The Analysis and Discussion on the Government Function Boundary in the Process of Medical and Health Reform in China
|Keywords||Government Function Boundary Medical and Health Reform New Public Management|
The medical and health reform in China experienced two stages of planned-economy and marketed-economy, and the government played different functional roles. After 20 years’ reform, the level of medical and health technique has been improved prominently, but the new problems appear constantly and being difficult and expensive to see a doctor is coming into force. At present, the academia is debating on the "government-leading " and the "market-leading" mode. How to carry on the further reform becomes the point at issue.Reform means to break up the original boundary of power and interest and to set up a new equivalent relation. System transformation is a new form of Boundary Management. Government is the carrier of reform and system transformation, which is realized by adjusting the government function boundary.The thesis suggests analyzing the above issue from the boundary management. Government function boundary management emphasizes to analysis administrational behavior and deal with the public issues from the vision of the "boundary". As a new method of management, Boundary Management is put forward in the field of management of the private department at first. On the history of management, we can see that the essence of the management, which has different propositions at different stages, is to raise or emphasize the boundary line between power, responsibility and interest. The theory of Max Web’s Bureaucracy typically demonstrates the importance of boundary during the management process. Meanwhile, the theory of New Public Management maintains that government should separate its power to the market or the society to provide public goods and service, which can impel the market and the-third-part to participate in the government management. It means that government tends to transfer the possession of power to the other fields. All of which mentioned establishes a theory foundation for the thesis.Based on some documents and policies, the thesis describes the background and problems at different phase. From the point of view of the government function boundary, it initiationally analyzes the reason that the government couldn’t draw out a clear line of function boundary. Specifically speaking, influenced by the unicity and unlimitedness of power in the planned-economy system, the function boundary was so broad that the government intervened too much. During the process of reform, the government reduced its function scale too much and put its obligation to the market. It is obvious that the government went from one extreme to the other.After comparing the British and American reform model which introduced the marketalization mechanism, the paper comes to the conclusion that the government has to intervene efficiently and readjusts its function boundary.Based on the analysis above, we propose that the feasible method of Chinese medical and health reform relies on adjusting the government function boundary. Firstly, we must recognize clearly the nature of medical and health cause and the goal of medical and health reform. Secondly, we have to strengthen the government’s leading role and identify the government function boundary, including separation of government and medical institutions, separation of management and conduct, increase of the financial input, improvement of the medical and health-care insurance and legislation system to regulate the market service of medical and health, and intervening the construction and development of medical and health system. Finally, we’d better to learn from the successful experience of the New Public Management, which means using the market rules to stimulate the government to adjust its function boundary, to pay attention to result-based management, to set up custom-oriented idea, to reform responsibility mechanism, and to diversify subjects in public service supply.Reform is fulfilled by adjusting government function boundary. From the boundary management point of view, the further reform should be carried out through dealing with the boundary relationship with government, market and society, the power, obligation and interest of government. It aims not only to provide theoretical base and successful experience for the other fields’ reform in China but also to enrich the content of boundary management theory and to enlarge the boundary management from the private department to the public department.