| Summary: | 碩士 === 國立中正大學 === 社會福利所 === 95 === Abstract
In order to solve the health care resource scarcity caused by the increase of people’s health care needs and the rise in medical expenses, since the reformation in 1979, the Chinese government has begun to change its health care policy. It turns gradually national socialized health care on ‘‘welfare make all’’ towards the Singapore model－the Medical Savings Accounts System (MSA) －, in which the personal financial responsibilities are strengthened. On the basis of socialism and political system in China, this thesis had analyzed the reform of ‘‘China's Urban Employees’ Basic Health Care Insurance’’ by focusing on the politics, the economy, and the society in China. The Chinese experience can be regarded as the reference of the health care reforms in other countries.
The secondary analysis was used to analyze the political, economic, and social context, the process and the content of the health insurance reform in China. We have the following findings: (1) The reform of the health care insurance in China was aimed at reducing the national expenditure in health care, not mainly at ensuring the whole people to be healthy. It thus has caused insufficient coverage of population and health care benefits; (2) The local government has been the main role of planning and implementing the health insurance reform. It also has shown that the nation has shifted health care responsibility toward the local governments; (3) The politics, economy, culture and population structure has influenced the diversity of health care financing and planning in China.
The adoption of the system of ‘‘the Personal Medical Savings Accounts’’ in China has caused all sorts of disputes. In order to localize the MSA in China, we have two following suggestions: (1) In order to avoid the problem that a person enrolled in the insurance scheme, but the whole family consumes the fund, the personal account could be replaced by the family account. According to a certain proportion, the employee’s contribution will be divided into two parts: the family account and the social fund. The family account is owned by family and shared by members of the family; (2) Adjusting the benefit coverage of the personal medical savings accounts can not only reduce moral hazard, but also be able to include the employee’s spouses and children who are excluded from the previous scheme because of lacking funds in the previous social insurance. This will facilitate to expand the coverage of the population and to increase the ability of risk resistance of the system.
The Chinese experience suggests that a health care policy in one country might not be applicable for the other. Therefore, the planning and implementing of a policy needs to accord with the national conditions so as to ensure the people's health.
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