China is a large agricultural country, and whether it can solve the problem of medical insurance for the rural population will directly affect the economic development and social stability of China's rural areas. The cooperative medical system in rural areas of China has played an extremely important role as the main medical insurance system for the rural population under the planned economy. This paper firstly reviews the development history of the cooperative medical system in rural areas: the emergence of the cooperative medical system, the promotion and development of the cooperative medical system, and the decline of the cooperative medical system. Then it briefly analyzes the current situation of rural medical security in China after the decline of the cooperative medical system. The role of various forms of medical security in rural areas is very limited, and farmers still rely mainly on their families to solve the problem of medical care, and medical security, especially social medical security is basically in a "vacuum". The medical insurance, especially the social medical insurance, is basically in a "vacuum zone". For this reason, in 2003 the Chinese Government proposed the establishment of a system of mutual medical assistance for farmers, organized, guided and supported by the Government, with the voluntary participation of farmers, and with funding from individuals, collectives and the Government, and with the main focus on the coordination of major illnesses. Starting in 2003, each province, autonomous region and municipality directly under the Central Government was to select at least two or three counties (cities) to pilot the system first, and then gradually roll it out after gaining experience. By 2010, to realize the establishment of the basic coverage of rural residents in the country's new rural cooperative medical system goal, reduce the economic burden of farmers due to disease, improve the health of farmers. This paper mainly introduces the pilot implementation in two areas of Shandong Province - Laoshan District of Qingdao City and Linyi County of Dezhou City, on the basis of which the problems arising from the implementation of the new rural cooperative medical care system are discussed and the basic direction of the development of China's rural medical security is proposed.
Keywords: rural medical security cooperative medical new rural cooperative medical system security model
I. The emergence and development of China's rural cooperative medical system
Theoretically, the cooperative medical system relies on the strength of the community's residents in accordance with the principle of "risk-sharing, mutual ****** relief. Cooperative medical care in rural China has its own developmental footprint and is an inevitable choice under China's special national conditions. The World Health Organization (WHO) said in a report that "the reference to primary health care workers is largely inspired by China. The Chinese have developed a successful primary health care system in rural areas, which account for 80% of the population, to provide people with low-cost, appropriate health care technology services to meet the basic health needs of the majority of the population, a model that is well suited to the needs of developing countries."
The development of China's rural cooperative medical system is as follows:
1. The emergence of the cooperative medical system
China's rural cooperative medical system can be traced back to the period of the War of Resistance Against Japanese Aggression, when it was organized in the form of "cooperatives" for the cause of medicine and health care, which was actually the germination of a rural medical insurance system. The germ of the medical insurance system. In the early years of the founding of the nation, due to limited resources, we chose the principle of welfare provision that differentiated between urban and rural areas, so that the vast majority of farmers in rural areas were basically outside of the state's social welfare system, and those who lacked medical care took the form of spontaneous mutual aid to solve their medical problems. The emergence of cooperative medical care system with mutual assistance nature in rural areas of China precisely was at the climax stage of rural cooperativeization in 1955. In some places such as Shanxi and Henan, health care stations organized by rural production cooperatives appeared, adopting the method of combining the "health care fee" contributed by the members of the community and the subsidy from the production cooperative public welfare fund, with the masses pooling their money to cooperate in medical treatment and practicing mutual assistance.In early 1955, the first medical health care station was set up in China in Mishan Township, Gaoping County, Shanxi Province, realizing the goal of providing medical care to farmers. In early 1955, Mishan Township, Gaoping County, Shanxi Province, established China's first health care station, realizing the farmers' wish of "early prevention of disease, making paper for disease, saving labor and money, convenient and reliable". [2]
2. Promotion and development of the cooperative medical system
After the Ministry of Health recognized the practice of Mishan Township, its experience was popularized in some parts of the country; in November 1959, the Ministry of Health affirmed the form of cooperative medical care in rural areas at the National Health Work Conference, which led to its further emergence and development. In February 1960 the central government recognized cooperative medicine as a form of medical care and forwarded the Ministry of Health's Report on the On-Site Meeting on Rural Health Work, making this system a collective health care system. [3] On May 18, 1960, the Health News recognized this approach to the collective health care system in its editorial "Actively Implementing the Basic Health Care System", which played a role in promoting the development of the cooperative health care system in rural areas throughout the country; by this time, the number of agricultural production brigades that operated a cooperative health care system nationwide had already reached 40%. "During the Cultural Revolution, the emerging rural cooperative health care system was vigorously promoted. According to the World Bank (1996), the cost of cooperative medicine at that time was only about 20 percent of the national health cost, but it initially solved the health care problems of 80 percent of the rural population at that time. By 1976, about 90% of the administrative villages in the country's rural areas had introduced the cooperative medical care system.
3. The Decline of the Cooperative Medical Care System
In the late 1970s, as a result of the implementation of the economic system reform in the countryside, which was mainly based on the household contract responsibility system, and the establishment of a two-tier management system combining the unification and division of labor, the original "one big, two communal" "team-based" form of social organization became the basis for the development of the cooperative medical care system. The original "one big, two public" and "team-based" forms of social organization were dismantled, and rural cooperative medical care declined sharply, with 1989 statistics showing that only 5% of the country's administrative villages continued to adhere to cooperative medical care. [4]
The current situation of medical insurance in rural areas in China after the decline of the cooperative medical system
Let's take a look at the situation of various forms of medical insurance in rural areas in China:
1. Social medical insurance
China's current reform of the medical insurance system is mainly aimed at employees of urban enterprises and staff members of the state administrative institutions, while peasants, who are the majority of the population, are the most vulnerable. staff, while farmers, who are the majority of the population, are still excluded from the system's arrangements. Therefore, it can be said that in the vast rural areas of China, social medical insurance is basically a blank.
2. Commercial medical insurance
The lack of social medical insurance provides a certain space for the development of commercial medical insurance in rural areas, and it can be said that it is a very important way to solve the problem of the majority of farmers seeking medical treatment. However, commercial medical insurance is for-profit and voluntary, in order to ensure that profits are made, commercial medical insurance companies tend to exclude those who are old, weak and in poor health when choosing policyholders, while this part of the population's need for medical insurance is the most urgent. In addition, since the government has not made it mandatory for farmers to participate in commercial medical insurance by way of policies and regulations, and since the premiums for commercial medical insurance are generally high, farmers are very cautious in making their choices, and they need to consider whether they can afford to spend money on medical insurance. Therefore, although there is room for the development of commercial medical insurance in rural areas, this room is also very limited.
3, social assistance - the scope of enjoyment is very limited
Currently, China's rural areas for the unsupported, no source of livelihood, no fixed provider (support person) of the "three noes" to implement the protection of food, clothing, housing, The "Five Guarantees" support system for the "three have-nots" in rural areas, which provides food, clothing, shelter, medical care, and burial (early childhood education), can to a certain extent solve the problem of access to medical care for this special group, but the coverage of this system is very limited.
4, neighbors help each other
Neighbors support and help each other has been our country's vast rural areas of the prevailing good traditions, the so-called "distant relatives worse than close neighbors" is the best interpretation of this behavior. This kind of neighborhood mutual aid in solving the problem of medical insurance will also play a role, but it can only be in a very small range and relatively low level of occurrence, for some suffering from serious illnesses, serious illnesses appear to be a bit unable to do. So, neighborhood assistance does not solve the problem at its root.
In the 1990s, some localities saw the emergence of different models of cooperative medical system pilot, mainly "welfare type", "risk type" and "welfare risk type" three. Although the central government proposed in January 1997 that it would "strive to establish various forms of cooperative medical systems in most rural areas by the year 2000," only 18 percent of the country's administrative villages had cooperative medical systems in place, covering only 10 percent of the country's rural population, and 90 percent of the peasants still had to pay their own way to see a doctor. the Ministry of Health was transferred to the Ministry of Labor and Social Security, and the latter was unable to solve a series of policy issues such as related financial inputs and burden reduction for farmers on its own, resulting in a virtual "vacuum" in rural medical protection, with the majority of farmers relying on their families for their medical care. The problem is basically solved by the family security.
Three, the implementation of the new rural cooperative medical system
1, the introduction of the new rural cooperative medical policy and policy provisions
In the "General Office of the State Council forwarded to the Ministry of Health and other departments on the establishment of a new type of rural cooperative medical system of the notice of the views of the General Office of the State Council (2003)," it is proposed that: "the new rural cooperative medical system is organized, guided, supported by the government, the farmers, and the farmers. The new rural cooperative medical care system is a system of mutual medical assistance and provision for farmers, organized, guided and supported by the government, with farmers participating voluntarily, and with multiple funding from individuals, collectives and the government, and with the coordination of major illnesses as the mainstay. Starting in 2003, each province, autonomous region and municipality directly under the central government will select at least 2-3 counties (cities) to pilot the system first, and then gradually roll it out after gaining experience. By 2010, the goal of establishing a new rural cooperative medical care system that basically covers rural residents throughout the country will be realized, reducing the economic burden of illness on farmers and improving their health." [5] Subsequently, localities took action to carry out the pilot of the new rural cooperative medical care system and gained some experience.
2, the implementation of the new rural cooperative medical system - in Shandong Province as an example of the pilot
Shandong Province, the pilot of the new rural cooperative medical care is also from 2003, in the "General Office of the People's Government of Shandong Province, forwarded to the Provincial Department of Health and other departments on the establishment of a new rural cooperative medical care system of the Opinions of the notice (Lu Zhengban Fa [2003] No. 12)", combined with the specific situation of Shandong Province, put forward some guiding principles and opinions in three phases:
The first phase (March 2003 to December 2003) for the pilot stage. The province identified Linyi, Wulian, Qufu, Qingzhou, Guangrao, Zhaoyuan, Laoshan and other seven counties (cities and districts) for the first batch of provincial pilot counties. Municipalities according to the local actual situation, select 1 to 2 townships for municipal pilot, the conditions of the city can choose the county (city, district) for the pilot. Through the pilot, to explore the new rural cooperative medical management system, financing mechanism and operation mechanism. Pilot unit conditions are, local leaders attach importance to the financial subsidies in place, sound management institutions, farmers are highly motivated, work on a better basis. Provincial pilot counties (cities, districts) by the county people's government applying for the pilot to develop a pilot implementation program, by the municipal people's government of the district to review and agree, reported to the Provincial Department of Health, in conjunction with the Provincial Department of Finance, Department of Agriculture for approval and implementation. Municipalities to determine the implementation of municipal pilot program to be reported to the Provincial Department of Health, Department of Finance, Department of Agriculture for the record. After the end of the pilot, the provincial pilot counties (cities, districts) to write a summary of the pilot work by the approval of the department to organize the assessment and acceptance.
The second stage (January 2004 to December 2005) for the expansion of the pilot phase. On the basis of consolidating the first batch of pilots, an additional 16 or so provincial-level pilot counties each year (priority will be given to the original municipal pilot counties into the provincial pilot). Municipal pilots should also be expanded accordingly. Through the expansion of the pilot, further in-depth exploration and summarize experience, improve the management system, the provincial government to develop a new type of rural cooperative medical management methods, municipal and county (city, district) governments to develop the implementation of the implementation of the respective methods and implementation plan, in order to lay the foundation for the full implementation.
The third stage (January 2006 to 2010) for the full implementation of the stage. On the basis of carefully summing up the pilot experience, gradually spread throughout the province, by 2010, the establishment of a new rural cooperative medical system basically covering the province's rural residents, and constantly improve the degree of socialization and risk-resistant capacity. [6]
Under the guidance of these principles, the pilot work of the new rural cooperative medical care in Shandong Province, each district and city in full swing:
(1) Shandong Province, the eastern coastal area of Qingdao Laoshan
Laoshan District is located in the eastern part of Qingdao, with a total area of 390 square kilometers. Laoshan District is located in the eastern part of Qingdao City, with a total area of 390 square kilometers, 4 streets and 139 communities under its jurisdiction, with a total population of 199,600 in 2003, an agricultural population of 141,000, a GDP of 15.11 billion yuan, a fiscal revenue of 997 million yuan, a financial outlay of 1.38 billion yuan, an annual average wage of 16,175 yuan for employees, and an annual average per capita net income of 5,394 yuan for peasants. From January 1, 2003 onwards, the implementation of rural cooperative medical care for major diseases, was identified as the first batch of new rural cooperative medical care pilot units in Shandong Province. 2004 in the summary of the pilot experience on the basis of reforms and innovations, and the introduction of new initiatives, the establishment and improvement of a unique "to the major diseases as the main focus of the integrated preventive health care and assistance for serious illnesses taking into account the" new rural cooperative medicine "In 2003, the number of insured people in the region was 153,600, with a population coverage rate of 92%; in 2004, the number of insured people was 161,800, with a population coverage rate of 96.82%. In 2004, the number of participants was 161,800, with a coverage rate of 96.9%. The part of the contribution to be paid by the population of 2,152 low-income households is fully covered by the district finances after examination by the district civil affairs bureau. The financing of cooperative medical care adheres to the principle of government subsidies, village collectives and individuals **** together. Per capita funding from 30 yuan in 2003 to 50 yuan. 2003 to raise 4.61 million yuan of cooperative medical funds, in 2004 the cooperative medical funds should be raised 8.069 million yuan, the balance of all the funds carried over to the next year to use. Cooperative medical funds in the individual part of the payment by the community committee to the household as a unit of the annual collection, the use of the District Finance Bureau issued a uniform receipt; community collective part of the payment from its own funds, together with the individual funds and by the street registration form approved by the Office of Cooperative Medical Care in the streets before December 31 each year to the streets of the financial institute, the streets of the financial institute will be the fund-raising, together with the streets of subsidized funds and submitted to the District Cooperative Medical Center. After the funds are collected, they will be submitted to the district cooperative medical care financial account together with the street subsidy. The part of the district financial subsidies, in the streets, village collectives and individual financing part in place, according to the actual number of participants, the subsidy will be allocated to the district cooperative medical care financial account. The funds are mainly used for compensation for major medical expenses, 80% for compensation for medical expenses, 15% for assistance for major illnesses, 5% for risk money in 2003; 75% for compensation for medical expenses, 10% for assistance for major illnesses, 10% for preventive health care and 5% for risk money in 2004. In 2003, the starting line for compensation for hospitalized medical expenses within the coordinated scope was 800 yuan for first-level hospitals, 1,500 yuan for second-level hospitals, and 2,000 yuan for third-level hospitals; in 2004, the starting line for all levels of hospitals was lowered by 500 yuan from 2003, and the amount for family beds was reduced from 1,500 yuan to 300 yuan. In 2004, the number of people who receive compensation for major diseases is expected to reach 320, and the expenditure on medicine is expected to reach 5.6 million yuan, accounting for 93% of the budgeted expenditure of 6.05 million yuan, and the beneficiary rate is expected to reach 23%, which is higher than that of last year. The beneficiary rate by human unit is expected to reach 23%, 21.9% higher than last year, and the family beneficiary rate can reach 50.8%, 47.3% higher than last year. [7]
(2) Central and western Shandong Province? --Linyi, Dezhou
Linyi County belongs to Dezhou City, located north of the Yellow River, with 7 towns and 3 townships, 859 administrative villages, covering an area of 10,106 square kilometers, with a population of 519,000, of which 439,500 are agricultural.
The government of Shandong Province convened the province's Rural Health Work Conference in February 2003, which formally identified Linyi County as one of the province's new rural health centers. In February 2003, the government of Shandong Province held a provincial rural health work conference, and formally identified Linyi County as the first pilot counties of the new rural cooperative medical care system in the province. in June 2003, on the basis of the experience of the pilot townships, the new cooperative medical care system was comprehensively spread throughout the county. By the end of 2003, 410,900 farmers in the county participated in the cooperative medical care, the participation rate of 93.49%; August 2004 to start the second cycle of operation, to date, there are 415,600 farmers have all the relevant procedures, the participation rate of 94.56%. In order to ensure the healthy development of the new rural cooperative medical system, the county government has issued a series of supporting documents such as the Opinions on the Establishment of the New Rural Cooperative Medical System and the Implementation Measures for the New Rural Cooperative Medical System in Linyi County, and formulated rules and regulations on fund-raising, fund use and management, reimbursement of expenses, and referrals of farmers to medical institutions. The county management committee carries out occasional inspections of the operation of the program; the county supervision committee and the county supervision and auditing departments carry out quarterly comprehensive reviews of the management and use of the funds. In accordance with the principle of multiple financing, including individual contributions, collective support and government funding, in 2003 the county raised 9,449,700 yuan, of which 4,109,200 yuan was raised by farmers and 5,340,000 yuan was subsidized by the provincial, municipal, county and township governments. In terms of consultation, it is divided into two parts: outpatient and hospitalization. Medicine costs are reimbursed at a rate of 20% for outpatient visits to village health offices or township health centers; hospitalization in township health centers or designated medical units at or above the county level is reimbursed cumulatively in segments according to the following standards: (1) reimbursement of 30% of hospitalization fees for the portion of hospitalization fees up to and including RMB 1,000; (2) 40% of hospitalization fees for the portion of hospitalization fees from more than RMB 1,000 up to and including RMB 3,000; and (3) 40% of hospitalization fees for the portion of hospitalization fees of RMB 3,000. (3) 50% reimbursement for the portion of the hospitalization fee from RMB 3,000 to RMB 5,000 (inclusive); (4) 60% reimbursement for the portion of the hospitalization fee from RMB 5,000 to RMB 8,000 (inclusive); (5) 70% reimbursement for the portion of the hospitalization fee from RMB 8,000 to RMB 10,000 (inclusive); (6) 80% reimbursement for the portion of the hospitalization fee from RMB 10,000 (inclusive); and (6) 80% reimbursement for the portion of the hospitalization fee above RMB 10,000, with a maximum reimbursement of RMB 10,000 per person per year. When farmers seek medical treatment, they are registered by the cooperative medical office of the designated medical unit. For outpatient treatment, the medication fee is directly reimbursed in proportion to the rate, and this reimbursement is advanced by the village health office, and then summed up at the end of the month and submitted to the cooperative medical office of the township for review and payment. In the case of hospitalization, the farmers will first make personal advances, and will be reimbursed in accordance with the regulations when they are discharged from the hospital and settle their accounts. In terms of the use of the fund, in accordance with the principle of "determining expenditure on the basis of income, keeping expenditure within the limits of revenues and balancing revenues and expenditures", the implementation of earmarked funds, special account storage. The 23 yuan of the operating fund is divided into two parts, 6 yuan for outpatient care and 17 yuan for hospitalization, and managed separately. Of this amount, 6 yuan is set aside for the individual accounts of farmers' families, and 17 yuan is set aside for the coordination of major illnesses. As of August 2004, 185,000 farmers had benefited from the scheme, paying out 8,275,300 yuan in medical fees, including 169,000 outpatient visits and 2,275,000 yuan, and 21,500 hospitalizations and 6,002,000 yuan, with a beneficiary surface of 45%. [8]
3. Problems in the implementation of the system
Of course, a variety of problems have been exposed in the course of the pilot.
(1) Sources of Funds
According to the current policy, the funds for cooperative medical care should come from the contributions of individual farmers as well as the financial subsidies of the governments at the provincial, municipal and county levels. From the pilot situation in various places, with the development of the rural economy and the general increase in the income level of farmers in recent years, for farmers who choose to participate in the cooperative medical care, it should be affordable to pay 10 yuan per year, and the enthusiasm of individual farmers to pay the fee should be said to be relatively high. However, whether or not financial subsidies from all levels of government are available in a timely manner may vary greatly from region to region. For regions with better economic conditions, these funds may be allocated to farmers' individual medical accounts in a timely manner, whereas for those cities and counties (districts) with poorer economic foundations, the situation may not be optimistic. Relying only on the 10 yuan paid by individual farmers, there may not be too many problems in the treatment of some minor illnesses, but in the event of serious illnesses and patients with serious illnesses, due to the lack of financial security, the cooperative medical system will be difficult to play the function of risk sharing and mutual **** relief.
(2) Coverage
In the "General Office of the State Council forwarded the Ministry of Health and other departments on the establishment of a new type of rural cooperative medical system of the views of the notice (2003)," it is clearly stipulated that "the new type of rural cooperative medical system is organized by the government to guide and support the farmers to participate voluntarily," such a provision is fully taken into account in each region. Such a provision takes full account of the actual situation in each region and gives the general peasantry more room for choice. However, the voluntary principle may lead to many problems: in a family, the old, the sick and the disabled are artificially separated from the healthy, and only the old, the sick and the disabled are chosen to participate in the cooperative medical care system; or those who are sick are very happy to participate in the cooperative medical care system, while those who are in good health are not willing to participate, etc. These practices are contrary to the governmental organization and support of the cooperative medical care system. All these practices run counter to the original purpose of the cooperative medical care system - to solve the problem of farmers' access to medical care by means of social attacks. It may be that in some pilot areas, thanks to the strong efforts of governments at all levels and the fact that the majority of farmers have seen the immediate benefits that cooperative medical care can bring to them, the motivation to participate in cooperative medical care is very high. But overall, China's cooperative medical care is still in a spontaneous and voluntary pilot stage, and has not been expanded nationwide to cover all farmers within the scope of the system.
(3) Service Provision and Reimbursement
Farmers participating in cooperative medicine need to go to designated clinics or hospitals to receive services when they are sick, with relatively little freedom of choice, which pushes designated hospitals or clinics at all levels into a "monopoly" position. These hospitals or clinics will lack the corresponding economic incentives to provide services, and their attitude and quality of service may be greatly reduced. The farmers have to follow strict procedures to reimburse the medical expenses after visiting the doctor, whether the medical expenses of visiting the doctor, especially the high medical expenses of serious diseases and big diseases can be reimbursed in time is also a serious problem faced by the cooperative medical system at the present stage.
(4) Inspection and Supervision
Since the cooperative medical system is still in a pilot stage in general, each region basically develops a set of independent implementation methods in the light of the actual situation in the region during the pilot stage. The next question is how to carry out effective inspection and supervision of the pilot situation in these areas, due to the lack of a unified supervisory and management organization, so the specific implementation of the process will be a variety of problems.
Fourth, the development direction of rural medical security
We can find that in different historical stages, cooperative medical care in the political, economic and safeguard the health of farmers have played a certain role. At the present stage, due to the development of the rural economy, the further improvement of the living standard of the farmers, the diversification of the demand for medical security, and the problems encountered in the implementation of the cooperative medical system, in order to effectively protect the medical health of the rural population, there is an urgent need for us to find and establish a new type of rural medical security system. In such a system, the first need to solve the problem are:
1, the scope of coverage
The current implementation of the new rural cooperative medical system is based on the voluntary participation of farmers, the funds raised are divided into two parts: individual medical accounts and social funds, individual medical accounts are mainly used to pay for minor illnesses of the outpatient costs, the social part is mainly used to protect the medical costs of farmers who suffer from serious illnesses, major illnesses, and medical expenses. The individual medical account portion is mainly used to cover outpatient expenses for minor illnesses, while the social co-ordination portion is mainly used to cover medical expenses for farmers suffering from serious or major illnesses. However, since the level of economic development in rural areas varies, such an arrangement will inevitably affect farmers' motivation to participate in the insurance scheme. Therefore, in areas with better economic conditions, where farmers have a relatively strong capacity for self-protection, the principle of voluntary participation can be emphasized more, and the level of insurance premiums can be raised accordingly, so that farmers can be insured against both the major and minor illnesses, and can enjoy comprehensive medical insurance services. For regions with a relatively poor level of economic development, a combination of government subsidies and voluntary participation can be implemented, with the focus of protection being on the medical costs of serious and major illnesses, because "poverty caused by illness" and "poverty returned to the poor because of illness" are still a very important cause of poverty among farmers. The government's policy is to provide a comprehensive and effective protection of the health care system for the poor.
2, the object of protection
The object of protection of the rural medical insurance system is the majority of rural residents, but in recent years, with the acceleration of social mobility, more and more farmers have joined the ranks of mobile groups, such as migrant workers, is a very large group. Should this group of people be included in the rural medical insurance system? Under the current system, they should also be treated as the beneficiaries of the rural medical insurance system. Because the urban social security system basically excludes this group of people, and to some extent, they are the most in need of social security, under such a systematic arrangement, the rural migrant population's medical insurance problem should be returned to the rural areas to solve. This part of the people compared to other farmers have a higher awareness and higher income level, they also really appreciate the importance of the social security system for their own, so in the participation of medical insurance will have a higher enthusiasm.
3. Mode of protection
The level of economic development in different regions of China varies greatly, and farmers' incomes are also different, so only according to the specific situation of each region to choose the appropriate medical insurance. The country is not yet capable of taking full account of the medical security problems of 900 million farmers, and cooperative medical care is not the only way out of the problem of rural medical security. Whether from the point of view of the long-term development of the rural medical security system or from the point of view of the integration of rural medical security into the overall plan for national social security, the medical insurance system is undoubtedly a better mode of security than the cooperative medical system. Any security system cannot be established merely to solve and deal with short-term problems; it should have long-term, strategic considerations and be characterized by sustainable development, whereas cooperative medical care does not have long-term planning in terms of its system and management, and there is obvious short-term behavior. In addition, under the inevitable development trend of urbanization, rural medical insurance must also be unified with urban medical insurance. Therefore, we must gradually conform to the laws of economic and social development, follow the principle of social security and economic development, and incorporate rural medical security into the overall plan of national social security. However, in China's rural areas under the current realities of economic development and people's awareness of the concept of the existence of large differences in the implementation of medical insurance in rural areas can not be completed in the short term. Therefore, the establishment of a rural medical insurance system should not be confined to a single model, but should actively explore a multi-form, multi-level medical insurance system that suits the characteristics of rural areas. Differences in the level of economic and social development in the eastern, central and western regions of China will also lead to different choices between regions in terms of the situation and level of medical insurance coverage:
Coastal areas, high-income eastern rural areas. With the increasing level of industrialization and the growth of farmers' incomes, the demand for medical security is higher and their ability to pay is stronger. The form of cooperative medical care is in the process of transitioning to medical insurance, and it can rely on a strong collective economy and government support to implement a multi-level medical security, and ultimately unify the medical insurance system in towns and cities.
Middle-income central rural areas. These areas have weaker collective economic strength, coupled with the limitations of farmers' income levels, so the new rural cooperative medical system should be implemented to focus on the coordination of major illnesses, focusing on solving the phenomenon of poverty due to major illnesses among farmers. Specific financing methods and ratios can be determined according to the local level of economic development and farmers' income affordability.
Low-income western regions. Due to low income levels, most farmers have difficulty in accessing primary health care services and are in the most difficult position to develop rural medical security. The ability of farmers in these areas to participate in cooperative health care financing is very low, and the total amount of funds is also small, and the ability to guarantee is limited, so it is possible to establish economically affordable and sustainable health services and delivery programs through the implementation of medical assistance for the poor. [9]
In short, with the further development of rural socio-economic development, as well as the accelerating process of urbanization, rural social security will surely be integrated into the urban social security system, so that the farmers' health care security to reach a high level.
Reference:
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