Medical expenditure has become a heavy burden on the public sector and the family system in many countries. Expanding the coverage and reimbursement of medical insurance has become a common way to reduce the burden. This book will elaborate on how medical insurance may increase the burden instead.
It explains why the existing medical insurance system results in increased medical costs, where higher costs may offset the benefits of certainty brought by medical insurance, forming the "paradox of medical care insurance". This assumption is verified by empirical evidence in China, through a new method developed to find out the actual medical costs, using two parameters: ratio of self-payment of medical insurance and the level of monopoly in the supply of medical services. The book also describes the history, the current situation, and the reform of the health care system in China.
| The Effect of this Research Reform Program |
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v | |
| The Effectiveness of the Reform |
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vii | |
| Summary |
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ix | |
| Abstract |
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xv | |
| Members of the Research Team |
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xxi | |
| Acknowledgments |
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xxiii | |
| Division of Work |
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xxv | |
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Chapter 1 Economic Subjects and Markets in the Medical Field |
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1 | (22) |
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I The Patient: The Situation Before the Professional Doctor Appeared and the Basic Characteristics of the Patient |
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1 | (2) |
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II Doctors and the Simple Medical Market |
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3 | (9) |
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III The Pharmaceutical Industry: The Situation After the Division of Labor Between Medical and Pharmaceutical Branches |
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12 | (11) |
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Chapter 2 The Insurance System and Its Problems |
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23 | (56) |
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I Purpose of Insurance: To Eliminate Uncertainty and Increase Utility |
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23 | (6) |
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II Existing Understanding and Criticism of the Insurance System |
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29 | (3) |
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III Further Questions: The Weakening of the Medical Insurance System Owing to Market Mechanisms |
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32 | (9) |
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IV Insurance Paradox: Insurance Does Not Reduce but Increases Medical Cost |
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41 | (15) |
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V Other Problems of Insurance |
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56 | (8) |
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VI Economic Subject and Market Under Insurance System |
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64 | (14) |
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78 | (1) |
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Chapter 3 Government Involvement in the Medical Field |
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79 | (18) |
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I The Government's Tradition of Involvement in the Medical Field |
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79 | (1) |
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II Intervention Due to Market Failure |
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80 | (2) |
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III Intervention of Uncertainty: The Government Directly Establishes the Insurance System |
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82 | (1) |
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IV Government Intervention Under the Insurance System |
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82 | (10) |
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V Macroresults Caused by the Insurance System Under Government Intervention |
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92 | (3) |
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VI Summary of the Theoretical Part |
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95 | (2) |
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Chapter 4 The Formation, Status Quo and Problems of China's Basic Medical System |
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97 | (80) |
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I System and Policy Changes in China's Medical Industry |
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97 | (18) |
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II The Institutional and Policy Framework for the New Medical Reform in 2009 |
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115 | (21) |
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III The Basic Framework and Characteristics of the Existing Medical System |
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136 | (16) |
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IV China's Medical Insurance System |
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152 | (19) |
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171 | (6) |
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Chapter 5 Efficiency and Fair Evaluation of Resource Allocation in the Medical Industry |
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177 | (70) |
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I The Standard of Efficiency and Fairness of the System |
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177 | (4) |
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II The Phenomenon of Medical System Problems |
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181 | (30) |
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III The System Analysis and Evaluation of China's Medical System |
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211 | (8) |
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IV The Efficiency Evaluation of Resource Allocation in the Medical Industry |
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219 | (16) |
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V Fair Evaluation of Resource Allocation in the Medical Industry |
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235 | (11) |
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246 | (1) |
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Chapter 6 Reform Plan Based on Market System |
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247 | (42) |
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I Direction and Principle of Medical Reform: Based on the Market System, Supplemented by Government Regulation |
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247 | (3) |
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II Comparison and Reference of Several Medical Systems in the World |
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250 | (6) |
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III Reform of Medical Security System |
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256 | (6) |
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IV Reform of Medical Service System |
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262 | (3) |
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V Drug Production and Circulation System Reform |
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265 | (2) |
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VI Carry Out Auxiliary Regulations for Medical Field |
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267 | (1) |
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VII Evaluation of the Effect of Medical Reform |
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268 | (17) |
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285 | (4) |
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Chapter 7 Strategies and Timing of Medical System Reform |
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289 | (16) |
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I Transitional Economics: Pursuing the Minimization of Reform Costs |
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289 | (1) |
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II China's Reform Experience |
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290 | (1) |
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III The Problems that May Be Encountered in the Reform of the Medical System and Their Solutions |
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291 | (6) |
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IV The Breakthrough of Reform |
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297 | (2) |
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299 | (4) |
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VI The Timing of the Reform |
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303 | (2) |
| Subject Report: Survey Report on Going to the Hospital to See a Doctor |
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305 | (26) |
| Appendix: Questionnaire for Going to the Doctor |
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331 | (10) |
| References |
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341 | (10) |
| Index |
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351 | |
Sheng Hong, Director of the Unirule Institute of Economics (20032019), a retired professor at the Economic Research Institute of Shandong University, was born in 1954, graduated from People's University of China in 1983, and received Master's Degree and Doctor's Degree in Economics from Chinese Academy of Social Sciences in 1986 and in 1990 respectively. He was a visiting scholar of the University of Chicago from 1993 to 1994.
Since 1990s, Sheng Hong has been focusing on institutional economics, international political economy, and comparing and combining traditional Chinese culture and Western economic theories. He has published dozens of papers and books in China's main academic journal and press of economics. His representative books are: Division of Labor and Transactions (1992), Transitional Economics of China (1994, as chief editor), Creating Peace Forever (1996), Seeking for a Stable Way for the Reform (2002), Governing a Large Country as Cooking Small Fishes: An Institutional Economics on Governments (2003), The Great Wall and the Coase Theorem (2010), The Natural Law is the Gentlemen's Mission (2013), An Explanation on Confucianism by Economics (2015), and Research on Efficiency and Fairness of Resources Allocation by China's Governmental Administration (2019).
Zhang Lin is Researcher of Unirule Institute of Economics, Academic Assistant of Professor Mao Yushi, Columnist. He was born in 1988, conferred Master's degree in Economics from the Graduate School of Chinese Academy of Social Sciences in 2011. He organized and took part in many projects related to market economy promotion and private economy protection; published several in-depth reports on public policy analysis. He has written both Chinese and English reviews in mainland China and Hong Kong, focusing on China's and the world's macroeconomic operation and China's public policies. He has also attended several training sessions from The Ronald Coase Institute, Friedrich-Naumann-Stiftung and CIPE.
Qian Pu, female, born in 1974, graduated from the Department of Urban and Rural Construction Economics, Graduate School of Chinese Academy of Social Sciences. She holds a Master's degree in Economics. She is now the Deputy Director of the Public Utilities Center of Unirule Institute of Economics. Her research fields include urban economy, investment and financing mode of municipal public facilities, reform of government management system and so on. She has taken part in many public policy research projects in Unirule Institute of Economics, including: "The Nature, Performance and Reform of State-owned Enterprises" (20102011), "Administrative Monopoly in China, Cause, Behaviors, and Termination" (20122013), "Opening up China's Markets of Crude Oil and Petroleum Products, Theoretical Research and Reform Solutions" (20132014), and "Research on Efficiency and Fairness of Resources Allocation by China's Governmental Administration " (2019).
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