Health Care Product Supply And Its Institutional Arrangements

No matter from the reality of domestic healthcare reform or the practice of overseas healthcare development, it is an important study task of realistic meaning and urgency to guarantee the medical and healthcare products' provision by effective institutional design and arrangement. However, in current healthcare theory system, more studies lay particular attention to settle healthcare problems from demand side analysis while scarce studies on deep research of healthcare products provision by applying economics theory. Although being often used in judging the role played by government and market in healthcare, mainstream economics theory rarely contributes to the study on organization and arrangement of service products as well as basically not involves in institutional arrangement problems. Therefore, with the new approaches of public goods, neo-institutional economics and public choice, the theory discussion and analysis of healthcare products provision mechanism and institutional arrangement in terms of institutional design not only complements healthcare economics theory but also is the theory basis for drawing up healthcare development policies and guiding health reform practice for each authorities.Accordingly, the article starts with the analysis of social attribute of healthcare products, makes use of economic analysis methods, especially applying the current study achievements of public goods theory, neo-institutional economics and public choices theory, into systematic analysis and explanation of attribute, provision mechanism and institutional arrangement of healthcare products, which may provide a guidance to practice of domestic healthcare system reform.The dissertation comprises seven chapters. Chapter 1 is the introduction section. Based on explicating topic background and meaning, the chapter explains the research thinking, research approach and research framework as well as research difficulties and innovative points. Chapter 2 is the section of relative literatures retrospection. Through summarizing relative literatures, the chapter tries to make succession and innovation of the current theories to seek for effective solution to institutional arrangement of healthcare products' provision.Chapter 3 to chapter 5 is the main body of the research. Chapter 3 is the section of connotation definition of healthcare products and measurement of its social attribute. Based on the deep analysis of healthcare products' connotation and characteristics, the chapter clarifies industry characteristics and social public welfare of healthcare. Towards the classification standard defect of traditional product public/private attribute, the article regards its social attribute as one gradual pedigree, which establish research basis for analyzing and studying different healthcare products' provision mechanisms and institutional arrangements in the following text. Chapter 4 is the mechanism analysis of healthcare products' provision based on the perspective of financing. In the context of healthcare products' financing patterns, the chapter establishes one gradual pedigree from public to private, from government guiding to market dominance. Based on this pedigree, the chapter deeply discusses logic causes of different healthcare products' provision mechanisms. Finally, by modeling, the chapter compares three patterns of two mechanisms of healthcare products' provision. Chapter 5 is the institutional arrangement of healthcare products' provision from the angle of healthcare delivery organizations. Through historical comparison method, the chapter reviews the historical progression of continual change-over functional boundary between government and market in healthcare. By applying Aoki Masahiko's institutional analysis framework, the author looks upon the evolution of healthcare products' provision system as changing course of institutional equilibrium based on common relief. Finally, by analysis of multi-center order of healthcare products' provision and different mode of its institutional arrangement, the article concludes that only by diversified institutional arrangement and synergetic effect of government, corporations and social public etc can realize and satisfy people's multi-level healthcare demands.Chapter 6 is the section of lessons from domestic healthcare system reform. Transferring from theory analysis to the current situation of domestic healthcare reform, the chapter combines the previous basic theory analysis of healthcare products provision with domestic healthcare reality. The author considers the healthcare provision in commanding economy era as low-level equilibrium based on healthcare products provision by government while considers the healthcare system after opening-up as provision disequilibrium due to over market-orientation of healthcare provision and failure government intervention. Furthermore, towards the real dilemma of domestic healthcare status quo, the author points out six striking contradictions and corresponding deep-seated causes. Meanwhile, the article put forward relative policy suggestion to establishment of the new healthcare system that meeting domestic economic development level and public affordability.Chapter 7, section of conclusion and future research orientation, summarizes the article's main research conclusions and relative deductions, explains research limitations and points out the future research orientation.