Incentives, Constraints and the Farmers’ Participation
|Keywords||The farmers’participation The power of inspiration The feeling of unfair|
There are three main purposes of this article: First, to have a comprehensive understanding about the farmers’participation in the new rural cooperative medical treatment; Second, to aggregate the characteristics of the farmers’participation, as well as the factors which influence the farmers’participation; Third, through the study of the farmers’participation, raise up some reasonable proposals to the development of the new rural cooperative medical treatment.The farmers’participation is the basement of the new rural cooperative medical treatment. How to effectively mobilize the enthusiasm of the farmers to participate the new rural cooperative medical treatment in China, which is a developing country of so many farmers, as well as how to keep the stability of the farmers’participation, has become much more important by the academic and leadership. The former studies on this problem based on a single angle, and ignored the incentives and constraints of the farmers’participation. So, there were so many questions about the farmers’participation during the structure of the new rural cooperative medical treatment.In this article, we take the D Town of the F City in Heilongjiang Province for example, and analyze the farmers’participation during the execution of the new rural cooperative medical treatment. We take time for the clue, divide the farmers’participation into five stages. The first is to ensure the farmers to know the facts of the new rural cooperative medical treatment; the second is to ensure the farmers to join in the treatment insurance; the third is to optimize the treatment; the fourth is to ensure the apply of reimbursement; the fifth is to encourage the farmers to join in the new rural cooperative medical treatment again. Based on these analyses, we conclude that the farmers’participation has the potential instability. The potential instability displays mainly for the following areas: NO.1, the farmers know little of the new rural cooperative medical treatment. Many farmers don’t know the limits and the ratio of the reimbursement, and they also don’t know the method to count the expenses, and so on. The farmers don’t have definite purpose to join in the new rural cooperative medical treatment, the main purpose of them to participate in the treatment is not to resist the dangers of the diseases, and they have many other considerations; NO.2, the degree of the satisfy of the farmers who participate in the treatment is a little lower; NO.3, the farmers expect to change the mode of compensation. The new rural cooperative medical treatment is an institution to help each other during the treatment, which ensuring the serious disease is main its power. Its main purpose is to resolve the problem about the high expense of the farmers’medical treatment. But, the usual illnesses of the farmers now are the common illnesses, the farmers could get less repayment during the progress of the new rural cooperative medical treatment, so the farmers hope that the mode of compensation would be changed in order to acquire more actual benefit; NO.4, there are some farmers who had participated in the new rural cooperative medical treatment, want to retreat from the treatment. This phenomenon is directly influences the ratio of the farmers’participation.The instable ratio that the farmers participate in the new rural cooperative medical treatment is complex, this article takes the theory of expectation and justice which belong to the theory of progress encouragement as the analyze means, and tries to talk about the factors which influence the farmers’participation. The power of encouragement is the basic agent during the farmers’participation, it is influenced by the farmers’benefit and the possibility they gain the benefit, the two factors all influence the ratio of the farmers’participation. The benefit the farmers could gain which would be more or less is also named efficiency value, and the possibility they gain the benefit also means expectation value, the power of encouragement increases with both of them. In this article, the efficiency value includes the degree of the reimbursement in the new rural cooperative medical treatment, and the degree of the service in the medical organizations, and the excessive medical treatment, the expectation value includes the mode of reimbursement and the degree of the farmers’health. The feeling of justice is the necessary factor during the farmers’participation, having the feeling of unfair or not influences the farmers’participation directly. The subjective feeling and objective feeling of unfair are the two important factors which influence the farmers’participation. The subjective feeling of unfair means that the motion of the new rural cooperative medical treatment is fair, but the farmers are influenced by the less understanding of the institution, so they have some unreal recognize about the institution. The objective feeling of unfair means that the unfairness and the really exist, and these unfairness is recognized by the farmers.In the area that investigated in this article, there are two modes of compensation of the new rural cooperative medical treatment, one is the insurance of serious disease, and the other is the family account. The condition of the insurance of serious disease is that the farmers should take medical treatment when they are living in hospital, the family account could be used when the farmers take medical treatment and buy medicines in the hospitals or clinics at the rural area or villages. The farmers that have participated in the new rural cooperative medical treatment, when they have or will have the ambulatory treatment in the medical organization of the city, would be discarded by the two modes of compensation. Usually, the farmers would have common illnesses, this mode of compensation reduces the scope of the farmers’benefit, and also reduces the healthy farmers’expectation. The family account would increase healthy farmers’expectation in a certain degree, but the medical service of the grass-roots unit in the rural area couldn’t content with the farmers’basic medical requirement. So, when the farmers have common illness, they will choose the medical organization of the city, and take ambulatory treatment. The insurance of serious disease is a reimbursement institution which is divided into different levels, different sections and different items, the reimbursement that the farmers really gain is only 18.4% of their expense, and this degree of reimbursement is so lower that the power of encouragement is weak. This lower degree of insurance is not only caused by the lower reimbursement, but also by the excessive medical treatment which offset the reimbursement of the new rural cooperative medical treatment. The excessive medical treatment also results in the farmers’feeling of unfair about the new rural cooperative medical treatment, the difference between the subjective and objective feeling of unfair is that the objective feeling is caused by the reasons like the government publicizes the institution incomprehensive, and the medical servicer explain the reimbursement detail indistinctly when they take the treatment to the farmers, and the limited understanding of the farmers themselves, these reasons enable the farmers’misunderstanding to the new rural cooperative medical treatment. The subjective feeling and objective feeling of unfair directly influence the initiative and activity when the farmers participate in the new rural cooperative medical treatment.The factors that influence the farmers’participation include the content design of the new rural cooperative medical treatment, and the capability and quality of the medical service, and also the farmers’unfair feeling during the structure of the new rural cooperative medical treatment. The farmers participate is of their own free will, and the healthy condition is also the factor which influences the farmers’participation. The factors which influence the farmers’participation are complex, any factor has its own impression.How to bring the encouragement into play and how to confine its unfavorable factors during the new rural cooperative medical treatment, has become the vital question in front of us. The purpose of the new rural cooperative medical treatment is to ensure the farmers’health and to increase the ability that resists the diseases during the farmers, so we could see that the insurance of serious disease is its main principle. This principle is not only out-of-date, but also inefficient. Nowadays, the main principle of the international medical insurance is to prevent. In China, the medical insurance has attached importance to prevent the disease in a certain degree, but in the rural area, prevention has less expression in the new rural cooperative medical treatment. For example, the new rural cooperative medical treatment provides that the expenses for prevention and the health subsidies are out of the reimbursement list. The common illnesses are usually happen in the rural area, the ratio of serious disease is comparatively lower.Some studies make clear that if we invest more in prevention, and we could cut down the expenses in serious disease. Mr. Edison had said that in the future, the doctors shouldn’t supply the medicine, but to teach the people how to keep figure, food, drink, and let them know the reasons of the disease and the methods to prevention. Paying attention to prevention doesn’t mean that ignoring the medical treatment. In this article, we raise up that the combination of the prevention and treatment is the main orientation of the new rural cooperative medical treatment. The first stage of the combination is prevention, we should readjust the reasons and the related factors of the diseases in order to reduce the ratio of the diseases. The prevention takes effect before the diseases had caused, its purpose is to strangle the diseases in the cradle. The second stage of the combination is the prevention and treatment, we should give the patients release from pain through the earlier diagnose and timely treatment, and control the related complications of the disease. The third stage of the combination is treatment, its purpose is to prevent the diseases from deteriorating and control the complications, and take the accurate treatment after the disease have caused, it is not only a part of the treatment, but also a part of recovery.The combination of the prevention and treatment would reduce the ratio of the diseases in farmers, and it would also improve the activity and enthusiasm of the farmers. In the practice, we should do that:In the stage of prevention, we should publicize the basic hygienic knowledge to the farmers, and make the people’s food better, and quicken the reconstruction of the drinking water and lavatory in the rural area. Some studies show that among the factors which influence human life and health, the gene of parents occupies 15%, the social factors occupies 10%, the natural environment occupies 7%, the medical hygiene occupies 8%, and the livelihood occupies 60%. World health organization puts forward that many people didn’t die of illness, but died of their unhealthy livelihood. In rural area, the farmers still take their unhealthy livelihood, the related department should give energetic support to the farmers’living environment and unhealthy livelihood, especially bring the physical examination and precautionary measure into line with the new rural cooperative medical treatment in order to increase the farmers’benefit.In the stage of prevention and treatment, we should avoid the serious diseases by timely treatment, and change the phenomenon that there is a serious disease if a farmer goes to a doctor. And then, we should strengthen the construction of the medical installations in rural areas, and improve the doctors’ability in rural area, and establish the standard to the medical behavior. So we would enlarge the acquirement and limits during the medical treatment.In the stage of treatment, we should pay more attention to the farmers who have been ill seriously, and increase the corresponding compensation, especially control the phenomenon of excessive medical treatment. At the same time, the government should not be inactive, and also should not administer excessively. The government should avoid misunderstanding because of the inactivity to publicize the new rural cooperative medical treatment, and also should avoid the apportioned phenomenon to farmers for the achievements in someone’s official career. These behaviors would cause farmers’unfair feelings about the rural cooperative medical treatment, and reduce the activity and enthusiasm of the farmers’participation.