Rural Health Protection System In The Main Body Of Behavioral Research

In the new Cooperative Medical System, the interactive among different related-interest groups or roles, such as providers, insured, fund and government agencies, jointly determines the efficiency of the system. The purpose of this dissertation is to analyze and discuss the behavior mechanism of related roles, demonstrate the challenges and dilemma, and further to discuss solutions to important incentive problems in which threaten their sustainability.Health financing has made important influence on the three goals of health systems: financial fairness, disability-adjusted life expectancy and responsiveness. Health financing involves risk pooling and resources pooling, which affects the use of health care for different income groups. The introduction of health insurance influences demand and supply and other variables. The growth of community-based health financing arrangements rests on developments in three related areas ,that is microfinance (microcredits, microsavings, microinsurance, financial intermediation), social capital (community, network, institutional, and societal links), mainstream theories (welfare of society, public finance, social policy, and health policy).Ever since the collapse of the once successful Rural Cooperative Medical System in the early 1980s, many rural communities, especially the poorer residents, have faced several major problems. User charges effectively blocked access for many rural residents who lack adequate income to purchase basic health care when needed. Impoverishment due to medical expenses is also a serious problem.The vicissitude of Cooperative Medical System can be explained with the theory of New Institutional Economics. The early flourishing of Cooperative Medical System was the result of institution equilibrium. The collapse of the once successful Rural Cooperative Medical System was due to inside dilemma and outside adverse environment, which led to disequilibrium. Because of the interactive of demand and supply, especially inadequate government policies, led to inadequate incentive for both induced and forced institution vicissitudes. These hindrances explain the lack of rural health insurance in the whole 1990s. Recently, the Chinese government announced a new rural health financing policy, which was a forced institution change in the new environment.Community financing can be seen as having three independent objectives: (a)mobilizing financial resources to promote better health and to diagnose, prevent, and treat known illnesses;(b) protecting individuals and households against direct financial cost of illness when channeled through risk-sharing mechanisms;and (c) giving the poor a voice in their own destinies and making them active participants in breaking out of the social exclusion in which they are often trapped.According to this framework, Rural Cooperative Medical System has played a important role in risk sharing and financial protection. But with the model of low premium and high co-payment, it was somewhat unfair in acquiring the benefits for the poorer.The ability and willingness of rural farmers to pay contributions to Rural Cooperative Medical System is the basis for sustainable development. This thesis predicts the ability to pay with the extended linear expenditure system. It discovers that the poor cannot afford to pay. But for most of the farmers with middle or above income, willingness to pay is more important than ability to pay. The factor influencing willingness to pay includes trust for government, the ability of government, the amount of subsidy, social capital, the tradeoff between costs and benefits, risk sharing mechanism within a family and among families and some individual characteristics.This thesis discusses solutions to important incentive problems in Rural Cooperative Medical System which threaten their sustainability. In particular, three issues explored are adverse selection, moral hazard and provider-induced demand. Compulsory Rural Cooperative Medical System isn't justified at the moment. It can perhaps prevent adverse selection, but at the same time bring about moral hazard from administrators and providers. Household as unit of insurance doesn't always mitigates adverse selection problem and is not always appropriate, so the best way of providing incentives depends very much on the context, that is, on the characteristics of the target population and the health risk profile. At the same time, household as unit of insurance can bring about some unexpected outcomes, that is, hinders the development of cities.Co-payment can prevent moral hazards, but it also block access for health care, especially for the poor. Co-payment is needed as not financial cause but as incentive to prevent cost. Ex ante moral hazard problem can be circumvented through group insurance contract.Providers, knowing that their patients are covered by insurance, may alsoencourage unnecessary utilization. Different payment mechanisms can prevent providers-induced demands. Appropriate payment ways should be chosen and institutional causes should be eliminated.Governments can take a lot of actions to facilitate the development, sustainability, and impact of Rural Cooperative Medical System. The subsidy for rural health protection substantially lags behind the appropriate level. To eliminate the big gap, government should transform to focus public services. It is also important to adjust intergovernmental fiscal relations.From the perspective of justice of Rawls, substantive freedom and capability of Amartya Sen, human rights, health entitlement and social security entitlement, a universal basic health protection system should be established. The thesis put forwards the framework of the universal basic health protection system.