Study On Current Chinese New Rural Cooperative Medical System Development

The present dissertation aims to discuss issues on China's new rural cooperative medical care system development from multiple perspectives. The new system is strongly featured by joint support and relief with combined commitments of government organization, direction and support, farmers' voluntary participation, pool of funds by parties of individuals, collectives, and governments, so as to enable farmers to access medical care when in need, lessen their financial burden, and improve their level of health. The nature of the new system itself as well as in-depth discussions about theoretical foundations and explorations about the path to healthy and sustainable development of the new system suggests the practical and theoretical significance of the present study. The findings will help strengthen the awareness of the importance of the sustainable development of the new system, identify the conditions and operation mechanism for the ultimate goal to materialize, and yield institutional insights for how and in what new directions the new system will develop.The current academic research in the field of China's current new rural cooperative medical care system has developed mainly along the following lines. They include its fund raising mechanism, compensation mechanism, government's responsibility for its construction and amelioration, practiced models of its experimental areas, performance assessment indictors of its implementation, etc. Though these findings have laid foundations and opened paths for further and systematic research, there are some gaps needed to be further explored and improved in both practice and theory respects. Though there has been a relatively large body of research on the new system itself, government's responsibility for its construction and amelioration and their role, recipients management enhancement, little has been done with societal environment for the new system to be grounded in, farmer participation mechanism and function for its construction and amelioration, effective supplier management enhancement. Significant remains lack of systematic discussion about the new system's sustainable development issues from a multi-dimensional perspective and of empirical study as well. The present study aims to open such a discussion and fill the gap. Inspired by the current research literature, the present study begins with an introduction to its background, i.e. the construction of a full-scale well-off society and a socialist new village through vigorous efforts and a socialist harmonious society, and theoretically grounded on social security and cooperative economy by Marxist classic writers, relevant rural medical care security by the Communist Party of China, and relevant western social security. Its research methodology is characteristically multi-dimensional, inclusive of a combination of normative and empirical approaches, and quantitative and qualitative approaches, and perspectives of history and reality, theory and practice, necessity and feasibility, system and environment, participating agent function and conduct, etc. A holistic, multi-dimensional, multi-layered study is conducted to examine the necessity, feasibility and path of the sustainable development of the new rural cooperative medical care system. Its objective is to explore effective counter-measures and solutions for the new system to healthily develop and sustain. The main contributions of the present study lie in the following three respects. First, it opens a holistic and multi-dimensional discussion about the necessity and feasibility of the new rural cooperative medical care system construction and amelioration from a perspective of theoretical foundations, thereby revealing theoretical and practical support, and facilitating conditions. Second, it provides a relatively thorough, and systematic description of the contemporary China new rural cooperative medical care system operation based on a large collection of reliable statistics and data and an objective, and sufficient categorization and analysis of problems and achievements concerning the new system. Third, it concludes with some ideas and proposals for how to promote the healthy and sustainable development of the new system from perspectives such as system design, agent accountability, and external environment.The new system evolves from the traditional rural cooperative medical system. To fully understand and analyze the new rural cooperative medical system requires a historical review of China's traditional rural cooperative medical system. Explanatory reasons for success or failure in the course of China's traditional rural cooperative medical system lay foundations for analyzing problems in the new rural cooperative medical system and provide insights on its sustainable development. A review and reflection of China's traditional rural cooperative medical system has yielded three findings. First, a comprehensive system is designed to ensure the foundation of sustainable development in the cooperative medical system. Despite an important role in protecting farmers the health, The rural cooperative medical system design was flawed and insufficient because of a limited fund coverage, weak capacity to shelter from risks, lack of effective expense restraint mechanism for farmers, and effective fund management and supervision mechanism, a focus on prevention but a low level of protection. These weaknesses were closely tied with the traditional planned economic system for its operating environment. All in-built deficiencies determine the unsustainable development of the system. Second, appropriate environment is required for a system to operate soundly. Even the same system design will have varied outcome if operating in different environments. From 1960s through 1970s, the traditional rural cooperative medical system functioned well because its arrangement was suitable for its operating environment. From the 1980s through the 1990s, the widespread breakdown and subsequent recovery and reconstruction of tradition rural cooperative medical system were attributable to great changes in the socio-economic environment. The environment was no longer suitable for the traditional system. Third, the government's active intervention and public support was key to sustainable cooperative medical system development.To develop and ameliorate a new rural cooperative medical system is not only necessary but also practical. The necessity can be understood in terms of both theory and practice. On the one hand, propositions related to social security and cooperative economy theories by Marxist classic experts provide important theoretical foundations for the new rural medical system. Guidelines for the rural medical care and hygiene cause by communist party leaders such as Mao Zedong, Deng Xiaoping, Jiang Zemin, Hu Jintao, constitute the direct theoretical source of the new system. Other theoretical sources include propositions and implications of western risk theory, counter-poverty theory, welfare economic theory, human capital theory, government intervention theory. On the other hand, to construct and ameliorate the new system is an inherent requirement by defending and warranting citizens' health right, an eventuality of constructing a comprehensive well-off society, an important guarantee by smoothly promoting a new socialist village, and an important move of building a socialist treatment standard and improve their service capacity. Moreover, external environment also constrains the new system's sustainable development. Significant is the constraint of farmers' low income, particularly in poverty-stricken areas. These problems, if not managed and solved duly and effectively, may reduce its security effect or lead in a wrong direction, thereby hindering its healthy operation and sustainable development.The healthy and sustainable development of the new rural cooperative medical system requires a proper scientific system design, continual efforts in mobilizing parties concerned to their full play and in regulating their conduct, and efforts in improving favorable external environment. First, it is imperative to improve and invent the fund-raising mechanism and compensation mechanism of the new system based on thorough survey and research and guided by relevant scientific principles so as to continually ameliorate the system design. Second, it is urgent to marshal the commitment by three main parties concerned in the new system, i.e. government, participating farmers, and designated medical institutions, and bring their function and role to full play: 1) the government must learn from the history of the traditional rural medical system boom and collapse, and practices outside mainland China as well, and undertake full responsibility of system design, propaganda and launch, pumping funds, organizational coordination, administrative supervision, health service, administrative legislation, among other functions; 2) it is crucial to stimulate farmers' participation by all means and take measures to reduce the "adverse selection" and "moral hazard" problem to a minimum extent; and 3) it is necessary to reinforce management and supervision of designated medical institutions, and raise their service awareness, regulate their service conduct, so as to provide participating farmers with standard, high-quality, and affordable medical service. Third, it is a must to continually improve the external environment favorable to the new system's healthy and sustainable development. Vigorous efforts must be taken to increase farmers' income, further the rural drug market reform and the rural medical and health service system construction, and refine the rural medical relief and support system, etc.As an evolving process, the current new system involves continual cultivation and refinement. The economic growth in the past few decades and beyond have treatment standard and improve their service capacity. Moreover, external environment also constrains the new system's sustainable development. Significant is the constraint of farmers' low income, particularly in poverty-stricken areas. These problems, if not managed and solved duly and effectively, may reduce its security effect or lead in a wrong direction, thereby hindering its healthy operation and sustainable development.The healthy and sustainable development of the new rural cooperative medical system requires a proper scientific system design, continual efforts in mobilizing parties concerned to their full play and in regulating their conduct, and efforts in improving favorable external environment. First, it is imperative to improve and invent the fund-raising mechanism and compensation mechanism of the new system based on thorough survey and research and guided by relevant scientific principles so as to continually ameliorate the system design. Second, it is urgent to marshal the commitment by three main parties concerned in the new system, i.e. government, participating farmers, and designated medical institutions, and bring their function and role to full play: 1) the government must learn from the history of the traditional rural medical system boom and collapse, and practices outside mainland China as well, and undertake full responsibility of system design, propaganda and launch, pumping funds, organizational coordination, administrative supervision, health service, administrative legislation, among other functions; 2) it is crucial to stimulate farmers' participation by all means and take measures to reduce the "adverse selection" and "moral hazard" problem to a minimum extent; and 3) it is necessary to reinforce management and supervision of designated medical institutions, and raise their service awareness, regulate their service conduct, so as to provide participating farmers with standard, high-quality, and affordable medical service. Third, it is a must to continually improve the external environment favorable to the new system's healthy and sustainable development. Vigorous efforts must be taken to increase farmers' income, further the rural drug market reform and the rural medical and health service system construction, and refine the rural medical relief and support system, etc.As an evolving process, the current new system involves continual cultivation and refinement. The economic growth in the past few decades and beyond have impacted and will impact the external environment where the new rural cooperative medical system operates. New issues will emerge along with the on-going implementation and require solutions different from conventional ones. In return, they call for empirical research on sustainable development issues of the new rural cooperative medical system. These lines of considerations not only give support for the significance and value of the present study but also highlight the need to continue the present line of study in the future.