The Study Of Chinese Rural Medical Insurance System Changes

As one of the main contents of political science,institution runs through the development of political science.As the main system of rural social security,the reform,development and improvement of rural medical insurance system can not only disperse farmers' disease risk,reduce their medical burden and improve their health and well-being,but also help alleviate social interest conflicts,safeguard social fairness and justice,and enhance the legitimacy of state power.It can be seen that the rural medical insurance system,while reflecting its sociality,also shows a strong political nature.Chinese rural medical insurance system has gone through a "ups and downs" of institutional changes from the micro-community mutual medical insurance at the beginning of the founding of the People's Republic of China to the "transitional" social medical insurance in the integration period of urban and rural integration.Up to now,there are still many problems,such as the unsmooth management and handling system,the unreasonable financing structure,the unsound treatment and payment system,the imperfect supervision and control mechanism,and the excessively rapid growth of medical expenses,which pose great challenges to social stability and fairness,as well as the ability of the state and the government.Although,the complicated changes of Chinese rural medical insurance system have always been paid close attention to by the academic circle,and formed different research paths such as economy,system,society,culture and politics.But the analysis of single Angle can't show the "real" process and internal logic of Chinese rural medical insurance institutional change,which due to Chinese rural medical insurance system having three core elements of macro management,financing,treatment pay system,relationship between medical insurance and medical service "two markets",pertaining to the country,the government,social organizations and individual farmers and other diverse interests,with the political,economic,and social environment being highly coupled.Therefore,the historical institutionalism theory that combines "Structure","action" and "history" elements to explain system vicissitude,provides a broad perspective for exploring the deep logic of Chinese rural medical insurance system change and providing the path for the future reform of Chinese rural medical insurance system.Hence,this paper uses the method of historical institutionalism dividing institutional change stages based on key nodes to divide Chinese rural medical insurance system change process into five stages.The first is initial stage(1949-1957),the second is the people's commune period(1958-1977),the third is the early reform and opening up stage(1978-2001),the forth is early in the new century(2002-2008),the fifth is urban and rural integration acceleration period(2009-present).Through a comprehensive and systematic analysis of the evolution of Chinese rural medical insurance system,the paper summarizes the overall characteristics of Chinese rural medical insurance system changes,and focuses on exploring the internal logic of the changes.Three main conclusions can be drawn as follows:Firstly,Chinese rural medical insurance system has complex transformation processes and multivariate change characteristics.Chinese rural medical insurance system has experienced five major changes,which are micro-community mutual medical insurance,collective welfare medical insurance,institutional rupture,primary social insurance medical insurance,“transitional” social medical insurance.At the same time,under each big institutional change stage,there are continuous and different institutional change processes,such as institutional innovation,institutional diffusion and institutional improvement.In addition,it forms the change path of stratified order,which includes the parallel of inducement and compulsion,the interaction of endogenous and exogenous,the coexistence of gradual and sudden,the coexistence of desirability and contingency,as well as the performance of institutional change with both advantages and disadvantages.Secondly,the change of Chinese rural medical insurance system follows the logic of "environment,subject and time".The institutional environment influences the change of rural medical insurance system through the sticky coupling mechanism.The macro-management,financing and treatment payment systems in the structure of Chinese rural medical insurance system are highly intertwined with the political,economic and social environment,forming the structural logic of Chinese rural medical insurance system changes.The subject of action affects the change of rural medical insurance system through value preference and interest game mechanism.Farmers in the early years of the founding of the common action,the integrity of the people's commune period of national mobilization,early stage of reform and opening to the government,medical institutions,farmers,such as multiple subject of cooperative game,multiple subject at the beginning of new century of cooperative game and urban-rural integration acceleration period people clubs and health management of the race,between the two departments to promote Chinese rural medical insurance system autonomic change.In addition,Chinese rural medical insurance system has formed a strong dependence on the path of "state-led","voluntary cooperation" and "dual security" during the nearly one hundred years of vicissitude history,and has also been deeply affected by many accidental events and key nodes.Thirdly,in the future,Chinese rural medical insurance system should develop towards a more equitable,healthy,efficient and sustainable direction on the basis of optimizing the institutional environment,standardizing the behaviors of all actors,breaking through path dependence and grasping key nodes.