Basic Medical Insurance for urban Employees (BMIE) scheme was introduced in 1998 which gradually replaces Government-funded Medical Insurance (GMI) and Labor Insurance (LI) schemes and become a predominant medical insurance scheme in urban China. In 2007, Catastrophic Diseases Insurance (CDI) for the elderly and the young (yilao yixiao) as a pioneer form of Basic Medical Insurance for urban Residents (BMIR) scheme was implemented in Beijing which further changed the scenario of the access to health care of urban people. Previous studies on the equity of access to health care in China generally use economic methods of analysis and focus on the horizontal equity between different geographical areas and social groups. Seldom is the problem of access to health care studied and analyzed from an ethical perspective based on the conception of social justice. In the case of urban medical insurance schemes, little attention has been paid to the question of how the impact of different insurance schemes are being distributed among different insurance participants and to what extent such a distribution is compatible or incompatible with general conceptions of social justice and with the particularistic values of the local society.
By combining the philosophical perspective of analysis with empirical ethnographic exploration, this research conducts a case study of the BMIE and CDI schemes in Beijing to investigate the local experience of and discourse on justice in access to healthcare in Urban China, and its implications for our understanding of general theories of social justice. Face-to-face active interviews of 47 local respondents were conducted in February and March 2009 in Beijing, including the participants of BMIE and CDI and other stakeholders in the health care sector. The present study firstly explores to what extent the BMIE and CDI schemes are able to improve participantsprinciples: justice as utility, justice as fairness, and justice as humaneness, as well as their implications for a just health care system for China. This study also provides a more in-depth analysis of the significance of the local discourse for three major philosophical theorizations of justice, namely, Confucianism, Welfare Liberalism, and Utilitarianism.
Findings show that both BMIE and CDI schemes have positive but limited impact on the improvement of financial affordability of the insurance participants. The arrangements of double deductibles of BMIE, high copayment rate for the CDI participants, low maximum payment a year and the high price of out-of-pocket medicines are main complaints of local respondents. Poorer respondents had less improvement in access to health care, and a more serious disease resulted in less improvement. In addition, both BMIE and CDI schemes have negative impact on the efficiency of the access process due to complicated reimburse procedure. Second, although a large numbers of local respondents regard the arrangement of the medical insurance schemes as unjust, their underlying moral perspectives are different. These gives rise to different conceptions of a just health care system with different basic principles and organizing methods. The local discourse reflects both particularistic values and universal principles. There is clear evidence of the existence of value pluralism. The values of Confucianism are still pervasive, followed by those of Welfare Liberalism, and Utilitarianism, but very much mediated by the experience and interpretation of the local people. Marxist Socialism was commented on a lot with nostalgia, but was also widely accepted as no longer practicable for the realities of China today.
This study is innovative in the sense that it brings together two fields of research, one is empirical study of access to health care and the other is normative ethical study of social justice. By including local moral perspective in a normative study of justice in access to health care, this study enriches our understanding of the concept of justice and shed lights on the relationship between universal ethical principles and particularistic local values. This study also contributes to the development of a more in-depth and nuanced approach regarding our understanding of multiple values and value changes in building a just health care system in contemporary China. access to health care in urban China in terms of financial affordability, access process efficiency, and the quality of care based on their experience. Secondly, this study solicits and interprets local people's opinion on the evaluation of BMIE and CDI schemes in terms of three different major justice principles: justice as utility, justice as fairness, and justice as humaneness, as well as their implications for a just health care system for China. This study also provides a more in-depth analysis of the significance of the local discourse for three major philosophical theorizations of justice, namely, Confucianism, Welfare Liberalism, and Utilitarianism.
Findings show that both BMIE and CDI schemes have positive but limited impact on the improvement of financial affordability of the insurance participants. The arrangements of double deductibles of BMIE, high copayment rate for the CDI participants, low maximum payment a year and the high price of out-of-pocket medicines are main complaints of local respondents. Poorer respondents had less improvement in access to health care, and a more serious disease resulted in less improvement. In addition, both BMIE and CDI schemes have negative impact on the efficiency of the access process due to complicated reimburse procedure. Second, although a large numbers of local respondents regard the arrangement of the medical insurance schemes as unjust, their underlying moral perspectives are different. These gives rise to different conceptions of a just health care system with different basic principles and organizing methods. The local discourse reflects both particularistic values and universal principles. There is clear evidence of the existence of value pluralism. The values of Confucianism are still pervasive, followed by those of Welfare Liberalism, and Utilitarianism, but very much mediated by the experience and interpretation of the local people. Marxist Socialism was commented on a lot with nostalgia, but was also widely accepted as no longer practicable for the realities of China today.
This study is innovative in the sense that it brings together two fields of research, one is empirical study of access to health care and the other is normative ethical study of social justice. By including local moral perspective in a normative study of justice in access to health care, this study enriches our understanding of the concept of justice and shed lights on the relationship between universal ethical principles and particularistic local values. This study also contributes to the development of a more in-depth and nuanced approach regarding our understanding of multiple values and value changes in building a just health care system in contemporary China.
| Date of Award | 16 Jul 2012 |
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| Original language | English |
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| Awarding Institution | - City University of Hong Kong
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| Supervisor | Po Wah Julia TAO LAI (Supervisor) & Bing Leung Anthony CHEUNG (Supervisor) |
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