Second, although the resumption of cooperative medical care does not depend on the existence of a collective economic organization, the pre-community public **** capital and wealth is indeed a condition that must be present in the cooperative medical care;
Third, after the decentralization of farmers, the villagers' autonomy on the basis of the community's re-cooperative, re-organized The organization is also a must-have condition for cooperative medical care;
Fourth, the credibility of the medical insurance organization is a must-have condition for the implementation of farmers' medical insurance.
Rural medical security consists of two aspects: the health service supply system and the rural health care system. For a long time, cooperative medical care has been the main form of rural health care system in China. However, since the establishment of the rural cooperative medical system, in China's vast rural areas have experienced several ups and downs, to date, most areas of the cooperative medical care has gone into decline.
After major economic and social changes in rural areas, can cooperative medical care be restored? Is medical insurance feasible?
What is a viable rural medical insurance system?
This series of major issues related to the development of rural society has been the concern of the government, farmers and researchers.
A great deal of research and study has been done in terms of financing capacity, financing levels, payment methods, and cost-sharing mechanisms. On the basis of these studies, we believe that it is also necessary to listen to the ideas of the direct beneficiaries, the farmers, on the issue of rural medical insurance. To this end, we interviewed more than 60 farmers in eight villages in Wenxi County, Shanxi Province, including ordinary farmers, village cadres, and rural doctors. Most of the interviewees were over 40 years old, and about half of them were between 40 and 60 years old. Based on the audio recordings of the interviews, 45 interview transcripts were organized. This report is a preliminary analysis of the interview transcripts. Background of Wenxi County Wenxi County belongs to the old revolutionary area, located in the southern part of Shanxi Province, and is a seriously water-poor agricultural county. Constrained by geography and natural conditions, agricultural production is inefficient and farmers' living standards are slow to improve.In 1990, Wenxi County was listed by the state as an additional poor county during the Eighth Five-Year Plan period.
Farmer Interview Overview
1. Family Economy:
Farmer families still focus on grain cultivation, while growing vegetables, medicinal herbs, fruit trees, or engaging in farming. Some members of the family have part-time jobs or are engaged in other occupations away from agriculture, including those who work in township and village enterprises or private enterprises, those who open their own stores, and those who go out to work. Although farmers still live off the land, but the harvest of food cultivation is only for the payment of public food and their own family food consumption, some families do not have enough food to eat, but also from the market to buy part of the majority of farmers to rely on the increase in family income * planting of other cash crops or engaged in other sectors of the labor to obtain.
2, disease patterns:
Farmers believe that due to the excessive use of pesticides on food and vegetables, environmental pollution caused by village-run enterprises, the increase in the incidence of malignant tumors in the countryside, and the increase in the incidence of cardiovascular and cerebrovascular diseases after the improvement of living conditions.
3, family security:
Elderly farmers are relying on * family security in old age, usually by the family has become a self-supporting children for the elderly to provide food, vegetables and other physical or to provide the cash earned from work to solve the daily living costs of the elderly, the elderly disease treatment costs are generally also shared by the children.
Often peasant families show more concern for their children's illnesses than for those of the elderly. If the children are filial, they will spend money on treatment for the elderly; if the children are unfilial, they will refuse to treat the elderly, and some elderly people say to the village doctor, "We don't pay", so they will not be treated. Generally, the main labor force of the family is willing to spend a lot of money to treat the disease, the child's disease also want to find a way to treat.
The cost of treatment for the sickest members of a peasant family is paid from the family savings, while other members of the extended family (e.g., brothers) help each other out or borrow from relatives or people in the village with whom they have good relations.
4. Medical care:
Many villages have multiple health points, including government-recognized collective health clinics, approved private clinics, and unapproved private clinics.
Old village doctors trained in the 1960s are still functioning in the countryside; currently village doctors are reluctant to use traditional Chinese medicine (TCM) treatments such as acupuncture and fire-cupping due to the unprofitable nature of some traditional treatments. But on the other hand, for poor families who cannot afford to pay for medicines, rural doctors often allow them to default on their medical bills for years or give them reductions.
5, medical behavior:
Farmers in villages, townships, health centers and individual clinics to seek medical treatment is to choose their own trusted doctors, the criteria for their choice is generally good for minor injuries and diseases, relatively inexpensive, and good service attitude.
Farmers' minor injuries and illnesses are treated in the village, which is convenient and cheap, and the routine medication for chronic diseases is usually purchased wholesale from clinics or herb companies that offer cheap medication. Farmers with major illnesses or more difficult diseases, often in the county or region-wide hospitals, private clinics and other places to seek treatment, but also to the provincial capitals or the adjacent provinces of the big cities to seek medical treatment.
Single prescriptions, tested recipes and local remedies are still circulating among farmers over 40 or 50 years of age, while young people buy medicines exclusively from medical centers or pharmacies, and tend to take all kinds of new medicines. As the number of traveling doctors and drug dealers is high in the countryside, it is difficult for farmers to identify the authenticity and efficacy of the medicines, and they are often deceived.
Peasants' views on rural medical insurance
1. Wish to get medical insurance
On the question of seeing and taking medicines, they said that in general, a family can afford to pay for colds, fevers, minor injuries and illnesses, but it will be difficult to spend tens of thousands of dollars on medical expenses. If you get a serious illness, you have to spend years of savings to get into a big hospital, and even * borrow to see the glass
Because of the slow growth of farmers' income and the large increase in medical costs, the current farmers are really facing the risk of the economic burden of a major illness. For the farmers in Wenxi County, in their life experience, to avoid the risk of medical costs of the approach historically available only the cooperative medical system. Therefore, a part of the farmers believe that as long as the government policy allows and someone organizes it, the cooperative medical care can be run. Especially poor families want to get help, want to have cooperative medical care or medical insurance as a guarantee, and want someone to organize medical care.
In the 1970s, cooperative medical care provided free vaccinations, reduced or waived some medical fees, production brigades organized villagers to collect and grow medicines, and village health offices provided villagers with cauldrons of prophylactic medicines to prevent epidemics, and so on; among the peasants we interviewed, all who had experienced that era remembered it very well, and basically responded favorably to it.
2, that cooperative medicine can not be restored
Despite the farmers' desire to obtain medical protection, most of the farmers, from the reality of the rural economic and social status quo, believe that in the context of the great changes in the rural society, the cooperative medical care can not be revived.
(1) Economically, the collective economy has not been accumulated, the village collective economy is an "empty shell", the current collective retention can only solve the village cadres' salaries, * peasants one by one to raise funds, cooperative medical care can not be done.
(2) Organizationally, the family business makes people take care of themselves individually, and there is no one to organize them, so everyone's heart is scattered, and if they participate voluntarily, they may not all participate in the cooperative medical care.
(3) Management, in the past, when the collective economy, there was a phenomenon in the cooperative medical care that the people who had the status to eat good medicine, and the people who did not have the status could not get the medicine, and now it is difficult to avoid this situation.
(4) service delivery, the current health center doctors are not high skilled, good doctors and not come to the countryside, the problem of cooperative medicine can not be solved; now the doctor is no profit not to do, cooperative medicine can not be done.
(5) the concept of the fear of losing, if you pay the money not to be sick, money to other people to see a doctor with a psychological imbalance, therefore, it has to be "whoever is sick, who recognizes the bad luck". If it is mandatory to participate, we must find a way to pay all the money to eat back.
3, that medical insurance is difficult to implement
Part of the farmers believe that not only the cooperative medical care is outdated, medical insurance can not get up. The reasons are: (1) the poor economic situation in rural areas, can not engage in medical insurance; (2) the social atmosphere is not good, who run the insurance he is not assured; (3) if the leadership change, the policy will change, the policy is not stable, the more insurance the more risk; (4) the poor quality of cadres in rural grass-roots organizations, medical insurance is difficult; (5) the lack of awareness of the risk, do not want to pay first without the disease, young people are generally not sick, and therefore are not willing to participate in the medical insurance.
4. Cautious attitude toward medical insurance
Most farmers, while believing that it is difficult to implement cooperative medical care, think that medical insurance may help solve the problem, but at the same time there are many worries and a cautious attitude toward medical insurance.
Since the level of medical costs is much higher than it was in the 1970s, the farmers, based on the judgment that there is a risk of financial burden of medical care, think that the cooperative medical insurance will not be useful as it only reduces a little bit of the medical costs because of the high medical costs nowadays. Compared with cooperative medical care, medical insurance can prevent the risk of major illnesses. They think that they can afford minor illnesses, but it is better to insure against major illnesses. In terms of willingness to take out insurance, they believe that farmers * day to day, not much income, but a lot of family expenses, children still have to pay tuition fees for school, etc., if you pay 10-30 yuan a year insurance premiums can be. Some people think that if the state, the collective out of most, farmers out of a small part of the okay. Some people are also going along with the idea that "if everyone pays, I'll pay".
Farmers believe that health insurance must be credible and long-lasting, and not subject to change. As for who will organize the health insurance, many farmers expressed their trust in the government. They think that insurance companies are more cumbersome and not good at compensating them, and that they have to invite people to dinner and give them gifts to get compensation for what they are supposed to get. Insurance often fails to deliver, making it impossible to trust.
If compared with insurance companies, they still trust the government to run it better. But many stress that health insurance should be organized by the government at the county level or above and that it should be well publicized. They worry that funds will be misappropriated if they stay in the townships or villages. Some suggest that insurance should be run by the state, so that funds can be easily transferred and credit can be *. The management of medical insurance should be standardized and supervised by the public in order to convince them. It is also suggested that the local township or village should be responsible for organizing the insurance, so that the operator can't run away and make people feel at ease.
Some farmers believe that medical insurance should be run by insurance companies. They think it's better to let insurance companies manage the money, because government policies are easy to change. Some people say, "I'm afraid that after I've invested my hard-earned money for a year, the policy will change, and I won't have any money left to invest. There are also some people say that "rural cooperative funds have been the government to let the office, but ultimately not by the cleanup".