中国醫疗卫生政策史研究

Abstract

A Study on the History of Chinese Health Care Policy

Piao Xian Advisor: Prof. Kim, Yong-Seob Ph. D. Department of Social Welfare Graduate School of Chosun University

History of social welfare can explain the creation and the process of development of social welfare policy. This study uses the development theory of social welfare policy to study China’s history of medical hygiene policy step by step, and analyze the practice of the policy and service offer to draw a new desirable implication in reformation of medical hygiene policy. China’s social welfare policy that was put into practice since founding of the country in 1950, showed many problems as the reform and openness policy deepened. To solve this problem, Chinese government modified and supplemented social welfare policy through several system reformation. China achieved rapid economical growth after 1978 reformation and opening, but as the gap between area, class, and nation became bigger, developed medical hygiene policy reformation aggressively to ensure continuous growth and safety policy. China started medical hygiene policy reformation since 1980’s and started new sweeping medical hygiene reformation in March 2009, with proclamation of “Opinion on reinforcement of medical hygiene policy reformation.” Basic idea of medical hygiene policy reformation is to provide all citizens with medical hygiene policy as public commodity so that everybody can enjoy the basic medical hygiene service, and institutionally guarantee equal basic medical hygiene service regardless of area, nation, age, gender, occupation and wage. China’s basic medical hygiene policy is mainly composed of four systems and eight supports of medical hygiene. Four systems are public hygiene service system, medical service system, medical security system and medical supply security system. Eight supports are to improve medical hygiene care, management, investment, price, supervision, technique and manpower system structure, information and construction of the law to efficient running of the four systems. In most countries, medical system could be said to have gradually improved from existing institutional frame. China’s medical hygiene policy was developed in China’s economy and social structure reformation, and therefore the development process had links to China’s economy and society. China’s medical hygiene system reformation is, like economical system reformation, is gradual reformation process. This gradual reformation process’s biggest characteristics is that it gradually expands rights of the lower agents of economy, and based on old system and as long as not causing rapid destruction, go through partial, phased practice to gradually expand. Medical hygiene system, in any country, is decided by its politics and economical system. China’s medical hygiene reformation is a big part of reformation and opening. After 1949, China’s medical hygiene system brought three major changes, and this is actually changes of systems’ inner mechanism. China, under planned economy system, copied Soviet Union’s model and constructed medical hygiene system that combines procuring public resources, public service, public administration. With 1978 reformation and opening system, China’s medical hygiene industry achieved rapid improvement. The first and second reformation was a gradual change into market model from planned model. The third reformation was to realize separation of public administration with service, emphasizing social equality and clear the role of government and market. This study considers history of China’s medical hygiene policy in steps and understands the structure and characteristics of policy to find out the reasons for change and formation of the policy to draw a desirable implication in new reformation of medical hygiene system. To achieve the goal of this study, analyzed development process of China’s medical hygiene policy using social welfare development theory. The results of study on China’s medical hygiene policy development are summarized as followings. Formative period of medical hygiene policy can be seen as embodied by medical security system and medical hygiene system. At this time the government had control and monopoly in ownership, processing all expression of profit from profit agents through affiliated unit group. At this time, medical security system had three systems of communist medical system, worker medical system and rural cooperative medical system. Analyzing structure and characteristics of medical security system shows that the government has unconditional power, and medical system of this time applied the hygiene system model of Soviet Union, which is physically close, under planned economy, implementing hygiene supplement system that is under planned economy. In other words, medical security system in formative period can be explained with diffusion theory and state-centric theory. At this time, medical hygiene service of this time was guaranteed in quality and quantity by the government with highly concentrated public service method, directly controlling investment and foundation of organization in medical hygiene. Also, supplying medical hygiene service was important policy means in maintaining the social order of the time. That is, medical hygiene service in formative period can be explained with state-centric theory and plot theory. Transition period of medical hygiene policy can be considered four, public hygiene service system, medical service system, medical security system and medicine supply security system. Country supplied the whole citizens with basic public hygiene service for free and in special disease and special area, country carried out critical public hygiene service project, directly implementing. In other words, public hygiene service system can be explained with social conscience theory by spread of social obligation and satisfaction of social desire and provided to public. After the reformation and opening, the important characteristics of medical hygiene area were innovation of technology, and it achieved rapid economical growth. Under the reformation of system, technology innovation revitalized the area of medical hygiene, and through market expansion effect, made the system to change towards high efficiency. With this characteristic, the medical service system, medical security system, medicine supply security system can be explained with rational theory. Medical security system, with technical development of policy analyzing the systems’ establishment, practice and evaluation, made the system effective. This area can be explained by technology theory of social welfare development. Medical hygiene system of this time was first started in order to realize the freedom of ideology, and classes of society were able to have the rights of individual profit and individual happiness, and pursuing individual rights became the basic idea of reformation. Institutional circumstances brought changes in quality, and with localized liberalization realized, many classes, groups, and individuals of the society started to pursue individual happiness. The method of economical encouragement was to mobilize initiatives of medical organization and medical people, expanding medical service, and improve service quality. New medical hygiene reformation guarantees supplying basic medical hygiene system as public commodity to all people so that individuals can enjoy the basic medical hygiene service, and acquire basic medical hygiene service equally without discrimination in are, nation, ager, gender, occupation and wage. The major point of reformation is to separate the public administration with service to emphasize the social equality. The medical service system of this time has social justice theory and citizenship theory applied.