Research On The Introduction Of Market Mechanism Reform In China's Medical Security System

Health care/medical security has been a difficult problem to be solved all over the world.It is of great significance to China.There are different views on the reform of the medical security system.The prevailing view is that both the government and the market should be introduced to the medical security system and be given full-play to the role of the two mechanisms in order to take into account the accessibility,fairness and efficiency requirements of medical security.According to the current state of our country,the main problem of medical security system is the lack of efficiency.To resolve inefficiency,there are two aspects which are to introduce market mechanism and to increase investment in government social security institutions.The increase of government investment in social security institutions cannot radically resolve the problem of better operation in health insurance business,however,it will further increase the financial burden of the government.The introduction of market mechanism is the only way to improve operational efficiency of China's health insurance system.During the 20 years of the establishment of social health insurance system,China has worked out four kinds of models of introducing market mechanism into health insurance system:delegated administration model,critical illness insurance model,full coverage model and co-grant model.Germany,Switzerland and the Netherlands,which are the three typical countries take the same social health insurance model as China does,have also been to improve market participation as the main feature of the health insurance reform.Dutch model is especially highly respected.These five models can be used as China's future options to introduce market mechanism into health insurance.In view of the difference of the real conditions between China and the Netherlands,China is still not ready to implement the Dutch model.Of the other four native models as which are the most suited to our country,this paper will compare them from four aspects.The first is the comparison based on Situational Determinism Theory.This theory derives from Professor Zheng Gongcheng's thesis about the Social Security Model.The writer proposes a theoretical framework about medical security model combining Zheng's theory in the reality of China.That is,the role of government and market in certain medical security system,the relationship of government and market in other words,is determined by two kinds of factors: controlling-demand factors and vitality-demand factors.Considering social security tradition,medical and health service market,the degree of maturity of the insurees,commercial health insurance and so on,the relationship of government-market in China medical insurance system should be a equal cooperation model.On the whole,the model of co-grant is most consistent with Situational Determinism Theory.The second is based on the comparison of actual results of above four models.From the actual results,there are a lot of problems or limitations in the delegated administration model,full coverage model,and critical illness insurance model.Only the co-grant model can overcome these problems and limitations existing in the other three kinds of models and get optimal effect.The third is the comparison based on Transaction Cost Theory.According to Coase's theory of transaction cost,the four models are compared comprehensively from the six aspects of information search cost,negotiation decision cost,contract cost,supervision cost,execution cost and conversion cost.Compared with the other three modes,the total cost of the co-grant model is the lowest.The transaction cost theory holds that the cooperation model with the lowest transaction cost is the best.The fourth is the comparison based on Mechanism Design Theory.According to the Mechanism Design Theory,the cooperation mechanism which is most consistent with the participation constraint,information efficiency and incentive compatibility constraint is the best choice.This article,from comparison in the three aspects amongthe four models,points out that the co-grant model is the most consistent with the above three requirements.Therefore,from the four dimensions of comparison,co-grant model is currently the best option for China to introduce market mechanism to medical insurance system.Of course,the existing practice is not perfect,but also need to improve from all aspects.At the same time,we need to take a variety of supporting measures for the comprehensive promotion of co-grant model.This article has eight chapters.Chapter One is the introduction which is a brief introduction to the relevant research background and the basic situation.The second chapter is literature review of the basic theory of introducing market mechanism to the medical insurance systemand develops the Situational Determinism Theory based on Zheng Gongcheng's theory.The third chapter analyzes the special environment of the medical insurance system reform in our country.The fourth chapter analyzes the problems existing in the operation of basic medical insurance in China and points out that these problems should be solved by introducing market mechanism rather than increasing investment in social security institutions.The fifth chapter introduces the four typical models of introducing market mechanism to medical security in China's practice.The sixth chapter is a review of the international experience(mainly Germany,Switzerland,the Netherlands).At the same time,based on the analysis of the social environment on which the reform of the three countries succeeds,it is pointed out that China cannot implement this kind of reform.In the seventh chapter,the four typical models of domestic exploration are compared from four aspects:situational determinism,actual effect,transaction cost and mechanism design theory,and the conclusion is drawn.Chapter Eight is the conclusion and the prospects.