism, strengthening theconstruction of information platform, realizing the integration of management and supervision system of medical insurance, strengthening legislation of the basic medical insurance system,realizing rational allocation of resources and improving the external environment and supporting measures, etc.