| According to the world health report 2000 published by the WHO, China ranked 188 among the 191 member countries in terms of the medical contribution equality. The resource of the medical security is unequally distributed with more than 2/3 resources given to the 15% city members while the 1/3 left given to the 85% rural members. China's cooperative medical security system, which was once successfully recommended to other developing countries in the 1960s and 1970s, has been disabled in the 1980s, and the rural members in China are lack of medical security system. 90% rural members are out of the security of social medical security, more than 13.05 million rural members become poor annually because of illness. In 2003, the SARS disclosed the vulnerability of the rural medical security system. It's very urgent and important to build the rural medical security system. In the transitional period, great change has taken place in China in terms of the economy, the society and the rural culture. The east middle and west part of China are different from each other, the peasants are differently employed, the medical security agents are pursuing profit and the price of the medical rise at a rate faster than that of the income of the peasants, all of which are restricting the building of the rural medical security system. Which kind of medical security system to build and how to build it are the two key points of this essay.This essay is written in time logic, from the analysis of the past failure, I propose the problem; from the present reason analysis, I explore the problem; at last I vision the future medical security system model and propose the detailed measures to realize the model.This essay consists of a preface and four chapters:In the preface, I introduce the background and the method of this essay. Rural medical security system is under great attention of the government and the researchers, and there is trial system in the countryside. But this essay regards medical security system as an institution and analyzes it in the context of history. I think the problem of the rural medical security system is policy problem, capital problem and the inter-belief of the government and peasants in the transitional period.In the first chapter, I retrace the history of rural medical security system and analyze the ups and downs of the first and second cooperative medical security system respectively. The success of the first cooperative medical security relies on the complex of rural doctors and the medical agent system. While the economic basis relapsed in the 1980s and the doctors became profit-hunters, the first cooperative medical security system became over and the second cooperative medical security system began to explore a new way out.In the second chapter, I analyze the situation and the reasons of the problem. Because of the unequal distribution of medical resources and the human resources, the peasants have no access to medical security; because of lack of the medical security system and the price rises faster than the income, the peasants cannot pay the medical security. To explain these difficulties, I think the government was not acting suitably in the transitional period and the local government was not motivated to provide public goods, while the peasants were doubtful about the medical security reform because of the historical failure.In the third chapter, I analyze the constricting factors in the transitional period to rebuild the medical security system and propose a multi-level rural medical security model. I think the government should shoulder the task to finance more for the peasants, let the peasants choose freely and encourage multiple agents to finance and supervise it. In the whole nation, I propose a multi-level medical security system model and different parts of the countryside should choose different model suitable for the special situation.In the fourth chapter, I give some proposals to the building of the medical security system scheme after the analysis of the ref... |
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